provisional diagnosis
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Author(s):  
Alla Melman ◽  
Chris G. Maher ◽  
Chris Needs ◽  
Gustavo C. Machado

AbstractTo determine the proportion of patients admitted to the hospital for back pain who have nonserious back pain, serious spinal, or serious other pathology as their final diagnosis. The proportion of nonserious back pain admissions will be used to plan for future ‘virtual hospital’ admissions. Electronic medical record data between January 2016 and September 2020 from three emergency departments (ED) in Sydney, Australia were used to identify inpatient admissions. SNOMED-CT-AU diagnostic codes were used to select ED patients aged 18 and older with an admitting diagnosis related to nonserious back pain. The inpatient discharge diagnosis was determined from the primary ICD-10-AM codes by two independent clinician-researchers. Inpatient admissions were then analysed by sociodemographic and hospital admission variables. A total of 38.1% of patients admitted with a provisional diagnosis of nonserious back pain were subsequently diagnosed with a specific pathology likely unsuitable for virtual care; 14.2% with a serious spinal pathology (e.g., fracture and infection) and 23.9% a serious pathology beyond the lumbar spine (e.g., pathological fracture and neoplasm). A total of 57% of admissions were identified as nonserious back pain, likely suitable for virtual care. A challenge for implementing virtual care in this setting is screening for patients with serious pathology. Protocols need to be developed to reduce the risk of patients being admitted to virtual hospitals with serious pathology as the cause of their back pain. Key Points• Among admitted patients provisionally diagnosed in ED with non-serious back pain, 38.1% were found to have ‘serious spinal pathologies’ or ‘serious pathologies beyond the lumbar spine’ at discharge.• Spinal fractures were the most common serious spinal pathology, accounting for 9% of all provisional ‘non-serious back pain’ admissions from ED.• 57% of back pain admissions were confirmed to be non-serious back pain and may be suitable to virtual hospital care; the challenge is discriminating these patients from those with serious pathology.


2022 ◽  
Vol 9 (1) ◽  
pp. 82-84
Author(s):  
Syed Sajid Hussain Shah ◽  
Bibi Aaliya

A two-month-old male infant presented with history of respiratory difficulty and got admitted with provisional diagnosis of pneumonia. On examination patient was having unilateral nasal hypoplasia and cyanosis with echocardiography showing truncus arteriosus. Detail history revealed that mother had valve replacement and she was taking warfarin during pregnancy. After initial management patient was referred to pediatric cardiac surgery and plastic surgery for further management. Parents were counseled regarding contraception and family planning.  


Author(s):  
Tri Nugraha Susilawati ◽  
Winda Rahayuningtyas ◽  
Triyanta Yuli Pramana

Background: A persistent infection of hepatitis B virus (HBV) can cause liver cirrhosis and hepatocarcinoma even though the virus itself is non-cytopathic and does not cause cell injury. It has been asserted that liver injury in chronic HBV infection is attributed to the host immune system responding to HBV infection. Cytokines have a critical role in mediating immune responses to viral infection. This study aimed to determine the correlation between the levels of serum IFN-γ, IL-2, IL-17, and TNF- α with the progress of chronic HBV infection that was determined through provisional diagnosis, patient’s age, and the levels of serum transaminases.Method: Blood samples were collected from patients with chronic hepatitis B and the levels of serum IFN-γ, IL-2, IL-17, and TNF-α were measured by using ELISA. The correlation between each cytokine levels and the provisional diagnosis, patient’s age, and serum transaminases were analyzed by using the Spearman correlation test with a p value of 0.05 is considered as statistically significant.Results: A total of 47 samples were collected from patients with chronic hepatitis B (n=38), chronic hepatitis B with liver cirrhosis (n = 6), and chronic hepatitis B with hepatocellular carcinoma (nc = 3). A significant correlation was found between the levels of serum IFN-γ and aspartate aminotransferase (AST) (p = 0.04).Conclusion: The increase of serum IFN-γ and AST levels may highlight the importance of these particular cytokine and liver transaminase in the immune response to chronic HBV infection since IFN-γ is capable to induce apoptotic cell death which promotes AST release and facilitates liver injury.


