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3.
Radiol Clin North Am ; 59(2): 279-290, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33551087

RESUMO

Chest computed tomography (CT) is the modality of choice for mediastinal imaging. The high-resolution images provided by multi-detector CT result in routine visualization of normal anatomic structures, which can be confused with pathology. In addition, many mediastinal abnormalities are discovered incidentally, with a routine chest CT protocol which may be insufficient for definite diagnosis. Awareness of the spectrum of potential pitfalls of mediastinal imaging, artifacts related to flow, motion, and solutions to mitigate these problematic issues is important in accurate interpretation. The purpose of this review is to highlight and discuss potential pitfalls in the imaging of the mediastinum.


Assuntos
Erros de Diagnóstico/prevenção & controle , Diagnóstico por Imagem/métodos , Neoplasias do Mediastino/diagnóstico por imagem , Humanos , Mediastino/diagnóstico por imagem
4.
Medicine (Baltimore) ; 100(6): e24699, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578605

RESUMO

RATIONALE: Pulmonary artery intimal sarcoma is a rare tumor with exceptionally high mortality and easily misdiagnosed as pulmonary thromboembolism pulmonary thromboembolism (PTE) due to the nonspecific clinical presentation and symptom. Misdiagnosis or untimely diagnosis makes the disease progress to an advanced stage and eventually leads to a poor prognosis. PATIENT CONCERNS: A 37-year-old Chinese female presented with chest tightness and dyspnea for 3 months. Echocardiography and chest computed tomography revealed an intraluminal obstruction of the pulmonary arteries. Tests of serum tumor makers showed slight elevation for carbohydrate antigen-125, and α-fetoprotein. PTE was suspected according to the radiological and laboratory findings. DIAGNOSIS: Microscopic findings of the presumed thrombus showed prominent myxoid and edematous background with atypical spindled cells and curvilinear vascularity. Immunohistochemical staining demonstrated that the atypical spindled cells were positive for vimentin but negative for CK, S100, SMA, desmin, CD68, STAT6, CD34, ß-catenin, ALK-p80, p53, and MDM2. According to the radiological and pathological findings, the diagnosis of fibrosarcoma of pulmonary artery was made. INTERVENTIONS: The patient underwent surgical resection and the mass was excised as completely as possible. OUTCOME: Follow-up information showed no evidence of recurrence or metastasis after 3 months postresection. LESSONS: Because of the low incidence rate, nonspecific clinical symptoms, and radiological findings, primary fibrosarcoma of the pulmonary artery is commonly misdiagnosed as PTE. Pathological examination is necessary to confirm the diagnosis.


Assuntos
Fibrossarcoma/diagnóstico , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Túnica Íntima/patologia , Adulto , Assistência ao Convalescente , Grupo com Ancestrais do Continente Asiático/etnologia , Antígeno Ca-125/metabolismo , Erros de Diagnóstico/prevenção & controle , Erros de Diagnóstico/estatística & dados numéricos , Ecocardiografia/métodos , Feminino , Fibrossarcoma/sangue , Fibrossarcoma/patologia , Fibrossarcoma/cirurgia , Humanos , Embolia Pulmonar/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Vimentina/metabolismo , alfa-Fetoproteínas/metabolismo
5.
Clin Lab ; 67(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33616332

RESUMO

BACKGROUND AND METHODS: 2019 Corona Virus Disease (COVID-19) caused by SARS-CoV-2 is still pandemic now. RT-qPCR detection was the most common method for the diagnosis of SARS-CoV-2 infection, facilitated by amounts of nucleic acid testing kits. However, the accuracy of nucleic acid detection is affected by various factors such as specimen collection, specimen preparation, reagents deficiency, and personnel quality. RESULTS: In this study, we found that unmatched virus preservation solution will inhibit N gene and OFR-1ab gene (two independent genes of SARS-CoV-2) amplification in one-step detection reagent. CONCLUSIONS: Despite just being a particular phenomenon we found in our work to fight 2019-nCoV, we concluded that unmatched virus preservation solution may have an inhibitory effect on SARS-CoV-2 nucleic acid detection which may lead to incorrect clinical diagnosis.


