Spinal infection caused by Prevotella intermedia:analysis of misdiagnosis and literature review / 中国感染控制杂志

Objective To explore the clinical characteristics and treatment scheme of patients with spinal infection caused by Prevotella intermedia(P.intermedia).Methods Clinical diagnosis and treatment processes of a patient with spinal infection caused by P.intermedia admitted to the spinal surgery department of a hospital were summa-rized,and relevant literature was retrieved from database for reviewing.Results The patient,a 50 year old male,was admitted to the hospital due to"lumbago pain complicated with pain in double lower extremities for 2 months".The lesion tissue was taken for metagenomic next-generation sequencing(mNGS)detection,which detected P.in-termedia,and the patient was diagnosed with P.intermedia spondylitis.After treatments with open lesion clea-rance,tube rinsing+autologous bone transplantation fusion internal fixation,intravenous drip of ceftriaxone sodium and metronidazole,as well as metronidazole rinsing,infection was under control.A total of 16 available papers were retrieved,together with this case,a total of 17 patients were included,with 7 males and 10 females.The main risk factors were diabetes and history of corticosteroid use(35.3％).The most common invasion sites were lumbar ver-tebra(n=12)and thoracic vertebra(n=6).13 cases were positive for pathogen culture,3 cases were positive for molecular detection,and 1 case was positive for staining microscopy.17 patients received anti-anaerobic bacteria treatment,with 14 cases receiving combined surgical treatment.One case died,with a mortality of 5.9％;5 cases had partial neurological impairment,with a disability rate of 29.4％.The survival rate of patients who received treatment of anti-anaerobic bacteria combined with surgery was 92.8％,3 patients only with anti-anaerobic bacteria treatment but without surgery were all cured.Conclusion P.intermedia is an opportunistic pathogeanic bacteria which often causes infection in immunocomprised individuals and is prone to be misdiagnosed.It is recommended to perform mNGS detection to identify the pathogen as early as possible and seize the opportunity for treatment to reduce mortality.

Plasmodium falciparum malaria with acute abdominal pain as the first symptom: a case report / 中国血吸虫病防治杂志

Plasmodium falciparum malaria, caused by Plasmodium falciparum infection, is an Anopheles mosquito-transmitted infectious diseases, which predominantly occurs in tropical areas of Africa. P. falciparum malaria is characterized by complex and atypical clinical manifestations, and high likelihood of misdiagnosis and missing diagnosis, and may be life-threatening if treated untimely. This case report presents the diagnosis and treatment of a P. falciparum malaria case with acute abdominal pain as the first symptom.

Giant ovarian mucinous cystadenoma in Derna, Libya

Giant mucinous cystadenomas of the ovary are seldom documented in literature within developed countries, primarily due to the widespread availability of diagnostic technologies. However, in developing nations, such situations pose a challenge owing to limited access to diagnostic tools and constrained resources. Herein, we present the case of 35-year-old women, who reported a three-year history of a progressively enlarging giant mucinous cystadenoma which was initially mistaken for obesity, accompanied by abdominal distension and pain, and was not diagnosed during the cesarean section performed three weeks prior to the significant increase in size. Cystectomy performed, the resected cyst measured 25x23x17 cm, with no evidence of ascites. Subsequent histopathological analysis confirmed the diagnosis of mucinous cystadenoma. The patient experienced a complete postoperative recovery without any complications. Notably, the presence of vague gastrointestinal symptoms unrelated to the actual diagnosis underscores the importance of considering giant ovarian cysts as a potential differential diagnosis for ambiguous abdominal symptoms, given the varied clinical presentations they may manifest. This case underscores the necessity for multidisciplinary collaboration among various specialists to facilitate early diagnosis. Furthermore, it emphasizes the indispensable role of histopathological examination in ensuring accurate diagnosis and appropriate management of ovarian cysts

Surgical treatment of Stanford type A aortic dissection after coronary artery stenting / 中国胸心血管外科临床杂志

