Wrong Diagnosis Research Articles

Діагностика та лікування інфільтратів черевної порожнини в дітей

Мета дослідження — покращити результати лікування дітей з інфільтратами черевної порожнини за рахунок удосконалення діагностичних заходів, хірургічних технологій і післяопераційної реабілітації. Матеріали та методи. За 22 роки в Чернігівській області виконано 27 325 операцій на органах черевної порожнини в дітей, із них у 19 842 (72,6 %) — із причини різних форм апендикулярного відростка. Ускладнення у вигляді інфільтратів та абсцесів черевної порожнини встановлено у 285 (100,0 %) хворих дітей, з яких інфільтрати діагностовано в 78 (27,4 %) та абсцеси — у 207 (72,6 %). Хворі розподілені на дві підгрупи: групу дослідження (I; 2005–2015 рр.) — 29 дітей (37,2 %) і групу порівняння (II; 1994–2004 рр.) — 49 (62,8 %). Первинні інфільтрати черевної порожнини (ПІЧП) установлено в 51 хворого (65,4 %), з яких у I групі — у 27 (34,6 %), у II — у 24 (30,8 %). Вторинні інфільтрати черевної порожнини (ВІЧП) встановлено у 27 хворих (34,6 %), з яких у I групі — у 2 (2,6 %), у II — у 25 (32,0 %). Усім хворим проводилися загальноклінічне, лабораторне, а в групі дослідження — ультразвукове дослідження черевної порожнини з кольоровим допплерівським картуванням та комп’ютерна томографія органів черевної порожнини. Результати. Проведені дослідження показали, що термін госпіталізації дітей із первинними інфільтратами в I групі становив 11,75 ± 0,23 доби, а в II — 13 ± 1 доба, із вторинними інфільтратами — 13,65 ± 1,65 доби, серед дітей у I групі — 19 ± 9 діб, у II — 12,52 ± 1,71 доби. Клінічна картини у хворих із ПІЧП була такою: лихоманка — у 86,3 % випадків, симптоми дисфункції шлунково-кишкового тракту — у 41,1 %, нудота — у 29,4 %, біль у животі — у 62,4 %. Дані симптоми вказували на атиповість перебігу захворювання, що спричинило помилки на діагностичному етапі. Причинами несвоєчасної діагностики ПІЧП були: самолікування — у 43,1 % випадків, пізнє звернення за медичною допомогою — у 37,2 %, несвоєчасна амбулаторна діагностика — у 19,6 %. Променеві методи дослідження (оглядова рентгенографія черевної порожнини та комп’ютерна томографія): у II групі в 6 дітей (11,7 %) проти 18 (35,3 %) — у I. Клінічна картина з ВІЧП: лихоманка — у 100,0 % дітей, нудота — у 63 %, блювання — у 37 %, здуття черевної порожнини — у 55,6 % дітей, що була більш специфічною для ранніх післяопераційних інфільтратів — у 10 хворих (37 %). При об’єктивному обстеженні визначалися біль у животі — у 81,4 % дітей, симптоми подразнення очеревини — у 96,3 %, симптом «пухлини, що пальпується» — у 63 %. Променеві методи дослідження: у II групі в 5 дітей (18,5 %) проти 2 (100 %) — у I. З метою покращання результатів лікування нами була розроблена шкала бальної оцінки. Пацієнтам, які згідно з діагностичною шкалою мали 26–36 балів, було показане консервативне лікування. У хворих, які мали 37–45 балів, застосовували хірургічне лікування недуги через місцевий доступ. У хворих, які мали 46–72 бали, застосовували хірургічне лікування недуги через серединну лапаротомію. У 7 (9 %) хворих із ПІЧП при обстеженні згідно з діагностичною шкалою було встановлено 26–36 балів — показане консервативне лікування, з яких у І групі — у 3 (3,9 %), у ІІ — у 4 (5,1 %). У 35 дітей (44,9 %) було 37–45 балів — застосовували хірургічне лікування через місцевий доступ, з яких у І групі — у 18 (23,1 %), у ІІ — у 17 (21,8 %). У 9 дітей (11,5 %) було 46–72 бали, у них застосовували хірургічне лікування через серединну лапаротомію, з яких у І групі — у 6 (7,6 %), у ІІ — у 3 (3,9 %). Таким чином, у 44 хворих із ПІЧП проведено оперативне лікування. У 26 (33,4 %) хворих із ВІЧП згідно з діагностичною шкалою було встановлено 26–36 балів та показано консервативне лікування, з яких у І групі — у 2 (2,6 %), у ІІ — у 24 (30,8 %). В 1 дитини (1,2 %; хворий із ІІ групи) було встановлено 37–45 балів, застосовували хірургічне лікування з місцевого доступу. Висновки. Установлено, що клінічний перебіг інфільтратів черевної порожнини у хворих у 12,5–18,9 % випадків характеризується атиповою клінічною симптоматикою, що здебільшого призводить до запізнілого звернення до дитячого хірургічного стаціонару. Впровадження шкали бальної оцінки недуги черевної порожнини дозволило досягти покращання результатів лікування як у близькому, так і віддаленому періодах. У дослідженнях встановлено, що найбільш вразливими до розвитку інфільтратів черевної порожнини є діти віком від 7 до 12 років, які мають атипову локалізацію апендикулярного відростка в 62,3 % спостережень.

