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1.
Emerg Med Clin North Am ; 39(3): 479-491, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215398

RESUMO

The top 5 reasons for pediatric malpractice are cardiac or cardiorespiratory arrest, appendicitis, disorder of male genital organs, encephalopathy, and meningitis. Malpractice is most likely to result from an "error in diagnosis." Claims involving a "major permanent injury" were more likely to pay out money, but of all claims, only 30% result in a monetary pay out. Consideration of "high-risk misses" may help to direct a history, examination, testing, and discharge instructions.


Assuntos
Erros de Diagnóstico/legislação & jurisprudência , Medicina de Emergência Pediátrica/legislação & jurisprudência , Apendicite/diagnóstico , Criança , Internação Compulsória de Doente Mental/legislação & jurisprudência , Diagnóstico Diferencial , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Masculino , Imperícia/economia , Imperícia/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudência , Torção do Cordão Espermático/diagnóstico , Estados Unidos
2.
BMC Womens Health ; 21(1): 264, 2021 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217289

RESUMO

BACKGROUND: Robert's uterus is a rare Mullerian anomaly, which can be described as an asymmetric, septate uterus with a non-communicating hemicavity. Herein, we present the case of a misdiagnosed Robert's uterus, resulting in an invasive and disadvantageous surgery. CASE PRESENTATION: A 16-year-old woman was referred to our department because of dysmenorrhea and suspicion of uterine malformation. We misdiagnosed Robert's uterus as a unicornuate uterus with a non-communicating rudimentary horn and hematometra, and performed laparoscopic hemi-hysterectomy. Although the patient's symptoms were relieved, our surgical procedure left the lateral uterine wall weak, making the patient's uterus susceptible to uterine rupture in any future pregnancy. CONCLUSIONS: Although the early diagnosis of Robert's uterus is challenging, it is important in order to determine appropriate surgical interventions and management for maintaining the quality of life and ensuring safety in future pregnancies.


Assuntos
Hematometra , Anormalidades Urogenitais , Adolescente , Erros de Diagnóstico , Feminino , Humanos , Gravidez , Qualidade de Vida , Útero/cirurgia
3.
J Radiol Case Rep ; 15(6): 19-25, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34276877

RESUMO

A 66-year-old cachectic female with underlying anorexia nervosa and lower limb weakness was referred for a spinal Magnetic Resonance Imaging. Imaging appearances were initially thought to represent underlying systemic pathology involving bone marrow or inadvertent wrong selection of imaging sequences. It was, however, established that unique imaging appearances are secondary to 'Flip-Flop' phenomenon owing to underlying nutritional status of the patient. 'Flip-Flop' phenomenon on the Magnetic Resonance Imaging is result of an underlying pathological process of serous atrophy of bone marrow. Appreciation and recognition of this phenomenon will help in the correct interpretation of the images and leads a clinician toward appropriate management.


Assuntos
Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Erros de Diagnóstico , Imageamento por Ressonância Magnética , Idoso , Anorexia Nervosa/complicações , Atrofia/diagnóstico por imagem , Atrofia/patologia , Caquexia/complicações , Feminino , Humanos , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia
5.
Trop Biomed ; 38(2): 129-133, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34172701

RESUMO

We describe a child with acute fever and abdominal pain who developed rash and edema of extremities. Blood test revealed thrombocytopenia, lymphopenia, positive dengue-IgM, and hypoalbuminemia with elevated procalcitonin. Right pleural effusion revealed from chest x-ray. Diagnosed as dengue hemorrhagic fever (DHF) grade 1, however, at 7th day of illness, altered mental status, respiratory and circulatory failure occurred. Laboratory examination showed marked thrombocytopenia, transaminitis, metabolic acidosis, elevated D-dimer, decrease fibrinogen, and elevated cardiac marker (troponin I and CKMB). The patient then developed catecholamine-resistant shock and did not survive after 48 hours. Although rapid test of SARS CoV-2 infection was negative, rapid deterioration with some unusual clinical feature suggest multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection. This case raises an awareness of MIS-C that clinical features resemble dengue infection.