@#Objective    To retrospectively analyze the surgical treatment of Stanford type A aortic dissection after coronary artery stenting, and to explore the surgical techniques and surgical indications. Methods    Clinical data of 1 246 consecutive patients who underwent operations on Stanford type A aortic dissection from April 2016 to July 2019 in Beijing Anzhen Hospital were retrospectively analyzed. Patients with Stanford type A aortic dissection after coronary artery stenting were enrolled. Results    Finally 19 patients were collected, including 16 males and 3 females with an average age of 54±7 years ranging from 35 to 66 years. There were 11 patients in acute phase, 15 patients with AC (DeBakey Ⅰ) type and 4 patients with AS (DeBakey Ⅱ) type. In AC type, there were 10 patients receiving Sun's surgery and 5 patients partial arch replacement. Meanwhile, coronary artery bypass grafting was performed in 7 patients and mitral valve replacement in 1 patient. Stents were removed from the right coronary artery in 4 patients. In this group, 1 patient died of multiple organ failure in hospital after operation combined with malperfusion of viscera. Eighteen patients recovered after treatment and were discharged from hospital. The patients were followed up for 30 (18-56) months. One patient underwent aortic pseudoaneurysm resection, one thoracic endovascular aortic repair, one emergency percutaneous coronary intervention due to left main artery stent occlusion, and one underwent femoral artery bypass due to iliac artery occlusion. Conclusion    Iatrogenic aortic dissection has a high probability of coronary artery bypass grafting at the same time in patients with Stanford type A aortic dissection after coronary artery stenting. Complicated type A aortic dissection after percutaneous coronary intervention should be treated with surgery aggressively.

A CASE REPORT OF RIGHT UNILATERAL PULMONARY ARTERY ATRESIA (UPAA) MISDIAGNOSED AS RIGHT CHRONIC PULMONARY THROMBO-EMBOLISM

Unilateral pulmonary artery atresia is a rare condition with clinical presentation as exercise intolerance, recurrent infections, hemoptysis to asymptomatic state with incidental diagnosis. Common modalities of management include medical management for pulmonary hypertension , angioembolisation of collaterals followed by pneumonectomy. However surgical reconstruction of atretic pulmonary artery segment is an uncommon surgical management strategy employed in our case with satisfactory outcome

Retrospective Analysis of Misdiagnosed Literature in 445 Cases with Neck Pain and Reflection / 世界科学技术-中医药现代化

Objective Analysis of misdiagnosis and causes of neck pain related diseases,and to explore the different diagnostic ideas of Chinese and Western medicine and the countermeasures to reduce misdiagnosis,so as to help acupuncturists improve their understanding of this disease.Method The relevant literature on conditions with neck pain as the chief complaint was systematically searched,using data mining for retrospective analysis,sorting out the different diagnostic ideas of Chinese and Western medicine,proposing individualized countermeasures for reducing misdiagnosis.Results ①After retrieval,126 case reports were included,totaling 445 cases of diagnostic error,involving 9 systems and 38 conditions,of which cervical spondylosis was the most commonly misdiagnosed.The confirmed cases involved 7 systems and 46 conditions,of which tumors,subacute thyroiditis,eagle syndrome,acute myocardial infarction and thoracic outlet syndrome were the most commonly misdiagnosed.②The are various causes for the misdiagnosis of this condition,including atypical symptoms,insufficient understanding of the condition,lack of understanding of rare conditions,incomplete physical and auxiliary examina-tions,or wrong guidance.③There are many erroneous diagnosis of neck pain,which can delay the condition and even endanger lives.A clear diagnosis is the premise and basis for effective Traditional Chinese and Western medical intervention.Conclusion There exists a number of possibilities for the misdiagnosis of this disease.Therefore,we must meticulously collect medical history,improve specialist physical and auxiliary examination,emphasizing holistic thinking and differential diagnosis.Acupuncture department as the main department of patients with neck pain,in order to improve the level of diagnosis and treatment of neck pain,requires acupuncturists to consolidate the Western medicine diagnosis of neck pain,closely linked to the Traditional Chinese Medicine"three principles"of"treatment based on disease differentiation",in order to reduce misdiagnosis,cure the disease,improve long-term efficacy.

