The Sierra Leone Ultrasound Rainbow4Africa Project (SLURP): an observational study of ultrasound effectiveness in developing countries.

BACKGROUND: Diagnostic tools available in low-income countries are often really basic even if patients can be as sick as those of the richer countries. Point-of-care ultrasound could be a solution for this problem. We studied the impact of ultrasound at the Holy Spirit Hospital, Makeni, Sierra Leone. METHODS: This is a prospective, observational study on outpatients presenting at the HSH. We enrolled continually for 1 month 105 patients asked for ultrasound examination by the caring physician that had to indicate the differential diagnosis hypothesized, the confidence degree about these on a 5-point Likert scale, and the therapy before and after the US. The primary outcome was to measure the difference in the number of differential diagnoses. Secondary outcomes were the rate of new diagnoses, the confidence changes of the visiting physician, and the changes in prescribed therapy or management. Categorical variables were compared using the Chi-square test, and continuous ones using two-tailed Student's test and Likert with the Wilcoxon rank-sum test. RESULTS: 194 differential diagnoses were formulated, with a mean of 1.85 (DS 0.87) diagnoses per patient. 89 (46%) were excluded on the basis of US, reducing the mean of differential diagnosis per patient to 1, 0 (p < 0.001). US also introduced 53 new diagnoses in 42 patients (mean 1.26; SD 0.54), raising the final differential diagnosis from 105 to 158 (+50.5%) that is 1.51 (DS 0.79) per patient. There is a statistically significant reduction (18.6%) in diagnoses per patient after having performed the ultrasound (p < 0.001). The certainty level increased (Wilcoxon rank-sum test: p < 0.001). We did not reach the statistical significance studying the changes in therapy and management because the subgroups for analysis were too small. Nonetheless, we saw interesting changes in drug prescription and referral rate before and after the US. CONCLUSION: Ultrasound is feasible in low-income countries; with it diagnostic hypotheses were reduced and new unexpected diagnoses were introduced. Further studies are needed to explore other strong outcomes like mortality, length of stay in hospital, and money saved with the use of ultrasound in developing countries.

Schistosoma haematobium infection, health and nutritional status in school-age children in a rural setting in Northern Senegal.

BACKGROUND: The aim of this study was to investigate the occurrence of urinary schistosomiasis in school children in a rural village of Northern Senegal, and to evaluate the impact of this parasitic infection on children's health, growth, and nutritional status. METHODS: A cross-sectional survey was carried out on 465 children resident in the village of Kassak Nord, in Senegal, in an area which is highly endemic for Schistosoma haematobium. Data on health, nutritional status and urinary schistosomiasis were collected. RESULTS: The overall prevalence of urinary schistosomiasis in school children in Kassak was 47.4%. As for malnutrition, 29.7% of children were malnourished (BMI-for-age Z-score [BAZ] <-2) and 14.5% had a significant linear growth retardation (height-for-age Z-score [HAZ] <-2). Children with urinary schistosomiasis showed lower mean BAZ and HAZ than uninfected children (HAZ positives -0.7±1.4 vs. HAZ negatives -0.4±1.4, P=0.004; BAZ positives -1.5±1 vs. BAZ negatives -1.3±1.1, P=0.03). It was also found that infected children were at greater risk of malnutrition (BAZ<-2; OR 1.5; 95% CI 1.01-2.26). CONCLUSIONS: The results of this study support the hypothesis that urinary schistosomiasis affects negatively childhood health and nutritional status and are of importance for planning intervention aimed to monitoring and control Urinary Schistosomiasis and malnutrition.

Safety of magnesium-lidocaine combination for severe head injury: the Turin lidomag pilot study.

BACKGROUND: Neuroprotection in the setting of severe head injury (SHI) remains an unsettled problem. We tested a combination of high-dose magnesium and low-dose lidocaine, infused over 3 days, in a pilot study to assess safety. This combination appears indicated to protect both gray and white matter from secondary injury following SHI. METHODS: We studied 32 consecutive patients admitted to the emergency department of our hospital, a large tertiary referral center. RESULTS: No toxicity was observed. Mortality was lower than published statistics. CONCLUSIONS: These results open the stage to a controlled randomized study.