Diagnostic Accuracy of Point-Of-Care Ultrasound for Paediatric Testicular Torsion
The present systematic review and meta-analysis showed that POCUS had high sensitivity and specificity for identifying testicular torsion in paediatric patients although the risk of bias was high in the studies analysed.
Summary
A Systematic Review And Meta-Analysis
[Posted 17/May/2022]
AUDIENCE: Emergency Medicine, Pediatric
KEY FINDINGS: The present systematic review and meta-analysis showed that POCUS had high sensitivity and specificity for identifying testicular torsion in paediatric patients although the risk of bias was high in the studies analysed.
BACKGROUND: Previous studies have examined the utility of ultrasonography performed by radiologists for diagnosing paediatric testicular torsion. While point-of-care ultrasound (POCUS) is used in paediatric emergency medicine, its diagnostic accuracy is still unknown. The present systematic review and meta-analysis aimed to clarify the accuracy of POCUS in diagnosing testicular torsion in children.
DETAILS: Following the Preferred Reporting Items for Systematic Review and Meta-analysis of Diagnostic Test Accuracy guidelines, a systematic review was performed. Any study investigating the diagnostic accuracy of POCUS for paediatric testicular torsion was extracted. The primary outcome was the assessment of the diagnostic accuracy of POCUS for paediatric testicular torsion. The pooled sensitivity and specificity were calculated. Quality analysis was conducted using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Four studies enrolling 784 patients in total were included. The pooled sensitivity, specificity, and positive and negative likelihood ratios of POCUS were 98.4% (95% CI: 88.5% to 99.8%), 97.2% (95% CI: 87.2% to 99.4%), 34.7 (95% CI: 7.4 to 164.4) and 0.017 (95% CI: 0.002 to 0.12), respectively. Risk-of-bias assessment using QUADAS-2 revealed that two of the studies had a high risk of bias in patient selection.
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Source: Mori, T., Ihara, T., Nomura, O. (2022). Diagnostic Accuracy Of Point-Of-Care Ultrasound For Paediatric Testicular Torsion: A Systematic Review And Meta-Analysis. Emergency Medicine Journal . 2022; e212281. Published: May 6, 2022. DOI: 10.1136/emermed-2021-212281.
High-Quality Donor Kidneys Frequently Allocated to Adults Despite Pediatric Priority
Among deceased-donor kidneys with KDPI-10 below 35%, 23.4% were allocated to higher-priority adults. For ideal pediatric-quality kidneys, this proportion was 34.3%, with 77.5% received by multiorgan transplant recipients. KDPI-8 is unlikely to materially change pediatric access to ideal donor kidneys.
KEY FINDINGS: Despite pediatric allocation priority, a substantial proportion of high-quality donor kidneys continues to be allocated to adults with greater priority, predominantly multiorgan transplant recipients. The revised KDPI-8 calculation is not expected to materially alter the proportion of ideal pediatric-quality kidneys prioritized for children, although it changes the clinical composition of the donor pool by increasing the proportion of HCV-seropositive donors and reducing the proportion of donors after circulatory death. These findings highlight persistent limitations of KDPI-based allocation for pediatric candidates and support continued evaluation of policies that balance equity, donor-recipient matching, and long-term transplant outcomes.
BACKGROUND: Children receive allocation priority for deceased-donor kidneys with a kidney donor profile index (KDPI) <35%, although certain adult candidates retain higher priority. The recent transition from the 10-variable KDPI (KDPI-10) to the revised 8-variable KDPI (KDPI-8), which excludes donor race and hepatitis C virus (HCV) status, raised questions regarding its potential effect on pediatric access to high-quality donor kidneys.
DETAILS: This retrospective cohort study analyzed 60,587 deceased donors and their kidney recipients recorded in the Organ Procurement and Transplantation Network registry from January 1, 2018, through December 31, 2023. The investigators compared donor characteristics and kidney allocation patterns using KDPI-10 and KDPI-8. Ideal pediatric-quality donors were defined as donors with a KDPI <35%, donation after brain death, age <35 years, creatinine <=1.5 mg/dL, and no infectious risk, diabetes, or hypertension. Among kidneys from donors with KDPI-10 <35%, 23.4% were allocated to adults in categories with greater priority than pediatric candidates. Among ideal pediatric-quality kidneys, 34.3% were allocated to these higher-priority adult recipients, and 77.5% of these transplants were received by multiorgan transplant recipients. The proportion of donors meeting ideal pediatric-quality criteria was similar with KDPI-10 and KDPI-8 calculations (32.7% vs 33.5%). However, the KDPI-8 group included more Black donors (15.3% vs 9.9%) and HCV-seropositive donors (11.1% vs 3.6%) and fewer donors after circulatory death (12.7% vs 20.3%).
