Inappropriate Diagnosis Research Articles

Clinical Characteristics of Malignant Pulmonary Sclerosing Pneumocytoma Based on a Study of 46 Cases Worldwide.

ObjectiveTo analyze the clinical characteristics of patients with malignant pulmonary sclerosing pneumocytoma (PSP) with metastasis, recurrence, and growth and to improve clinicians’ understanding of PSP in patients with malignant tumor characteristics.MethodsA total of 46 PSP patients with malignant tumor characteristics were identified in the literature search and compared with 38 patients with benign PSP diagnosed and treated in our hospital in the past 5 years. We explored the pathogenesis, clinical symptoms, diagnostic methods, treatment strategies and prognosis of PSP patients with malignant tumor.ResultsThe characteristics of young age (≤41 years old), larger tumor (≥36mm), lymph node metastasis and distribution in East Asians are indicative of PSP with malignant potential. Such patients should undergo segmental resection or lobectomy, combined with necessary lymph node dissection or biopsy. All patients with PSP should have an entire course of follow-up management, because they may have an adverse prognosis such as recurrence, growth, metastasis, and even death.ConclusionPSP has the potential for malignancy. Anatomical lobectomy or segmental resection combined with lymph node dissection should be performed in PSP with some specific characteristics. Inappropriate diagnosis and treatment may lead to poor prognosis in PSP patients.

Prevalence and factors associated with latent autoimmune diabetes in adults (LADA): a cross-sectional study

BackgroundThe Latent Autoimmune Diabetes in Adults (LADA) is a slowly progressive Type 1 diabetes subgroup with onset during middle age. Studies report that about 10% of adults initially diagnosed with clinical Type 2 diabetes (T2D) have LADA. Inappropriate diagnosis and mismanagement of the LADA can increase the risk of diabetic complications, which affect the quality of life and is the cause of increased mortality. In low-income countries setting, data regarding the magnitude of LADA is limited. We carried out this study to estimate the burden of misdiagnosed LADA among T2D patients in selected health facilities in Dar es Salaam and to bring awareness to the use of Glutamic Acid Decarboxylase (GAD) autoantibody in screening for LADA.MethodologyWe enrolled 186 phenotypically T2D patients in this cross-sectional study, through a standardized data collection tool we obtained participants’ demographic and clinical information. For testing GAD levels, we used a double-antibody Enzyme-Linked Immunosorbent Assay (ELISA). The Fisher’s Exact and student t-tests were used to test the significance of the statistical associations of the glycaemic control and diabetes complications between T2D and LADA.ResultsOut of 186 patients, 156 gave conclusive GAD Ab ELISA reading with LADA accounting for 5.1% (95% CI: 2.5 - 10.0). The mean age of subjects was 54.3 years (Range: 33-85 years). The parameters such as mean age, family history of diabetes mellitus status, Fasting Blood Glucose, clinical characteristics, and complications did not show significant statistical differences between patients with LADA and Type 2 diabetes. However, all LADA- Human Immunodeficiency Virus (HIV) comorbid patients had retinopathy, which was statistically insignificant in 20 (87%) T2D-HIV comorbid patients (p = 0.669). Neither neuropathy, nephropathy, nor Diabetic Mellitus (D.M.) foot syndrome was observed among LADA-HIV comorbid patients. Nevertheless, 22 (95.7%), 3 (13%), and 2 (8.7%) of T2D-HIV comorbidity had neuropathy, nephropathy, or D.M. foot syndrome, respectively.ConclusionsThe study established a LADA prevalence of 5.1% among T2D patients and has shown the role of GAD autoantibody in the screening for LADA. The study calls for a well- designed larger longitudinal study to generate strong evidence on the association of risk factors and complications associated with the LADA. This will develop robust evidence on the association of risk factors and complications associated with the LADA and T2D.