Assuntos
COVID-19/diagnóstico , COVID-19/mortalidade , Erros de Diagnóstico/mortalidade , Dengue Grave/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Criança , Cuidados Críticos , Vírus da Dengue , Diagnóstico Diferencial , Feminino , Humanos , SARS-CoV-2
6.
Pan Afr Med J ; 39: 10, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34178238

RESUMO

Introduction: salivary gland tumors mainly occur in the parotid gland. These tumors are rare but are characterized by histological heterogeneity, thus posing diagnostic challenges. Magnetic resonance imaging (MRI) is currently the most reliable imaging test for the evaluation of these tumors. The purpose of this study was to highlight the diagnostic value of MRI and its role in parotid gland tumor histopathology. Methods: we conducted a retrospective descriptive and analytical study of 50 patients with parotid gland tumor, operated and treated in the ear, nose and throat (ENT) Department and in the Department of cervicofacial surgery at the Tahar Sfar University Hospital of Mahdia between 2001 and 2019. All patients underwent preoperative MRI of the parotid gland. Results: out of 50 patients included in the study, 36 (72%) had benign tumor and 14 (28%) malignant tumor. The sensitivity of MRI for the diagnosis of malignant tumor was 92.8% with a specificity of 97.2%, a negative predictive value of 93% and a positive predictive value of 97%. With respect to benign tumor characterization, MRI suggested the diagnosis of Warthin tumor in all cases (13 cases) and of pleomorphic adenoma in 22 out of 23 cases. There were two diagnostic errors: MRI suggested the diagnosis of pleomorphic adenoma instead of adenoid cystic carcinoma in one case and of malignant tumor instead of pleomorphic adenoma due to diffusion restriction. Conclusion: MRI is highly efficient in the assessment of parotid tumor histology and, especially, after the advent of new functional sequences. However, only histological examination allows to confirm with certainty the diagnosis.


Assuntos
Imageamento por Ressonância Magnética , Glândula Parótida/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Adenolinfoma/diagnóstico por imagem , Adenoma Pleomorfo/diagnóstico por imagem , Adolescente , Adulto , Idoso , Carcinoma Adenoide Cístico/diagnóstico por imagem , Erros de Diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Parótida/patologia , Neoplasias Parotídeas/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Adulto Jovem
7.
Medicine (Baltimore) ; 100(26): e26509, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190181

RESUMO

ABSTRACT: Medical diagnosis and therapy often rely on laboratory testing. We observed mistaken testing in evaluations for hemophagocytic lymphohistiocytosis (HLH) that led to delays and adverse outcomes. Physicians were mistakenly ordering interleukin-2 and quantitative natural killer cell flow cytometry, rather than soluble interleukin 2 receptor (sIL2R) or qualitative natural killer functional tests in the evaluation of patients suspected to have HLH.We initiated a prospective quality improvement project to reduce mistaken testing, reduce delays in correct testing due to mistaken ordering, and improve HLH evaluations. This consisted of provider education, developing an evaluation algorithm, and ultimately required systems interventions such as pop-ups and removal of the mistaken tests from the electronic ordering catalog.Active education reduced mistaken testing significantly in HLH evaluations from baseline (73.3% vs 33.3%, P = .003, relative risk reduction (RRR) 54.5%), but failed to meet the pre-specified RRR cutoff for success (70%). Education alone did not significantly reduce the proportion of HLH evaluations with delays in sIL2R testing (23.3% vs 7.4%, P = .096). Mistaken testing increased after the active intervention ended (33.3% vs 43.5%, P = .390, with RRR 40.7% from baseline. Mistaken test removal was successful: mistaken testing dropped to 0% (P < .001, RRR 100%), saved $14,235 yearly, eliminated delays in sIL2R testing from mistaken testing (23.3% vs 0%, P = .008), and expedited sIL2R testing after admission for HLH symptoms (14.6 days vs 3.8 days, P = .0012). These data show systems controls are highly effective in quality improvement while education has moderate efficacy.


