Mission POCUS in Haiti

Introduction

Point-of-care ultrasound (POCUS) has enhanced patient care and safety around the world. Clinicians can now use a small diagnostic ultrasound imaging device to answer some binary clinical questions and manage patients more effectively. Since the COVID-19 pandemic, there has been a significant adoption of POCUS by clinicians worldwide.

Materials and Methods

A basic cardiac POCUS training was conducted in Haiti with focus on physics, instrumentation, and basic echocardiography.

Results

The Mission POCUS team trained 15 Haitian physicians interested in better serving their patients with the implementation of POCUS cardiac in their patient assessment.

Conclusion

POCUS skills will empower clinicians from around the world to make rapid and accurate diagnosis and help save lives by diagnosing life threatening conditions and manage patient appropriately. Our experience in Haiti showed that a short POCUS training course can help improve the knowledge of physicians.

Spectrum of outpatient illness in a school-based cohort in Haiti, with a focus on diarrheal pathogens

Currently, there are only limited data available on rates of major diagnostic categories of illnesses among Haitian children. We have established a cohort of 1,245 students attending schools run by the Christianville Foundation in the Gressier/Leogane region of Haiti, for whom our group provides primary medical care. Among 1,357 clinic visits during the 2012–2013 academic year, the main disease categories (with rates per 1,000 child years of observation) included acute respiratory infection (ARI) (385.6 cases/1,000 child years of observation), gastrointestinal complaints (277.8 cases/1,000 child years), febrile illness (235.0 cases/1,000 child years), and skin infections (151.7 cases/1,000 child years). The most common diarrheal pathogen was enteroaggregative Escherichia coli (present in 17% of children with diarrhea); Vibrio cholerae O1 and norovirus were the next most common. Our data highlight the importance of better defining etiologies for ARI and febrile illnesses and continuing problems of diarrheal illness in this region, including mild cases of cholera, which would not have been diagnosed without laboratory screening.

Functional magnetic resonance imaging for preoperative localisation of eloquent brain areas relative to brain tumours: clinical implementation in a regional hospital

The purpose of this study was to evaluate the implementation of functional magnetic resonance imaging (fMRI) for clinical use in patients with a brain tumour in the setting of a regional hospital. Twenty-three patients underwent a fMRI examination as preoperative evaluation for a tumour adjacent to a eloquent brain area. The location and distance of the tumour relative to the fMRI activation area for this eloquent brain area was determined. Presence of postoperative neurological deficits was compared to the result of the fMRI examination. The fMRI examination was not interpretable in four of the twenty-three patients. In nine patients the eloquent brain area was located more than two centimetres from the tumour: seven showed no neurological deficit postoperatively, one patient experienced a temporary deficit, and one patient has not been operated yet. In the remaining ten patients the eloquent brain area was located less than two centimetres from the tumour: after (partial) resection of the tumour often using intra-operative cortical stimulation, six patients showed no neurological deficits, and three patients had temporary or permanent deficits. One patient was not operated. The clinical implementation of fMRI was successful in the preoperative evaluation of patients with a brain tumour and useful to plan the surgical intervention and to minimize postoperative neurological deficits.

T cell vaccination in multiple sclerosis patients with autologous CSF-derived activated T cells: results from a pilot study

Myelin-reactive T cells are considered to play an essential role in the pathogenesis of multiple sclerosis (MS), an autoimmune disease of the central nervous system. We have previously studied the effects of T cell vaccination (TCV), a procedure by which MS patients are immunized with attenuated autologous myelin basic protein (MBP)-reactive T cell clones. Because several myelin antigens are described as potential autoantigens for MS, T cell vaccines incorporating a broad panel of antimyelin reactivities may have therapeutic effects. Previous reports have shown an accumulation of activated T cells recognizing multiple myelin antigens in the cerebrospinal fluid (CSF) of MS patients. We conducted a pilot clinical trial of TCV with activated CD4+ T cells derived from CSF in five MS patients (four RR, one CP) to study safety, feasibility and immune effects of TCV. CSF lymphocytes were cultured in the presence of rIL-2 and depleted for CD8 cells. After 5-8 weeks CSF T cell lines (TCL) were almost pure TCR alpha beta+CD4+ cells of the Th1/Th0 type. The TCL showed reactivity to MBP, MOG and/or PLP as tested by Elispot and had a restricted clonality. Three immunizations with irradiated CSF vaccines (10 million cells) were administered with an interval of 2 months. The vaccinations were tolerated well and no toxicity or adverse effects were reported. The data from this small open-label study cannot be used to support efficacy. However, all patients remained clinically stable or had reduced EDSS with no relapses during or after the treatment. Proliferative responses against the CSF vaccine were observed in 3/5 patients. Anti-ergotypic responses were observed in all patients. Anti-MBP/PLP/MOG reactivities remained low or were reduced in all patients. Based on these encouraging results, we recently initiated a double-blind placebo-controlled trial with 60 MS patients to study the effects of TCV with CSF-derived vaccines in early RR MS patients.

MRI in the assessment of pregnancy related intrauterine bleeding: a valuable adjunct to ultrasound?

