Inappropriate Diagnosis Research Articles

Ethylenediaminetetraacetic Acid‑Dependent Pseudothrombocytopenia in Patient Previously Treated as Dengue Fever

Abstract: One of the most widely used anticoagulants for a complete blood count is ethylenediaminetetraacetic acid (EDTA). Pseudothrombocytopenia (PTCP) may be caused by EDTA, this condition may lead to inappropriate diagnosis and treatment. We report a 25-year-old female with unspecific headache and joint pain with very low platelet count since 1 month before hospital admission. She was diagnosed with Dengue fever infection and got some platelet transfusion from the previous secondary hospital. She was carried out for a blood test with another anticoagulant (sodium citrate) and bone marrow aspiration. The results showed that she had normal platelet count and bone marrow cellularity. When a patient was identified with thrombocytopenia without any bleeding manifestation, hematology disease, and family history, PTCP should be taken into consideration to prevent unnecessary intervention. Keywords: platelet, pseudothrombocytopenia, ethylenediaminetetraacetic acid, Dengue fever

Inappropriate Automatic Diagnosis of Atrial Fibrillation in Widely-used Electrocardiograph : Current Situation and Problems

【背景】心電図自動診断はすでに半世紀を超える歴史があり，健診や臨床の場で広く用いられている．各心電計メーカーの汎用心電計には，それぞれ最新の自動解析プログラムが搭載されているが，その診断精度は決して十分とはいえず，実臨床の場ではいまだに専門医によるオーバーリードが不可欠である．【目的】近年，臨床的意義が高まっている心房細動を取り上げ，不適切自動診断の現状とその問題点ならびに不適切診断をもたらした要因について検討することを目的とした．【方法】有志の集まりである「心電図自動診断を考える会」会員から収集した，匿名化心房細動関連不適切診断心電図計145例について，世話人間で詳細解析を行った．【結果】①一般健康診断（会員A）における不適切自動診断は，健診心電図連続50,000例中1,108例（2.2％）に見られ，そのうち心房細動関連は54例（約0.11％，誤診43例，読み落とし11例）であった．一方，循環器専門外来（会員B）の調査では，さまざまな不適切診断連続272例中51例（18.8％）で心房細動の読み落としが見られた．②心房細動を読み落とした計62例では，f波を洞性P波と誤認したのが42例（67.7％），異所性P波としたのが5例（8.1％），心房粗動としたのが8例（12.9％），心房波を読み取れなかったのが7例（11.3％）であった．③心房細動と誤診した計83例では，洞性P波を見落としたのが38例（45.8％），異所性P波を認識できなかったのが37例（44.6％），粗動波をf波と誤認したのが8例（9.6％）であった．【結論】心房細動の不適切診断に関しては，誤診が不要な再検査や専門医受診を招く一方，読み落としによる治療の遅れが脳梗塞や心不全の発症など，重大な合併症を引き起こす危険性をもたらす．波形計測や診断アルゴリズムのさらなる改良に加え，適切な心電図所見のビッグデータを用いた人工知能（AI）の導入など，より精度の高い自動診断システムの構築が求められる．

An Update in Health Disparities in COPD in the USA

COPD is a prevalent, highly morbid, but manageable disease. Challenges exist in diagnosis that leads to both missed and inappropriate diagnosis with apparent ethnic, sex, and socioeconomic disparities. Disease management is possible with medications and intensive efforts such as pulmonary rehabilitation, but as these interventions are become increasingly expensive, the divide in socioeconomic outcomes expands. Health systems have increasingly focused resources on COPD, but the efforts have not been equally implemented. There is increasing prevalence of COPD in women, patients with low socioeconomic status, and minorities attributable to higher burden of tobacco, occupational, and rural exposure. Recent mortality estimates suggest a growing socioeconomic divide. As providers and healthcare systems work to improve the diagnosis and care of COPD patients, biases and disparities must be measured, appreciated, and addressed to assure just implementation.

Cytologic and Molecular Diagnostics for Vitreoretinal Lymphoma: Current Approaches and Emerging Single-Cell Analyses.