Assuntos
Serviços de Laboratório Clínico/normas , Erros de Diagnóstico , Linfo-Histiocitose Hemofagocítica/diagnóstico , Melhoria de Qualidade/organização & administração , Erros de Diagnóstico/prevenção & controle , Erros de Diagnóstico/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Avaliação de Resultados em Cuidados de Saúde , Risco Ajustado/métodos , Risco Ajustado/organização & administração , Desenvolvimento de Pessoal/métodos , Desenvolvimento de Pessoal/organização & administração , Tempo para o Tratamento/estatística & dados numéricos
8.
Trop Biomed ; 38(2): 129-133, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1282843

RESUMO

We describe a child with acute fever and abdominal pain who developed rash and edema of extremities. Blood test revealed thrombocytopenia, lymphopenia, positive dengue-IgM, and hypoalbuminemia with elevated procalcitonin. Right pleural effusion revealed from chest x-ray. Diagnosed as dengue hemorrhagic fever (DHF) grade 1, however, at 7th day of illness, altered mental status, respiratory and circulatory failure occurred. Laboratory examination showed marked thrombocytopenia, transaminitis, metabolic acidosis, elevated D-dimer, decrease fibrinogen, and elevated cardiac marker (troponin I and CKMB). The patient then developed catecholamine-resistant shock and did not survive after 48 hours. Although rapid test of SARS CoV-2 infection was negative, rapid deterioration with some unusual clinical feature suggest multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection. This case raises an awareness of MIS-C that clinical features resemble dengue infection.


Assuntos
COVID-19/diagnóstico , COVID-19/mortalidade , Erros de Diagnóstico/mortalidade , Dengue Grave/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Criança , Cuidados Críticos , Vírus da Dengue , Diagnóstico Diferencial , Feminino , Humanos , SARS-CoV-2
9.
Biochem Med (Zagreb) ; 31(2): 020710, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: covidwho-1278714

RESUMO

Introduction: The COVID-19 pandemic has posed several challenges to clinical laboratories across the globe. Amidst the outbreak, errors occurring in the preanalytical phase of sample collection, transport and processing, can further lead to undesirable clinical consequences. Thus, this study was designed with the following objectives: (i) to determine and compare the blood specimen rejection rate of a clinical laboratory and (ii) to characterise and compare the types of preanalytical errors between the pre-pandemic and the pandemic phases. Materials and methods: This retrospective study was carried out in a trauma-care hospital, presently converted to COVID-19 care centre. Data was collected from (i) pre-pandemic phase: 1st October 2019 to 23rd March 2020 and (ii) pandemic phase: 24th March to 31st October 2020. Blood specimen rejection rate was calculated as the proportion of blood collection tubes with preanalytical errors out of the total number received, expressed as percentage. Results: Total of 107,716 blood specimens were screened of which 43,396 (40.3%) were received during the pandemic. The blood specimen rejection rate during the pandemic was significantly higher than the pre-pandemic phase (3.0% versus 1.1%; P < 0.001). Clotted samples were the commonest source of preanalytical errors in both phases. There was a significant increase in the improperly labelled samples (P < 0.001) and samples with insufficient volume (P < 0.001), whereas, a significant decline in samples with inadequate sample-anticoagulant ratio and haemolysed samples (P < 0.001). Conclusion: In the ongoing pandemic, preanalytical errors and resultant blood specimen rejection rate in the clinical laboratory have significantly increased due to changed logistics. The study highlights the need for corrective steps at various levels to reduce preanalytical errors in order to optimise patient care and resource utilisation.


Assuntos
Coleta de Amostras Sanguíneas/métodos , COVID-19/diagnóstico , Fase Pré-Analítica , Coleta de Amostras Sanguíneas/instrumentação , COVID-19/epidemiologia , COVID-19/virologia , Erros de Diagnóstico , Humanos , Laboratórios Hospitalares/normas , Pandemias , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação
11.
J Prim Care Community Health ; 12: 21501327211024431, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1268186

RESUMO

The term "COVID arm" has been coined to describe a harmless delayed hypersensitivity reaction occurring approximately a week after administration of the novel SARS-CoV-2 mRNA vaccine. It appears as a red, warm, pruritic, indurated, or swollen area in the vicinity of the vaccine site. These reactions, especially if accompanied by systemic symptoms, have been mistaken for cellulitis. We report 3 cases of COVID arm, 2 of which were mistaken for cellulitis. Distinguishing features of COVID arm from cellulitis include pruritus as a common finding, occurrence approximately a week after vaccination, a lack of progression of symptoms, rapid response to topical steroids, and/or spontaneous resolution usually over 4 to 5 days.Practice Points:• Patients receiving SARS-CoV-2 vaccines may experience delayed hypersensitivity reactions characterized by erythema, swelling, and itching occurring near the vaccination site (COVID arm), approximately a week after vaccination.• Clinicians can distinguish SARS-CoV-2 vaccine reactions from cellulitis by the time of onset (approximately a week vs 5 days), by the lack of progression of symptoms, and resolution over 4 to 5 days.• Severe cases of COVID arm may be treated with topical steroids.