Cystic echinococcosis misdiagnosed as hepatic cyst: a case report / 中国血吸虫病防治杂志

This case report presents the diagnosis and treatment of a case of cystic echinococcosis misdiagnosed as hepatic cyst. The case had anaphylactic shock caused by extravasation of cyst fluid during extraction of hepatic cyst and suffered from postoperative recurrence of echinococcosis. This case report may provide insights into diagnosis and treatment of cystic echinococcosis among healthcare workers in non-endemic areas.

Missed diagnosis or misdiagnosis: Common pitfalls in genetic testing

Genetic testing has the power to identify individuals with increased predisposition to disease, allowing individuals the opportunity to make informed management, treatment and reproductive decisions. As genomic medicine continues to be integrated into aspects of everyday patient care and the indications for genetic testing continue to expand, genetic services are increasingly being offered by non-genetic clinicians. The current complexities of genetic testing highlight the need to support and ensure non-genetic professionals are adequately equipped with the knowledge and skills to provide services. We describe a series of misdiagnosed/mismanaged cases, highlighting the common pitfalls in genetic testing to identify the knowledge gaps and where education and support is needed. We highlight that education focusing on differential diagnoses, test selection and result interpretation is needed. Collaboration and communication between genetic and non-genetic clinicians and integration of genetic counsellors into different medical settings are important. This will minimise the risks and maximise the benefits of genetic testing, ensuring adverse outcomes are mitigated.

Misdiagnosis of adenoid cystic carcinoma of oropharynx: a case report / 临床耳鼻咽喉头颈外科杂志

Adenoid cystic carcinoma usually occurs in the salivary glands of the head and neck. It is a malignant tumor with a high degree of malignancy, resistance to radiotherapy and chemotherapy and poor prognosis. The clinical course of adenoid cystic carcinoma is slow and easy to be misdiagnosed. The main diagnosis and treatment means are individualized and precise treatment under the multi-disciplinary consultation mode, that is, surgical treatment and radiotherapy and chemotherapy. Adenoid cystic carcinoma is prone to relapse and hematologic metastasis, and the traditional radiotherapy and chemotherapy based therapies have not achieved satisfactory efficacy in the past three decades. How to detect, diagnose and treat early is an urgent task faced by clinicians.

Application of a sleep electroencephalogram in the diagnosis of epilepsy in children / 中国基层医药

Objective:To investigate the significance of sleep electroencephalogram (EEG) monitoring in the diagnosis and differential diagnosis of childhood epilepsy.Methods:The clinical data of 56 children with epilepsy diagnosed in The Maternal and Child Health Hospital of Huainan from February 2020 to February 2022 were retrospectively analyzed. The relationship between the positive rate of epileptiform discharge under sleep EEG monitoring and its location and sleep phase was analyzed.Results:Of the 56 children, 36 (64%) children had normal results of routine awake EEG monitoring, and 20 (36%) children had abnormal results. Among the 56 children, 9 (16%) children had normal sleep and 47 (84%) had abnormal sleep. The difference in EEG monitoring results between the awake and asleep states was statistically significant ( χ2 = 27.08, P < 0.001). Among abnormal EEG in 47 patients, paroxysmal abnormality (epileptiform discharge) was found in 44 patients and non-specific abnormality was found in 3 patients. Among the 44 children with epileptic discharges, 5 (11%) had epileptic discharges during wakefulness, 11 (25%) children had epileptic discharges during a sleepless period, and 28 (64%) had epileptic discharges during a slight sleep period. EEG epileptiform discharges occurred in the central temporal region in 9 (21%) patients, temporal region in 8 (18%) patients, parieto-occipital region in 1 (2%) patient, frontal region in 5 (11%) patients, and the frontotemporal region in 6 (14%) patients. Generalized discharges were found in 14 (32%) patients, and generalized hypsarrhythmia was found in 1 (2%) patient. Conclusion:Children with clinically highly suspected epilepsy should be reexamined by sleep EEG if the routine awake EEG, monitoring results are normal, to reduce the rates of misdiagnosis and missed diagnosis in children with epilepsy.