Vitreoretinal lymphoma (VRL) is a rare ocular malignancy that manifests as diffuse large B-cell lymphoma. Early and accurate diagnosis is essential to prevent mistreatment and to reduce the high morbidity and mortality associated with VRL. The disease can be diagnosed using various methods, including cytology, immunohistochemistry, cytokine analysis, flow cytometry, and molecular analysis of bulk vitreous aspirates. Despite these options, VRL diagnosis remains challenging, as samples are often confounded by low cellularity, the presence of debris and non-target immunoreactive cells, and poor cytological preservation. As such, VRL diagnostic accuracy is limited by both false-positive and false-negative outcomes. Missed or inappropriate diagnosis may cause delays in treatment, which can have life-threatening consequences for patients with VRL. In this review, we summarize current knowledge and the diagnostic modalities used for VRL diagnosis. We also highlight several emerging molecular techniques, including high-resolution single cell-based analyses, which may enable more comprehensive and precise VRL diagnoses.

Extra-adrenal pheochromocytoma with initial symptom of haemoptysis: a case report and review of literature

BackgroundPheochromocytoma is a catecholamine-secreting tumour that leads to various symptoms. Haemoptysis is rarely caused by a pheochromocytoma occurring outside the bronchus or thoracic cavity. Here, we report the case of an extra-adrenal abdominal pheochromocytoma initially manifesting as haemoptysis/dyspnoea during exercise without classic symptoms.Case presentationA 22-year-old man with a history of severe dyspnoea experienced difficulties in breathing following a marathon owing to haemoptysis that required ventilator management 1 year before presentation. His father had undergone surgery for ectopic pheochromocytoma. Computed tomography (CT) revealed a 30-mm tumour between the inferior vena cava and pancreatic head while urinalysis revealed abnormally high noradrenaline levels. He was clinically diagnosed with an extra-adrenal abdominal ectopic pheochromocytoma. After controlling blood pressure, surgery was performed, and the tumour was successfully removed. Histopathology revealed chromogranin A (+), synaptophysin (+), S100 protein (+), and MIB-1 index of 1%. Therefore, the patient was finally diagnosed with extra-adrenal abdominal ectopic pheochromocytoma.ConclusionsHaemoptysis is a rare manifestation of abdominal ectopic paraganglioma. Prompt consideration of pheochromocytoma/paraganglioma when patients experience haemoptysis without any other possible aetiology may prevent inappropriate diagnosis and treatment and ultimately fatalities.

Medical Diagnosis Using Machine Learning: A Statistical Review

Decision making in case of medical diagnosis is a complicated process. A large number of overlapping structures and cases, and distractions, tiredness, and limitations with the human visual system can lead to inappropriate diagnosis. Machine learning (ML) methods have been employed to assist clinicians in overcoming these limitations and in making informed and correct decisions in disease diagnosis. Many academic papers involving the use of machine learning for disease diagnosis have been increasingly getting published. Hence, to determine the use of ML to improve the diagnosis in varied medical disciplines, a systematic review is conducted in this study. To carry out the review, six different databases are selected. Inclusion and exclusion criteria are employed to limit the research. Further, the eligible articles are classified depending on publication year, authors, type of articles, research objective, inputs and outputs, problem and research gaps, and findings and results. Then the selected articles are analyzed to show the impact of ML methods in improving the disease diagnosis. The findings of this study show the most used ML methods and the most common diseases that are focused on by researchers. It also shows the increase in use of machine learning for disease diagnosis over the years. These results will help in focusing on those areas which are neglected and also to determine various ways in which ML methods could be employed to achieve desirable results.

Complications of Kalazar among Children in Hilla-city

Objective: This study aimed to detect the types of complications of children suffering from kalazar; also toidentify the reason of these complications.Methodology: A descriptive study carried out from Feb15th to June 15th of the academic year 2017. Thesample consisted (109) children from general maternal and children hospital in Hilla/Babylon. The studydesigned and data was collected using structural questionnaire which was prepared by consulting panelresearch expertise, also by assessment approach and interview was done with parents of children. Thecollected data were analyzed through descriptive statistics by frecuency and percentage.Results: The results of the present study indicated that most of the children age were (13-18) yrs.(40.4%);male gender more involved (67%) and (27%) were from Mesaib city. The education level of parents werewithin secondary school, mothers (52%) fathers (43%). The income of affected children families involvedin the study were (51%) poor, which isn’t enough to maintain healthy well being status and medicalrequirements. Complications revealed that children suffers from bleeding tendancy (13.5%) sever animeawere (20%) hepato spleenomegaly were (14.0%) , finally death occurs because of septicemia (37%).Conclusion: Complications accurs because of poor and inappropriate medical diagnosis, also infectivemedical treatment during hospitalization and lake of medical follow up to children suffering from kalazar bythe health team after hospital discharge.