Evaluation of drug-resistant focal epilepsy in the western Indian adult population

Despite the best possible pharmacotherapy, 30% of persons with epilepsy will remain drug resistant. Drug resistant Epilepsy (DRE) has many different presentations and causes; hence evaluation may help to understand and manage appropriately. To study a cohort of adult patients with refractory focal epilepsy, focusing on clinical semiology, risk factors, imaging and video EEG findings. This is a prospective observational study done in adult neurology department of tertiary care hospital, from 2013 to 2016. The primary inclusion criteria were patients with drug refractory focal seizure (as per ILAE definition 2010), with age more than 12 years. Detailed clinical data, long term EEG monitoring, MRI and minimum follow up of 6 months were collected. Of 120 patients of DRE, 72% were in the age group of 12-30 yrs. Febrile seizure (26%) and head injury (17%) were the most significant antecedent history. Focal seizures with dyscognitive features were present in 87%. 16 patients had abnormal neurological examination. The most common radiological finding was mesial temporal sclerosis and gliosis. After complete evaluations, 30% of the patients were found to have pseudo-resistance. The evaluation led to modification of treatment in more than three-fourth of the patients. Early age of onset, history of febrile seizures, past history of head injury, focal dyscognitive type of seizures and structural lesion on imaging are common factors in patients with DRE. Pseudo- resistance due to wrong diagnosis and inadequate AEDs were responsible for one third of cases.

Accuracy and usability of a diagnostic decision support system in the diagnosis of three representative rheumatic diseases: a randomized controlled trial among medical students

BackgroundAn increasing number of diagnostic decision support systems (DDSS) exist to support patients and physicians in establishing the correct diagnosis as early as possible. However, little evidence exists that supports the effectiveness of these DDSS. The objectives were to compare the diagnostic accuracy of medical students, with and without the use of a DDSS, and the diagnostic accuracy of the DDSS system itself, regarding the typical rheumatic diseases and to analyze the user experience.MethodsA total of 102 medical students were openly recruited from a university hospital and randomized (unblinded) to a control group (CG) and an intervention group (IG) that used a DDSS (Ada – Your Health Guide) to create an ordered diagnostic hypotheses list for three rheumatic case vignettes. Diagnostic accuracy, measured as the presence of the correct diagnosis first or at all on the hypothesis list, was the main outcome measure and evaluated for CG, IG, and DDSS.ResultsThe correct diagnosis was ranked first (or was present at all) in CG, IG, and DDSS in 37% (40%), 47% (55%), and 29% (43%) for the first case; 87% (94%), 84% (100%), and 51% (98%) in the second case; and 35% (59%), 20% (51%), and 4% (51%) in the third case, respectively. No significant benefit of using the DDDS could be observed. In a substantial number of situations, the mean probabilities reported by the DDSS for incorrect diagnoses were actually higher than for correct diagnoses, and students accepted false DDSS diagnostic suggestions. DDSS symptom entry greatly varied and was often incomplete or false. No significant correlation between the number of symptoms extracted and diagnostic accuracy was seen. It took on average 7 min longer to solve a case using the DDSS. In IG, 61% of students compared to 90% in CG stated that they could imagine using the DDSS in their future clinical work life.ConclusionsThe diagnostic accuracy of medical students was superior to the DDSS, and its usage did not significantly improve students’ diagnostic accuracy. DDSS usage was time-consuming and may be misleading due to prompting wrong diagnoses and probabilities.Trial registrationDRKS.de, DRKS00024433. Retrospectively registered on February 5, 2021.