Clinical characteristics in the misdiagnosis of cytomegalovirus retinitis: A retrospective analysis of eight patients

Purpose: To highlight characteristics in the misdiagnosis of cytomegalovirus retinitis (CMVR). Methods: Misdiagnosed cases related to CMVR were analyzed retrospectively at the Department of Ophthalmology, Beijing Youan Hospital, from July 2017 to October 2019. The medical records were reviewed by two independent senior ophthalmologists and the patients’ clinical characteristics were analyzed. Results: Eight patients (16 eyes) were identified with misdiagnoses related to CMVR. Six of the patients with CMVR were previously unaware of their human immunodeficiency virus (HIV) infection; one patient with CMVR concealed their history of HIV infection. The cases were initially misdiagnosed as diabetic retinopathy (1/7, 14.3%), branch retinal vein occlusion (1/7, 14.3%), ischemic optic neuropathy (1/7, 14.3%), Behçet’s disease (1/7, 14.3%), iridocyclitis (2/7, 28.6%), and progressive outer retinal necrosis (1/7, 14.3%). One patient with binocular renal retinopathy and chronic renal insufficiency was misdiagnosed with CMVR. Four eyes (4/16, 25%) presented with pan?retinal involvement. Fourteen eyes (14/16, 87.5%) had optic disc or macular area involvement. At the final diagnosis, one patient was blind, and two patients had low vision. Seven AIDS patients showed an extremely low level of CD4+ T lymphocytes (median of 5 cells/?l; range 1–9 cells/?l). Conclusion: CMVR may be misdiagnosed in the absence of known immune suppression. CMVR and HIV screening cannot be overlooked if a young male patient presents with yellowish?white retinal lesions. These misdiagnosed patients had severe retinitis associated with poor vision

Osteomielite crônica como uma armadilha ao diagnóstico na prática do dermatologista / Chronic osteomyelitis as a diagnostic pitfall in the practice of the dermatologist: a case report

Na prática clínica da dermatologia não é incomum nos depararmos com situações desafiadoras, de difícil caracterização e que podem nos induzir ao erro diagnóstico. Quadros cutâneos com apresentações semelhantes entre si estão aqui inclusas e, neste caso, é de suma importância a atuação do médico dermatologista de forma a unir as informações da anamnese, exame físico e exames complementares, a fim de excluir condições de pior prognóstico e que requerem atuação mais agressiva de outras condições benignas e/ou com menor impacto negativo. Apresentamos abaixo uma dessas situações de desafio diagnóstico em que uma lesão cutânea secundária à osteomielite crônica foi inicialmente atribuída à causa inflamatória ou neoplásica (AU)

In the clinical practice of Dermatology, it is not uncommon to encounter challenging situations that are difficult to characterize and may lead to misdiagnosis. Skin conditions with similar presentations are included here and, in this case, it is of utmost importance that the dermatologist combines information from the medical history, physical examination and complementary tests in order to exclude conditions with worse prognosis and that require more aggressive action than other benign conditions and/or with less negative impac (AU)

The current situation of the diagnosis of fibromyalgia syndrome / 中华风湿病学杂志

Objective:To investigate the currentstatus of the diagnosis of fibromyalgia syndrome (FMS), and analyze the related factors in order to improve the diagnostic level of the disease.Methods:A survey was carried out, A "FMS diagnosis table" was developed. The demographic data and past medical experience of patients were recorded. The rates of misdiagnosis and missed diagnosis were calculated. The specific misdiagnosed cases were recorded and analyzed. According to the previous diagnosis history, patients were divided into misdiagnosed group, missed diagnosis group and correct diagnosis group. The demographic characteristics, medical history and disease severity in the misdiagnosis group and missed diagnosis group were statistically analyzed, and compared with the correct diagnosis group. The reasons for missed diagnosis or misdiagnosis were explored.Results:A total of 277 patients were included in the survey. Only 19.1%(53 cases) of patients were correctly diagnosed, 22.7%(63 cases) of patients were misdiagnosed, 58.1% of patients were missed. The mean time from first symptom to disease diagnosis was (51.0±81.2) months. They were often misdiagnosed as osteoarthritis ( n=21, 33.3%), rheumatoid arthritis ( n=13, 20.6%), lumbar disease ( n=12, 19.0%), and anxiety and depression ( n=11, 17.4%). Patients' social and economic status such as age, income, educational level and the diagnosis level of pain related clinicians in medical institutions at all levels were factors that might influence misdiagnosis and missed diagnosis rate. In terms of demographic characteristics, the correctly diagnosed group had a lower average age of (44±13) years ( t=8.64/9.20, P<0.05), a higher proportion of employees, a higher monthly income ( χ2=7.10/6.87, P<0.05), and a higher education level ( χ2=7.12, P<0.05). In terms of visits, the rate of visits to other medical institutions (private hospitals) in the missed diagnosis group was higher, and the number of doctors visited was also lower. In terms of illness, the diffuse pain index (WPI) score and FMS symptom severity (SSS) score were lower in the missed diagnosis group. Conclusion:The current situation of the diagnosis of FMS in China is not optimistic, and the diagnosis should be differentiated from osteoarthritis, rheumatoid arthritis, cervical and lumbar diseases, and cardiac diseases. In order to reduce the misdiagnosis and missed diagnosis of this disease, it is necessary to strengthen the public education, improve the understanding of this disease in primary care doctors, and physicians in orthopedics, acupuncture and pain departments.

Hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis: one case report / 中国血吸虫病防治杂志

Hepatic cystic echinococcosis is a chronic parasitic disease caused by the infection with the larvae of Echinococcus granulosus in human or animal liver tissues. As a chronic active infectious disease, tuberculous empyema mainly invades the pleural space and then causes visceral and parietal pleura thickening. It is rare to present comorbidity for hepatic cystic echinococcosis and tuberculous empyema. This case report presents a case of hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis, aiming to improve clinicians’ ability to distinguish this disorder.

Main causes of aplastic anemia misdiagnosed as immune thrombocytopenia in children / 中华实用儿科临床杂志

Objective:To explore the main causes of 50 children with aplastic anemia misdiagnosed as immune thrombocytopenia(ITP), summarize differential diagnosis experience, and provide clinical reference.Methods:According to the diagnostic criteria of aplastic anemia and ITP in children, the initial data of misdiagnosed cases in other hospital admitted to the Department of Pediatrics, Shanghai Tongji Hospital from January 2007 to December 2020, and the results of their re-examination tests in this hospital were analyzed.The causes of misdiagnosis and the main points of differential diagnosis were summarized.Results:Of the 165 children with aplastic anemia treated in the same period, 50 cases (30.3%) had been misdiagnosed as ITP.The main causes of misdiagnosis were summarized as follows.(1) The clinical manifestations in 22 cases disagreed with " typical symptoms of ITP" , and necessary bone marrow examinations were not performed in accordance with the international guidelines to confirm the diagnosis.(2) The bone marrow test results were interpreted falsely.Among 28 patients who underwent the bone marrow smear examination, 6 cases (21%) showed typical aplastic bone marrow, but they were still misdiagnosed with ITP.(3) Patients (15/28 cases, 54%) with atypical bone marrow smears did not receive further bone marrow biopsy to facilitate the diagnosis.(4) In 7 cases (7/28 cases, 25%), their bone marrow examination results met the diagnostic criteria of ITP at initial diagnosis, but no necessary review was performed to verify and correct the diagnosis after glucocorticoid trea-tment failed.Conclusions:Clinical diagnosis should be made in restrict accordance with related disease diagnostic criteria to avoid empirical errors.Diagnosis of ITP requires caution.Especially for those with atypical clinical manifestations or irresponsive to first-line drugs, bone marrow examinations (bone marrow biopsy if necessary) must be performed, and the test results should be correctly interpreted according to the diagnostic criteria to prevent clinical misdiagnosis or missed diagnosis.

Analysis of diagnosis and treatment of 18 cases with patellar sleeve fracture in children / 中华实用儿科临床杂志

