Likelihood Of Misdiagnosis Research Articles

CBCT in Dental Implantology: A Key Tool for Preventing Peri-Implantitis and Enhancing Patient Outcomes.

(1) Introduction: Trust is a cornerstone of the patient-physician relationships. Unforeseen complications in the health care system could jeopardize patients' trust in their physicians. (2) Aim: This article presents a quantitative figure regarding foreseeing the necessity of a three-dimensional quantitative visualization of bone structure and concurrently preparing for an ancillary procedure by a dentist to successfully perform the surgery that could minimize unforeseen complications; (3) Materials and method: This retrospective study has been derived based on an analysis of 1134 patients who had received 4800 dental implants from January 2001 to August 2020, out of which 200 cases were randomly selected for this study. Each procedure during implant treatment was categorized as OPG (Orthopantomography) or OPG with CBCT as per all the procedures which included and were coded as follows, 1: Surgery & Restoration, 2: GBR (Guided Bone Regeneration), 3: GTR (Guided Tissue Regeneration), 4: Block Bone Graft, 5: Spreading, 6: Splitting, 7: Internal Sinus, 8: External Sinus, 9: PRF (Platelet Rich Fibrin). Any of the 200 cases in which implant placement could not have been performed for reasons related to a lack of CBCT were selected for this study. The surgery was aborted halfway through without implant placement in these cases due to a lack of bone quantity and/or lack of primary stability. These cases were registered for re-evaluation and statistical analysis; (4) Results: 7% of the cases that used OPG alone led the surgeon to unexpectedly abort in the middle of the surgery without implant placement. All (100%) of the patients who had CBCT during treatment planning were able to receive implants during the surgery. None of the patients left the surgery without receiving implants if CBCT was used (0%); (5) Discussion: Radiographic image quality is defined as the amount of information within the image that allows the radiologist to make a diagnostic decision with a particular level of certainty (Martin et al., 1999) and hence the importance of CBCT. The unexpected 7% of devastating situations for patients who started surgery but did not have implant placement led to [A] aborting the surgery, [B] procedural difficulties requiring an alternative treatment plan, [C] a negative impact on the patient's behavior, and [D] wanting to change doctor due to a lack of trust; (6) Conclusion: This study indicates that in implant dentistry patients' mistrust could be avoided by 7% if CBCT is obtained. It also shows the significance of cone-beam computed tomography as an adjunct to panoramic radiography during the diagnosis and treatment planning phase. The use of panoramic radiography alone can lead to a 7% likelihood of misdiagnosis. A lack of CBCT during treatment planning negatively affects the outcome of surgical procedures.

H - 61 Towards a Clinical-Cultural Neuropsychological Science: a Case Study of a Bilingual Spanish-Speaker with Untreated Sleep-Wake Disturbance.

Access to neuropsychological services for bilingual individuals remains limited and more research is needed to clarify benefits of testing in both languages. Additionally, certain disorders remain underdiagnosed in the Hispanic/Latinx population. This case study describes the use of a comprehensive culturally and linguistically appropriate neuropsychological evaluation to leverage linguistic, cognitive, and social context to assist with establishing needed care and diagnostic clarity. The patient was a 40-year-old right-handed Spanish-bilingual Hispanic male community-referred to rule out attention deficit hyperactivity disorder (ADHD). He learned English at the age of 4. History was remarkable for parasomnias in childhood, sleep disturbance, multiple closed head injuries, cannabis use, and chronic pain. He completed a comprehensive neuropsychological battery with measures in both Spanish and English. Cognitive findings revealed deficits in verbal memory, variable executive functioning, and better performances in English relative to Spanish. Findings from the evaluation supported a diagnosis of mild neurocognitive disorder secondary to untreated sleep-wake disturbance. Recommendations included reasonable occupational accommodations, sleep study, pain management, brief psychotherapy to address sleep hygiene, and re-evaluation in one year. Following the evaluation, the patient received 6-sessions of a highly structured treatment for insomnia and is no longer endorsing clinically significant levels of sleep disturbance. Sleep-wake disorders are underdiagnosed among Hispanic/Latinxs, and these disorders can manifest with similar symptoms to ADHD. Without culturally and linguistically appropriate services, the likelihood of misdiagnosis and issues of access to treatment will persist. Importantly, the present evaluation was able to identify cognitive and linguistic strengths and weaknesses to best direct referral needs.