Assuntos
COVID-19 , Hipersensibilidade Tardia , Vacinas , Braço , Vacinas contra COVID-19 , Celulite (Flegmão)/induzido quimicamente , Celulite (Flegmão)/diagnóstico , Erros de Diagnóstico , Humanos , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Tardia/diagnóstico , SARS-CoV-2
12.
Biochem Med (Zagreb) ; 31(2): 020713, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: covidwho-1290399

RESUMO

Introduction: Following a pandemic, laboratory medicine is vulnerable to laboratory errors due to the stressful and high workloads. We aimed to examine how laboratory errors may arise from factors, e.g., flexible working order, staff displacement, changes in the number of tests, and samples will reflect on the total test process (TTP) during the pandemic period. Materials and methods: In 12 months, 6 months before and during the pandemic, laboratory errors were assessed via quality indicators (QIs) related to TTP phases. QIs were grouped as pre-, intra- and postanalytical. The results of QIs were expressed in defect percentages and sigma, evaluated with 3 levels of performance quality: 25th, 50th and 75th percentile values. Results: When the pre- and during pandemic periods were compared, the sigma value of the samples not received was significantly lower in pre-pandemic group than during pandemic group (4.7σ vs. 5.4σ, P = 0.003). The sigma values of samples transported inappropriately and haemolysed samples were significantly higher in pre-pandemic period than during pandemic (5.0σ vs. 4.9σ, 4.3σ vs. 4.1σ; P = 0.046 and P = 0.044, respectively). Sigma value of tests with inappropriate IQC performances was lower during pandemic compared to the pre-pandemic period (3.3σ vs. 3.2σ, P = 0.081). Sigma value of the reports delivered outside the specified time was higher during pandemic than pre-pandemic period (3.0σ vs. 3.1σ, P = 0.030). Conclusion: In all TTP phases, some quality indicators improved while others regressed during the pandemic period. It was observed that preanalytical phase was affected more by the pandemic.


Assuntos
COVID-19/epidemiologia , Laboratórios Hospitalares/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , COVID-19/patologia , COVID-19/virologia , Erros de Diagnóstico/estatística & dados numéricos , Humanos , Pandemias , Indicadores de Qualidade em Assistência à Saúde/normas , SARS-CoV-2/isolamento & purificação , Turquia/epidemiologia
13.
BMC Infect Dis ; 21(1): 532, 2021 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-34092232

RESUMO

BACKGROUND: Legionella bacteria is a common cause of pneumonia, but the infection may affect several organs in the most serious cases. A systemic involvement ab initio could be non-specific, leading to a diagnostic misinterpretation. CASE PRESENTATION: A 33-year-old woman had been complaining of mental confusion, restlessness, aggressiveness, and, subsequently, hirsutism. After 3 weeks, the patient developed pneumonia and died during the hospitalization. The autopsy examination revealed a multi-organ necrotizing exudative disease involving the lung, the heart and the brain. The microbiological tests of tracheal aspirate were positive for Legionella pneumophila serotype 1. CONCLUSION: The Legionella infection may show a proteiform clinical course and an extra-pulmonary manifestation may be the first sign of the disease. Herein, we report a case of Legionella infection in a young female, presenting with non-specific neurological symptoms and hirsutism at onset, misdiagnosed as a metabolic disease.


