MONGOLIAN SPOTS CAN MIMIC BODY INJURIES: CASE REPORT

Mongolian spots are congenital dermatological conditions often observed in the neonatal period resulting from the migration of melanocytes to the dermis during embryogenesis. They are bluish grey spots typically located in the lumbosacral region, which tend to regress in the first years of life. As skin lesions are frequent signs in infant maltreatment, Mongolian spots can be misinterpreted as ecchymoses, which would lead to a false diagnosis. This can culminate in serious and dramatic consequences for the patient and family, as well as overloading the public system. Therefore, it is essential that health professionals know how to differentiate Mongolian stains from injuries resulting from child abuse. This study aims to describe a case that was mistakenly attributed to mistreatment for the presence of Mongolian spots in atypical places.

An Image Pre-Processing Improvement Procedure for Standardizing Multiple Colour Variations in the Astrocytoma Immunohistochemical Staining Images

Colour variations in the histopathological images can occur when the acquired images came from different laboratories. This issue happens may be due to different protocols between each laboratory. Besides that, the usage of dye or staining is also different since it arrived from different manufacturers. Hence, it will affect the performance of a system, especially for an automated image diagnosis system. If this issue is taken lightly, the whole process of image analysis can produce a false diagnosis outcome, and thus, it will affect the patient’s treatment options and endanger the patient’s life. This paper proposed an automated image pre-processing procedure for standardizing the colour variations in immunohistochemical staining images. The proposed procedure was done by modifying the reference image, which will be used later for the stain standardization process. Based on 50 astrocytoma histopathological images, the proposed procedure showed a promising result, where the quality of the output images has been enhanced and standardized.

EP.FRI.34 Audit of management of shoulder dislocations against BOA Traumatic anterior shoulder instability Guidelines

Background Traumatic anterior shoulder dislocation is associated with a high risk of shoulder instability, reduced functional outcome, and recurrence. We conducted an audit to assess the direct management, review in fracture clinic, and definitive imaging of patients with anterior shoulder instability in Southport and Formby Hospital. Aim To identify compliance with the 2015 BOA Traumatic anterior shoulder instability guidelines. Method Identified all patients from 01/01/2019 to 31/12/2019 who had shoulder dislocation coded for their diagnosis. We used imaging, scanned notes, and clinic letters where available to identify the clinical information. We excluded patients with a false diagnosis code, and those with non-local post codes from the analysis. Results We identified 67 patients who had an anterior dislocation. 88% of patients had x-rays in both AP and Lateral. We identified that 8.9% of patients had pre-reduction x-rays in AP only, 11.9% had no pre-reduction x-rays, and 1.5 % had no post reduction imaging. 79% of patients were seen in clinic within 6 weeks but only 40.3% were seen by a shoulder specialist and only 43.3% had appropriate imaging. 16.4% of patients were not given fracture clinic follow up. Conclusion Although most patients were managed acutely according to the guidelines, the follow up and subsequent investigations of these patients can be improved. One method we suggest is renaming fracture clinic days from consultant names to sub-specialty clinic names. In addition, a dedicated session to review the guideline with senior orthopedic surgeons cold improve the compliance as well.

94 Audit of Management of Shoulder Dislocations Against BOA Traumatic Anterior Shoulder Instability Guidelines

Background Traumatic anterior shoulder dislocation is associated with a high risk of shoulder instability, reduced functional outcome, and recurrence. We conducted an audit to assess the direct management, review in fracture clinic, and definitive imaging of patients with anterior shoulder instability in Southport and Formby Hospital. Aim To identify compliance with the 2015 BOA Traumatic anterior shoulder instability guidelines. Method Identified all patients from 01/01/2019 to 31/12/2019 who had shoulder dislocation coded for their diagnosis. We used imaging, scanned notes, and clinic letters where available to identify the clinical information. We excluded patients with a false diagnosis code, and those with non-local post codes from the analysis. Results We identified 67 patients who had an anterior dislocation. 88% of patients had x-rays in both AP and Lateral. We identified that 8.9% of patients had pre-reduction x-rays in AP only, 11.9% had no pre-reduction x-rays, and 1.5 % had no post reduction imaging. 79% of patients were seen in clinic within 6 weeks but only 40.3% were seen by a shoulder specialist and only 43.3% had appropriate imaging. 16.4% of patients were not given fracture clinic follow up. Conclusions Although most patients were managed acutely according to the guidelines, the follow up and subsequent investigations of these patients can be improved. One method we suggest is renaming fracture clinic days from consultant names to sub-specialty clinic names. In addition, a dedicated session to review the guideline with senior orthopedic surgeons cold improve the compliance as well.