2021 ◽  
Vol 81 (04) ◽  
pp. 415-419
Author(s):  
Martha Rondón-Tapia ◽  
◽  
Eduardo Reyna-Villasmil ◽  
Duly Torres-Cepeda

The bicorne uterus with a rudimentary non-communicating horn may be associated with gynecological and obstetric complications such as infertility, endometriosis, hematometra, urinary tract abnormalities, abortions, and preterm deliveries. Excision of the rudimentary horn should be done outside of pregnancy, with followup during pregnancy, looking for complications. We present the case of a 40-year-old patient, who presented abdominal pain and vaginal bleeding, with a full-term pregnancy in a rudimentary non-communicating horn of a bicorne uterus. Physical examination showed abdominal distention and loss of uterine contour and no fetal parts were palpated. The provisional diagnosis of rupture of the uterus was made. Emergency laparotomy revealed a dead and deformed fetus, 37 weeks old, in a bicorne uterus with a broken rudimentary non-communicating horn, along with an acretic placenta. Extraction of the gestational sac, fetus and placenta and subtotal hysterectomy with conservation of the left annex were performed. Keywords: Rudimentary horn not communicating, Bicornuate uterus, Term pregnancy


2021 ◽  
pp. 193864002110624
Author(s):  
Yaser Ghani ◽  
Ali-Asgar Najefi ◽  
Alessio Bernasconi ◽  
Matthew Welck ◽  
Nick Cullen ◽  
...  

Introduction: There is little information on the value of using single photon emission computerized tomography–computed tomography (SPECT-CT) in non-arthritic and non-neoplastic conditions of the foot and ankle (F&A). The vast majority of studies have investigated the role of SPECT-CT in degenerative conditions, bony pathology, and neoplastic conditions. The diagnostic value of SPECT-CT in purely non-arthritic and non-neoplastic conditions, in the absence of other conclusive radiological findings, is yet to be clarified. The aim of this study was to evaluate the value of SPECT-CT in a cohort of patients with complex F&A pathology, in whom diagnostic uncertainty existed after conventional imaging techniques, and to assess its added value in routine clinical practice. Methodology: A retrospective analysis of 297 SPECT-CTs from 2010 to 2017 found 18 SPECT-CTs (age = 16-56 years) performed for non-arthritic F&A pathology. Changes in diagnosis, management, and clinical outcome scores were recorded before and after SPECT-CT imaging. Results: The results demonstrated that the provisional diagnosis was different from the SPECT-CT diagnosis in 10 (56%) out of the 18 patients and led to a modified treatment plan, which was successful in 8 (80%) out of the 10 patients. The post-intervention Manchester Oxford Foot Questionnaire (MOX-FQ) and Visual Analogue Scale (VAS) score improved from 76 ± 18 to 58 ± 24 ( P = .02), and from 72 ± 17 to 49 ± 32 ( P = .01), respectively. The SPECT-CT scan was useful in confirming the provisional diagnosis in the remaining 8 patients where a diagnostic uncertainty existed after conventional imaging techniques. Overall, a total of 15 out of 18 patients (83%) showed an improvement in their symptoms after management led by SPECT-CT diagnosis. Conclusion: Our study highlights the added value of SPECT-CT in patients presenting with non-arthritic and non-neoplastic F&A conditions in which there is diagnostic uncertainty after conventional imaging. In 80% of cases, a change in management driven by the SPECT-CT findings led to a successful outcome. We have found SPECT-CT to be a useful investigative modality in assessing these complex F&A cases. Levels of Evidence: Level IV


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesca Rubino ◽  
Sofia Capocci ◽  
Leonardo Portolan ◽  
Alessia Gambaro ◽  
Michele Pighi ◽  
...  