Pediatric Patient Safety: Shared Learning to Improve Patient Outcomes.

Two decades ago, the seminal Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) report To Err Is Human: Building a Safer Health System first highlighted the influence of poorly designed health care delivery systems and suboptimal processes as contributors to patient safety.1 Substantial progress has occurred since then, including creation of a federally mandated Child Health Patient Safety Organization,2 which uses a standardized taxonomy for patient safety events, contributory factors, and severity of harm,3 with shared learning by dissemination of reports to individual institutions and to the public.4 In this issue of Pediatrics, Burrus et al analyze and report on 4 years of serious safety events (SSEs) from 44 Child Health Patient Safety Organization–participating hospitals regarding the types of safety events, severity of harm, and contributory factors.5 Their results underscore the overall improvement in pediatric safety in these institutions during the study period as demonstrated by a downward trend in SSEs from 0.71 to 0.41 per 10 000 adjusted patient days. The strengths of this study are the learnings from a collaborative, which can be disseminated publicly, the spectrum of harm among the reported SSEs (with one-fifth of SSEs having the highest severity defined as death or permanent harm), and the identification of more important contributory factors, such as lack of situational awareness. However, the study results also reveal there is still much to be done to mitigate pediatric patient harm.Organizations must continue to implement strategies to eliminate harm related to procedures (eg, retained foreign objects, wrong procedures). Recently there has been controversy regarding the pursuit of zero harm because it might lead to provider burnout, which can lead to harm and increased health care costs.6 Regardless, as stated by the legendary football coach Vince Lombardi, “Perfection is not attainable, but if we chase perfection we can catch excellence.” Hospitals need to remain laser-focused on all causes of preventable patient harm, especially those resulting from procedures, medications, and other products and devices. There are also important lessons to be learned from non-SSEs that were excluded from this analysis.Furthermore, patient safety needs to be understood in the context of the care setting. Several studies have revealed that certain settings such as emergency departments, operating rooms, and ICUs are more prone to safety events. Indeed, several reports from the federally supported pediatric research network Pediatric Emergency Care Applied Research Network highlight the types, contributory factors, and severity of harm in the context of pediatric emergency care.7–10 Finally, as the number of procedural events and medication errors decrease, the hidden impact of missed, delayed, or wrong diagnosis was justifiably identified in the Burrus et al article. Diagnostic errors have been considered for a long time as the “blind spot” in patient safety and the National Academies of Sciences, Engineering, and Medicine report Improving Diagnosis in Health Care highlighted that most individuals will experience at least 1 diagnostic error in their lifetime, sometimes with devastating consequences.11 Similar to other safety events, diagnostic safety needs standardized taxonomy, validated and accepted definitions, and robust study designs, including prospective, multicenter studies to understand the epidemiology, contributory factors, severity of harm, and impact of interventions to mitigate harms.12 Ultimately, patient safety (avoidance of negative outcome) and quality (achievement of positive outcome) need to be at the center of all health care services. The imperative to support multidimensional approaches to reduce patient harm, including research, education, training, and policy, has never been greater.

Factors Related to Serious Safety Events in a Children's Hospital Patient Safety Collaborative.

Serious safety events (SSEs) occur infrequently at individual hospitals, making it difficult to establish trends to improve patient care. Patient safety organizations, such as the Child Health Patient Safety Organization (CHILDPSO), can identify trends and support learning across children's hospitals. We aim to describe longitudinal trends in SSE rates among CHILDPSO member hospitals and describe their sources of harm. SSEs from 44 children's hospitals were assigned severity and reported to CHILDPSO from January 1, 2015, to December 31, 2018. SSEs were classified into groups and subgroups based on analysis. Events were then tagged with up to 3 contributing factors. Subgroups with <5 events were excluded. There were 22.5 million adjusted patient days included. The 12-month rolling average SSE rate per 10 000 adjusted patient days decreased from 0.71 to 0.41 (P < .001). There were 830 SSEs reported to CHILDPSO. The median hospital volume of SSEs was 12 events (interquartile range: 6-23), or ∼3 SSEs per year. Of the 830 events, 21.0% were high severity (SSE 1-3) and approximately two-thirds (67.0%, n = 610) were patient care management events, including subgroups of missed, delayed, or wrong diagnosis or treatment; medication errors; and suboptimal care coordination. The most common contributing factor was lack of situational awareness (17.9%, n = 382), which contributed to 1 in 5 (20%) high-severity SSEs. Hospitals sharing SSE data through CHILDPSO have seen a decrease in SSEs. Patient care management was the most frequently seen. Future work should focus on investigation of contributing factors and risk mitigation strategies.

