scholarly journals Diagnostic Bias in the COVID-19 Pandemic: A Series of Short Cases

2021 ◽  
Author(s):  
Anete Zieda ◽  
Silvia Sbardella ◽  
Malika Patel ◽  
Richard Smith
Keyword(s):  
Cognitive Bias ◽  
Critical Appraisal ◽  
Correct Diagnosis ◽  
Final Diagnosis ◽  
Healthcare Systems ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Acute Pulmonary Oedema ◽  
Diagnostic Bias ◽  
New Information ◽  
St Elevation

During the COVID-19 pandemic, healthcare systems have faced unprecedented pressures. One challenge has been to promptly recognise non-COVID-19 conditions. Cognitive bias due to the availability heuristic may cause difficulties in reaching the correct diagnosis. Confirmation bias may also affect imaging interpretation. We report three cases with an alternative final diagnosis in whom COVID-19 was initially suspected: (a) Pneumocystis jirovecii pneumonia with unrecognised HIV infection; (b) pulmonary lymphangitis carcinomatosis; and (c) ST elevation myocardial infarction causing acute pulmonary oedema. To help mitigate bias, there is no substitute for thoughtful clinical assessment and critical appraisal when evaluating new information and formulating the differential diagnosis

scholarly journals Use of Circulating MicroRNAs to Diagnose Acute Myocardial Infarction

2012 ◽  
Vol 58 (3) ◽  
pp. 559-567 ◽  
Author(s):  
Yvan Devaux ◽  
Mélanie Vausort ◽  
Emeline Goretti ◽  
Petr V Nazarov ◽  
Francisco Azuaje ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Troponin T ◽  
Correct Diagnosis ◽  
Patient Treatment ◽  
Healthy Controls ◽  
Clinical Model ◽  
Acute Mi ◽  
St Elevation

Abstract BACKGROUND Rapid and correct diagnosis of acute myocardial infarction (MI) has an important impact on patient treatment and prognosis. We compared the diagnostic performance of high-sensitivity cardiac troponin T (hs-cTnT) and cardiac enriched microRNAs (miRNAs) in patients with MI. METHODS Circulating concentrations of cardiac-enriched miR-208b and miR-499 were measured by quantitative PCR in a case-control study of 510 MI patients referred for primary mechanical reperfusion and 87 healthy controls. RESULTS miRNA-208b and miR-499 were highly increased in MI patients (>105-fold, P < 0.001) and nearly undetectable in healthy controls. Patients with ST-elevation MI (n= 397) had higher miRNA concentrations than patients with non–ST-elevation MI (n = 113) (P < 0.001). Both miRNAs correlated with peak concentrations of creatine kinase and cTnT (P < 10−9). miRNAs and hs-cTnT were already detectable in the plasma 1 h after onset of chest pain. In patients who presented <3 h after onset of pain, miR-499 was positive in 93% of patients and hs-cTnT in 88% of patients (P= 0.78). Overall, miR-499 and hs-cTnT provided comparable diagnostic value with areas under the ROC curves of 0.97. The reclassification index of miR-499 to a clinical model including several risk factors and hs-cTnT was not significant (P = 0.15). CONCLUSION Circulating miRNAs are powerful markers of acute MI. Their usefulness in the establishment of a rapid and accurate diagnosis of acute MI remains to be determined in unselected populations of patients with acute chest pain.

scholarly journals Clomiphene Associated Inferior STEMI in a Young Female due to Right Coronary Artery Dissection

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Feras Husain Abuzeyad ◽  
Eltigani Seedahmed Ibnaouf ◽  
Mudhaffar Al Farras
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Hormonal Therapy ◽  
Ovulation Induction ◽  
Final Diagnosis ◽  
Young Female ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
St Elevation

Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is an uncommon cause of myocardial infarction. It most commonly affects females in the perimenopausal age. NA-SCAD has been associated with many predisposing factors including pregnancy and hormonal therapy for both contraception and ovulation induction. The presented case is a previously healthy 41-year-old woman diagnosed with inferior ST-elevation myocardial infarction due to right descending coronary artery dissection associated with recent use of clomiphene monotherapy for ovulation induction (a previously fertile woman), which was not previously reported. Learning Objectives. Emergency physicians (EPs) should be aware about NA-SCAD as a cause of acute coronary syndrome (ACS) especially in perimenopausal women even with no risk factors. NA-SCAD occurs more commonly in the postpartum period and in females following hormonal therapy. Here, clomiphene monotherapy was reported as a possible contributing factor to NA-SCAD. Guidelines for NA-SCAD management are not up to date, and EPs should avoid some interference before the final diagnosis of the cause of myocardial infarction.