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Source: Sonnenberg, E. M., Amaral, S., Zhang, S., et al. Allocation of Kidney Allografts From Donors With Kidney Donor Profile Index <35% and the Impact of Kidney Donor Profile Index Revisions on Access to Transplantation for Children. American Journal of Kidney Diseases. 2026; Published: August 22, 2026. DOI: 10.1053/j.ajkd.2026.02.643.
Nationwide Recall of Cetirizine Hydrochloride Tablets USP 5 mg Due to Potential Ranitidine Cross-Contamination
Four nationwide-distributed lots of Cetirizine Hydrochloride Tablets USP 5 mg are being voluntarily recalled because of potential ranitidine cross-contamination. Patients with ranitidine hypersensitivity may be at risk for severe allergic reactions or anaphylaxis. No recall-related adverse events had been reported.
KEY FINDINGS: Unique Pharmaceutical Laboratories has initiated a voluntary nationwide recall of four lots of Cetirizine Hydrochloride Tablets USP 5 mg because of potential cross-contamination with ranitidine. The affected product was distributed nationwide in 100-count HDPE bottles under the Rising Pharma Holdings Inc. brand. Patients with hypersensitivity to ranitidine ingredients may be at risk for serious reactions, including severe hypersensitivity and life-threatening anaphylaxis. No adverse events related to the recalled product had been reported at the time of the announcement.
The recall was initiated after a pharmacy technician identified a discrepancy while counting tablets during dispensing. A product complaint described red dots and discoloration on some cetirizine tablets. The recalled lots are GY825029, GY825030, GY825031, and GY825032, each with an expiration date of 10/2028 and NDC 16571-401-10.
The manufacturer and distributor are arranging the return of the affected products. Clinicians should consider the recall when evaluating patients who may have received the affected medication and should assess and manage any suspected adverse reactions appropriately.
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Source: Unique Pharmaceutical Laboratories (A Div. of J. B. Chemicals & Pharmaceuticals Ltd.) Issues Voluntary Nationwide Recall of Cetirizine Hydrochloride Tablets USP 5 mg Due to Potential Cross Contamination with Ranitidine. FDA. Published: July 20, 2026.
Ambient Heat Significantly Elevates Hypoglycemia Risk in Type 1 Diabetes Patients
A study of 679 adults with T1DM using 33 million CGM readings identified a U-shaped risk curve between heat and hypoglycemia. Lowest risk was at 13C; at 25C temperature, the odds of hypoglycemia rose by 30%. Clinicians must advise dose adjustments in heat. Future automated insulin delivery systems should incorporate ambient temperature data to better predict and prevent hypoglycemic events.
KEY FINDINGS: Physicians should proactively educate patients with T1DM about the heightened risk of hypoglycemia during periods of increased ambient temperature. Managing glycemic levels in hot weather may require anticipatory reductions in insulin dosages to prevent dangerous declines. These findings also suggest that ambient temperature should be considered a dynamic variable within automated insulin delivery (AID) and hybrid closed-loop algorithms to optimize patient safety during seasonal heat waves.
BACKGROUND: As global temperatures continue to rise, understanding the impact of environmental factors on metabolic stability is increasingly critical for clinicians. Patients with Type 1 Diabetes (T1DM) often report seasonal fluctuations in glucose control, yet clinical guidelines remain ambiguous regarding whether high ambient temperatures primarily elevate the risk of hyperglycemia or hypoglycemia. This study was conducted to clarify the short-term relationship between outdoor temperature and the incidence of hypoglycemic events.
DETAILS: Researchers employed a case time series analysis using 33 million continuous glucose monitoring (CGM) data points collected between 2017 and 2024. The study cohort included 679 adults with T1DM residing in Sussex, UK. The primary exposure was the daily mean outdoor temperature at the participants' residential postcodes. Hypoglycemia was defined as a sensor glucose reading below 3.9 mmol/L (70 mg/dL) for a minimum of 15 minutes. The analysis revealed a non-linear, U-shaped association between ambient temperature and hypoglycemia risk. The lowest risk was observed at a daily mean temperature of 13°C. Risk significantly increased at temperature extremes, with the strongest effect seen during hotter weather. Specifically, at a daily mean temperature of 25°C, the odds of experiencing hypoglycemia were approximately 30% higher compared to the reference temperature of 13°C.
