Handheld Ultrasound Devices Used by Newly Certified Operators for Pneumonia in the Emergency Department-A Diagnostic Accuracy Study.

The diagnostic accuracy of handheld ultrasound (HHUS) devices operated by newly certified operators for pneumonia is unknown. This multicenter diagnostic accuracy study included patients prospectively suspected of pneumonia from February 2021 to February 2022 in four emergency departments. The index test was a 14-zone focused lung ultrasound (FLUS) examination, with consolidation with air bronchograms as diagnostic criteria for pneumonia. FLUS examinations were performed by newly certified operators using HHUS. The reference standard was computed tomography (CT) and expert diagnosis using all medical records. The sensitivity and specificity of FLUS and chest X-ray (CXR) were compared using McNemar's test. Of the 324 scanned patients, 212 (65%) had pneumonia, according to the expert diagnosis. FLUS had a sensitivity of 31% (95% CI 26-36) and a specificity of 82% (95% CI 78-86) compared with the experts' diagnosis. Compared with CT, FLUS had a sensitivity of 32% (95% CI 27-37) and specificity of 81% (95% CI 77-85). CXR had a sensitivity of 66% (95% CI 61-72) and a specificity of 76% (95% CI 71-81) compared with the experts' diagnosis. Compared with CT, CXR had a sensitivity of 69% (95% CI 63-74) and a specificity of 68% (95% CI 62-72). Compared with the experts' diagnosis and CT diagnosis, FLUS performed by newly certified operators using HHUS devices had a significantly lower sensitivity for pneumonia when compared to CXR (p < 0.001). FLUS had a significantly higher specificity than CXR using CT diagnosis as a reference standard (p = 0.02). HHUS exhibited low sensitivity for pneumonia when used by newly certified operators.

Focused abdominal ultrasound.

A focused point-of-care abdominal ultrasound is an examination performed at the patient's location and interpreted within the clinical context. This review gives an overview of this examination modality. The objective is to rapidly address predefined dichotomised questions about the presence of an abdominal aortic aneurysm, gallstones, cholecystitis, hydronephrosis, urinary retention, free intraperitoneal fluid, and small bowel obstruction. FAUS is a valuable tool for emergency physicians to promptly confirm various conditions upon the patients' arrival, thus reducing the time to diagnosis and in some cases eliminating the need for other imaging.

[Life-threatening ketoacidosis in a 25-year-old woman treated with sodium-glucose cotransporter 2 inhibitor].

We report a case of atypical ketoacidosis in a patient treated with a sodium-glucose cotransporter- (SGLT) 2 inhibitor. The 25-year-old woman, who one year earlier had been prescribed dapagliflozin for presumed Type 2 diabetes, came to the emergency department in a state of severe ketoacidosis, pH 6.85, and a plasma glucose level of 14.3 mmol/l. She received standard treatment and recovered. We discuss the increasing evidence for atypical ketoacidosis being a serious side effect of the SGLT2 inhibitors.

[Severe macrocytic anaemia and secondary hyperparathyroidism in a vegan]. / Svær makrocytær anæmi og sekundærhyperparatyroidisme hos en veganer

Nutritional deficiency anaemia in vegans is common and usually due to lack of vitamin B12, as this vitamin is found almost exclusively in animal-based food products. In this case report we present a 39-year-old male vegan with severe macrocytic anaemia due to vitamin B12 deficiency as well as secondary hyperparathyroidism due to severe vitamin D deficiency. We want to emphasize the importance of a detailed nutritional history for patients with anaemia, and the need for vitamin B12 and vitamin D supplements for people who comply with a vegan diet.

[Anaphylactic reaction to intravenous glucocorticoid in a patient with chronic obstructive pulmonary disease]. / Anafylaktisk reaktion på intravenøst givet glukokortikoid hos en patient med kronisk obstruktiv lungesygdom

Serious anaphylactic reactions to systemic glucocorticoids are rare and have previously mainly been reported in patients with asthma or aspirin allergy. We report a case of severe anaphylactic reaction to an intravenous (IV) glucocorticoid in a patient with chronic obstructive pulmonary disease. A 61-year-old male developed severe bronchospasm within seconds after IV injection of methylprednisolone sodium succinate. The condition was immediately treated with adrenaline and the patient recovered quickly. Clinicians should be aware of the possibility of anaphylactic reactions to glucocorticoids.

[Compliance to drug prescriptions]. / Komplians ved behandling med laegemidler.

Non-adherence or incomplete adherence to drug prescriptions is common. In long-term therapy for chronic disease, it has been estimated that only half of all drug doses are taken as prescribed. In this article we discuss poor adherence in terms of prevalence, clinical significance, treatment opportunities and ethical aspects.