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Frontotemporal dementia (FTD) is a clinical syndrome characterized by progressive changes in personality, behavior, and/or language with relative sparing of memory/learning. The behavioral variant of FTD (bvFTD) typically presents with insidious onset of changes in personality and behavior with a gradually progressive course. Such presentation can be easily attributed to other psychiatric disorders such as schizophrenia, obsessive compulsive disorder, or mood disorders. The most common age of presentation of bvFTD is in the fifth or sixth decades of life. However, in this case series, we present two rare cases of very early onset bvFTD with the onset of symptoms as early as third decade of life who were misdiagnosed as other psychiatric disorders.

Background: Autoinflammatory diseases (AIDs) are rare, mostly genetic diseases that affect the innate immune system and are associated with inflammatory symptoms. Both paediatric and adult patients face daily challenges related to their disease, diagnosis and subsequent treatment. For this reason, a survey was developed in collaboration between the FMF & AID Global Association and the Erlangen Center for Periodic Systemic Autoinflammatory Diseases. Methods: The aim of the survey was to collect the personal assessment of affected patients with regard to their current status in terms of diagnostic timeframes, the interpretation of genetic tests, the number of misdiagnoses, and pain and fatigue despite treatment. Results: In total, data from 1043 AID patients (829 adults and 214 children/adolescents) from 52 countries were collected and analyzed. Familial Mediterranean fever (FMF) (521/50%) and Behçet's disease (311/30%) were the most frequently reported diseases. The average time to diagnosis was 3 years for children/adolescents and 14 years for adults. Prior to the diagnosis of autoinflammatory disease, patients received several misdiagnoses, including psychosomatic disorders. The vast majority of patients reported that genetic testing was available (92%), but only 69% were tested. A total of 217 patients reported that no increase in acute-phase reactants was detected during their disease episodes. The intensity of pain and fatigue was measured in AID patients and found to be high. A total of 88% of respondents received treatment again, while 8% reported no treatment. Conclusions: AID patients, particularly adults, suffer from significant delays in diagnosis, misdiagnosis, and a variety of symptoms, including pain and fatigue. Based on the results presented, raising awareness of these diseases in the wider medical community is crucial to improving patient care and quality of life. [ABSTRACT FROM AUTHOR]

Background: FNAC is a safe, reliable, cost-effective, and efficient method for initial screening of patients with cervical lymphadenopathy. Aims: The purpose of this study was to identify cytomorphological features and to evaluate the diagnostic efficacy of FNAC as a screening tool for cervical lymphadenopathy. Materials and Methods: A study included 952 cases of FNAC, with 215 cases being compared to histological diagnosis. Subsequently, discordant cases, including both false negatives and false positives, were retrospectively re-evaluated. Additionally, a thorough review of previous research on the factors that contribute to misdiagnosis was conducted. Results: Discordance was found more in benign lesions (12.4%) as compared to malignant lesion aspirates (4.9%). When suspected malignant and malignant group are all classified as cytologically positive, the sensitivity and specificity are 97.3% and 95.8% respectively. Overlapping cytological features, heterogeneity, unsampled areas and error in interpretation were the primary factors contributing to false positive and false negative diagnosis. Conclusion: FNAC of cervical lymphadenopathy is a precise, sensitive, and specific initial diagnostic procedure. However False-negative diagnoses are mainly due to issues with the specimens obtained, while false-positive diagnoses are primarily caused by errors in interpretation. Experienced cytopathologists are expected to analyze the outcomes of FNAC while considering the accompanying clinical, radiographic, and laboratory information. In cases where there is ambiguity in the interpretation of these results, additional investigations and ancillary technique are essential to address potential misdiagnoses. [ABSTRACT FROM AUTHOR]

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AbstractThe postmortem examination can be used as a means of quality control for clinical diagnoses. A retrospective study on 300 dogs and cats that had been admitted to a small animal intensive care unit was performed comparing the clinical and postmortem findings, using the Modified Goldman criteria. All patient files were reevaluated for clinical diagnoses and all postmortem material was reevaluated for pathological diagnoses. After this, the Modified Goldman criteria were applied to score the discrepancies between them, and factors associated with the occurrence of an undiagnosed major unexpected finding were analyzed. The postmortem examination revealed additional findings in 65% of the cases. Major discrepancies, defined as those affecting treatment and possibly outcome of the patient, were present in 21.3% of the cases. The most frequently missed diagnoses detected at necropsy were pneumonia of various etiologies, meningitis/meningoencephalitis, myocarditis and generalized vasculitis. A shorter ICU stay was associated with increased odds of a major discrepancy. Conditions affecting the urinary or gastrointestinal system were negatively associated with major discrepancy.