A Cadaveric study on Rectus Sternalis muscle and its clinical significance in Western part of Tamilnadu state (Kongunadu region)

Background: Rectus sternalis is considered as an unusual accessory or supernumerary muscle which appears either unilateral or bilateral in the anterior thoracic wall of human beings. It varies in length, breadth, thickness and incidence among different races and in both sexes. Regarding its origin and insertion still a clear conclusion has not been reached because some authors says it originates and ascends for insertion while some of them opines it originates and descends for insertion. Clinically, its presence also leads to false diagnosis such as Breast tumours, lipoma etc. Aim of the study: To find out the presence of Rectus sternalis muscle in the anterior chest wall during routine dissection. Materials and Methods: 37 well embalmed and preserved cadavers of both sexes which is used for routine dissection to Phase-I MBBS students were taken into condideration. The pectoral region on either side of sternum was dissected in layers and visualised for the presence of Rectus sternalis. Results: Among 37 cadavers dissected, Rectus sternalis was found in the pectoral region of a male and a female cadaver. In male it appeared bilateral, whereas in female it is unilateral. In both the cases it lie superficial to pectoralis major. Conclusion: The incidence of Rectus sternalis reported from our study was 5.4%. In the earlier days it lead to misdiagnosis and made great challenge to radiologists and surgeons, but now-a days with advancement in imaging techniques its presence can be detected clearly thus avoiding unnecessary expenditure and invitro techniques. Clinically it is also used as pedicle flap in breast reconstructive surgeries. KEY WORDS: Cadaver, Dissection, Pectoral region, Rectus sternalis, sternocleidomastoid.

‘Hybrid’ oncocytoma: collecting duct (Bellini) carcinoma—the peril from this extremely rare intratumoural coexistence

We presented an extremely rare entity of ‘hybrid’ oncocytoma and collecting duct (Bellini) carcinoma. The intratumoural coexistence of benign and malignant cells may lead to false diagnosis and suboptimal treatment of an aggressive tumour. Diagnosis may be challenging if only based on imaging modalities. Even the established value of targeted renal biopsy may be questioned in such scarce cases. Consequently, active surveillance for small renal tumours shall not considered a widely safe management.

A rational diagnostic approach to the “phantom hCG” and other clinical scenarios in which a patient is thought to be pregnant but is not

The scenario in which a patient tests positive for human chorionic gonadotropin (hCG) in the absence of pregnancy can pose a diagnostic dilemma for clinicians. The term “phantom hCG” refers to persistently positive hCG levels on diagnostic testing in a nonpregnant patient and such results often lead to a false diagnosis of malignancy and subsequent inappropriate treatment with chemotherapy or hysterectomy. There remains a need for a consistent and rational diagnostic approach to the “phantom hCG.” This article aims to review the different etiologies of positive serum hCG testing in nonpregnant subjects and concludes with a practical, stepwise diagnostic approach to assist clinicians encountering this clinical dilemma.

COVID-19 causing HELLP-like syndrome in pregnancy and role of angiogenic factors for differential diagnosis

Importance: The clinical presentation of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is one of the more severe forms of preeclampsia. COVID-19 infection exhibits signs that are shared with preeclampsia and HELLP syndrome, which may lead to needless interventions and iatrogenic preterm delivery. Objective: We evaluated the prevalence of HELLP-like signs in pregnant women admitted for COVID-19 and the value of angiogenic factors to rule out preeclampsia. Methods: a consecutive series of 27 pregnant women beyond 20 weeks of gestation, with symptomatic COVID-19. Clinical and analytical features were recorded and those cases with signs of HELLP syndrome were tested for sFlt-1/PlGF ratio. Results: Seven patients (25.9%) presented at least one sign of suspected HELLP syndrome, of which 2 (7.4%) were diagnosed clinically with PE because of hypertension and high transaminases and 5 (18.5%) had only elevated transaminases. sFlt-1/PlGF ratio was normal in 6 of 7. Conclusion: Symptomatic COVID-19 may simulate severe preeclampsia in pregnancy. Angiogenic factors may be essential to avoid false diagnosis and needless interventions. These data were presented in a Virtual Symposium on Covid-19 and Pregnancy on 17 April: 2020:(http://medicinafetalbarcelona.org/simposiocovid19/ [Spanish] and https://medicinafetalbarcelona.org/symposiumcovid19/ [English]