Background Point of care ultrasound (POCUS) is a useful diagnostic tool in medicine. POCUS provides an easy and reproducible method of diagnosis where conventional radiologic studies are unavailable. Telemedicine is also a great means of communication between educators and students throughout the world. Hypothesis Implementing POCUS with didactics and hands-on training, using portable ultrasound devices followed by telecommunication training, will impact the differential diagnosis and patient management in a rural community outside the United States. Materials and methods This is an observational prospective study implementing POCUS in Las Salinas, a small village in rural western Nicaragua. Ultrasound was used to confirm a diagnosis based on clinical exam, or uncover a new, previously unknown diagnosis. The primary endpoint was a change in patient management. International sonographic instructors conducted didactic and practical training of local practitioners in POCUS, subsequently followed by remote guidance and telecommunication for 3 months. Results A total of 132 patients underwent ultrasound examination. The most common presentation was for a prenatal exam (23.5 %), followed by abdominal pain (17 %). Of the 132 patients, 69 (52 %) were found to have a new diagnosis. Excluding pregnancy, 67 patients of 101 (66 %) were found to have a new diagnosis. A change in management occurred in a total of 64 (48 %) patients, and 62 (61 %) after excluding pregnancy. Conclusion Implementing POCUS in rural Nicaragua led to a change in management in about half of the patients examined. With the appropriate training of clinicians, POCUS combined with telemedicine can positively impact patient care.Keywords Point of care ultrasound Á Rural medicine Á Telemedicine Sommario Background La diagnostica ecografica (POCUS) é un utile strumento diagnostico in medicina. Fornisce un metodo semplice e riproducibile di diagnosi, dove studi radiologici convenzionali non siano disponibili. Anche la telemedicina é un grande mezzo di comunicazione tra docenti e studenti di tutto il mondo. Ipotesi L'implementazione della POCUS con formazione didattica diretta, utilizzando ecografi portatili, seguita da una formazione attraverso la telecomunicazione, avrà un impatto nella diagnosi differenziale e nella gestione del paziente in una comunità rurale fuori degli Stati Uniti. Materiali e Metodi Presentiamo uno studio prospettico sull'implementazione della POCUS a Las Salinas, un piccolo villaggio rurale del Nicaragua occidentale. L'ecografia è stata utilizzata per confermare la diagnosi clinica, o per nuove diagnosi. Il punto primario era un cambiamento nella gestione del paziente. Istruttori internazionali hanno condotto una formazione didattica pratica locale, poi seguita da una guida a distanza con telecomunicazione, per tre mesi. Risultati Un totale di 132 pazienti sono stati sottoposti ad esame ecografico. L'esame più comune era per la diagnostica prenatale (23,5 %), seguito dal dolore addominale (17 %). Dei 132 pazienti, 69 (52 %) h...

The National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents recently recommended staging hypertension (HTN) in children and adolescents based on blood pressure severity. The use of blood pressure staging and its corresponding therapeutic approach was examined in this pooled analysis assessing the risk for end-organ damage, specifically left ventricular hypertrophy among hypertensive adolescents stratified by working group criteria. Newly diagnosed hypertensive adolescents and normotensive control subjects similar in age, race/ethnicity, gender, and body mass index completed casual and 24-hour ambulatory blood pressure measurements, M-mode echocardiography, and fasting serum laboratories. Hypertensive subjects had higher insulin and cholesterol but similar glucose levels as compared with control subjects. Among subjects with stage 1 HTN by casual blood pressure, 34% had white-coat HTN as opposed to 15% of stage 2 hypertensive subjects. Of the subjects with normal casual measurements, 20% had HTN by ambulatory monitoring. Subjects with stage 2 HTN by casual measurement alone (odds ratio: 4.13; 95% CI: 1.04 to 16.48) and after 24-hour ambulatory confirmation (odds ratio: 7.23; 95% CI: 1.28 to 40.68) had increased odds for left ventricular hypertrophy. In addition, the risk for left ventricular hypertrophy was similar for subjects with masked and confirmed stage 1 HTN, whereas subjects with white-coat HTN had a risk comparable to normotensive subjects. Thus, recommendations that adolescents with stage 2 HTN by casual measurements alone receive medication initially along with therapeutic lifestyle counseling are reasonable, though ambulatory blood pressure monitoring remains a valuable tool for evaluating children with stage 2 HTN, because >10% have white-coat HTN.

A significant ONSD response to acute postural change and to spaceflight was demonstrated in this preliminary study. Increases in Doppler peak flow velocities correlated with increases in ONSD. Further investigations are warranted to corroborate the relationship between ONSD, intracranial pressure, and central retinal blood flow for occupational surveillance and research purposes.