Dealing with prostate cancer? Don\u2019t let histiocytic lesions fool you!

BackgroundProstate adenocarcinoma has well known benign mimickers. Histiocytic proliferations usually impose differential diagnosis with high-grade component of acinar adenocarcinoma (Gleason pattern 5).Case presentationWe present herein three cases of histiocytic lesions of the prostate in which accurate recognition avoided inappropriate upgrading (malakoplakia associated with prostate adenocarcinoma, two cases) and false positive diagnosis at biopsy (xanthoma with signet ring morphology).ConclusionIn needle biopsies, pathologists should have a low threshold to perform immunostains when considering a differential diagnosis between high-grade carcinoma and a histiocytic lesion. In prostatectomy specimens, abrupt transition to solid areas in low and intermediate grade tumors should raise concern to exclude malakoplakia. PAS and von Kossa stains are inexpensive and a valuable tool to highlight typical Michaelis–Gutmann bodies.

Real Time Pathological and Molecular Characterization of Aggressive B-Cell Lymphomas Based on a National Network. a Lysa Project

Real Time Pathological and Molecular Characterization of Aggressive B-Cell Lymphomas Based on a National Network. a Lysa Project

CT reconstruction with thick slices not only underestimates lymph node size but also reduces data reproducibility in colorectal cancer.

Reliable size measurement of lymph node (LN) metastases is important for the evaluation of cancer treatment. However, image analyses without proper settings may result in inappropriate diagnoses and staging. To investigate whether reconstruction slice thickness in computed tomography (CT) affects measurements of LN size and reproducibility. We analyzed 48 patients with histological diagnoses of sigmoid colon and rectal cancer who underwent contrast-enhanced CT colonography as part of a surgical treatment preparation. A board-certified radiologist selected 106 LNs whose short-axis diameter was ≥5 mm on 1-mm-thick images; the short-axis diameters were measured on 1- and 5-mm-thick images by the radiologist and residents and compared using Wilcoxon matched-pairs signed rank test. Data variation and reproducibility were evaluated using the F test and Bland-Altman analysis. P<0.05 was considered significant. Short-axis diameters measured on 5-mm-thick images were significantly lower than those measured on 1-mm-thick images (P<0.01), even in the LNs whose short-axis diameters were over twice the slice thickness (P<0.05). Of the 106 LNs, 57 showed short-axis diameter <5 mm on 5-mm-thick images; the maximum short-axis diameter was 6.7 mm on a 1-mm thick image. Data variation was significantly larger on 5-mm thick images than 1-mm-thick images in small LNs (P<0.05) and reproducibility on 5-mm-thick images was inferior to that on 1-mm-thick images. Thick reconstruction slices in CT can result in an underestimation of LN size and reduce data reproducibility. When measuring LN size, a thin reconstruction slice would be recommended based on targeted LN size.

Tratamiento de malformaciones y tumores vasculares, en un centro de referencia en Bogotá

Introducción. Las malformaciones vasculares son anomalías que están presentes desde el nacimiento, no desaparecen y pueden crecer a lo largo de la vida. Se ha demostrado en estudios retrospectivos que la terminología para clasificar las anomalías vasculares es inexacta en un 69 % de casos, por lo que se hace un diagnostico inadecuado y en un 53 % de casos se brinda al paciente y su familia una información incorrecta del tratamiento y el curso clínico.&#x0D; Métodos. Estudio prospectivo longitudinal, realizado entre 2016 y 2019, donde se incluyeron pacientes con anomalías vasculares, que consultaron a nuestra institución, fueron valorados por el servicio de cirugía vascular, se hizo un plan diagnóstico y manejo integral, vía endovascular, quirúrgica o mixta, de acuerdo con cada caso.&#x0D; Resultados. La malformación más común fue la de tipo venoso, en el 40,3 % de los casos. Se realizó manejo endovascular en el 93,1 % de casos de malformaciones vasculares y quirúrgico en el 6,9 %. La mejoría de los síntomas que motivaron la consulta fue del 100 % para los tumores vasculares y del 70,8 % para las malformaciones. Sin embargo, los resultados son heterogéneos.&#x0D; Discusión. Es necesario realizar un adecuado diagnóstico de las anomalías vasculares, para alcanzar un tratamiento eficaz, con mejoría de los síntomas.