Morphological features of 52 cases of breast phyllodes tumours with local recurrence

Typical phyllodes tumours (PTs) of the breast are fibroepithelial neoplasms characterised histologically by stromal hypercellularity and leaf-like structures. However, morphological changes may be atypical in some cases, increasing the difficulty of diagnosis and the likelihood of misdiagnosis. To provide more morphological clues for pathological diagnosis of PTs, we retrospectively analysed 52 PT cases with typical morphological features after recurrence, and summarized the clinicopathological characteristics of the paired primary tumours. We found five special histological features in the primary tumours distinct from classic PTs, namely (1) PTs with epithelioid feature (three cases); (2) PTs with gland-rich feature (eight cases); (3) PTs with fibroadenoma-like feature (20 cases); (4) PTs with myxoid fibroadenoma-like feature (five cases); and (5) PTs with pseudohemangiomatoid stromal hyperplasia–like feature (four cases). All the features can exist independently, and a few cases displayed more than two distinctive features at the same time. In this cohort of recurrent PTs, all the primary tumours were absent of recognisable stromal hypercellularity and leaf-like structures that are the critical diagnostic criteria of PTs; however, they showed some other non-classic characteristics which may provide significant clues for the diagnosis of PTs. Particularly, tumours with epithelioid feature displayed high grade at earlier stages, tumours with fibroadenoma-like feature were most likely to be confused with classical fibroadenomas, and tumours with myxoid feature were prone to be neglected because of their hypocellularity.

Impact of Malaria Diagnostic Technologies on the Disease Burden in the Sub-Saharan Africa.

Worldwide, transmission of emerging and reemerging malaria infections poses a significant threat to human health in the Sub-Saharan Africa, one that can quickly overwhelm public health resources. While the disease burden of malaria in the Sub-Saharan Africa appears to be on a gradual decline, it is characterized by spatial and temporal variability occasioning a sorry state for the Global South Countries. New evidence on long-term complications of malaria heightens our awareness of its public health impact. Given the likelihood of misdiagnosis, and the unknown levels of malaria transmission across different landscapes, many missed opportunities for prevention occur. Africa's population growth, unplanned urbanization, habitat destruction, and trans-border travel are contributing to a rise in the calamitous epidemiology of malaria. Despite empirical statistics demonstrating a downward trend in the malaria disease burden attributable to the scale-up of multiple control strategies, including new diagnostic technologies, malaria remains a global threat to human health in Sub-Sahara Africa. Malaria is a severe public health threat globally, despite several advancements and innovations in its control. Six species of the genus Plasmodium including Plasmodium malariae, Plasmodium falciparum, Plasmodium cynomolgi, Plasmodium knowlesi, Plasmodium ovale, and Plasmodium vivax are known to infect humans. However, greatest disease burden and fatalities are caused by Plasmodium falciparum. Globally, about 3 billion individuals are at risk of contracting malaria disease every year, with over 400,000 fatalities reported in the Sub-Saharan Africa. World Health Organization (WHO) 2018 malaria report indicated that approximately 405,000 mortalities and 228 million cases were reported worldwide, with Africa carrying the highest disease burden. Over the last decade, there has been a significant decline in malaria deaths and infections, which may be related to the availability of effective diagnostic techniques. However, in certain areas, the rate of decline has slowed or even reversed the gains made so far. Accurate diagnosis, adequate treatment, and management of the disease are critical WHO-set goals of eliminating malaria by 2030. Microscopy, rapid diagnostic tests (RDTs), nucleic acid amplification tests (NAATs), and biosensors are all currently accessible diagnostic methods. These technologies have substantial flaws and triumphs that could stymie or accelerate malaria eradication efforts. The cost, ease, accessibility, and availability of skilled persons all influence the use of these technologies. These variables have a direct and indirect ramification on the entire management portfolio of patients. Despite the overall decline in the malaria disease burden driven partly by new diagnostic technologies, a sobering pattern marked by limited number of studies and spatial as well as temporal heterogeneity remains a concern. This review summarizes the principle, performance, gaps, accomplishments, and applicability of numerous malaria diagnostic techniques and their potential role in reducing the malaria disease burden in Sub-Saharan Africa.

Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea.

RationaleRecent studies suggest that obstructive sleep apnea (OSA) severity can vary markedly from night to night, which may have important implications for diagnosis and management.ObjectivesThis study aimed to assess OSA prevalence from multinight in-home recordings and the impact of night-to-night variability in OSA severity on diagnostic classification in a large, global, nonrandomly selected community sample from a consumer database of people that purchased a novel, validated, under-mattress sleep analyzer.MethodsA total of 67,278 individuals aged between 18 and 90 years underwent in-home nightly monitoring over an average of approximately 170 nights per participant between July 2020 and March 2021. OSA was defined as a nightly mean apnea–hypopnea index (AHI) of more than 15 events/h. Outcomes were multinight global prevalence and likelihood of OSA misclassification from a single night’s AHI value.Measurements and Main ResultsMore than 11.6 million nights of data were collected and analyzed. OSA global prevalence was 22.6% (95% confidence interval, 20.9–24.3%). The likelihood of misdiagnosis in people with OSA based on a single night ranged between approximately 20% and 50%. Misdiagnosis error rates decreased with increased monitoring nights (e.g., 1-night F1-score = 0.77 vs. 0.94 for 14 nights) and remained stable after 14 nights of monitoring.ConclusionsMultinight in-home monitoring using novel, noninvasive under-mattress sensor technology indicates a global prevalence of moderate to severe OSA of approximately 20%, and that approximately 20% of people diagnosed with a single-night study may be misclassified. These findings highlight the need to consider night-to-night variation in OSA diagnosis and management.

Pediatric Chronic Myeloid Leukemia with Megakaryocytic Blast Crisis as Initial Presentation: Case Report and Review of Literature

Abstract: Background: Pediatric Chronic Myeloid Leukemia (CML) is a rare entity accounting for 2-3% of pediatric malignancies. CML rarely presents as Blast Crisis (BC) at the time of diagnosis, and megakaryocytic blast crisis is even rarer. Case Presentation: We herein, report a case of a young female, 10-year-old who presented with anemia, leukocytosis and massive splenomegaly. Clinical features, peripheral film and bone marrow findings were consistent with CML in megakaryocytic blast crisis. Bone marrow cytogenetic analysis revealed karyotype of 46, XX, t(9:22)(q34;q11.2) in 20 metaphases and BCR-ABL P210 by PCR was detected with transcript level of 83%, which further confirmed our diagnosis. Conclusion: De novo presentation of chronic myeloid leukemia with megakaryocytic blast crisis is rarely observed in pediatric population with very few cases published till now. We are presenting this case because of its rarity, likelihood of misdiagnosis as AML (M7) and poor prognosis, if not treated precisely. Keywords: Chronic Myeloid Leukemia (CML), Acute Myeloid Leukemia (AML), Blast Crisis (BC), Acute Megakaryocytic Leukemia (AMKL), Chronic Phase (CP), Accelerated Phase (AP), Tyrosine Kinase Inhibitor (TKI).

Misdiagnosis of leprosy in Brazil in the period 2003 - 2017: spatial pattern and associated factors

BackgroundLeprosy causes a range of symptoms, and most diagnoses are established based on the clinical picture. Therefore, false negative and positive diagnoses are relatively common. We analyzed the spatial pattern of leprosy misdiagnosis and associated factors in Brazil. MethodExploratory analyses of Kernel density of the new case detection rate (NCDR) and proportion of misdiagnosis in Brazil, 2003–2017. Factors associated with misdiagnosis were identified by logistic regression at the 5% significance level. ResultA total of 574,181 new leprosy cases were recorded in Brazil within the study period, of which 7,477 (1.3%) were misdiagnoses. No spatial correlation was observed between the proportion of misdiagnoses and the NCDR. The likelihood of misdiagnosis was elevated for females [OR: 1.58 (1.51–1.66)], children [OR: 1.49 (1.36–1.64)]; paucibacillary [OR: 1.08 (1.02–1.13)], indeterminate clinical forms [OR: 2.37 (2.15–2.62)], for cases diagnosed in the frame of mass screenings [OR: 3.36 (3.09– 3.73)] and contact examination [OR: 2.30 (2.13–2.49)] and for cases with affected nerves but no skin lesions [OR: 2.47 (2.19–2.77)] when compared with those presenting both skin lesion and affected nerves. ConclusionMisdiagnosis of leprosy is not correlated with the endemicity level in Brazil but rather with personal, diagnosis-related and disease characteristics.