Frontotemporal dementia (FTD) is a clinical syndrome characterized by progressive changes in personality, behavior, and/or language with relative sparing of memory/learning. The behavioral variant of FTD (bvFTD) typically presents with insidious onset of changes in personality and behavior with a gradually progressive course. Such presentation can be easily attributed to other psychiatric disorders such as schizophrenia, obsessive compulsive disorder, or mood disorders. The most common age of presentation of bvFTD is in the fifth or sixth decades of life. However, in this case series, we present two rare cases of very early onset bvFTD with the onset of symptoms as early as third decade of life who were misdiagnosed as other psychiatric disorders. [ABSTRACT FROM AUTHOR]

Background: FNAC is a safe, reliable, cost-effective, and efficient method for initial screening of patients with thyroid nodules. Aims: The purpose of this study was to evaluate the diagnostic efficacy of FNAC as a screening tool for thyroid nodules, identify cytomorphological features that contribute to diagnostic errors, and suggest improvements. Materials and Methods: A study included 611 cases of FNAC, with 99 cases being compared to histological diagnosis. Subsequently, discordant cases, including both false negatives and false positives, were retrospectively re-evaluated. Additionally, a thorough review of previous research on the factors that contribute to misdiagnosis was conducted. Results: When BSRTC categories IV, V, and VI are all classified as cytologically positive, the sensitivity, specificity, PPV, NPV, and diagnostic accuracy are 84.6%, 97.1%, 93.4%, 86.7%, and 91.9%, respectively. The primary reason for false-negative diagnoses was sampling errors (4/5, 80%), while the majority of false-positive diagnoses were attributed to interpretation errors (1/3, 33.3%). Overlapping cytological features in adenomatoid hyperplasia, thyroiditis, and cystic lesions were the primary factors contributing to misinterpretation. Additionally, heterogeneity and unsampled areas were responsible for variations in nodule size and number. This may have resulted in a false negative diagnosis. Conclusion: The results of our study have demonstrated that FNAC of thyroid lesions exhibits a significant level of accuracy, sensitivity, and specificity, enabling appropriate initial diagnostic intervention. Cytopathologists should improve their criteria for identifying adenomatous hyperplasia, thyroiditis, and cystic lesions in order to avoid false-positive diagnoses caused by errors in interpretation. [ABSTRACT FROM AUTHOR]

Astrid Juhl Terkelsen,1 Frank Birklein2 1Department of Neurology, Aarhus University Hospital and Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 2University Medical Centre Mainz, Department of Neurology, Mainz, GermanyCorrespondence: Astrid Juhl Terkelsen, Tel +45 78 46 33 80, Fax +45 78 45 42 54, Email astrterk@rm.dkAbstract: Most frequently, complex regional pain syndrome (CRPS) develops after a trauma and affects distal parts of the limbs. Early recognition and initiation of adequate treatment is crucial for a favorable outcome. On the other hand, misdiagnosing other disorders as CRPS is detrimental because more appropriate treatment may be withheld from the patients. Despite intensive research, a specific biomarker or paraclinical measure for CRPS diagnosis is still lacking. Instead, clinical criteria approved by the International Association for the Study of Pain (IASP) and latest adapted in 2019 are central for diagnosing CPRS. Thus, the CRPS diagnosis remains challenging with the risk of a “deliberate diagnosis” for unexplained pain, while at the same time a delayed CRPS diagnosis prevents early treatment and full recovery. CRPS is a diagnosis of exclusion. To clinically diagnose CRPS, a vigorous exclusion of “other diseases that would better explain the signs and symptoms” are needed before the patients should be referred to tertiary centers for specific pain treatment. We highlight red flags that suggest “non-CRPS” limb pain despite clinical similarity to CRPS. Clinical and neurological examination and paraclinical evaluation of a probably CRPS patient are summarized. Finally, we pinpoint common differential diagnoses for CRPS. This perspective might help CRPS researchers and caregivers to reach a correct diagnosis and choose the right treatment, regardless whether for CRPS mimics or CRPS itself.Keywords: diagnostic criteria, differential diagnoses, paraclinical evaluation, misdiagnoses