Value of preoperative echocardiography for the diagnosis of coronary artery patterns in neonates with transposition of the great arteries

Abnormal coronary pattern may complicate coronary transfer during arterial switch operation. To evaluate the accuracy of echocardiography in assessing the anatomy of coronary arteries in neonates with transposition of the great arteries, and determine impact on outcomes. We conducted a 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 the impact on perioperative outcome were assessed. Coronary patterns were classified into four groups: type 1 (normal); type 2 (risk of coronary with intramural course); type 3 (coronary loop); and type 2+3. Overall, 108 neonates who underwent an arterial switch operation were included: 68 were classified as type 1; seven as type 2; 32 as type 3; and one as type 2+3. Overall, 10 adverse events occurred. Five patients died, three from coronary causes. Survival was 96% at 1 month. Transthoracic echocardiography and surgical intraoperative reports differed in 17.6% of cases. Mortality was 15.8% in case of inappropriate diagnosis and 2.2% for appropriate diagnosis (P=0.01). Mortality in type 2 was 66.7% in case of discordance versus 0% when concordant. Multivariable analysis found that 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. Preoperative misdiagnosis of coronary artery anomaly may impact perioperative mortality. However, this assessment will have to be confirmed by further larger studies.

Association of Positive Delirium Screening with Incident Dementia in Skilled Nursing Facilities.

Early detection of delirium in skilled nursing facilities (SNFs) is a priority. The extent to which delirium screening leads to a potentially inappropriate diagnosis of Alzheimer's disease and related dementia (ADRD) is unknown. Nationwide retrospective cohort study from 2011 to 2013. An SNF. A total of 1,175,550 Medicare enrollees who entered the SNF from a hospital and had no prior diagnosis of dementia. A positive screen for delirium using the validated Confusion Assessment Method (CAM), performed as part of the federally mandated Minimum Data Set (MDS) assessment. Incident all-cause dementia, ascertained through International Classification of Diseases, Ninth Revision (ICD-9), diagnosis in Medicare claims or active diagnoses in MDS. Positive screening for delirium was identified in 7.7% of cases (n = 90,449), and most occurred within the first 7 days of SNF admission (62.5%). The overall incidence of ADRD was 6.3% (n = 73,542). Nearly all new diagnoses of ADRD (93.5%) occurred within the first 30 days of SNF admission. Patients who screened CAM positive for delirium had a nearly threefold increased risk of receiving an incident ADRD diagnosis on the same day (hazard ratio (HR) = 2.63; 95% confidence interval (CI) = 1.50-4.63). Among patients who screened CAM positive for delirium, those who were cognitively intact or had mild cognitive impairments were, on average, six times more likely to receive an incident ADRD diagnosis (HR = 6.64; 95% CI = 1.76-25.0) relative to those testing CAM negative. Among older adults not previously diagnosed with dementia, a positive screen for delirium was significantly associated with higher risk of ADRD diagnosis after admission to a SNF. This risk was highest for patients in the first days of their stay and with the least cognitive impairment, suggesting that the ADRD diagnosis was potentially inappropriate.

Stratégie diagnostique des sarcomes des tissus mous de l’enfant et adolescent

Soft tissue sarcomas in children are rare tumor, representing around 6 to 7% of children cancer. They spread mostly sporadically (90%) and therefore are rarely associated to an underlying constitutional genetic disease (10%). About half of those sarcomas are rhabdomyosarcomas and the others are a very heterogenous histologic group with various bio-pathologies and prognosis. Clinical presentation is mainly a soft tissue lump often difficult to distinguish from more frequent benign causes (malformative, infectious, benign, or pseudotumor). Inappropriate initial diagnosis work-up has a strong impact on soft tissue sarcomas' prognosis. Adapted complementary investigations (first ultrasound and MRI) are important to compile arguments for a malign origin and to indicate a biopsy. However, predictive value of imaging exams still remains imperfect, and histological analysis by percutaneous image-guided biopsy and sometimes by surgical biopsy is often necessary. Authors realize an update on optimal diagnostic pathway including molecular tests in presence of a soft tissue mass in a child.

Impact of culture on refugee women's conceptualization and experience of postpartum depression in high-income countries of resettlement: A scoping review.