Misdiagnosis of cystic pancreatic tumors during a 30-year study period

Cystic pancreatic tumors are increasingly found in medical practice. The aim of this study was to examine the prevalence of misdiagnosis of these lesions and the factors associated with preoperative misdiagnosis. A retrospective analysis included 66 patients treated in the Clinic for Digestive Surgery, Clinical Center of Serbia, from 1983 to 2013. We included all patients with biopsy-confirmed cystic pancreatic tumors during the study period. We analyzed preoperative parameters, intraoperative and postoperative data of examined patients. Based on the preoperative diagnosis and the biopsy findings, patients were divided into two groups: correct preoperative diagnosis and misdiagnosis. Prevalence of misdiagnosis was 34.85%. Average age was 45.3 ± 16.9 years, 54 (81.8%) were females. Patients with misdiagnosis had significantly higher odds of being older (Odds ratio [OR]: 1.06, 95% Confidence interval [CI]: 1.01–17.86), to present with symptoms of nausea or vomiting (OR: 5.85, 95% CI: 1.49–23.00), to have a clinically palpable tumor (OR: 4.64, 95% CI: 1.21–17.86), and to have received the diagnosis in the period between 1992 and 2003. During the 30-year study period, more than one third of the patients in our study had a misdiagnosis preoperatively. The likelihood of misdiagnosis was higher among older patients, patients with symptoms of nausea or vomiting, patients with a clinically palpable tumor, and patients treated during the period between 1992 and 2003. The decline in the prevalence of misdiagnoses should be expected, due to advances in imaging methods and their availability, which are increasing significantly.

ADHD and addictive disorders: What links?

The links between ADHD and addictive disorders have been the subject of a large number of studies showing a high prevalence rate of ADHD in substance abusing populations as well as an increased risk of substance use disorder (SUD) in ADHD patients that may be independent of other psychiatric conditions. High prevalence of ADHD has also been highlighted among individuals suffering from other addictive disorders such as pathological gambling. Adequate diagnosis of ADHD in SUD patients is challenged by phenomenological aspects of addiction and by frequently associated other psychiatric disorders that overlap with key symptoms of ADHD. A detailed comprehensive search for child and adult symptoms including the temporal relationship of ADHD, substance use and other psychiatric disorders should maximize the validity and the reliability of adult ADHD diagnosis in this population. Further, a follow-up evaluation of ADHD symptoms during treatment of SUD may reduce the likelihood of misdiagnosis. Finally, it should be noticed that when SUD occurs with ADHD, it is associated with a greater severity of SUD compared to other SUD patients. This has been shown with an earlier age at onset, antisocial behavior, risk for depression, chronicity of substance use, need for hospitalization and likelihood of a complicated course. Recent data suggest that the effects of ADHD on SUD outcomes are independent of other psychiatric comorbidities. This highlights the need of an earlier implementation of preventive interventions for substance use or behavioral addiction in children/adolescents with ADHD and the necessity to consider this disorder in the treatment of addictive disorders. Benefices and risk of MPH in adult patients with addiction and ADHD are discussed.

Efficient Replication of over 180 Genetic Associations with Self-Reported Medical Data

While the cost and speed of generating genomic data have come down dramatically in recent years, the slow pace of collecting medical data for large cohorts continues to hamper genetic research. Here we evaluate a novel online framework for obtaining large amounts of medical information from a recontactable cohort by assessing our ability to replicate genetic associations using these data. Using web-based questionnaires, we gathered self-reported data on 50 medical phenotypes from a generally unselected cohort of over 20,000 genotyped individuals. Of a list of genetic associations curated by NHGRI, we successfully replicated about 75% of the associations that we expected to (based on the number of cases in our cohort and reported odds ratios, and excluding a set of associations with contradictory published evidence). Altogether we replicated over 180 previously reported associations, including many for type 2 diabetes, prostate cancer, cholesterol levels, and multiple sclerosis. We found significant variation across categories of conditions in the percentage of expected associations that we were able to replicate, which may reflect systematic inflation of the effects in some initial reports, or differences across diseases in the likelihood of misdiagnosis or misreport. We also demonstrated that we could improve replication success by taking advantage of our recontactable cohort, offering more in-depth questions to refine self-reported diagnoses. Our data suggest that online collection of self-reported data from a recontactable cohort may be a viable method for both broad and deep phenotyping in large populations.