Using Patient Experience Surveys to Assess Diagnostic Safety in Urgent Care

Research ObjectiveDiagnostic error is the leading patient safety concern in the U.S. One in twenty patients seeking care in the U.S. is estimated to be harmed by diagnostic errors annually. Identifying diagnostic pitfalls is a significant challenge. This study explored the utility of negative sentiment free‐text comments from patient satisfaction surveys to identify patient‐perceived failures in the diagnostic process within an urgent care context.Study DesignWe used an exploratory mixed‐methods study design to explore perceived breakdowns in diagnosis in urgent care. We systematically coded negative sentiment free‐text responses from de‐identified Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG‐CAHPS) surveys using content and semantic analyses. The coding schema was designed to discern concepts within the definition of diagnostic error and the pitfalls in the diagnostic process presented in the National Academy of Medicine's 2015 report on improving diagnosis. The process includes six domains: patient engagement with the health system, information gathering, information interpretation, working diagnosis, diagnosis communication, and treatment. Descriptive statistics are used to summarize the results.Population StudiedAdult patients (≥18 years) presenting to urgent care centers between January and December 2019 who completed a CG‐CAHPS survey and included a response to one of two open ended questions on the survey. We selected urgent care for the study because patients do not have an existing relationship with the provider and access urgent care for primary and emergent care concerns.Principal FindingsDuring the study period, 7245 CG‐CAHPS surveys were completed and returned. Of these, 4315 (60%) patients included a free‐text comment. Most of the comments were from women (n = 3072; 71.2%) with a mean age of 58 years (SD = 17). Of the total reports, 1630 (37.8%) were sentiment coded as negative. Negative reporters were primarily women (n = 1175; 72.1%) and younger than those reporting positive, neutral, or both positive and negative sentiments. Of the free‐text responses coded as negative, 328 (20%) reported at least one breakdown in the diagnostic process. The 328 reports translated to 548 breakdowns in the diagnostic process. Breakdowns were reported by patients across all six domains of the diagnostic process. Most breakdowns occurred during information gathering (n = 172;31.4%) and treatment (n = 148; 27.0%). Phrases used to describe a wrong diagnosis included “misdiagnosed,” “incorrectly diagnosed,” “my diagnosis was incorrect,” “get the diagnosis correct,” “proper diagnosis and care,” and “wrong diagnosis” (n = 91; 27.7%). We also observed 15 (4.5%) reports of “missed diagnosis”. Diagnostic accuracy and timeliness were also questioned in 117 (35.7%) and 139 (42.4%) of reports.ConclusionsPatients have unique and powerful insights on diagnostic safety in urgent care settings. Patient experience surveys are an unlikely but rich source of patient‐perceived diagnostic safety issues, particularly identifying issues in information gathering (history and physical examination) and treatment.Implications for Policy or PracticeLearning healthcare systems should promote the utilization of patient experience surveys to estimate the impact of diagnostic errors and to design systems‐based solutions for improving diagnostic safety.Primary Funding SourceAgency for Healthcare Research and Quality.

1515P Common presenting symptoms in cancer patients that mimic tuberculosis leading to erroneous diagnosis in Pakistan

Tuberculosis (TB) is a common disease worldwide and nearly 10 million people succumb to this disease annually. It is endemic to certain areas including South Asia. A lot of cancer patients at presentation have symptoms that mimic TB as a consequence of which they get misdiagnosed and treated initially for TB. The rationale of this study was to determine the presenting symptoms of cancer patients that are akin in both diseases leading to wrong diagnosis as TB and patients get treated for TB before presenting to oncologists.

Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making

ObjectiveThe main aim of this study was to ascertain the effectiveness of ultrasound-guided fine needle aspiration cytology (US-FNAC) in the diagnosis of para-aortic lymph node (PALN) metastasis in uterine cervical cancer and to establish its potential impact on clinical therapeutic decision making.MethodsWe retrospectively reviewed clinical data from 92 patients diagnosed with cervical cancer with PALN enlargement between 2010 and 2018. Cytological results obtained with US-FNAC were classified by the same experienced cellular pathologists. Diagnostic indicators were determined on the basis of biopsy, imaging and clinical follow-up results. Univariate and multivariate analyses were used to assess the differences of influencing factors. The effect of US-FNAC on clinical decision making was evaluated.ResultsCytological results of US-FNAC were categorized as malignancy (n = 62; 67.4%), suspicious malignancy (n = 11; 12.0%), undetermined (n = 5; 5.4%), benign (n = 10; 10.9%), and inadequate (n = 4; 4.3%). Satisfactory biopsy samples were obtained from 95.7% of PALNs sampled (88/92). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC in distinguishing benign from malignant cases were 90.1% (95% CI: 0.809–0.953), 100% (95% CI: 0.561–1), 100% (95% CI: 0.938–1), 46.7% (95% CI: 0.223–0.726) and 90.9% (95% CI: 0.848–0.970), respectively. Univariate analysis indicated significant differences in experience of puncture physicians (radiologists) between the correct and wrong diagnosis groups (P < 0.05), which was further confirmed as an independent predictor of diagnostic accuracy in multivariate analysis (p = 0.031, OR = 0.077, 95% CI: 0.354–0.919). All patients tolerated the US-FNAC procedure well and only nine presented slight abdominal discomfort. The therapeutic strategies for 74 patients (80.4%) were influenced by US-FNAC findings.ConclusionsUS-FNAC was a relatively safe and effective technique for examination of enlarged para-aortic lymph nodes and may therefore serve as a routine diagnostic tool to guide clinical decision making for management of cervical cancer.

Clinical diagnosis of vertebral fractures in osteoporosis (literature review)

Background. Osteoporosis is a common pathology among older age groups. Vertebral fractures are one of the most severe complications of osteoporosis, as they lead to a decrease in the quality of life, disability and increased mortality. The risk of vertebral fractures increases with age, especially in those who have already has a fracture of this localization. To improve the prognosis in this category of patients, early detection, treatment of patients with fractures, as well as prevention of new fractures, are important. At the same time, the diagnosis of osteoporotic vertebral fractures presents certain difficulties due to the variability of their clinical manifestations, which often leads to insufficient detection, wrong diagnosis and, as a consequence, to the lack of adequate treatment.Purpose of the review. To conduct a literature search to evaluate the clinical diagnosis of osteoporotic vertebral fractures.Conclusion. There was no single highly specific and at the same time sensitive clinical symptom of osteoporotic vertebral fractures. Back pain remains a relatively nonspecific symptom in vertebral fractures. The most specific symptoms: kyphosis and height loss have a high predictive value only when they are significantly changed. Thus, vertebral fractures should be suspected if height decreased more than 2.0 cm per year or more than 4.0 cm per life, if the patient does not reach the wall with his head or if the «rib to pelvis» distance is two fingers or less. The combination of clinical symptoms with the assessment of risk factors and bone mineral density has the greatest clinical significance. If a vertebral fracture is clinically suspected, it is advisable to perform an X-ray of the thoracic and lumbar spine, since the localization of pain indicated by the patient may not correspond to the localization of the fracture.

Diagnostic Framework for Automatic Classification and Visualization of Alzheimer’s Disease with Feature Extraction Using Wavelet Transform

Alzheimer’s Disease (AD) is a serious disease that destroys brain and is classified as the most widespread type of dementia. Manual evaluation of image scans relies on visual reading and semi-quantitative investigation of various human brain sections, leading to wrong diagnoses. Neuroimaging plays a significant part in AD detection, using image processing approaches that succeed the drawback of traditional diagnosis methods. Feature extraction is done through Wavelet Transform (WT). Feature selection is an important step in machine learning, where best features set from all possible features is determined. Mutual Information based feature selection (MI) and Correlation-based Feature Selection (CFS) captures the ‘correlation’ between random variables. Machine Learning techniques are broadly used in a classification problem, as it is simple, effective mechanisms and capability to train to contribute intelligence to the arrangement. Classifiers used in this proposed work are Artificial Neural Network (ANN), Random Forest, Convolutional Neural Network (CNN), and Wavelet-based CNN. The superior ability of ANN is high-speed processing achieved through extensive parallel implementation, and this has emphasized necessity of research in this field. CNN has encouraged tackling this issue. This work proves that wavelet-based CNN performs better with a classification accuracy of 91.87%, the sensitivity of 0.94 for normal brain and 0.88 for AD affected brain, the positive predictive value of 0.91 for normal brain and 0.92 for AD affected brain, and F measure of 0.92 for normal brain and 0.90 for AD affected brain on ADNI MRI dataset of the human brain in detecting AD.