Breast Tuberculosis: A Report of Two Cases

Introduction: Breast Tuberculosis is relatively uncommon in the modern era. However, it is necessary to understand how to manage this disease since most patients require medical management, despite presenting as a lump. Case Presentation: Both patients were young females presented with lump breasts. Bilateral breast ultrasound with axilla was suggestive of infective aetiology. Fine needle aspiration cytology (FNAC) revealed ZN stain positive acid-fast bacilli. Both patients were started on anti tubercular treatment. One patient had complete resolution of the lump; however, another patient developed an abscess drained via percutaneous aspiration. Subsequently, the dissolution of the lump was observed. Conclusions: The diagnosis of breast tuberculosis is challenging and involves constant vigilance, detailed clinical history, examination, and supporting investigations, including chest X-ray, breast ultrasound with axilla, CT thorax, FNAC, and blood investigations such as erythrocyte sedimentation rate and Mantoux test. After diagnosis, treatment with antitubercular drugs should be started and regularly followed up. Inappropriate diagnosis and treatment can result in complications such as the non-resolution of lump and/or abscess.

Role of Computed Tomography in The Evaluation of Focal Liver Lesions

The liver lesions have marked differences across geographic regions and ethnic groups. In order to avoid inappropriate diagnosis and unnecessary surgery, Computed Tomography (CT) being a non-invasive imaging modality and with high sensitivity, provides better detection and distinguishing benign from malignant focal liver tumor lesions. Objective: To determine the role of Computed Tomography in the evaluation of focal liver lesions. Methods: A descriptive study was conducted at Government Kot Khawaja Saeed Teaching Hospital, Lahore, Pakistan. A sample size of 124 patients of both genders, age ranging from 22-90 years were enrolled in this study with a convenient sampling technique. Pregnant females and patients having renal insufficiency were excluded. The variables used to obtain data were: Age, Gender, Presenting complex clinical risk factors, CT findings, and other diagnoses. Toshiba Aquilion 16 CT scanner with KV 80-135 and MAs 500 was used. Injections of 1.5ml/kg IV contrast were given to patients, with a total dosage of 80-100ml at 4.5ml/sec through an 18G intravenous catheter. After contrast injection liver was scanned at 3 different time points or phases. All of the factors mentioned above were documented and kept in each patient's individual case record form (CRF). Data was gathered during the time frame specified. To examine the acquired data and arrange and compile the results, the statistical tool SPSS version 24 was used. Descriptive statistics and a Chi-square test was applied to check the comparison. Results: Among 124 individuals, 77 (62.1%) individuals were males, and 47 (37.9%) individuals were female. Average age of patients was 53.85±13.50 years. Multiple lesions were observed in 79 (63.7%) individuals had multiple lesions while 45 (36.3%) individuals had a single lesion. 94 (75.8%) individuals had malignant lesions while 30 (24.2%) had benign lesions. Lesions were more common in males than in females. The most common presenting complex clinic risk factor was hepatitis C virus with 45 individuals (36.3%) with Hepatitis C +ve. The most common CT finding was Hepatocellular Carcinoma with 41(33.1%). Conclusions: The study concluded that Computed Tomography being a non-invasive imaging modality and with high sensitivity, provides better detection and differentiation between benign and malignant focal liver lesions.

Prospective audit and feedback of Clostridioides difficile PCR at the time of ordering increases appropriateness of testing