Efficient Replication of Over 180 Genetic Associations with Self‐Reported Medical Data

AbstractWhile the cost and speed of generating genomic data have come down dramatically in recent years, the slow pace of collecting medical data for large cohorts continues to hamper genetic research. Here we evaluate a novel online framework for amassing large amounts of medical information in a recontactable cohort by assessing our ability to replicate genetic associations using these data. Using web‐based questionnaires, we gathered self-reported data on 50 medical phenotypes from a generally unselected cohort of over 20,000 genotyped individuals. Of a list of genetic associations curated by NHGRI, we successfully replicated about 75% of the associations that we expected to (based on the number of cases in our cohort and reported odds ratios, and excluding a set of associations with contradictory published evidence). Altogether we replicated over 180 previously reported associations, including many for type 2 diabetes, prostate cancer, cholesterol levels, and multiple sclerosis. We found significant variation across categories of conditions in the percentage of expected associations that we were able to replicate, which may reflect systematic inflation of the effects in some initial reports, or differences across diseases in the likelihood of misdiagnosis or misreport. We also demonstrated that we could improve replication success by taking advantage of our recontactable cohort, offering more in‐depth questions to refine self‐reported diagnoses. Our data suggests that online collection of self‐reported data in a recontactable cohort may be a viable method for both broad and deep phenotyping in large populations.

Efficient Replication of Over 180 Genetic Associations with Self-Reported Medical Data

AbstractWhile the cost and speed of generating genomic data have come down dramatically in recent years, the slow pace of collecting medical data for large cohorts continues to hamper genetic research. Here we evaluate a novel online framework for amassing large amounts of medical information in a recontactable cohort by assessing our ability to replicate genetic associations using these data. Using web-based questionnaires, we gathered self-reported data on 50 medical phenotypes from a generally unselected cohort of over 20,000 genotyped individuals. Of a list of genetic associations curated by NHGRI, we successfully replicated about 75% of the associations that we expected to (based on the number of cases in our cohort and reported odds ratios, and excluding a set of associations with contradictory published evidence). Altogether we replicated over 180 previously reported associations, including many for type 2 diabetes, prostate cancer, cholesterol levels, and multiple sclerosis. We found significant variation across categories of conditions in the percentage of expected associations that we were able to replicate, which may reflect systematic inflation of the effects in some initial reports, or differences across diseases in the likelihood of misdiagnosis or misreport. We also demonstrated that we could improve replication success by taking advantage of our recontactable cohort, offering more in-depth questions to refine self-reported diagnoses. Our data suggests that online collection of self-reported data in a recontactable cohort may be a viable method for both broad and deep phenotyping in large populations.

Noise reduction for ultrasonic elastography using transmit-side frequency compounding: a preliminary study

Ultrasonic elastography is an imaging technique providing information about the relative stiffness of biological tissues. In general, elastography suffers from noise artifacts, which degrade lesion detectability and increase the likelihood of misdiagnosis. This paper proposes a method called transmit- side frequency compounding for elastography (TSFC). Beamforming is modified to transmit frames with N alternating center frequencies. Pairs of frames with the same center frequency are used to calculate sub-elastograms that are then averaged to produce one compounded elastogram. Simulation results based on an uniformly elastic tissue model demonstrate the decorrelation among sub-elastograms and the improvement in elastographic signal-to-noise ratio (SNRe) achieved by compounding sub-elastograms. An elastic phantom experiment further validates the noise reduction obtained by the proposed technique.