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Source: Daultrey, H. E., Oliver, N. S., Chakera, A. J., et al. The Association Between Ambient Temperature and Hypoglycemia in People Living With Type 1 Diabetes: A Case Time Series Analysis Using Real-Time Continuous Glucose Monitoring. Diabetes Care. 2026; 49(8):1323-1329. Published: August, 2026. DOI: 10.2337/dc25-2383
Accuracy of Fetal Echocardiography for Detecting Associated Lesions and Predicting Surgical Management in Dextro-Transposition of the Great Arteries and Double Outlet Right Ventricle with Subpulmonary Ventricular Septal Defect
In a cohort of 99 fetuses with D-TGA or DORV-SPV, fetal echocardiography showed high diagnostic accuracy for simple D-TGA but lower accuracy for complex lesions. Serial assessment frequently altered VSD characterization, while fetal aortic measurements and aortic-to-pulmonary artery ratios (AUC above 0.9) accurately predicted postnatal CoA repair.
KEY FINDINGS: Fetal echocardiography demonstrated excellent diagnostic performance for simple D-TGA but substantially lower accuracy in complex D-TGA and DORV-SPV with associated lesions. Serial fetal assessment frequently altered qualitative VSD size estimation, while many small postnatally confirmed VSDs did not require surgical repair. Quantitative fetal aortic measurements and aortic-to-pulmonary artery ratios showed strong discriminatory ability (AUC >0.9) for identifying fetuses requiring postnatal CoA repair, supporting their role in improving prenatal risk stratification and surgical planning.
BACKGROUND: Associated cardiac lesions, including ventricular septal defect (VSD), coarctation of the aorta (CoA), and pulmonary stenosis (PS), substantially influence prenatal counseling and postnatal surgical management in fetuses with dextro-transposition of the great arteries (D-TGA) and double outlet right ventricle with subpulmonary ventricular septal defect (DORV-SPV). This study assessed the diagnostic accuracy of fetal echocardiography (FE) for identifying associated lesions and predicting the postnatal surgical approach.
DETAILS: This single-center retrospective cohort study included 99 fetuses with D-TGA or DORV-SPV managed at Lucile Packard Children's Hospital (Palo Alto, California, USA) between January 2013 and January 2024. Eligible fetuses were liveborn, had a documented prenatal surgical plan, and underwent postnatal management at the study center. In 65% of cases, serial fetal echocardiograms were available. Prenatal diagnoses and predicted surgical plans were compared with postnatal echocardiographic findings and the surgical procedures ultimately performed. Receiver-operating characteristic (ROC) analysis evaluated the predictive performance of fetal aortic and pulmonary artery measurements for postnatal CoA repair. Among the 99 fetuses, postnatal diagnoses included 45 with simple D-TGA, 38 with complex D-TGA, 15 with DORV, and 1 case reclassified from prenatal DORV-SPV to truncus arteriosus. Diagnostic concordance between fetal and postnatal echocardiography was highest for simple D-TGA (95% (42/44)) and D-TGA with VSD and PS (100% (3/3)), followed by D-TGA with VSD (93% (25/27)). Lower concordance was observed for DORV-SPV (60% (3/5)), DORV-SPV with CoA (40% (4/10)), D-TGA with VSD and CoA (29% (2/7)), D-TGA with isolated CoA (0% (0/2)), and DORV-SPV with PS (0% (0/1)). Surgical-plan prediction showed a similar pattern, with the greatest accuracy in simple D-TGA and D-TGA with VSD and PS. Qualitative assessment of VSD size frequently changed across serial fetal examinations, with defects generally appearing larger prenatally but often smaller on postnatal echocardiography. Only 50% of small VSDs identified postnatally required repair. All infants undergoing postnatal CoA repair had an associated VSD. ROC analysis demonstrated that fetal aortic measurements and aortic-to-pulmonary artery dimension ratios achieved area under the curve values greater than 0.9 for predicting the need for postnatal CoA repair.