Non-malignant gall bladder perforation: Our experience from an institution-based retrospective analysis of 25 cases.

Gallbladder perforation still continues to perplex surgeons; 25 such patients diagnosed either pre- or intra-operatively and managed at our institute over the last 10 years period were analysed. Only eight were diagnosed pre-operatively, while a large majority (17) had a wrong initial working diagnosis. Symptoms and signs were variable. No blood investigation was specific. A computed tomography scan was generally better than ultrasound in detecting the perforation. All our cases were managed operatively with no mortality and a mean duration of hospital stay of 6.8 days. Most perforations were extra-hepatic (84%) and those of Niemeier's type I (52.2%). Because of its varied clinical presentation, gallbladder perforation is often an intra-operative diagnosis, but early intervention carries a good outcome.

An enhanced separable reversible and secure patient data hiding algorithm for telemedicine applications

In telemedicine industry, a standout among the most significant issues is the exchange of Electronic Patient Information (EPI) between patient and a doctor that are remotely connected. A minute change to EPI may result in wrong diagnosis to the patient. With the aim to ensure secure and safe communications in telemedicine framework, an enhanced separable reversible data hiding technique in encrypted domain has been presented here that gives high embedding rate by embedding k, (k≥1) binary bits of patient data in base2k numeral framework using Average Pixel Repetition (APR) method. APR method converts original image of size M×N into encrypted scaled-up image of size (2×M−1)×(2×N−1) such that non-seed pixels are used for data embedding where as seed pixels remain as it is to facilitate reversibility. The experimental study shown that the proposed method gave extremely high embedding rates on both natural and medical images. For all test images, the proposed methodology altogether beated all the compared methodologies in its ability to embed patient information and precisely recover it with maintaining the visual quality of stego images too.

Level of anxiety in clinical settings and coping mechanisms used by dental undergraduate students to overcome it.

Dental undergraduate students encounter anxiety in their professional years of study, the impact of which is reflected on their overall performance. Various coping techniques are advocated that help individuals to deal effectively with the adverse effects of anxiety. The objectives of this study were to determine the level of anxiety encountered by dental undergraduate students during clinical rotations, the clinical procedures precipitating it and the number of different coping strategies (problem solving, social seeking support, and avoidance) used by students for anxiety management. A descriptive, questionnaire-based, cross-sectional study was conducted on the third and fourth-year undergraduate dental students from six colleges of Islamabad and Rawalpindi. A total of 353 students were included in the study, and their participation in the study was anonymous and voluntary. The administered questionnaire consisted of three parts: Part 1: Moss and McManus Scale (MMM) for anxiety-provoking situations; part 2: Hamilton Anxiety Rating Scale (HAM-A) for the level of anxiety, and Part 3: Coping Strategy Indicator Scale (CSI scale) to determine the frequency of coping strategies used by students. The data were collected and analyzed using SPSS version 22.0. A majority of participants (96.3%) felt mild to moderate levels of anxiety in the clinical settings. Students felt more anxious about getting infected by the patient (62%), extracting the wrong tooth (46.5%), and getting a wrong diagnosis (43.1%). A significant number of participants (47%) used problem-solving mechanisms to overcome their anxiety. Mild to moderate levels of clinical anxiety prevailed in most dental undergraduate students. The top clinical situations precipitating anxiety were getting infected by patients and extracting the wrong tooth. Measures should be taken to encourage a vigorous, confidence-enhancing environment for students. This will reduce their levels of clinical anxiety along with training and foster healthy coping strategies to deal with unavoidable anxiety.