Objective:To analyze the clinical characteristic of patellar sleeve fracture in children, so as to improve the understanding of pediatric patellar sleeve fracture and reduce the misdiagnosis rate.Methods:Clinical data of 18 children with patellar sleeve fractures admitted and followed up in Department of Pediatric Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University from January 2013 to December 2019 were retrospectively analyzed, including 10 males and 8 females with the mean age of 11.4 years (8.0-14.0 years). There were 10 right patellar sleeve fracture cases, 7 left cases, and 1 case on both sides.Classified by the fracture cause, 10 cases were caused by falls, 3 cases of high jump, 2 cases of falling from height, 2 cases of car accidents, and 1 case of rope skipping, and all of cases were closed injuries.The mean post-injury visit to Affiliated Hospital of Zunyi Medical University was 3.5 days (4 hours -7 days). Twelve out of cases were transferred from other hospitals.All patients were treated with the open reduction and tension band wiring or patella tendon suturing through bone tunnel + patella circumferential wire banding and fixation.The curative effect of patella fracture was evaluated by the Bostman score.Results:Eighteen children with patellar sleeve fracture were diagnosed and treated promptly after admission, and regularly followed up after the operation for an average of 14 months (9-28 months). All cases achieved stage Ⅰ wound healing, and Kirschner wires and steel wires were removed according to the condition of fracture healing at 6 to 10 months postoperatively.According to the Bostman score for evaluating the patella fracture, 15 cases were excellent, 3 cases were good, and there were no missed or misdiagnosed cases.Conclusions:Patella sleeve avulsion fracture is a unique type of fracture in children.As cartilage is the main distal avulsion fracture lesion, it is difficult to be detected on X-ray scans, thus easily leading to missed diagnosis and misdiagnosis.Improving the understanding of this fracture type is the key to the early diagnosis and treatment.

Misdiagnosis of Acute Renal Artery Thrombosis as Acute Abdominal Disease:Report of One Case / 中国医学科学院学报

Renal artery thrombosis can cause acute occlusion of unilateral or bilateral renal arteries,and kidney failure would be induced if it is not diagnosed and treated in time.Therefore,rapid and correct treatment is especially important for renal artery thrombosis.Due to the lack of specificity of clinical manifestations,this disease in commonly misdiagnosed or missed and thus has a low early diagnosis rate.Here we report a case of acute renal artery thrombosis to improve the diagnosis and treatment.

Patrones morfológicos erróneamente diagnosticados como huellas de mordedura en contextos forenses: una revisión con búsqueda sistemática / Morphological patterns misdiagnosed as bite marks in forensic contexts: a scoping review

RESUMEN: El análisis de huellas de mordedura para identificación forense puede ser clave para establecer la inocencia o culpabilidad del acusado. Sin embargo, esta evidencia ha sido cuestionada por su falta de consenso y objetividad, y por sus reportadas identificaciones erróneas. Se presenta una revisión con búsqueda sistemática de casos indicando errores diagnósticos y sus caracterizaciones, y se discuten las recomendaciones realizadas para evitarlos. Se utilizó la estrategia ("bite mark" OR "bitemark") AND ("artefactual" OR "misidentification" OR "misdiagnosis" OR "mistake"), incluyendo casos de huellas de mordedura humana en piel con reportes de errores diagnósticos, excluyendo diseños experimentales, huellas en alimentos u objetos. Fueron seleccionados un total de 13 documentos reportando 21 casos, abarcando los años 1989 a 2014. Los patrones morfológicos con mayor reporte de error diagnóstico fueron los producidos por trauma cortante o contuso por otras causas (10 casos), seguidos de los producidos por condiciones médicas y tratamientos de emergencia (6 casos). Al menos tres de los casos tomaron estado público, dos de ellos con sentencia de muerte y uno con condena de 25 años a prisión perpetua. Se ha enfatizado el dar minuciosidad y estandarización a la evaluación morfológica de este tipo de evidencias por la importante cantidad de condenas erróneas. Esta revisión pone en evidencia la escasa exposición y análisis de estos errores, con la insuficiente información para un aprendizaje significativo crítico y diseño de herramientas para evitarlos. Se coincide en la necesidad de estandarizar y optimizar protocolos para estas evidencias y adoptar una conducta reflexiva para sus análisis con fines de identificación forense.