Abstract Methods and results A 41-year-old black man complaining of severe oppressive chest pain radiated to the back presented to our accident & emergency department (A&E). His symptoms started few days before his hospital admission. Past medical history was remarkable for arterial hypertension in medical therapy and microdrepanocytosis. In A&E, the patient’s physical examination and vital signs were normal, he was normotensive, apyretic with normal oxygen saturation. The ECG showed ST elevation in anterior and lateral leads. Because of his history of arterial hypertension, and the severe chest pain irradiated to the back, an angio-CT was indicated at first. The CT ruled out acute aortic disease. Excluded the acute aortic disease, the patient underwent an urgent coronary angiography. No coronary stenosis was found. Therefore, the patient was admitted in cardiac intensive care unit. The blood test showed an elevation of high sensitive cardiac troponin T (cTnT peak 3093 ng/L) and inflammatory index (leukocytosis 13.65 109/l and protein C reactive peak 347 mg/L). An in-depth anamnestic collection revealed fever with respiratory symptoms about 2 weeks before. The echocardiography demonstrated left ventricular (LV) dysfunction with increased ventricular wall thickness and mild pericardial effusion. No LV outflow tract obstruction was found. A provisional diagnosis of peri-myocarditis was made. During hospitalization, anti-remodelling cardiac therapy was introduced and up titrated. To confirm the provisional diagnosis, a Gadolinium cardiac Magnetic Resonance (CMR) was performed, and it revealed myocardial oedema on basal anterior interventricular septum and multiple areas of late gadolinium enhancement with subepicardial pattern. Moreover, severe LV hypertrophy was confirmed (interventricular septum 19 mm, inferior wall 17 mm). This pattern was consistent to the diagnosis of peri-myocarditis on a hypertrophic cardiomyopathy (HCM). Main infectious causes of peri-myocarditis were investigated, but the results were inconclusive. Unfortunately, genetic test results are still not available. Patient was discharged with recovered LV systolic function and free of symptoms on optimal medical therapy; no ventricular arrhythmias was detected during hospitalization. HCM risk sudden cardiac death (SCD) was lower than 4%. Conclusions Peri-myocarditis can mimic symptoms of an acute coronary syndrome. Furthermore, the inflammation of cardiac muscle and the subsequent interstitial oedema may cause an increase in LV wall thickness. In this setting, the diagnosis of an underlying cardiomyopathy is challenging. This interesting and unusual case highlights the relevance of an accurate diagnostic work up to deliver good clinical practice. In particular, Gadolinium CMR is of paramount importance in this setting.


2021 ◽  
Vol 42 (2) ◽  
pp. 169-172
Author(s):  
Pises Insuan ◽  
◽  
Wimol Insuan ◽  

A Brunn’s cyst in the proximity of the bladder neck is a rare cause of bladder outlet obstruction. This case study concerns a 45-year-old male presenting with bladder outlet obstruction secondary to a Brunn’s cyst. A provisional diagnosis of Brunn’s cyst was based on ultrasonography, CT scan and cystoscopic examination which indicated a cystic lesion at the bladder neck. Transurethral resection of the cyst was performed with successful resolution of the obstructive voiding symptoms. The final diagnosis of this case based on the pathology is a Brunn’s cyst.


2021 ◽  
Vol 9 (2) ◽  
pp. 42-44
Author(s):  
Sadia Yeasmin Saki ◽  
Mezbahul Alam ◽  
Syeed Mehbub Ul Kadir

The purpose of the study is to describe a rare case report for raising the awareness of existence of this rare ocular disease and also review the characteristics of this disease.  A 35-year-old man presented with acute vision loss in both eye after high grade fever. On fundoscopic examination flower petal pattern blood vessel sheathing in temporal quadrant of both eyes was seen. A provisional diagnosis of frosted branch angiitis was considered. The patient responds promptly with Intravenous and oral corticosteroid. A total of 58 cases have been reported in worldwide literature. The disease is likely to represent a common immune pathway in response to multiple infective agents. CBMJ 2020 July: Vol. 09 No. 02 P: 42-44


2021 ◽  
pp. 436-438
Author(s):  
Shaik Mohammad Tahaseen ◽  
Ravi Kirti ◽  
Subhash Kumar

Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia linked to disseminated microvascular platelet-rich thrombi. We present the case of a 44-year-old lady who presented with severe thrombocytopenia and anemia that did not respond to repeated transfusions and steroids. Non-contrast computed tomography scan of the brain revealed an intracranial bleed. Schistocytes were seen on the peripheral blood smear. A provisional diagnosis of TTP was made. Plasmapheresis could not be done due to her deteriorating hemodynamic status. She succumbed to her illness in spite of the best possible efforts. This case highlights the need for keeping a high index of suspicion for TTP as early diagnosis and prompt initiation of plasmapheresis are crucial for preventing death.


2021 ◽  
pp. 097321792110549
Author(s):  
Joseph J. Thomas ◽  
Matthew J. Thomas ◽  
Frieda Hulka ◽  
Bruce Sindel

Meckel’s diverticulum (MD) is the most prevalent gastrointestinal congenital malformation, occurring in 2% to 4% of all live births. Typical symptoms of MD include intestinal bleeding and bowel obstruction, but MD can also present with many atypical symptoms of varying severity, posing a diagnostic challenge with severe complications if left untreated. Neonates presenting with symptomatic MD are uncommon. In this report, we describe a neonatal case of MD in which the patient presented with atypical symptoms including distended abdomen and constipation mimick necrotizing enterocolitis. This case emphasizes the importance of clinically correlating a provisional diagnosis while maintaining a broad differential, including uncommon conditions in this age group such as MD.


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