MR imaging using ultrafast MR sequences is a useful method in assessing pregnancies at risk. This is especially the case for fetal imaging. However, reports of imaging of the placenta or the uterus are rare. We report the MR findings in 8 pregnant patients with vaginal blood loss in whom the obstetrical ultrasound was equivocal. MR imaging was performed with a 1.5 T magnet and consisted of T2- (HASTE), fat-suppressed gradient echo T1- and gradient echo T2-weighted images. Adequate anatomical visualisation of the uterus, the placentary tissue and the intrauterine bleeding irrespective of size and location of the latter, were obtained in all cases.

Diffusion-weighted MR imaging in the evaluation of renal infection: preliminary results

Diffusion-weighted (DW) magnetic resonance imaging (MRI) has already gained status in the neuroradiological MRI approach of a patient suffering from a variety of neurological diseases. The clinical application of DW MRI in the evaluation of renal disease is not standard. This manuscript describes preliminary results of the application of DW imaging in renal infection to aid differential diagnosis and/or lesion detection in clinical MRI. Three patients with acute pyelonephritis and two patients with renal abscess (one with xanthogranulomatous pyelonephritis, the other with a solitary pyogenic renal abscess) were examined with MRI. Areas of acute pyelonephritis and abscedation have restricted proton diffusion and are demonstrated on the DW images. Refinement of the technique, in-depth investigation of the pathological background of the MR findings and evaluation of its true clinical value need further investigation. This manuscripts shows preliminary findings of DW imaging in patients with renal infectious disease.

Change in pattern of absenteeism as a result of workplace intervention for personnel support

The aim was to investigate whether a preventive intervention carried out in a predominantly female workplace, that of hospital cleaners (consisting of a group of 97 women), had any effect on patterns of absenteeism. As a background, a model for analysing complex patterns of absenteeism, including sickness absences, was also developed. A further aim was to study the interactions between different forms of absenteeism. Comparison was made with a reference group consisting of employees in the same job category who only received the customary personnel support. For individuals in the intervention group who were < 42 years of age, total absence due to sickness decreased. In a multiple regression analysis, the contribution from the intervention to the decrease was significant at the 5% level. This change was particularly obvious in those who had a previous history of high absence due to sickness. No clear relationship was shown between short-term absenteeism and the interventions applied. For those who were > 42 years, short-term absence decreased for those who had been in the same jobs for a long time. The combination of increased age and experience showed a tendency to enhance this decline in short-term absenteeism due to sickness. For those > 42 years, and who at the same time have a previous history of high absenteeism, long-term absenteeism due to sickness seemed to be increasing. Increased experience tended to reduce this increase in long-term sickness absence. This combination of different effects possibly indicated the presence of a process of selection which determined who remained in the job as opposed to those who did not. An important conclusion is that different forms of absenteeism need to be looked at in parallel, and at the same time multivariate statistical analysis needs to be carried out to determine the different interactions between the factors.

Change in pattern of absenteeism as a result of workplace intervention for personnel support

The aim was to investigate whether a preventive intervention carried out in a predominantly female workplace, that of hospital cleaners (consisting of a group of 97 women), had any effect on patterns of absenteeism. As a background, a model for analysing complex patterns of absenteeism, including sickness absences, was also developed. A further aim was to study the interactions between different forms of absenteeism. Comparison was made with a reference group consisting of employees in the same job category who only received the customary personnel support. For individuals in the intervention group who were < 42 years of age, total absence due to sickness decreased. In a multiple regression analysis, the contribution from the intervention to the decrease was significant at the 5% level. This change was particularly obvious in those who had a previous history of high absence due to sickness. No clear relationship was shown between short-term absenteeism and the interventions applied. For those who were > 42 years, short-term absence decreased for those who had been in the same jobs for a long time. The combination of increased age and experience showed a tendency to enhance this decline in short-term absenteeism due to sickness. For those > 42 years, and who at the same time have a previous history of high absenteeism, long-term absenteeism due to sickness seemed to be increasing. Increased experience tended to reduce this increase in long-term sickness absence. This combination of different effects possibly indicated the presence of a process of selection which determined who remained in the job as opposed to those who did not. An important conclusion is that different forms of absenteeism need to be looked at in parallel, and at the same time multivariate statistical analysis needs to be carried out to determine the different interactions between the factors.

Wernicke encephalopathy: MR findings in two patients

Wernicke encephalopathy is a serious neurologic disorder caused by vitamin-B1 or thiamine deficiency. In the literature the characteristic symmetric paraventricular lesions of Wernicke encephalopathy are hyperintense on T2-weighted sequences spin-echo (SE) and enhance on T1-weighted SE sequences after intravenous gadolinium administration in the acute phase. We present two patients in the acute phase of Wernicke encephalopathy with special reference to the MR imaging. One of our reported cases is special because of the MR demonstration of a hemorrhagic focus in the caput of the right nucleus caudatus. The other case demonstrates no enhancement on SE T1-weighted sequences after intravenous gadolinium administration.

Hydatid cyst of the kidney

We report a case of hydatidosis of the kidney and stress the importance of the different radiological modalities. In the presented case, diagnostic radiological procedures included plain radiography of the abdomen, intravenous urography, ultrasonography, computerized tomography and magnetic resonance imaging. The combination of all the radiological findings lead to a correct pre-operative diagnosis, which is important as cyst rupture and spillage may cause anaphylactic reaction.