SUMMARY: Bite mark analysis for forensic identification can be key to establishing the innocence or guilt of the defendant. However, this evidence has been challenged for its lack of consensus and objectivity, and its reported misidentifications. We present a scoping review of cases indicating misidentifications and their characterizations, and recommendations for avoid them are discussed. The strategy ("bite mark" OR "bitemark") AND ("artifactual" OR "misidentification" OR "misdiagnosis" OR "mistake") was used, including cases of human bite marks on skin with reported misdiagnosis, excluding experimental designs, bite marks on food or objects. A total of 13 documents were selected reporting 21 cases, covering the years 1989 to 2014. The morphological patterns with the highest report of misdiagnosis were those produced by cutting or blunt trauma due to other causes (10 cases), followed by those produced by medical conditions and emergency treatments (6 cases). At least three of the cases became public, two of them with a death sentence, and one with a 25-year sentence to life in prison. The thoroughness and standardization of the morphological evaluation of this type of evidence has been emphasized due to the significant number of erroneous convictions. This review highlights the scarce exposure and analysis of these errors, with insufficient information for critical meaningful learning and the design of tools to avoid them. There is agreement on the need to standardize and optimize protocols for these evidences and adopt a reflective behavior for their analysis for forensic identification purposes.

Risk factors for misdiagnosis of ruptured intracranial aneurysms / 中华神经医学杂志

Objective:To explore the risk factors for misdiagnosis of ruptured intracranial aneurysm.Methods:A total of 606 patients with ruptured intracranial aneurysms, admitted to our hospital from October 2014 to October 2020, were enrolled in our study; these patients were divided into two groups according to whether they were initially misdiagnosed: misdiagnosis group ( n=35) and non-misdiagnosis group ( n=571). The general clinical data of patients from the two groups were compared; multivariate Logistic regression was used to identify the independent influencing factors for misdiagnosis. Receiver operating characteristic (ROC) curve was drawn according to the regression model to evaluate the predictive value of different factors for misdiagnosis. The re-rupture of aneurysms and different prognoses were compared between the two groups. Results:There were significant differences in Fisher grading, primarily visited departments, aneurysm diameters, hospital levels, and propaganda and education situation of the first visited doctors between the 2 groups ( P<0.05). Multivariate Logistic regression analysis showed that the independent factors for misdiagnosis of ruptured intracranial aneurysms were as follows: modified Fisher grading 0-II ( OR=12.284, 95%CI: 5.397-27.958, P=0.000); aneurysm diameter ≥10 mm ( OR=2.871, 95%CI: 1.276-6.456, P=0.011), not neurology or neurosurgery as primarily visited departments ( OR=9.279, 95%CI: 4.019-21.420, P=0.001), and first visited doctor not receiving propaganda and education ( OR=2.907, 95%CI: 1.258-6.721, P=0.013); area under the ROC curve of not neurology or neurosurgery as primarily visited departments and modified Fisher grading 0-II were 0.747 and 0.754, which had good predictive value in the misdiagnosis of ruptured intracranial aneurysm. Re-ruptured aneurysms occurred in 37.1% patients from the misdiagnosis group and 5.3% patients from the non-misdiagnosis group, with significant difference ( P<0.05); and the proportion of patients with poor prognosis at discharge (modified Rankin scale scores>2) was 42.9% in the misdiagnosis group and 22.6% in the non-misdiagnosis group, with significant difference ( P<0.05). Conclusion:Patients with modified Fisher grading 0-II, without neurology or neurosurgery as primarily visited departments and with aneurysm≥ 10 mm, and patients whose first visited doctor not receiving professional education of spontaneous subarachnoid hemorrhage have high risks of misdiagnosis of ruptured intracranial aneurysm; strengthening the professional education of spontaneous subarachnoid hemorrhage for doctors from non-neurology or neurosurgery departments of hospital at different levels may reduce the misdiagnosis rate.

The misdiagnosis reported about a case of adrenal alveolar echinococcosis / 中华泌尿外科杂志

The clinical data of a case of adrenal alveolar echinococcosis treated and misdiagnosed in our hospital were reported retrospectively. The pre-operative CT examination of this patient showed that the liver S7 segment-the right adrenal gland area showed irregular masses of mixed density lesions, the boundary was unclear, consider the possibility of liver hydatid. During the operation, hydatid was found to only invade the liver capsule, and the primary lesion was the adrenal gland. The right adrenal gland and lesion were resected by urological surgeons. The pathological diagnosis was adrenal alveolar echinococcosis. When the imaging examination considers hepatic alveolar echinococcosis, and the lesion is mainly in the right adrenal gland area, it should be considered that the primary lesion could be in the adrenal gland.