Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the BLUE (Bedside Lung Ultrasound Examination) protocol developed by Lichtenstein et al, which can be utilized to diagnose the cause of acute dyspnea at the bedside. We attempt to provide a simplified approach to understanding the physics behind the artifacts used in lung ultrasound, the imaging techniques, and the application of the BLUE-protocol to diagnose the commonly presenting causes of acute dyspnea.

In India, a large number of sanitary care workers are involved in manual scavenging. This exposes them to sewer gas mainly consisting of hydrogen sulphide. Sewer gas toxicity primarily causes neurological injury, followed by cardiac and respiratory involvement. A few cases of diffuse ST-segment elevation in the electrocardiogram (ECG) following hydrogen sulphide poisoning are known in the literature. Here, we report a case of acute sewer gas poisoning in a 45-year-old man with transient and focal ST-segment elevation in the anteroseptal leads of the ECG mimicking acute anterior wall myocardial infarction.

The present study was designed to evaluate the spectrum of imaging findings seen on chest ultrasonography in patients presenting with dyspnea and verify the concordance between chest X-ray and chest ultrasound.Methods Fifty-three patients presenting with dyspnea were included in this study. Patients with known/suspected cardiac disease were excluded from the study. All patients underwent chest X-ray and chest ultrasound, reported by two different investigators. The concordance was analyzed using Cohen's kappa value with a ‘p-value’ less than 0.05 considered statistically significant.Results Among the fifty-three patients with dyspnea, five diagnostic pathologies were evaluated. Concordance between lung ultrasound and chest X-ray for diagnosis of pneumonia, pneumothorax, acute exacerbation of COPD/severe asthma, and diffuse alveolar interstitial syndrome was found to be high with Cohen's kappa value > 0.8 (p < 0.01). Ultrasound was able to correctly diagnose more cases of pneumothorax and pulmonary edema compared with chest X-ray with sensitivity and negative predictive value of 100%. Chest X-ray was found to be superior in correctly diagnosing COPD. The difference was, however, not statistically significant. Similarly, no statistically significant difference could be inferred between the diagnostic value of ultrasound and Chest X-ray in the diagnosis of pneumonia or pleural effusion.Conclusions A high concordance was noted between ultrasound and chest X-ray for diagnosis of all pathologies studied (p < 0.01), the highest noted in pneumonia/pleural effusion and diffuse interstitial syndrome (κ = 0.9). Hence, ultrasound may be considered a complimentary imaging modality for Chest-X-ray in the evaluation of dyspnea.

Background Ureaplasma urealyticum and Ureaplasma parvum have been associated with respiratory diseases in premature newborns, but their role in the pathogenesis of the respiratory distress syndrome (RDS) is unclear. The present study was conducted to investigate preterm newborns with respiratory distress for colonization of U. urealyticum and U. parvum in endotracheal fluid (TF)/nasopharyngeal aspirates (NPA) specimens employing culture and polymerase chain reaction (PCR).MethodsSixty preterm infants, presenting with respiratory distress persisting for more than 24 hours were investigated. Endotracheal fluid or nasopharyngeal aspirates specimens were inoculated in 2mL Ureaplasma broth and Ureaplasma agar for culture identification assay and PCR. DNA extracts were processed for a genus specific PCR (429 base pair region) on urease gene of U. urealyticum/U. parvum and species specific PCR (1305 base pair region) on 16S rRNA gene in U. parvum.Results Ureaplasma species colonization was positive in 11 (61.11%) male patients and7 (38.89%) females but there was no statistical association between sex and Ureaplasmaspecies colonization (P = 0.771). Ureaplasma spp. culture identification assay was positive in 7 (11.67%).Ureaplasma genus specific PCR was positive in 14 (23.33%) cases; species specific PCR in 9 (64.28%) infants were identified as U. parvum. Considering culture as diagnostic standard, sensitivity of PCR was 42.86%; specificity 79.24%; positive predictive value 21.43% and negative predictive value 91.30 %; with overall percentage agreement at 75%. Septicemia was positive in 12 (66.67%) infants colonized with Ureaplasmaspecies than in 5 (11.9%) of non colonized infants which was found to be significant (P = 0.00). Twelve (66.67%) patients with Ureaplasmaspecies colonization had lethargy with statistically significant association(P = 0.04).ConclusionThis study confirms that Ureaplasma species and particularly U. parvum colonization in preterm infants was related to respiratory distress.Disclosures All authors: No reported disclosures.