Assuntos
Hirsutismo/microbiologia , Legionella pneumophila , Doença dos Legionários/diagnóstico , Pneumonia Bacteriana/microbiologia , Adulto , Autopsia , Encéfalo , Erros de Diagnóstico , Evolução Fatal , Feminino , Humanos , Doença dos Legionários/complicações , Pulmão , Transtornos Mentais/microbiologia
14.
Medicina (Kaunas) ; 57(5)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068430

RESUMO

Introduction: Meckel's diverticulum (MD), a remnant of the omphaloenteric duct, is among the most frequent intestinal malformations. Another embryonic vestige is the urachus, which obliterates, becoming the median umbilical ligament; the failure of this process can lead to a urachal cyst formation. We present a case of Meckel diverticulitis misdiagnosed as an infected urachal cyst. Presentation of case: A 16-year-old girl presented with hypogastric pain, fever and vomiting. She had undergone an appendectomy 6 years prior and no digestive malformation had been documented. In the last 2 years, she had 3 events of urinary tract infections with Escherichia coli, and anabdominal ultrasound discovered a 28/21 mm hypoechogenic preperitoneal round tumor, anterosuperior to the bladder. We established the diagnosis of an infected urachal cyst, confirmed later by magnetic resonance imaging. Intraoperative, we found MD with necrotic diverticulitis attached to the bladder dome. Discussions: Meckel's diverticulum and urachal cyst (UC) are embryonic remnants. Both conditions are usually asymptomatic, being incidentally discovered during imaging or surgery performed for other abdominal pathology. Imaging diagnosis is accurate for UC, but for MD they are low sensitivity and specificity. For UC treatment, there is a tendency to follow an algorithm related to age and symptoms, but there is no general consensus on whether to perform a routine resection of incidentally discovered MD. Conclusion: Preoperatory diagnosis of MD represents a challenge. We want to emphasize the necessity of a thorough inspection of the small bowel during all abdominal surgical interventions and MD surgical excision regardless of its macroscopic appearance. These two actions seem to be the best prophylaxis measures for MD complications and consequently to avoid emergency surgery, in which case more extensive surgical procedures on an unstable patient may be needed.


Assuntos
Diverticulite , Divertículo Ileal , Cisto do Úraco , Adolescente , Erros de Diagnóstico , Feminino , Humanos , Divertículo Ileal/diagnóstico por imagem , Divertículo Ileal/cirurgia , Cisto do Úraco/diagnóstico por imagem , Cisto do Úraco/cirurgia
15.
Medicina (Kaunas) ; 57(5)2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-34066172

RESUMO

INTRODUCTION: Leriche syndrome is an aortoiliac occlusive disease caused by atherosclerotic occlusion. We report a case of Leriche syndrome with a fracture that was suspected as complex regional pain syndrome (CRPS), as the post-traumatic pain gradually worsened in the form of excruciating neuropathic pain. CASE REPORT: A 52-year-old woman with a history of hypertension was referred to the Department of Pain Medicine from a local orthopedic clinic because of suspected CRPS for excruciating neuropathic pain for one month. She complained of gait dysfunction and severe pain in the right foot following an incident of trauma with the right first toe. The average pain intensity assessed using the visual analog scale (VAS) was 90 (0: no pain, 100: the worst pain imaginable), and the neuropathic pain was evident as a score of 6/10 on Douleur neuropathique 4. Allodynia, hyperalgesia, blue discoloration of the skin, asymmetric temperature change (1.38 °C), and edematous soft tissue changes were observed. Ultrasonography showed a chip fracture in the first distal phalanx of the right first toe. The diagnosis was most probably CRPS type I according to the Budapest research criteria for CRPS. However, multiple pain management techniques were insufficient in controlling the symptoms. A month and a half later, an ankle-brachial index score of less than 0.4 suggested severe peripheral artery disease. Computed tomography angiography showed total occlusion between the infrarenal abdominal aorta and the bilateral common iliac arteries. Therefore, she underwent aortic-bifemoral bypass surgery with a diagnosis of Leriche syndrome. Three months after the surgery, the average pain intensity was graded as 10 on the VAS (0-100), the color of the skin of the right first toe improved and no gait dysfunction was observed. CONCLUSION: A chip fracture in a region with insufficient blood flow could manifest as excruciating neuropathic pain in Leriche syndrome.