Assuntos
/métodos , Genes Virais/efeitos dos fármacos , Soluções para Preservação de Órgãos/farmacologia , Manejo de Espécimes , /diagnóstico , Erros de Diagnóstico/prevenção & controle , Humanos , Kit de Reagentes para Diagnóstico/normas , /isolamento & purificação , Manejo de Espécimes/efeitos adversos , Manejo de Espécimes/métodos
6.
Clin Lab ; 67(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33616334

RESUMO

BACKGROUND: COVID-19 has recently been declared an epidemic by the WHO, and there is an urgent need for affected countries and laboratories to assess and treat people at risk of COVID-19. A heat procedure has been suggested for specimen inactivation. This study was designed to evaluate the effect of serum heating on biochemical indexes, and providing a basis for accurate detection results of the COVID-19 patients. METHODS: We collected 29 normal cases of two tubes of 5 mL whole blood. One tube was analyzed directly, and the other was analyzed after heating at 56°C 30 minutes. RESULTS: A total of 34 serum biochemical index quantitative results were obtained, 28/34 indexes were not significantly affected by the heat inactivation and remained clinically interpretable. As the thermal inactivation for these indexes showed good correlation, ALB (p = 0.04, Pearson R = 0.91, 2.6% mean increase), CysC (p = 0.03, Pearson R = 0.98, 9.9% mean increase), CO2CP (p < 0.001, Pearson R = 0.96, 13% mean decrease), they were still inter-pretable. Four biochemical indexes ALP, CK, CK-MB, and insulin were inactivated and showed significant statistical differences (p < 0.001). CONCLUSIONS: Our study showed CK, CK-MB, ALP, and insulin were sensitive to heat and will be inhibited or degrade after heating, indicating that the rapid decrease of this indexes in the COVID-19 patients may be caused by sample heat inactivation. For safety and diagnostic accuracy, we recommend the use of a point-of-care device for blood gases, electrolytes, troponin, and liver and renal function tests within a ISL 2 or above biosafety cabinet with level 3 or above biosafety laboratory practice.


Assuntos
Análise Química do Sangue , Erros de Diagnóstico/prevenção & controle , Temperatura Alta/efeitos adversos , Inativação de Vírus , Fosfatase Alcalina/sangue , Análise Química do Sangue/métodos , Análise Química do Sangue/normas , /diagnóstico , Creatina Quinase/sangue , Feminino , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , /fisiologia , Sensibilidade e Especificidade
7.
J Med Case Rep ; 15(1): 15, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33451352

RESUMO

BACKGROUND: Hyperreflective lesions at the level of ganglion cell (GCL) and inner plexiform retinal layers (IPL) by optical coherence tomography (OCT) and cotton wool spots in the examination of the eye fundus have recently been described as findings in patients with COVID-19 infection. CASE REPORT: We report the case of a 42-year-old healthy Caucasian male anesthetist who had treated COVID-19 patients during the previous 5 weeks and suddenly presented with a temporal relative scotoma in his left eye. Best-corrected visual acuity was 20/20 for the left eye, and no discromatopsy or afferent pupillary defect was present. Visual field test was performed, with no significant findings associated with the focal loss of sensitivity described by the patient. The anterior segment was unremarkable on slit lamp examination in both eyes. Fundus examination of the left eye showed no significant findings. A placoid, hyperreflective band at the level of the GCL and IPL was visible in OCT which spared the outer retina, at the time of diagnosis and 1 month later. An oropharyngeal swab test was performed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA), immunoglobulin G (IgG) and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) determination. Real-time reverse-transcriptase polymerase chain reaction (RT-PCR) was negative. ELISA testing and a third rapid antibody detection test performed 7 days after the onset of symptoms were positive. CONCLUSIONS: Ocular signs and symptoms in COVID-19 cases are rarely reported, but may be underestimated, especially those that affect the retina and occur in asymptomatic or paucisymptomatic cases. We present a case of COVID-19 diagnosis based on retinal ophthalmic examination.