Background: Over-testing for Clostridioides difficile infection outside acute diarrheal illness without a clear alternative cause can lead to inappropriate diagnosis and treatment with antibiotic therapy. Preanalytical interventions such as education, order restriction, and electronic order assistance are common but are limited in effectiveness. As an alternative approach, our antibiotic stewardship program (ASP) implemented prospective audit and feedback (PAF) on C. difficile PCR orders to reduce inappropriate testing.Methods: The study was conducted at a 399-bed, tertiary-care, Veterans’ Affairs Medical Center and included adult inpatients and outpatients for whom C. difficile PCR testing was ordered. In the preintervention period from June through September 2019, the ASP was alerted to C. difficile PCR tests and collected data but did not intervene. From October 2019 to January 2020, the ASP performed real-time PAF at the time of ordering. Appropriateness of testing was determined based on whether there was a negative result in the prior 7 days and a 3-step review of clinical factors (Fig. 1). When possible, a direct conversation took place with the ordering provider. If not possible, a general note delineating appropriate clinical criteria for testing was generated. No PAF was done outside standard hours. The ASP recommended cancelling tests deemed inappropriate. Monthly test rates during the pre- and postintervention periods were compared using the Student t test with α = .05, and test appropriateness was compared using the χ2 test. All analyses were conducted using Microsoft Excel software. Results: During the preintervention period, a total of 418 tests were ordered (104.5 per month). This number decreased to 276 (69 per month) during the intervention period. (p Conclusions: Direct PAF at the time of C. difficile PCR ordering may increase test appropriateness and is associated with a reduction in overall testing, primarily by reducing the number of tests that are considered not appropriate on clinical grounds. PAF is effective but requires significant time investment by ASP staff and may not be a sustainable intervention over time.Funding: NoneDisclosures: None

Combined Training Intervention Targeting Medical and Nursing Staff Reduces Ciprofloxacin Use and Events of Urinary Tract Infection.

Inappropriate diagnosis of urinary tract infections (UTI) contributes to antimicrobial overuse. A combined training intervention for medical and nursing staff mainly addressing the analytic process reduced UTI events (9.20 vs. 7.36 per 1000 PD, −20.0%, p = 0.003) and the utilization rate of ciprofloxacin (11.6 vs. 3.5, −69.6 p = 0.001) in a Bavarian University Hospital. Combined training intervention—as part of an antibiotic stewardship program—can be effective in avoiding unnecessary urinalysis and reducing antibiotic consumption.

Symptomatology of reconstitution of trauma in adults with a history of childhood sexual abuse. An approach from the perspective of SONapp application

Adults with a history of childhood sexual abuse often experience symptoms derived from lived traumatic experiences, which are analogous to many of the criteria of diagnosis of Borderline Personality Disorder (BPD) but also with those of stress disorder post-traumatic stress disorder (PTSD). We will briefly examine these symptoms in the context of a framework trauma, to conclude later whether symptomatic behaviors may be indicative more accurate for a post-traumatic response, especially in terms of behavior reconstitution or re-experience of trauma. Recognition of self-harm behavior or masochistic tendencies in adult survivors of sexual abuse trauma as an attempt to reconstitution of sexual trauma suffered in childhood, rather than as a manifestation characteristic of personality disorders, serves to establish an appropriate diagnosis, mental health professionals can continue to focus on the consequences of trauma unresolved sexual issues rather than personality restructuring. (Standardized intervention model SON, Delcea C ., 2019) Thus, seek to We understand clients in a trauma setting can provide a more objective treatment climate and can minimize the stigma that may result potentially from making an inappropriate diagnosis borderline personality disorder (BPD).

Autism: a diagnostic dilemma

In the last decades autism diagnosis has shown great differences in prevalence studies, apparently related to methods applied in the evaluation of children with relational and\or communicative difficulties. In the present study a literature evaluation is conducted, suggesting the advantages of an extensive and accurate clinical evaluation of the child with his family, possibly supported by tests like CARS, convergent with this approach and, in contrast, risks related to the use of semi-structured tests. Some of the last-mentioned tests have been considered, decades ago, as `golden standard' for diagnosis, but this was probably an unfortunate illusion, which may have favoured many inappropriate diagnoses. The history of the concept of autism is described, split between the suggestion of dealing with `one' condition and, alternatively, with a behaviour related to different syndromes and disorders. Various examples on positive evolution of this condition are reported, supporting the view of autism as an abnormal behaviour, usually comorbid with other conditions, in some cases curable and amenable to correction up to the removal of the diagnosis.

Clinical outcomes associated with guideline-discordant management of asymptomatic bacteriuria and urinary tract infection in hospitalized patients with neurogenic bladder.