Assuntos
Síndromes da Dor Regional Complexa , Síndrome de Leriche , Neuralgia , Aorta Abdominal , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/etiologia , Erros de Diagnóstico , Feminino , Humanos , Síndrome de Leriche/complicações , Síndrome de Leriche/diagnóstico , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Neuralgia/etiologia
16.
J Int Med Res ; 49(6): 3000605211012668, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34098756

RESUMO

Paragonimiasis is a disease caused by parasitic infections that mainly involve the lungs. However, it can also produce ectopic infections, such as when the parasites invade the liver, brain and subcutaneous tissue, which then cause different symptoms. This current case report describes a 55-year-old male patient with hepatic paragonimiasis that was misdiagnosed as liver cancer with rupture and haemorrhage. The initial computed tomography findings suggested ruptured liver cancer. The patient underwent laparoscopic right hemihepatectomy. Postoperative pathological analysis resulted in a diagnosis of hepatic paragonimiasis. The patient recovered well postoperatively and was treated with 25 mg/kg praziquantel orally three times a day for 3 days after discharge with good efficacy. In this present case, the rupture and haemorrhage of the liver mass made it difficult for the treating physicians to consider hepatic paragonimiasis, which lead to the initial misdiagnosis of this patient. Although paragonimiasis is very rare, medical staff should be vigilant and have a comprehensive understanding of the different diseases that can cause liver masses so that misdiagnosis can be avoided.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Paragonimíase , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/diagnóstico por imagem , Erros de Diagnóstico , Hemorragia , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Paragonimíase/diagnóstico , Paragonimíase/diagnóstico por imagem
17.
Biochem Med (Zagreb) ; 31(2): 020710, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34140833

RESUMO

Introduction: The COVID-19 pandemic has posed several challenges to clinical laboratories across the globe. Amidst the outbreak, errors occurring in the preanalytical phase of sample collection, transport and processing, can further lead to undesirable clinical consequences. Thus, this study was designed with the following objectives: (i) to determine and compare the blood specimen rejection rate of a clinical laboratory and (ii) to characterise and compare the types of preanalytical errors between the pre-pandemic and the pandemic phases. Materials and methods: This retrospective study was carried out in a trauma-care hospital, presently converted to COVID-19 care centre. Data was collected from (i) pre-pandemic phase: 1st October 2019 to 23rd March 2020 and (ii) pandemic phase: 24th March to 31st October 2020. Blood specimen rejection rate was calculated as the proportion of blood collection tubes with preanalytical errors out of the total number received, expressed as percentage. Results: Total of 107,716 blood specimens were screened of which 43,396 (40.3%) were received during the pandemic. The blood specimen rejection rate during the pandemic was significantly higher than the pre-pandemic phase (3.0% versus 1.1%; P < 0.001). Clotted samples were the commonest source of preanalytical errors in both phases. There was a significant increase in the improperly labelled samples (P < 0.001) and samples with insufficient volume (P < 0.001), whereas, a significant decline in samples with inadequate sample-anticoagulant ratio and haemolysed samples (P < 0.001). Conclusion: In the ongoing pandemic, preanalytical errors and resultant blood specimen rejection rate in the clinical laboratory have significantly increased due to changed logistics. The study highlights the need for corrective steps at various levels to reduce preanalytical errors in order to optimise patient care and resource utilisation.


Assuntos
Coleta de Amostras Sanguíneas/métodos , COVID-19/diagnóstico , Fase Pré-Analítica , Coleta de Amostras Sanguíneas/instrumentação , COVID-19/epidemiologia , COVID-19/virologia , Erros de Diagnóstico , Humanos , Laboratórios Hospitalares/normas , Pandemias , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação
18.
Biochem Med (Zagreb) ; 31(2): 020713, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34140836