The global refugee population has reached a staggering 25.9 million. Approximately 16% of global refugees resettle in high-income countries which are often culturally very different from their home countries. This can create cross-cultural challenges when accessing health services, leading to inappropriate assessments, diagnoses and treatments if cultural background is not factored in. The impact of culture on the conceptualization and experience of postpartum depression (PPD) amongst migrant women has received growing attention in recent years, however, a specific focus on refugee and asylum-seeking women is lacking. Given the unique mental health challenges refugee women face, it is hypothesized that the interplay between culture and postpartum depression amongst refugee women may differ from other migrant women. Therefore, a scoping review was conducted to characterize what is known about the impact of culture on the conceptualization and experience of PPD in refugee women resettled in high-income countries. This study was conducted as a scoping review in accordance with the Joanna Briggs Institute's Methodology for Scoping Reviews. A systematic search of studies addressing the relationship between culture and postpartum depression amongst refugee women (including asylum-seeking women) resettled in high-income countries was conducted across 6 databases including MEDLINE, PsycINFO and SOCINDEX between June 2018 and August 2019. A total of 637 articles were found. Studies were eligible if they focused on refugee women who had a pregnancy during forced migration or upon resettlement in a high-income country and focused on the impact of culture on women's conceptualization and/or experience of PPD. Eight studies met inclusion criteria and were included in the final analysis, the majority of which were qualitatively driven. Four key themes emerged: 1) there are diverse conceptualizations and experiences of postpartum depression amongst refugee women; 2) mental health stigma has a significant impact on women's conceptualizations and experiences of postpartum depression and help-seeking behaviors; 3) cultural traditions and social support play protective roles in postpartum mental wellbeing; and, 4) host culture has a significant influence on the pregnancy and postpartum experience of refugee women. The overall themes align with those seen in the literature on migrant women in general, however significant research gaps remain. The studies identified through this scoping review provide a rich description of the significant impact culture has on the conceptualization and experience of postpartum depression among refugee women resettled in high-income countries. Though overall themes align with those seen in the literature on migrant women in general, further research is needed to better characterize how culture impacts refugee women's experiences of PPD as a distinct sub-group of migrant women.

Laboratory diagnosis of COVID-19 in Africa: availability, challenges and implications.

The COVID-19 infection has been a matter of urgency to tackle around the world today, there exist 200 countries around the world and 54 countries in Africa that the COVID-19 infection cases have been confirmed. This situation prompted us to look into the challenges African laboratories are facing in the diagnosis of novel COVID-19 infection. A limited supply of essential laboratory equipment and test kits are some of the challenges faced in combatting the novel virus in Africa. Also, there is inadequate skilled personnel, which might pose a significant danger in case there is a surge in COVID-19 infection cases. The choice of diagnostic method in Africa is limited as there are only two available diagnostic methods being used out of the six methods used globally, thereby reducing the opportunity of supplementary diagnosis, which will further lead to inappropriate diagnosis and affect the accuracy of diagnostic reports. Furthermore, challenges like inadequate power supply, the method used in sample collection, storage and transportation of specimens are also significant as they also pose their respective implication. From the observations, there is an urgent need for more investment into the laboratories for proper, timely, and accurate diagnosis of COVID-19.

Alternating Hemiplegia of Childhood: A Series of Genetically Confirmed Four Cases from Southern India with Review of Published Literature.

Alternating hemiplegia of childhood (AHC) is a rare autosomal dominant neurodevelopmental disorder with mutation on ATP1A3 gene. Delay in diagnosis and inappropriate diagnosis are common. In this article, we described four genetically confirmed AHC patients to provide an improved understanding of the disorder. First symptom in two patients was seizures and in other two patients was abnormal eye deviation. All had onset of plegic attacks within the first 18 months of their life. Tone abnormalities and movement disorders were present in all patients. Electroencephalogram was abnormal in two patients and all had normal magnetic resonance imaging of the brain. Response to treatment of plegic attacks was poor and also epilepsy was drug resistant. All cases had significant development delay and disability as of last follow-up. Although there is no effective treatment so far, early diagnosis is required to avoid unnecessary treatment.

Total T4 rise in pregnancy: a relook?