Assuntos
Fundo de Olho , Retina/diagnóstico por imagem , Escotoma , Tomografia de Coerência Óptica/métodos , Adulto , Infecções Assintomáticas , /diagnóstico , /métodos , Erros de Diagnóstico/prevenção & controle , Técnicas de Diagnóstico Oftalmológico , Humanos , Masculino , Escotoma/diagnóstico , Escotoma/etiologia , Acuidade Visual
8.
JMIR Public Health Surveill ; 7(1): e24220, 2021 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-33406478

RESUMO

BACKGROUND: Real-time polymerase chain reaction using nasopharyngeal swabs is currently the most widely used diagnostic test for SARS-CoV-2 detection. However, false negatives and the sensitivity of this mode of testing have posed challenges in the accurate estimation of the prevalence of SARS-CoV-2 infection rates. OBJECTIVE: The purpose of this study was to evaluate whether technical and, therefore, correctable errors were being made with regard to nasopharyngeal swab procedures. METHODS: We searched a web-based video database (YouTube) for videos demonstrating SARS-CoV-2 nasopharyngeal swab tests, posted from January 1 to May 15, 2020. Videos were rated by 3 blinded rhinologists for accuracy of swab angle and depth. The overall score for swab angle and swab depth for each nasopharyngeal swab demonstration video was determined based on the majority score with agreement between at least 2 of the 3 reviewers. We then comparatively evaluated video data collected from YouTube videos demonstrating the correct nasopharyngeal swab technique with data from videos demonstrating an incorrect nasopharyngeal swab technique. Multiple linear regression analysis with statistical significance set at P=.05 was performed to determine video data variables associated with the correct nasopharyngeal swab technique. RESULTS: In all, 126 videos met the study inclusion and exclusion criteria. Of these, 52.3% (66/126) of all videos demonstrated the correct swab angle, and 46% (58/126) of the videos demonstrated an appropriate swab depth. Moreover, 45.2% (57/126) of the videos demonstrated both correct nasopharyngeal swab angle and appropriate depth, whereas 46.8% (59/126) of the videos demonstrated both incorrect nasopharyngeal swab angle and inappropriate depth. Videos with correct nasopharyngeal swab technique were associated with the swab operators identifying themselves as a medical professional or as an Ear, Nose, Throat-related medical professional. We also found an association between correct nasopharyngeal swab techniques and recency of video publication date (relative to May 15, 2020). CONCLUSIONS: Our findings show that over half of the videos documenting the nasopharyngeal swab test showed an incorrect technique, which could elevate false-negative test rates. Therefore, greater attention needs to be provided toward educating frontline health care workers who routinely perform nasopharyngeal swab procedures.


Assuntos
/métodos , Nasofaringe/virologia , Mídias Sociais , Manejo de Espécimes/métodos , Gravação em Vídeo , Erros de Diagnóstico/prevenção & controle , Humanos , Reação em Cadeia da Polimerase em Tempo Real
9.
Nurse Pract ; 46(2): 44-49, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33475330

RESUMO

ABSTRACT: Misdiagnosis and delayed diagnosis are common problems in healthcare and are typically related to patient, provider, and socioeconomic factors. A syndemics model of COVID-19 is used to analyze the synergistic relationship between diseases and influences that impact patients' living conditions and health. NPs can use this approach to promote patient safety and equitable healthcare.