RESUMO

Introduction: Following a pandemic, laboratory medicine is vulnerable to laboratory errors due to the stressful and high workloads. We aimed to examine how laboratory errors may arise from factors, e.g., flexible working order, staff displacement, changes in the number of tests, and samples will reflect on the total test process (TTP) during the pandemic period. Materials and methods: In 12 months, 6 months before and during the pandemic, laboratory errors were assessed via quality indicators (QIs) related to TTP phases. QIs were grouped as pre-, intra- and postanalytical. The results of QIs were expressed in defect percentages and sigma, evaluated with 3 levels of performance quality: 25th, 50th and 75th percentile values. Results: When the pre- and during pandemic periods were compared, the sigma value of the samples not received was significantly lower in pre-pandemic group than during pandemic group (4.7σ vs. 5.4σ, P = 0.003). The sigma values of samples transported inappropriately and haemolysed samples were significantly higher in pre-pandemic period than during pandemic (5.0σ vs. 4.9σ, 4.3σ vs. 4.1σ; P = 0.046 and P = 0.044, respectively). Sigma value of tests with inappropriate IQC performances was lower during pandemic compared to the pre-pandemic period (3.3σ vs. 3.2σ, P = 0.081). Sigma value of the reports delivered outside the specified time was higher during pandemic than pre-pandemic period (3.0σ vs. 3.1σ, P = 0.030). Conclusion: In all TTP phases, some quality indicators improved while others regressed during the pandemic period. It was observed that preanalytical phase was affected more by the pandemic.


Assuntos
COVID-19/epidemiologia , Laboratórios Hospitalares/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , COVID-19/patologia , COVID-19/virologia , Erros de Diagnóstico/estatística & dados numéricos , Humanos , Pandemias , Indicadores de Qualidade em Assistência à Saúde/normas , SARS-CoV-2/isolamento & purificação , Turquia/epidemiologia
19.
J Prim Care Community Health ; 12: 21501327211024431, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120504

RESUMO

The term "COVID arm" has been coined to describe a harmless delayed hypersensitivity reaction occurring approximately a week after administration of the novel SARS-CoV-2 mRNA vaccine. It appears as a red, warm, pruritic, indurated, or swollen area in the vicinity of the vaccine site. These reactions, especially if accompanied by systemic symptoms, have been mistaken for cellulitis. We report 3 cases of COVID arm, 2 of which were mistaken for cellulitis. Distinguishing features of COVID arm from cellulitis include pruritus as a common finding, occurrence approximately a week after vaccination, a lack of progression of symptoms, rapid response to topical steroids, and/or spontaneous resolution usually over 4 to 5 days.Practice Points:• Patients receiving SARS-CoV-2 vaccines may experience delayed hypersensitivity reactions characterized by erythema, swelling, and itching occurring near the vaccination site (COVID arm), approximately a week after vaccination.• Clinicians can distinguish SARS-CoV-2 vaccine reactions from cellulitis by the time of onset (approximately a week vs 5 days), by the lack of progression of symptoms, and resolution over 4 to 5 days.• Severe cases of COVID arm may be treated with topical steroids.


Assuntos
COVID-19 , Hipersensibilidade Tardia , Vacinas , Braço , Vacinas contra COVID-19 , Celulite (Flegmão)/induzido quimicamente , Celulite (Flegmão)/diagnóstico , Erros de Diagnóstico , Humanos , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Tardia/diagnóstico , SARS-CoV-2
20.
In Vivo ; 35(4): 2261-2273, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34182505

RESUMO

BACKGROUND/AIM: The diagnosis of gastric-type endocervical adenocarcinoma (GEA) is challenging because its differential diagnosis includes not only gynecological tumors, but also extragenital tumors. PATIENTS AND METHODS: We reviewed the electronic medical records and all available slides to investigate the clinicopathological characteristics of eight misdiagnosed GEA cases. RESULTS: Three tumors were initially misdiagnosed as endometrial carcinoma. They displayed extensive endomyometrial involvement and complex glandular architecture, but no severe nuclear pleomorphism. Another three tumors were misclassified as usual-type endocervical adenocarcinoma because of mucin-poor, pseudoendometrioid glands, apical mitotic figures, and karyorrhectic debris. The two remaining tumors presenting as adnexal masses mimicked primary ovarian mucinous tumor and metastatic cholangiocarcinoma. CONCLUSION: The varying pathological characteristics of GEA reflect the variability in clinical manifestations and its diagnostic difficulties. It is challenging to make an accurate diagnosis based solely on histological features. When suspecting GEA, clinicians should consider more comprehensively the clinicopathological context, along with immunostaining results.


Assuntos
Adenocarcinoma , Neoplasias Gástricas , Neoplasias do Colo do Útero , Adenocarcinoma/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Neoplasias do Colo do Útero/diagnóstico
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