Dry Mouth Caused by Facial Nerve Ischemia due to Subarachnoid Hemorrhage: An Experimental Study

Parasympathetic network damage results in facial nerve damage, sublingual ganglion degeneration, sublingual gland dysfunction, and dry mouth. In this study, subarachnoid hemorrhage (SAH) was considered to be the cause of dry mouth. We assessed 23 hybrid rabbits, including 5 control (group 1, Control). One milliliter of serum saline was injected into the cisterna magna of 5 animals (group 2). SAH was induced by injecting 1 mL of autologous blood into the cisterna magna of 13 animals (group 3). The animals were killed after 3 weeks of induction. The animals' sublingual ganglion and sublingual gland were excised for histopathological examination. The number of degenerated cells in the sublingual ganglion, secretory vesicles, and secretory granules in the sublingual gland that contain salivary components were estimated using Sequential Window Acquisition of All Theoretical Mass Spectra data analysis. The values were compared by the Mann-Whitney U-test. The numbers of secretory vesicles in the sublingual gland were 5.3 ± 1.1× 103 (group 1), 4.23 ± 0.45× 103 (group 2), and 1.56 ± 0.22× 103 (group 3); the numbers of secretory vesicles containing saliva in the sublingual gland were 324 ± 12.18 (group 1), 263 ± 36.23 (group 2), and 114 ± 23.14 (group 3); and the numbers of degenerated cells in the sublingual ganglion were 11 ± 3/mm3 (group 1), 98.43 ± 15.54/mm3 (group 2), and 346 ± 12.28/mm3 (group 3) (P < 0.05). Clinical findings in infection and diseases such as Sjögren syndrome, aseptic meningitis, and SAH are similar. However, until now, SAH has not been demonstrated experimentally to cause dry mouth. Discovering that SAH might cause dry mouth might prevent unnecessary use of antibiotics and decrease morbidity due to the wrong or late diagnosis.

English

BACKGROUND Measurement of chest expansion is commonly done in physical examination of patients as it gives reliable idea about the rib cage mobility &amp; capacity of lungs along with thorax to expand. Chest expansion values are reduced in diseases and it can be used to check progression of the diseases. In India there is lack of reference data on chest expansion due to which the values derived from other population are used for reference in India. Comparison of the patient with wrong population data will create misinformation &amp; wrong diagnosis. This study was designed to establish reference value for expansion of chest in healthy Indian children, understand relation of age, height, and weight with chest circumference &amp; compare these values with published global values. METHODS Chest expansion &amp; circumference of chest was measured in 229 boys and 226 girls aged 6 – 15 years. The study was conducted in Mumbai metropolitan region and Navi - Mumbai. Standing height, weight, age, sitting chest circumference and chest expansion were recorded. Chest expansion was measured at three different levels i.e. axillary, mammary and xiphoid. The correlation coefficient was used to understand relation of age, weight, height with chest expansion &amp; chest circumference. The prediction equation was derived for both genders separately by multivariate regression. RESULTS Significant positive correlation of chest circumference was observed with age and weight and negative correlation with height. Chest expansion was higher in males as compared to females. Chest expansion had shown positive correlation with age, height and weight. Pearson correlation coefficients were 0.927, 0.885 &amp; - 0.337 respectively. Different prediction equations were drawn for males and females for expansion of chest at all three levels. Significant difference was noted in values of this study and global values. CONCLUSIONS Gender wise differences exist in chest expansion values. Males have higher values than females. Hence gender specific equations are needed for estimation of chest expansion. KEY WORDS Chest Circumference, Indian Children, Chest Expansion, Prediction Equation

Prevalence of Diagnostic Errors as Predictors of Obstetric Outcomes among Post-Natal Mothers in Bungoma County, Kenya

Diagnosis is the foundation of a correct intervention. However, diagnostic errors result in wrong interventions. This is a global phenomenon, where it is a common problem; which has been understudied. Looking at the Philippines, diagnostic errors are three times most likely to make pregnant women develop obstetric complications. In Kenya, there is a high annual maternal mortality prevalence ratio of 362/100,000 live births, with Bungoma County exceeding the national maternal mortality prevalence ratio of 382/100,000 live births annually. Maternal mortality more often than not, a factor, that arises from morbidity is fuelled by diagnostic errors that required determination of its consequences on obstetric outcomes in Bungoma county. Thus, this study investigated the prevalence of diagnostic errors as predictors of obstetric outcomes among post-natal mothers in Bungoma County. The study employed a descriptive cross-sectional research design, which was hospital-based (Bungoma and Webuye hospitals). Systematic sampling was used to obtain 384 respondents and purposive sampling to select 8 health care workers as key informants. Data was collected using a structured questionnaire and an interview guide. the pre-test was done; validity was established through crosschecking and reliability calculated using the Cronbach method (0.89). Using a statistical package for social sciences version 25, descriptive statistics were run. The study revealed a prevalence ratio of 3.996 whereas delayed diagnosis was 43.1%, missed 38.8%, absent diagnosis 27.5%, wrong diagnosis 34.9%, misinterpretation of results 24.1, unmatched 26.3% and unnecessary investigation 9.3%. The study demonstrates that a correct diagnosis is a viable strategy in preventing unsafe obstetric outcomes and by extension minimizing morbidity and mortality among pregnant women.