To compare clinical outcomes associated with appropriate and inappropriate management of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) among inpatients with neurogenic bladder (NB). Multicenter, retrospective cohort. The study was conducted across 4 Veterans' Affairs hospitals. The study included veterans with NB due to spinal cord injury or disorder (SCI/D), multiple sclerosis (MS), or Parkinson's disease (PD) hospitalized between January 1, 2017, and December 31, 2018, with diagnosis of ASB or UTI. In a medical record review, we classified ASB and UTI diagnoses and treatments as appropriate or inappropriate based on national guidelines. Frequencies of Clostridioides difficile infection, acute kidney injury, 90-day hospital readmission, postculture length-of-stay (LOS), and multidrug-resistant organisms in subsequent urine cultures were compared between those who received appropriate and inappropriate management. We included 170 encounters with ASB (30%) or UTI (70%) diagnoses occurring for 166 patients. Overall, 86.1% patients were male, 47.6% had SCI/D and 77.6% used bladder catheters. All ASB encounters had appropriate diagnoses, and 96.1% had appropriate treatment. In contrast, 37 UTI encounters (31.1%) had inappropriate diagnoses and 61 (51.3%) had inappropriate treatment, including 30 encounters with true ASB. Among patients with SCI/D or MS, appropriate ASB or UTI diagnosis was associated with a longer postculture LOS (median, 14 vs 7.5 days; P = .02). We did not detect any significant associations between appropriate versus inappropriate diagnosis and treatment and other outcomes. Almost one-third of UTI diagnoses and half of treatments in hospitalized patients with NB are inappropriate. Opportunities exist to improve ASB and UTI management in patients with NB to minimize inappropriate antibiotic use.

Reliable and Resilient AI and IoT-Based Personalised Healthcare Services: A Survey

Recent technological and economic developments have transformed the healthcare sector towards more personalized and IoT-based healthcare services. These services are realized through control and monitoring applications that are typically developed using artificial intelligence/machine learning-based algorithms, which play a significant role in highlighting the efficiency of traditional healthcare systems. Current personalized healthcare services are dedicated to a specific environment to support technological personalization. However, they are unable to consider different interrelated health conditions, leading to inappropriate diagnoses and affecting sustainability and the long-term health of patients. To this end, current Healthcare 5.0 technology has evolved that supersede previous healthcare technologies. The goal of healthcare 5.0 is to achieve an autonomous healthcare service, that takes into account the interdependent effect of different health conditions of a patient. This paper conducts a comprehensive survey on personalized healthcare services. In particular, we first present an overview of key requirements of comprehensive personalized healthcare services in modern healthcare Internet of Things (HIoT), including the definition of personalization and an example use case scenario as a representative for modern HIoT. Second, we explored a fundamental three-layer architecture for IoT-based healthcare systems using AI and non-AI-based approaches, considering key requirements for CPHS followed by their strengths and weaknesses in the frame of personalized healthcare services. Third, we highlighted different security threats against each layer of IoT architecture along with the possible AI and non-AI-based solutions. Finally, we propose a methodology to develop reliable, resilient, and personalized healthcare services that address the identified weaknesses of existing approaches.