scholarly journals Global effect of COVID-19 pandemic on the rate of acute coronary syndrome admissions: a comprehensive review of published literature

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001645
Author(s):  
Ayman Helal ◽  
Lamis Shahin ◽  
Mahmoud Abdelsalam ◽  
Mokhtar Ibrahim
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Admissions ◽  
Absolute Risk ◽  
Pearson Correlation ◽  
Absolute Risk Reduction ◽  
Healthcare Systems ◽  
Global Effect ◽  
Coronary Syndrome ◽  
Admission Data ◽  
St Elevation

BackgroundThe COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied significantly.ObjectivesThe purpose of this study is to investigate the effect of the pandemic on ACS hospital admissions and to determine whether this is related to the number of COVID-19 cases in each country.MethodSearch engines including PubMed, Embase, Ovid and Google Scholar were searched from December 2019 to the 15 September 2020 to identify studies reporting ACS admission data during COVID-19 pandemic months in 2020 compared with 2019 admissions.ResultsA total of 40 studies were included in this multistudy analysis. They demonstrated a 28.1% reduction in the rate of admission with ACS during the COVID-19 pandemic period compared with the same period in 2019 (total of 28 613 patients in 2020 vs 39 225 in 2019). There was a significant correlation between the absolute risk reduction in the total number of ACS cases and the number of COVID-19 cases per 100 000 population (Pearson correlation=0.361 (p=0.028)). However, the correlation was not significant for each of the ACS subgroups: non-ST-elevation myocardial infarction (STEMI) (p=0.508), STEMI (p=0883) and unstable angina (p=0.175).ConclusionThere was a significant reduction in the rate of ACS admission during the COVID-19 pandemic period compared with the same period in 2019 with a significant correlation with COVID-19 prevalence.

Primary leptomeningeal lymphoma masquerading as infectious tubercular meningitis

2021 ◽  
Vol 14 (9) ◽  
pp. e243574
Author(s):  
Salini Sumangala ◽  
Thidar Htwe ◽  
Yousuf Ansari ◽  
Lidia Martinez- Alvarez
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Correct Diagnosis ◽  
Central Nervous System Lymphoma ◽  
Final Diagnosis ◽  
Csf Analysis ◽  
Antitubercular Treatment ◽  
Lymphoma Treatment ◽  
Work Up ◽  
Timely Treatment

Primary central nervous system lymphoma (PCNSL) is infrequent and often poses diagnostic conundrums due to its protean manifestations. We present the case of a South Asian young man presenting with raised intracranial pressure and a lymphocytic cerebrospinal fluid (CSF) with pronounced hypoglycorrhachia. Progression of the neuro-ophthalmic signs while on early stages of antitubercular treatment led to additional investigations that produced a final diagnosis of primary leptomeningeal lymphoma. Treatment with chemoimmunotherapy (methotrexate, cytarabine, thiotepa and rituximab (MATRix)) achieved full radiological remission followed by successful autologous transplant. This case highlights the difficulties and diagnostic dilemmas when PCNSL presents as a chronic meningeal infiltrative process. While contextually this CSF is most often indicative of central nervous system tuberculosis and justifies empirical treatment initiation alone, it is essential to include differential diagnoses in the investigation work-up, which also carry poor prognosis without timely treatment. High suspicion, multidisciplinary collaboration and appropriate CSF analysis were the key for a correct diagnosis.

scholarly journals The diagnosis of delirium in 80 emergency unit patients

1998 ◽  
Vol 56 (2) ◽  
pp. 176-183
Author(s):  
AFONSO CARLOS NEVES ◽  
RICARDO DE CASTRO CINTRA SESSO ◽  
HENRIQUE BALLALAI FERRAZ ◽  
SÍLVIO FRANCISCO ◽  
JOÃO BAPTISTA DOS REIS-FILHO
Keyword(s):  
Correct Diagnosis ◽  
Diagnostic Testing ◽  
Final Diagnosis ◽  
Initial Diagnosis ◽  
University Hospital ◽  
Emergency Unit ◽  
Predictive Values ◽  
Kappa Test ◽  
History Of ◽  
Sensitivity Specificity

We evaluated the initial and final diagnosis of 80 patients with delirium arriving at the emergence unit of a university hospital in a large Brazilian city over a period of 30 months up to December 1991. The diagnosis was based on the DSM-IIIR criteria. Patients with a known history of head trauma or epileptic seizure and patients younger than 13 years were excluded. Only patients with a disease of up to 7 days were included.The patients were subdivided into four etiologic groups: vascular; associated with the use of alcohol; infectious-parasitic; miscellaneous.The results showed a rate of correct diagnosis ranging from 65 to 80% with the use of kappa test (standard good to excelent). Sensitivity, specificity, positive predictive and negative predictive values had results showing different conditions for initial diagnosis in each group. This study can help the initial diagnosis of delirium and the choice for diagnostic testing.

