Editorial.

Abstract

Welcome to the third issue of 2021 as we continue to face uncertain futures as a consequence of the persistence of COVID-19 and its evolving variants. Tentative plans in our professional and personal lives run the risk of being dashed, although I hope that, by the time this Editorial is printed, the United Kingdom at least may be free of most restrictions. I continue to receive many Covid-related articles describing and analysing datasets in a variety of environments. One area, however, where burgeoning research has undoubtedly benefitted and exploded over the last 18months is in the field of lung ultrasound. We always knew ultrasound could have a significant role in the management of this disease if training and equipment issues are addressed. Lung ultrasound is here to stay and will continue to be applied to situations other than the Covid lung long after the pandemic. It gives me pleasure therefore to offer an insightful guest editorial this month from three clinicians, with a passion for ultrasound, based in the south of the UK. In addition to their work and our usual Echoes page, I offer the usual broad spectrum of article types and topics including a review, a pictorial essay, three original research papers and three informative case reports. You will see that despite differing conditions, many of the articles have the same goal; the desire to detect diseases more quickly, thus allowing for earlier treatment plans. This goal aligns very much with current UK government health initiatives and likely reflects similar aims internationally. First up is a review by Venables et al. who found that raised renal resistive indices could be as reliable a predictor of early diabetic kidney disease as albuminuria levels and more reliable than estimated glomerular filtration rate. Next, a team from Delhi looked at nerves in diabetic patients with and without diabetic polyneuropathy and identified changes on ultrasound which, when compared with a control group of healthy volunteers, may precede clinical symptoms. They suggest that high resolution ultrasound could be used as a screening tool for early detection and thus earlier management of this painful condition. Results from a small study from Iran suggest that hypertension has a detrimental effect on aortic wall elasticity and left ventricular function regardless of patient age, potentially making the patient more at risk of a cardiovascular event. Earlier detection may allow for prompt treatment, thus slowing disease progression. A timely article from Reeve et al. discusses the value of online journal clubs as a source of continuing professional development during a global pandemic. Online journal clubs allow international participation that traditional journal clubs could not. The article focuses specifically on the first BMUS journal club article from August 2020, which investigated professional practice in obstetrics. Taylor and MacLean offer an informative educational piece on neonatal hip imaging for dysplasia. In particular, they stress the value of the anterior imaging technique and suggest reasons why this method is underutilised in clinical practice. Brusic et al. describe an unusual case of a very large haemorrhagic hepatic cyst from which four litres of bloody fluid was drained. I bet the patient felt better after that. Good multimodality images support this educational report. Sepulveda et al. offer two interesting case reports involving prenatally diagnosed congenital hepatic cysts and their subsequent management in the neonates. Such findings may become less rare now that many more third trimester scans are performed. Nice supporting images including ultrasound, MRI and histology. Finally, Agrawal et al. present an unusual case study of a young man with emphysematous epididymoorchitis, a rare condition more commonly associated with diabetic and older men. The educational value here is that early diagnosis may avoid orchidectomy. Many thanks for the recent letters from readers. I look forward to including some in the November issue, all being well.