Evolution of Antimicrobial Resistance in the Era of COVID-19

Antimicrobial resistance is a slow-growing phenomenon that could even be a reason for a future pandemic. Due to inappropriate diagnosis and consumption of antibiotics, the bacteria have become resistant to the antibiotics used. In the era of COVID-19, this blind consumption of antibiotics has rapidly increased due to the period of quarantine and fear of the disease. Ligue to the fear of the pandemic, especially in ru, rural areas, many patients avoid going to the hospital and consuming antibiotics without any prescription. Various retrospective studies have shown a relationship between bacterial co-infection and AMR, which is increased in the era of COVID-19. Also, the secondary bacterial infections associated with the pandemic of COVID-19 have added to the risk of antimicrobial resistance. The viral effect on the respiratory system is favorable for bacterial infection, as in the case of COVID-19 affecting the respiratory tract followed by co-bacterial infection in some cases. COVID-19 has affected AMR in many aspects. Proper antibiotic resistance tests should be performed before prescribing any antibiotics to the patient to reduce the chances of AMR, especially in such an obnoxious situation of COVID-19. This crucially calls for a brand new and effective plan of action to attenuate the influence of the pandemic on antimicrobial resistance. Statistics of various countries in matters of antimicrobial resistance have shown an increase in AMR due to the concentration of health workers, researchers, and population on the pandemic associated with COVID-19. This calls for the necessity to aware the population worldwide about antimicrobial resistance and how it could be a hidden menace in the future and could probably prove to be a matter of concern as it would worsen the condition of the patients in a particular disease and would decrease the various possible aspects of the treatment especially in case of treatment based on antibiotics.

126. Outpatient Antimicrobial Stewardship Utilizing a Decentralized Model

BackgroundThe majority of human antimicrobial utilization occurs in the outpatient setting. Despite being mainly viral in etiology, upper respiratory tract infections (URIs) were the most common indication for outpatient antimicrobial prescriptions at our institution.MethodsThrough our electronic health record (EHR), we were able to determine our rate of antibiotic prescriptions for inappropriate URI diagnosis at our primary care practice sites. We selected staff volunteers from each our primary care practice sites to serve as stewardship champions. They were given training in stewardship best practices, and an URI stewardship toolkit which included viral URI prescription pad, EHR order panel, and patient education signage. They were tasked with providing education and feedback to their practice sites. We meet with them on a monthly basis to disseminate prescribing data and education. They also provided feedback from practice sites to the stewardship committee. ResultsOur decentralized model was put in place in November 2020. In the 6 months prior to the intervention, the average prescribing rate was 29.1%. In the 6 months after the intervention, the average prescribing rate decreased by 15% to 24.8%. During the intervention phase, there was an increase in number of non-COVID URIs diagnosed at our primary care sites. Temporal Trend in Inappropriate Antibiotics Prescribing Rates for Viral URIs Pre- and Post- Intervention Inappropriate antibiotic prescribing rate for viral upper respiratory tract infections from May 2020 until May 2021. Intervention started in December 2021 (arrow). Pre-intervention average was 29.1%. Post-intervention age was 24.8% which is a 15% decline in prescribing rate.Viral Upper Respiratory Infections Visits The total number of visits for presumed viral upper respiratory infections to primary care sites from May 2020 until May 2021. The majority of COVID-19 precautions in the area expired at the end of March 2021.ConclusionWe have been able to lower our inappropriate prescriptions for URIs utilizing a decentralized model of stewardship champions. This result was especially notable as the intervention phase corresponded with the end of COVID-19 precautions and an increase in non-COVID URIs diagnosed. The advantage of this approach includes an advocate embedded at each practice site who is familiar with the opportunities and challenges of the site, and a two-way flow of information from practice sites to the stewardship committee. This model provided additional benefit during the COVID-19 pandemic as the ability of centralized staff to travel to off campus clinic sites was curtailed. Disclosures All Authors: No reported disclosures

Expert consensus document on automated diagnosis of the electrocardiogram: The task force on automated diagnosis of the electrocardiogram in Japan: Part 2: Current status of inappropriate automated diagnosis is widely used electrocardiographs in Japan.

It is important to objectively grasp the current status of automated electrocardiogram (ECG) diagnosis. This report aimed to analyze and evaluate ECG records that our members have encountered as an inappropriate diagnosis in real-world clinical practices.