Assuntos
/diagnóstico , Diagnóstico Tardio , Erros de Diagnóstico , /enfermagem , Diagnóstico Tardio/prevenção & controle , Erros de Diagnóstico/prevenção & controle , Disparidades em Assistência à Saúde , Humanos , Profissionais de Enfermagem , Medição de Risco , Fatores Socioeconômicos , Sindemia
10.
Emerg Med Clin North Am ; 39(1): 181-201, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218657

RESUMO

Using an algorithmic approach to acutely dizzy patients, physicians can often confidently make a specific diagnosis that leads to correct treatment and should reduce the misdiagnosis of cerebrovascular events. Emergency clinicians should try to become familiar with an approach that exploits timing and triggers as well as some basic "rules" of nystagmus. The gait should always be tested in all patients who might be discharged. Computed tomographic scans are unreliable to exclude posterior circulation stroke presenting as dizziness, and early MRI (within the first 72 hours) also misses 10% to 20% of these cases.


Assuntos
Tontura/diagnóstico , Doença Aguda , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Tontura/etiologia , Tontura/fisiopatologia , Serviço Hospitalar de Emergência , Humanos
11.
Emerg Med Clin North Am ; 39(1): 67-85, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218663

RESUMO

In the initial assessment of the headache patient, the emergency physician must consider several dangerous secondary causes of headache. A thorough history and physical examination, along with consideration of a comprehensive differential diagnosis may alert the emergency physician to the diagnosis of a secondary headache particularly when the history is accompanied by any of the following clinical features: sudden/severe onset, focal neurologic deficits, altered mental status, advanced age, active or recent pregnancy, coagulopathy, malignancy, fever, visual deficits, and/or loss of consciousness.


Assuntos
Serviço Hospitalar de Emergência , Cefaleia/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Cefaleia/etiologia , Humanos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico
12.
Medicine (Baltimore) ; 99(52): e23782, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350764

RESUMO

ABSTRACT: Researchers have reported false positive/negative results of the cold test in the diagnosis of pulpitis. Knowledge of the correlation between results of the cold test and proteins could aid in decreasing the frequency of incorrect diagnosis. To associate the levels of matrix metalloproteinase-8 (MMP-8) with the responses (in seconds) to the cold test in teeth diagnosed with reversible and irreversible pulpitis.A cross-sectional study was performed. A total of 150 subjects were evaluated, of which 60 subjects met the selection criteria. The participants were divided into 3 groups: Group 1, healthy pulps, 20 subjects with 20 posterior teeth (premolars) with clinically normal pulp tissue; Group 2, reversible pulpitis, 20 patients with 20 teeth diagnosed with reversible pulpitis; and Group 3, irreversible pulpitis, 20 subjects with 20 teeth diagnosed with irreversible pulpitis. All participants were evaluated based on the following variables: medical and dental history, cold test, and expression of MMP-8 by enzyme-linked immunosorbent assay in dentin samples.Responses to the cold test between 4 to 5 seconds (second evaluation; P < .0001) were associated with high levels of MMP-8 (mean, 0.36 ng/mL) in the reversible pulpitis group. In the irreversible pulpitis group, the responses from 6 to ≥10 seconds (second evaluation; P < .0001) were associated with a higher average of MMP-8 levels (mean, 1.97 ng/mL).We determined that an increase in the duration of response to the cold test was associated with an increase in MMP-8 levels (Rho = 0.81, P < .0001) in teeth with pulpitis. The above correlations can be considered an adjunct to the clinical diagnosis of pulpitis.