A bi-level machine learning method for fault diagnosis of oil-immersed transformers with feature explainability

Power transformer faults are considered rare events, so data samples in normal operations are much more readily available than in faulty conditions. Traditionally, power transformer fault diagnoses were enabled through gas-in-oil data, where erroneous diagnoses of faulty conditions as normal could have a more significant effect on power system operations than wrong diagnoses of normal operations as a faulty condition. Therefore, it is imperative to analyze gas-in-oil data characteristics more effectively to improve the performance of diagnostic methods. In this paper, an explainable bi-level machine learning method is proposed for oil-immersed power transformer fault diagnoses, consisting of a binary imbalanced classification model and a multi-classification model. The proposed Extreme Gradient Boosting models are designed with custom functions at each level, and automatic hyperparameters tuning is conducted based on Bayesian optimization. A fault feature selection is developed using the SHapley Additive exPlanations method to explain the diagnosis results, which could mine the impacts of fault features on diagnosis results and find the approach to improve the model performance. The fault diagnosis results are presented with performance analysis and comparative studies, and the feature selection results with importance analysis for each fault type based on SHAP value is provided, which demonstrates the feasibility and effectiveness of the proposed method.

Factors affecting delay in diagnosis of colorectal cancer: A cross-sectional study from a tertiary care hospital of Karachi, Pakistan.

Colorectal cancer (CRC) incidence is increasing in our region. There is no specific CRC control programme or national cancer registry in Pakistan. Previously, no data have been published on presentation delay and diagnosis delay of CRC in our region. This study is conducted to determine the factors affecting delay in presentation and diagnosis and to provide baseline information to launch a CRC control programme. The primary objective is to determine factors causing delay in diagnosis of CRC. The secondary objective is to evaluate the relationship between tumour site and stage of CRC with presenting symptoms and symptom duration. This project is a prospective cross-sectional study on 113 biopsy-proven CRC patients admitted to the surgical ward of Civil Hospital Karachi. The total number of participants was 113. Presentation delay was observed in 83.2% of patients. The main reasons for a reported delay in the presentation were lack of patients' knowledge that these symptoms may be cancer (60.4%), the wrong diagnosis by the primary physician (34.6%) or the patient did not want to visit the doctor (0.04%). Most tumours (95%) originated from the sigmoid and rectum; 44.2% and 38.9% of the patients were diagnosed at Stages 3 and 4, respectively. This study revealed that CRC patients in Pakistan are facing delays in presentation and diagnosis. This is the reason behind diagnosis at the advanced stage with a poor prognosis. On the basis of this study findings, CRC control programme should be introduced to detect CRC at an early stage.

Stuck in a rut with the wrong diagnosis

Stuck in a rut with the wrong diagnosis

Orbital Aspergillosis Mimicking Giant Cell Arteritis

Orbital aspergillosis is a very rare, debilitating disease which can present solely with painful optic neuropathy and mimic giant cell arteritis in an elderly person. We report a case of orbital aspergillosis in a 65-year-old Malay man who presented with unilateral gradual blurring of vision and ipsilateral headache. Our initial working diagnosis was giant cell arteritis. Unfortunately, patient’s condition worsened with intravenous corticosteroid and developed into orbital apex syndrome. Imaging and biopsy results showed evidence of orbital aspergillosis. Patient lost his eyesight due to the wrong initial working diagnosis. This report is to emphasize that although giant cell arteritis is also a sight and life-threatening condition, it is rare among Asian populations. We need to take into account the epidemiology of the disease and look into any other differential diagnoses when the presentation is atypical.