S2373 A Case of a Deep Infiltrative Rectal Endometriosis Presenting as a Solitary Ulcer and Lumbosacral Shingles

Introduction: Deep bowel endometriosis is a rare, clinically challenging diagnosis mimicking many gastrointestinal diseases. There are no clear guidelines for the evaluation of patients with suspected bowel endometriosis, therefore a high index of suspicion is warranted. Case Description/Methods: A 39 year old female with a history remarkable for fibroidectomy and constipation presents for rectal bleeding and discomfort for 1 month. In 2012, FOBT was positive and colonoscopy findings were significant for a solitary rectal ulcer. Biopsies showed inflammation. Due to persistent symptoms, a flexible sigmoidoscopy (2013) with repeat biopsies confirmed the diagnosis of deep bowel endometriosis located at the anterior portion of the rectum. Hormonal therapy offered complete resolution of her symptoms. In 2021, due to menopausal symptoms, hormonal therapy was discontinued leading to recurrence of symptoms and new onset right sided lumbosacral shingles. Colonoscopy findings were significant for luminal narrowing and nodularity at the anterior portion of the rectum. Biopsies were nonspecific. Discussion: Given that endometriosis rarely infiltrates the submucosa or mucosa (6.4% of cases), initial colonoscopy and biopsy findings may be nonspecific. Hence, an initial inappropriate diagnosis may occur, demonstrating how challenging this diagnosis may become. Even though the gold standard for diagnosis is direct laparoscopic visualization or tissue diagnosis, imaging modalities such as transvaginal and transrectal US and MRI may diagnose and determine the extent of deep bowel endometriosis. Response to hormonal treatment in deeply infiltrating bowel endometriosis is unpredictable and may require a surgical approach. The natural course of bowel endometriosis has not been formally established. Some authors describe inactive endometriosis as a nodular and fibrotic lesion associated with adhesions and strictures. This correlated with the findings of our patient's latest colonoscopy. Association of endometriosis with rheumatological and autoimmune disorders have been established, where theories based on genetic dysregulation of immune, adhesion, and inflammatory processes take part in the disease pathology. This may explain the greater likelihood of shingles reactivation, such experienced by our patient, during an immunocompromised state such as menopause. Even though deep bowel endometriosis is poorly understood, a high index of suspicion is crucial to offer patients a correct diagnosis and appropriate treatment options.Figure 1.: Deep bowel endometriosis. (Top, left to right) Colonoscopy findings from 2012 (first 2 images) and 2013 respectively showing an abnormal mucosal lesion in the proximal portion of the anterior rectum. (Bottom, left to right) Colonoscopy findings from 2021 showing mucosal nodularity in the proximal portion of the anterior rectum.

Extragingival benign growth-Case report at a rare site

To present a case report of extragingival pyogenic granuloma on lower lip which is an uncommon site for pathological entity and also to emphasize the reason for its occurrence. Pyogenic granuloma (PG) is a benign vascular neoplasm more often appear as lobulated or smooth red nodular lesion commonly in gingiva. Extragingival occurrence of PG is very rare. The present article reports a rare case of 55-year-old female with PG presenting rapid growing mass on the lower lip. This article highlights the possibility on the reason for its occurrence which is important for the diagnosis in this atypical location. The primary etiology of lower lip lesion is trauma and contributory factors being poor oral hygiene and betel quid chewing. Pyogenic granuloma is one of the common lesions in oral cavity. This article highlights the pyogenic granuloma on lip which is an unusual site. Although it can be diagnosed clinically, atypical presentations lead to inappropriate diagnosis. Therefore, further investigation by biopsy confirms final diagnosis upon which treatment is instituted.

Identification of variant APL translocations PRKAR1A-RARα and ZBTB16-RARα (PLZF-RARα) through the MI-ONCOSEQ platform