Transthyretin-assoziierte familiäre Amyloidpolyneuropathie

2018 ◽  
Vol 143 (06) ◽  
pp. 427-430
Author(s):  
Christoph Niemietz ◽  
Christoph Röcken ◽  
Matthias Schilling ◽  
Jörg Stypman ◽  
Constantin Uhlig ◽  
...  
Keyword(s):  
Amyloid Fibrils ◽  
Clinical Symptoms ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Correct Diagnosis ◽  
Vitreous Body ◽  
Final Diagnosis ◽  
Autonomic Nerves ◽  
Loss Of Weight ◽  
Peripheral Polyneuropathy ◽  
Immunohistochemical Evidence

AbstractTransthyretin-related Familial Amyloid Polyneuropathy (ATTR Amyloidosis, former FAP, here called TTR-FAP) is a rare, progressive autosomal dominant inherited amyloid disease ending fatal within 5 – 15 years after final diagnosis. TTR-FAP is caused by mutations of transthyretin (TTR), which forms amyloid fibrils affecting peripheral and autonomic nerves, the heart and other organs. Due to the phenotypic heterogeneity and partly not specific enough clinical symptoms, diagnosis of TTR-FAP can be complicated. False diagnoses can include idiopathic polyneuropathy, chronic inflammatory demyelinating polyneuropathy, diabetic neuropathy as well as paraneoplastic syndrome. Hence, it is assumed that many cases remain unreported. Early and correct diagnosis of TTR-FAP is crucial, since appropriate therapeutic options exist. TTR-FAP should always be differentially diagnosed, when apart from a progressive peripheral polyneuropathy, additional symptoms as autonomic dysfunction, cardiomyopathy, gastrointestinal disorders, unexpected loss of weight, carpal tunnel syndrome, restrictions of renal function, epileptic fits, and corneal and vitreous body clouding occur. Histological evidence of amyloid and successive immunohistochemical evidence of transthyretin as well as genetic testing for transthyretin mutations, lead to an accurate diagnosis.

Desmoid tumor of the anterior abdominal wall in a female (Clinical case)

2018 ◽  
pp. 116-118
Author(s):  
M.V. Makarenko ◽  
◽  
D.O. Govseyev ◽  
S.V. Gridchin ◽  
N.H. Isaeva ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Desmoid Tumor ◽  
Clinical Case ◽  
Anterior Abdominal Wall ◽  
Correct Diagnosis ◽  
Final Diagnosis ◽  
Histological Findings ◽  
History Of ◽  
Slow Growing ◽  
Wall Tumor

Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy and postoperative surgeries. Our clinical case is interesting because of the rarity of the pathology and the difficulties in setting the correct diagnosis. The patient, with a history of laparoscopic myomectomy (2012), was preparing for a routine surgery for the endometrioma of the anterior abdominal wall, according to the results of the ultrasound and computed tomography. After surgical treatment, the final diagnosis was changed, based on the histological findings. Key words: desmoid tumor, abdominal wall tumor, fibroid.

Telephonic transmission of 12-lead electrocardiograms during acute myocardial infarction

2005 ◽  
Vol 11 (4) ◽  
pp. 185-190 ◽  
Author(s):  
K Mischke ◽  
M Zarse ◽  
M Perkuhn ◽  
C Knackstedt ◽  
K Markus ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Final Diagnosis ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Call Centre ◽  
Coronary Syndrome ◽  
False Positive Diagnosis ◽  
St Segment ◽  
St Elevation