Assuntos
Temperatura Baixa , Sensibilidade da Dentina/diagnóstico , Dentina , Metaloproteinase 8 da Matriz/análise , Pulpite , Adulto , Estudos Transversais , Dentina/metabolismo , Dentina/fisiopatologia , Erros de Diagnóstico/prevenção & controle , Feminino , Humanos , Masculino , México , Prognóstico , Pulpite/diagnóstico , Pulpite/metabolismo
14.
Can Respir J ; 2020: 2045341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33005276

RESUMO

Objective: Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, was first identified in December 2019 in Wuhan, China, and has since spread globally, resulting in an ongoing pandemic. However, the study of asymptomatic patients is still rare, and the understanding of its potential transmission risk is still insufficient. In this study, epidemiological investigations were conducted in the Zhejiang province to understand the epidemiology and clinical characteristics of asymptomatic patients with COVID-19. Methods: This retrospective study was carried out on 22 asymptomatic patients and 234 symptomatic patients with COVID-19 who were hospitalized in Zhejiang Duodi Hospital from January 21 to March 16, 2020. The characteristics of epidemiology, demography, clinical manifestations, and laboratory data of mild patients were compared and analyzed. Results: The median age was 28 years in asymptomatic patients and 48 years in symptomatic patients. The proportion who were female was 77.3% in asymptomatic patients and 36.3% in symptomatic patients (p < 0.001). The proportion of patients with coexisting diseases was 4.5% in asymptomatic patients and 38.0% in symptomatic patients (p=0.002). The proportion of patients with increased CRP was 13.6% in the asymptomatic group and 61.1% in the symptomatic group (p < 0.001). The proportion of patients received antiviral therapy was 45.5% in the asymptomatic group and 97.9% in the symptomatic group (p < 0.001). The proportion of patients received oxygen therapy was 22.7% in the asymptomatic group and 99.1% in symptomatic patients (p < 0.001). By March 16, 2020, all patients were discharged from the hospital, and no symptoms had appeared in the asymptomatic patients during hospitalization. The median course of infection to discharge was 21.5 days in asymptomatic patients and 22 days in symptomatic patients. Conclusions: Asymptomatic patients are also infectious; relying only on clinical symptoms, blood cell tests, and radiology examination will lead to misdiagnosis of most patients, leading to the spread of the virus. Investigation of medical history is the best strategy for screening asymptomatic patients, especially young people, women, and people without coexisting disease, who are more likely to be asymptomatic when infected. Although the prognosis is good, isolation is critical for asymptomatic patients, and it is important not to end isolation early before a nucleic acid test turns negative.


Assuntos
Doenças Assintomáticas , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias , Pneumonia Viral , Medição de Risco/métodos , Adulto , Fatores Etários , Doenças Assintomáticas/epidemiologia , Doenças Assintomáticas/terapia , Betacoronavirus/isolamento & purificação , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Erros de Diagnóstico/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Fatores Sexuais
16.
Clin Lab ; 66(10)2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33073969

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an emerging global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 mainly affects the tissues expressing angiotensinconverting enzyme 2 (ACE2). ACE2 is used as a receptor for the virus to enter the cells. Once SARS-CoV-2 enters the cells, it leads to further events through signaling pathways. This pathophysiological condition can appear as changes in laboratory tests. METHOD: However, the lack of studies in this area is strongly felt. The present study was conducted to review the most common abnormalities in laboratory tests caused by COVID-19 and their related molecular pathways and outcomes. RESULTS: It showed that the levels of IL-6, CRP, PCT, AST/ALT, bilirubin, ALP, GGT, LDH, ferritin, D-dimer, and neutrophils increased. Conversely, the levels of albumin and lymphocytes decreased. Since most of these parameters were related to hepatic function, their alterations indicated liver injury. CONCLUSIONS: Overall, the parameters CRP, D-dimer, and CBC are more important in diagnosis. Moreover, it seems that MAPK and NF-κB are the most frequent signaling pathways in which alterations may contribute to the pathogenesis of the virus. Altogether, our review encourages researchers to study signaling pathways as potential molecular targets to achieve effective treatment.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Transdução de Sinais , Betacoronavirus/isolamento & purificação , Betacoronavirus/fisiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/virologia , Erros de Diagnóstico/prevenção & controle , Descoberta de Drogas/métodos , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/metabolismo , Pneumonia Viral/virologia , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia
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