BackgroundTotal T4 (TT4) measurement is preferred to free T4 (FT4) especially in last part of pregnancy. Guidelines by American Thyroid Association, European Thyroid Association and Endocrine Society state that TT4 increases 1.5 times pre-pregnant levels after week 16 of pregnancy. However, this is based on a small study conducted 40 years ago which used radioimmunoassay for determination in changes in TT4.Materials and methodsA cross-sectional study was undertaken to find reference interval for thyroid function in different trimester of pregnancy with special reference to look at the degree of elevation of TT4 as compared to non-pregnant women. Two hundred non-pregnant women (excluding oral contraceptive users) and 600 pregnant women (200 from each trimester) aged 18–40 years were consecutively recruited starting from around 6th week of pregnancy having confirmed singleton pregnancy diagnosed at 8th week by ultrasound. The exclusion criteria included: (1) a personal or family history of thyroid disease; (2) presence of goiter or nodule confirmed by ultrasound; (3) anti-TPO antibody positive state (titre > 35 IU/ml). All subjects were tested for urinary spot iodine concentration and those with UIC < 150 μg/L were excluded. Finally, thyroid function tests (TSH, FT4, TT4, TT3) of 168 non-pregnant women and 163, 153 and 148 women at 1st, 2nd and 3rd trimester respectively were analysed..ResultsTotal T4 (mean ± SD, μg/dl) in non pregnant women and in different trimesters was 8.95 ± 1.71, 9.71 ± 2.39, 12.11 ± 1.55, 11.83 ± 1.49 respectively. Rise in TT4 occurred between 10-18th week. The mean TT4 in second trimester increased by 25% as compared with the value at 6-9th week and by 35% as compared to non-pregnant value.ConclusionRise in total T4 in second trimester pregnancy is only around 25% as compared to first trimester value and 35% than the non-pregnant value. Hence multiplying non-pregnant T4 value by 1.5 may actually over-diagnose maternal hypothroxinemia and lead to inappropriate diagnosis and treatment of isolated maternal hypothyroxinemia in a significant proportion of subjects.

Brain Tumor Classification and Segmentation Based on Morphological Operations using Image Processing Techniques

Brain Tumour is the solitary cause for the assassination of many individuals. A brain tumour is an accretion or widening of isolated cells in your brain. It can be identified by several tests like MRI (Magnetic Resonance Imaging), CT (Computer Tomography) scan along with several tests like biopsy, spinal tap etc. Classification and Segmentation activity take part a significant role in interpretation of brain tumours. In this paper the images should be taken in the form of jpeg format. The images are processed using data mining and machine learning classification methods. Previous research studies are intended as long as identifying brain tumours using dissimilar classification and segmentation approaches. The initiated system consists of certain process for recognition of the tumour. The first step is about Pre-processing and the next is about segmentation, Feature extraction is the third step in this process and Classification is used to detect the tumour. Morphological Operations are performed in this process based on the tumour size, shape and colour. Neural Network is used for classification along with -Support Vector Machine (SVM) classifiers are worn for structured recognition. Due to this we can reduce the inappropriate or false diagnosis error rate of brain tumour identification for the patients and also, we can get faster and accurate results.

The Role of Fractional Excretion of Uric Acid in the Differential Diagnosis of Hypotonic Hyponatraemia in Patients with Diuretic Therapy.

Hyponatraemia is the most common electrolyte imbalance found in hospital population and worldwide thiazide and loop-diuretics are among the most widely used drugs. Syndrome of inappropriate antidiuresis diagnosis (SIAD) is complicated in the presence of diuretic therapy due to the misleading clinical assessment of the extracellular volume status, and in order to make SIAD diagnosis it is often necessary to withdraw diuretic therapy. Our study aimed to investigate the diagnostic role of these alternative markers of volume status, serum uric acid (sUA) and fractional excretion of uric acid (FEUA), in hyponatraemic patients treated with different diuretic drugs. Eighty-nine patients were enrolled with the diagnosis of SIAD, diuretic-induced hyponatremia (DIH, treated with furosemide and potassium canrenoate) or thiazide-induced hyponatremia (TIH, treated with hydrochlorothiazide, metolazone or indapamide) and investigated with receiver operating characteristic analysis and a sensitivity test. Our results show that FEUA discriminated better than sUA between SIAD and DIH patients (area under curve 0.96, <0.001 vs. 0.88, <0.001) while it was a poor marker to discriminate between SIAD and TIH (0.65, NS vs. 0.67, NS). In conclusions, FEUA is an excellent marker to discriminate SIAD vs. sodium depleted patients treated with furosemide and/or potassium canrenoate while the diuretic withdrawal, beyond obtaining a serum Na normalization, is still mandatory for differential diagnosis of sodium depleted patients affected by thiazide-induced hyponatraemia.