To test the feasibility of a small and simple system for telephonic transmission of 12-lead electrocardiograms (ECGs), 70 patients with acute coronary syndrome admitted to the cardiac care unit (CCU) were included in a feasibility study. The transmission system consisted of a belt with multiple electrodes, which was positioned around the chest. The ECG signal was sent to a call centre via a standard telephone line. In parallel, a standard 12-lead ECG was recorded on site. In a retrospective analysis, each lead of the transmitted ECG was compared with the on-site 12-lead ECG with regard to ST-segment changes and final diagnosis. In all 37 patients with acute ST-elevation myocardial infarction, the diagnosis was correctly established on the basis of telephone-transmitted ECGs. In 96% of limb and 88% of chest leads, ST elevations which were visible in standard ECGs were correctly displayed on telephonically transmitted ECGs. In the remaining 33 patients no false-positive diagnosis was made using transtelephonic ECG analysis. A control group of 31 patients without apparent heart disease showed high concordance between standard ECGs and telephonically transmitted ECGs. Telephonically transmitted 12-lead ECGs interpreted by a hospital-based internist/cardiologist might allow a rapid and accurate diagnosis of ST-elevation myocardial infarction and may increase diagnostic safety for the emergency staff during prehospital decision making and treatment of acute myocardial infarction.

P1695Incidence and outcomes of unstable angina compared to non-ST elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Puelacher ◽  
M Gugala ◽  
P D Adamson ◽  
A S V Shah ◽  
A R Chapmann ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
St Elevation Myocardial Infarction ◽  
Cardiovascular Research ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
St Elevation ◽  
Heart Foundation

Abstract Objective Assess the incidence and compare characteristics and outcome of unstable angina (UA) and Non-ST-Elevation myocardial infarction (NSTEMI) Design Two independent prospective multicenter diagnostic studies (Advantageous Predictors of Acute Coronary Syndromes Evaluation (APACE) and High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome (High-STEACS)) enrolling patients with acute chest discomfort presenting to the emergency department. Central adjudication of the final diagnosis was done by two independent cardiologists using all clinical information including serial measurements of high-sensitivity cardiac troponin (hs-cTn). All-cause death and future non-fatal MI were assessed at 30-days and 1-year. Results 8992 patients were enrolled at 11 centres. UA was adjudicated in 366/4122 (8.9%) and 137/4870 (2.8%) patients in APACE and High-STEACS, respectively, and NSTEMI in 622 (15.1%) and 651 (13.4%). Coronary artery disease was pre-existing in 73% and 76% of patients with unstable angina. At 30-days, all-cause mortality in UA was substantially lower as compared to NSTEMI (0.5% versus 3.7%, p=0.002 in APACE, 0.7% versus 7.4%, p=0.004 in High-STEACS). Similarly, at 1-year in UA all-cause mortality was 3.3% [95% CI 1.2–5.3] vs 10.4% [7.9–12.9] in APACE, and 5.1% [0.7–9.5] vs 22.9% [19.3–26.4] in High-STEACS, and similar to non-cardiac chest pain (NCCP). In contrast, future non-fatal MI in APACE was comparable in UA and NSTEMI (11.2%, [7.8–14.6] and 7.9%, [5.7–10.2]), and higher than in NCCP (0.6%, [0.2–1.0]). 1-year survival free from future AMI Conclusions The incidence and the mortality of UA is substantially lower than that of NSTEMI, while the rate of future non-fatal MI is similar. Acknowledgement/Funding Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, British Heart Foundation Project Grants, Butler S

Metastasis of follicular variant of papillary thyroid carcinoma masquerading as primary temporal bone tumour

2011 ◽  
Vol 125 (5) ◽  
pp. 528-532 ◽  
Author(s):  
S C Hugh ◽  
D Enepekides ◽  
J Wong ◽  
R Yeung ◽  
V Y W Lin
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Bone Mass ◽  
Temporal Bone ◽  
Treatment Plan ◽  
Correct Diagnosis ◽  
Bone Tumour ◽  
Final Diagnosis ◽  
Papillary Thyroid ◽  
Follicular Variant

AbstractObjective:We describe the first published case of papillary thyroid carcinoma metastatic to the temporal bone.Case report:A 64-year-old woman presented with a large left temporal bone mass centred in the jugular foramen, initially thought to be a paraganglioma or schwannoma. She was simultaneously being investigated for a left-sided thyroid nodule, which was found to be unremarkable on repeated fine needle aspiration cytology. A biopsy of the temporal bone mass indicated that it was of thyroid origin. The patient underwent total thyroidectomy, which enabled a final diagnosis of follicular-variant papillary thyroid carcinoma with metastasis to the temporal bone.Conclusion:Although biopsy is not the usual management for many types of temporal bone mass, pathological investigation is recommended if the tumour has an atypical growth rate, location, spread and/or radiological features. Metastasis of papillary thyroid carcinoma to the skull base is extremely rare, and correct diagnosis is essential in order to pursue an effective treatment plan.

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