The cornerstone of management in patients with acute promyelocytic leukemia (APL) is early diagnosis and prompt initiation of treatment with an all-trans retinoic acid (ATRA)-based regimen. Identification of the t(15;17)(PML-RARA) chromosomal translocation through conventional cytogenetics fluorescence in-situ hybridization (FISH) or detection of the promyelocytic leukemia-retinoic acid receptor alpha (PML-RARα) fusion through RT-PCR represent the current standard of care for diagnosing APL. However, about 1–2% of patients with APL have a variant translocation involving other fusion partners with RARα besides PML. These patients present a unique diagnostic and clinical challenge in that conventional cytogenetics in addition to FISH and/or RT-PCR for PML-RARα may fail to identify these clinically relevant genetic lesions leading to an inappropriate diagnosis and treatment. We present two cases of patients who had APL with variant translocations whose bone marrow specimens were sent to the University of Michigan for enrollment in the MI-ONCOSEQ study (HUM00067928) after standard testing failed to identify PML-RARα or t(15;17) despite a phenotypic concern for this diagnosis. In these two patients, whole exome and transcriptome profiling via the MI-ONCOSEQ platform identified a PRKAR1A-RARα fusion in one patient and ZBTB16-RARα fusion in another patient. These cases illustrate the utility of whole exome and transcriptome profiling in diagnosing variant translocations in patients in whom there is a high clinical suspicion for APL based on hematopathology review.

Value of echocardiography to diagnose coronary arteries patterns in transposition of great arteries

Abnormal coronary pattern may complicate coronary transfer during arterial switch operation. The objective of this study was to evaluate the accuracy of echocardiographic to assess coronary arteries anatomy in transposition of the great arteries and determine impact on outcomes. Retrospective analysis of data in neonates with transposition of the great arteries. Preoperative echocardiographic coronary artery pattern and surgical intraoperative reports were compared. Mismatch between transthoracic echocardiography and surgical intraoperative reports, and its impact on perioperative outcome were assessed. Coronary patterns were classified in 4 groups: I = normal, II = coronary with intramural course, III = CA loop. One hundred and eight neonates who underwent arterial switch operation were included: 68 ranged in group I, 7 in group II, 32 in group III and 1 in group II + III. Intraoperative complications occurred in 10 cases. Five patients died, from coronary cause in 3 ( Table 1 ). Survival rates were 96% at 1-month. Transthoracic echocardiography and surgical intraoperative reports differed in 17.6%. Death rates were 15.8% in case of inappropriate diagnosis and 2.2% if the diagnosis was appropriate ( P = 0.0108) ( Fig. 1 ). Mortality in group II increased up to 50% in case of inappropriate diagnosis versus 0% if concordance. By multivariate analysis, an inappropriate preoperative transthoracic echocardiography diagnosis of coronary pattern was the only significant risk factor for mortality ( P = 0.04). Echocardiography can assess coronary artery anatomy in neonates with transposition of the great arteries. Intramural coronary course is often misdiagnosed. Missed diagnosis of coronary artery anomaly preoperatively may impact on perioperative mortality.

Evaluation of Hookworm Diagnosis Techniques from Patients in Debre Elias and Sanja Districts of the Amhara Region, Ethiopia.

Background Inappropriate diagnosis could intimidate the prevention and control of hookworm infection. Thus, this study was aimed at evaluating the performance of hookworm diagnosis methods. Methods An institution-based cross-sectional study was conducted from patients in Debre Elias and Sanja districts of the Amhara region, Ethiopia, from November 2019 to January 2020. The study subjects were selected conveniently. After the data was entered into Statistical Package for the Social Sciences (SPSS), sensitivity, specificity, predictive values, test accuracy, and agreement of the different hookworm diagnosis methods, namely, test tube flotation technique (TFT), McMaster (MM), formol-ether concentration (FEC), Kato-Katz (KK), and direct wet mount microscopy (DWMM), were calculated by using SPSS software. The composite reference standard (CRS) was used as the gold standard method. The kappa (κ) test was used to measure the level of agreement between diagnosis tests. Result A total of 389 stool samples were collected from patients in the study. The overall prevalence of hookworm was 63.24%. The test tube flotation technique (TFT) was found to be the highest both in terms of sensitivity and diagnostic accuracy (100%). McMaster (MM) was the second most sensitive test (68.7%), followed by FEC (44.3%) and KK (38.2%). On the other hand, DWMM had the lowest sensitivity (37.4%), and its diagnostic accuracy was also the least (60%). Only TFT had a perfect agreement (agreement = 100%, kappa = 1) with the CRS. The sensitivity of DWMM, KK, and FEC showed a kind of linear function with the intensity of infection, but TFT and MM methods were not affected by the infection intensity. Conclusion Hookworm is still a public health problem in the study area. TFT is by far more sensitive than MM, FEC, KK, and DWMM techniques.

Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department

BACKGROUND: Acute coronary syndrome (ACS) is a common cause of mortality and morbidity. An ACS diagnosis can be made with electrocardiogram (ECG) and cardiac markers. However, despite medical advances, 2–5% of ACS patients are undiagnosed and discharged from emergency departments (EDs) because clinicians often find it difficult not only to diagnose and treat high-risk patients but also to define nonemergency diseases or safely discharge healthy patients. Risk stratification can be prevented, and inappropriate diagnosis and treatment protocols can be identified. The ED Assessment of Chest Pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) scoring system, developed to identify patients with chest pain but at low risk for a major adverse cardiac event (MACE), is the first score based on clinical data from emergency medicine. OBJECTIVES: This study investigates the usability of EDACS-ADP in Turkey. MATERIALS AND METHODS: This is a prospective observational study of 392 patients. The primary outcome was a major adverse cardiovascular event (MACE) within thirty days. RESULTS: A total of 116 MACEs occurred in 65 (16,6%) patients during a one-month follow-up. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+ LR), and negative likelihood ratio (–LR) values of the EDACS-ADP score for the evaluation of 30-day MACE rate in patients who admitted with chest pain for two months were as follows: 96.9%, 64.5%, 35.2%, 99.1%, + LR: 2.73, and –LR: 0.05. CONCLUSION: Most of these patients were classified by the EDACS-ADP as low risk and suitable for discharge. The 30-day MACE rate of development was significantly low (0.9%) and acceptable in patients grouped as low risk.

Study of LDH Isoenzymes in Myocardial Infraction at Vidharbha Region (Central India)

Introduction: A significant cause of morbidity and mortality worldwide is myocardial infarction (MI).Within the first few hours of the beginning of MI, the greatest risk of death occurs. Thus, for the effectivetreatment of patients with MI, early detection of cardiac ischemia is essential. Inappropriate diagnosis ofpatients with chest pain sometimes leads to improper admission, and vice versa, of patients without MI.Physical examination, precise ECG results and evaluation of cardiac biomarkers play an important rolein the early diagnosis of acute ischemia, in addition to clinical history. In the present analysis, the cardiacbiomarker lactate dehydrogenase released during a MI event is discussed in depth.Aim: We conducted a cross sectional study to examine the different levels of LDH isoenzymes in myocardialinfarction patients those admitted in cardiac care unit in SMHRC Nagpur.Material and Methods: The present study included 100 subjects of age group 30-80 years. Patients admittedto the coronary care unit at SMHRC & AVBRH between January 2020 and June 2020 was consideredeligible for the study. These guidelines ensured that sufficient blood samples were available and the criteriafor diagnosis were consistent. Lactate dehydrogenase isoenzyme was fractionated by agarose gel electrophoresis as described by Cawley and Eberhard. The stained slides were scanned on Chromoscan at 520 mixand the percentages of the fractions were quantitated.Results: The results obtained in the present study indicate that serum lactate dehydrogenase enzyme activityincreases 4-5 folds in the first 24-72 hours after the onset of clinical infarction with a peak on the second day.It then declines gradually towards the normal within two weeks. Thus, determination of total serum LDHis valuable if patients present themselves for clinical check up even after a week from the day of infarct.Although the contribution of myocardium to total serum lactate dehydrogenase is large, its interpretationbecomes difficult if the diseases of other organs such as liver, kidney, etc.Conclusion: In conclusion, the present data strongly support the use of Lactate dehydrogenase for thediagnosis of MI. Such a strategy should boost both the precision and sensitivity for myocardial infarctiondiagnosis.