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Source: Chandrasekar, H., Kaplinski, M., Maskatia, S. A., et al. Accuracy of Fetal Echocardiography in Detecting Lesions Associated With, and Predicting Surgical Plan for, Dextro-Transposition of the Great Arteries and Double Outlet Right Ventricle With Subpulmonary Ventricular Septal Defect and Predicted Transposition Physiology. Ultrasound in Obstetrics & Gynecology. 2026; 68(1):v79-87. Published: January 30, 2026. DOI: 10.1002/uog.70169
T-Wave Morphology Variation Improves Risk Stratification in Type 2 Long-QT Syndrome Beyond QTc Duration
This study demonstrates that the TMV index provides prognostic information beyond QTc duration in patients with LQT2. More negative TMV values were independently associated with an increased lifetime risk of cardiac events, whereas T-wave amplitude and the morphology combination score were not predictive of outcomes. TMV may enhance ECG-based risk stratification, particularly in patients with borderline or prolonged QTc intervals, pending validation in larger prospective multicenter studies.
KEY FINDINGS: This study demonstrates that quantitative assessment of T-wave morphology using the TMV index provides prognostic information beyond conventional QTc duration in patients with LQT2. More negative TMV values, reflecting greater T-wave morphological distortion and broader repolarization, were independently associated with a markedly higher lifetime risk of cardiac events after adjustment for established clinical and electrocardiographic risk markers. In contrast, traditional morphology metrics such as T-wave amplitude and the morphology combination score did not independently predict outcomes. These findings suggest that TMV may serve as a complementary ECG biomarker to improve risk stratification, particularly among patients with borderline or prolonged QTc intervals. Because this was a relatively small, exploratory cohort, larger prospective multicenter studies are required before routine clinical implementation.
BACKGROUND: Risk stratification in patients with genotype-confirmed type 2 long-QT syndrome (LQT2) remains challenging because corrected QT (QTc) duration alone does not fully capture arrhythmic risk. A substantial proportion of genetically affected individuals have borderline or normal QTc intervals despite remaining susceptible to cardiac events. This study evaluated whether a novel electrocardiographic marker, the T-wave morphology variation (TMV) index, could provide incremental prognostic information by quantifying T-wave morphology abnormalities relative to a large population-based reference.
DETAILS: This combined retrospective and prospective cohort study included 54 genotype-confirmed patients with LQT2 recruited from three tertiary cardiogenetic centers in Sweden. T-wave morphology was analyzed from resting 12-lead ECGs using a dynamic time-warping algorithm that generated the TMV index by comparing each patient's T wave with sex-, heart rate-, and lead-matched reference waveforms derived from 23,962 healthy participants in the UK Biobank. The primary outcome was the first lifetime cardiac event, defined as syncope or ventricular arrhythmia, while ventricular arrhythmia alone served as the secondary endpoint. Cox proportional hazards models evaluated the association between TMV and clinical outcomes after adjustment for QTc, sex, and the morphology combination score (MCS). Among the 54 patients, 32 experienced at least one cardiac event, including 28 with syncope and 11 with documented ventricular arrhythmia. A TMV threshold of <=-18.41 ms (25th percentile) identified patients at substantially higher risk of cardiac events. Low TMV was associated with a significantly increased risk of cardiac events in univariate analysis (HR, 3.505 [95% CI, 1.673-7.341]; P<0.001). The association remained significant after adjustment for QTc (HR, 2.92 [95% CI, 1.111-7.676]; P=0.03), QTc plus sex (HR, 3.375 [95% CI, 1.256-9.067]; P=0.016), and QTc, sex, plus MCS (HR, 4.061 [95% CI, 1.369-12.046]; P=0.012). Patients with TMV <=-18.41 ms experienced cardiac events more frequently than those with higher TMV (93% vs 43%), while ventricular arrhythmias occurred in 43% versus 10%, respectively. TMV also predicted ventricular arrhythmias in univariate analysis (HR, 4.978 [95% CI, 1.4-17.705]; P=0.013), although this association did not remain statistically significant after multivariable adjustment. Neither T-wave amplitude nor MCS independently predicted cardiac events in this cohort.
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Source: Gomez, N., Ramirez, J., Savelev, A. A., et al. Risk Stratification of Patients With Type 2 Long-QT Syndrome Through Analysis of T-Wave Morphology. Journal of the American Heart Association. 2026; 15(3). Published: June 23, 2026. DOI: 10.1161/JAHA.125.048388.
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