Thyroid disorders in older people

SummaryThyroid disorders become more common with advancing age. Clinical features of hypothyroidism overlap with signs and symptoms often present in euthyroid older people and there is high likelihood of misdiagnosis. Conversely, there may be a relative paucity of signs and symptoms in hyperthyroid older people. A large number of patients may have subclinical disease. High suspicion and confirmation by laboratory assay is the key to correct diagnosis, though thyroid function tests should be interpreted with caution during acute illnesses. There is a reduced requirement for levothyroxine replacement in elderly hypothyroid patients and dosage should be titrated up cautiously as it can unmask symptoms of ischaemic heart disease. Drug interactions should be taken into account because a number of drugs interfere with levothyroxine absorption and metabolism. Radioactive iodine ablation of overactive thyroid tissue is the preferred treatment of hyperthyroidism in older people.

Human Plague in the Southwestern United States, 1957–2004: Spatial Models of Elevated Risk of Human Exposure to <I>Yersinia pestis</I>

Plague is a rare but highly virulent flea-borne zoonotic disease caused by the Gram-negative bacterium Yersinia pestis Yersin. Identifying areas at high risk of human exposure to the etiological agent of plague could provide a useful tool for targeting limited public health resources and reduce the likelihood of misdiagnosis by raising awareness of the disease. We created logistic regression models to identify landscape features associated with areas where humans have acquired plague from 1957 to 2004 in the four-corners region of the United States (Arizona, Colorado, New Mexico, and Utah), and we extrapolated those models within a geographical information system to predict where plague cases are likely to occur within the southwestern United States disease focus. The probability of an area being classified as high-risk plague habitat increased with elevation up to approximately 2300 m and declined as elevation increased thereafter, and declined with distance from key habitat types (e.g., southern Rocky Mountain piñon--juniper [Pinus edulis Engelm. and Juniperus spp.], Colorado plateau piñon--juniper woodland, Rocky Mountain ponderosa pine (Pinus ponderosa P.& C. Lawson var. scopulorum), and southern Rocky Mountain juniper woodland and savanna). The overall accuracy of the model was >82%. Our most conservative model predicted that 14.4% of the four-corners region represented a high risk of peridomestic exposure to Y. pestis.

Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, Bipolar, OCD, Asperger’s, Depression, and Other Disorders

Many of our brightest, most creative young minds not only go unrecognized, but also are often incorrectly diagnosed. Misdiagnoses can lead parents and teachers to pursue incorrect, and in some cases even damaging measures in response to symptoms displayed the children they are charged with. Educators and parents should be cautious about simply accepting many diagnoses unless the diagnosing professional is knowledgeable about gifted children. It is our intent to educate professionals to reduce the likelihood of misdiagnosis of gifted children and adults.

The Role of Prevalence Rates, Sensitivity, and Specificity in Assessment Accuracy

A little discussed issue for practitioners is the probability that a client actually has (or does not have) a disorder that he or she has been diagnosed as having (or not having). These probabilities depend upon the sensitivity and specificity of the assessment procedure used, and on the prevalence of the disorder among those seeking services. Probability theory is used in this article to demonstrate that in many, if not most cases, these probabilities will be quite low and that the likelihood of misdiagnosis will be high. The implications of these findings for assessment in social work practice are discussed.

Ethnic differences in schizophrenia

Controversial findings of ethnic differences in rates of psychiatric diagnosis, symptom profiles, degree of impairment and treatment outcome have long been reported. Studies focused on black-white comparisons have reported black schizophrenic patients to be less symptomatically impaired but to show more hallucinations. Patients of non-western origin may show few Schneiderian first rank symptoms. Minority patients are more likely to terminate prematurely from outpatient treatment. Socio-economic status and cultural bias in psychiatry leading to misdiagnosis and poorer access to appropriate services may account for some of these findings. This paper examines differences in symptom severity and profile, post-hospitalization social functioning including family attitudes and treatment history in patients of different racial and geographic origins. 350 schizophrenic subjects entering a multicenter treatment study show a wide spectrum of cultural variation including both immigrant and non-immigrant minority groups. Standardized diagnostic procedures using the SCID reduce the likelihood of misdiagnosis. Ethnic difference in course of illness and treatment outcome are explored with special attention to interactions between ethnicity and other sociodemographic variables, including socio-economic status, immigration status and gender.