Background: The 2022 study on diagnostic error in the emergency department (ED) published by the Agency for Healthcare Research and Quality (AHRQ) reported that one in every 18 ED patients is misdiagnosed. The report was methodologically critiqued by emergency physicians and researchers. However, little is known about public perception of error in the ED. We sought to characterize public response to AHRQ's publication., Methods: A search was conducted for online news articles published December 2022 reporting the AHRQ study and containing "public comment" sections. Verbatim comments and relevant characteristics were collected. Three coders completed content analysis and resolved any differences. Descriptive statistics and themes are reported., Results: Fifteen online articles were reviewed; three had public comment sections (New York Times, DailyMail, and Boston Globe). There were 553 unique user comments; 293 were original comments (53%) and 260 were replies to comments (47%). The 260 replies were in response to 113 original comments, with the remaining original comments having 0 replies (n = 180). Of the 202 commenters who identified a personal role in a health care encounter, 70 (35%) identified as patients and 68 (34%) identified as physicians. Comments centered on seven major themes: (1) negative personal experiences, (2) reframing study conclusions, (3) sense of decline in training standards, (4) internal stressors impeding ED diagnostic accuracy, (5) external stressors impeding ED diagnostic accuracy, (6) suggested solutions, and (7) role of the ED in diagnosis., Conclusions: The news coverage of AHRQ's report provided individuals a platform to share their perspectives. Many comments reflected a nuanced understanding of the role of emergency care and the stressors of the ED environment. Despite questions about the report's accuracy, there were many individuals who shared personal negative experiences suggesting that the public may feel directly impacted by error in the ED., (© 2024 The Author(s). Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

Background: Calciphylaxis is an ischemic vasculopathy with high morbidity and mortality. Early and accurate diagnosis is critical to management of calciphylaxis. Clinical mimickers may contribute to delayed or misdiagnosis.Objective: To assess the rate and risk factors for misdiagnosis and to identify clinical mimickers of calciphylaxis.Methods: A retrospective medical record review was conducted of patients with calciphylaxis at a large urban tertiary care hospital between 2006 and 2018.Results: Of 119 patients diagnosed with calciphylaxis, 73.1% were initially misdiagnosed. Of patients not initially misdiagnosed, median time to diagnosis from initial presentation was 4.5 days (interquartile range, 1.0-23.3), compared to 33 days (interquartile range, 13.0-68.8) in patients who were initially misdiagnosed (P = .0002). The most common misdiagnoses were cellulitis (31.0%), unspecified skin infection (8.0%), and peripheral vascular disease (6.9%). Patients who were misdiagnosed frequently received at least 1 course of antibiotics. Patients with end-stage renal disease were less likely to be misdiagnosed than those without this disease (P = .001).Limitations: Single-center, retrospective study.Conclusions: Understanding the risk factors for misdiagnosis of calciphylaxis is an opportunity for further education concerning this rare disease. [ABSTRACT FROM AUTHOR]

The focus of the review is on primary benign mesenchymal pancreatic tumors and their imaging appearance. These tumors are extremely rare. Usually, they are not diagnosed until postoperative histology is available, and so even benign tumors have undergone extensive pancreatic resection. The very limited data on abdominal and EUS findings including contrast-enhanced techniques of these pancreatic lesions are summarized here. Case reports will be presented for some of these rare tumors with application of modern ultrasound and endosonographic techniques., Competing Interests: Siyu Sun is the Editor-in-Chief of the journal, and Christoph F. Dietrich is a Co-Editor-in-Chief. Christian Jenssen and Michael Hocke are Editorial Board Members of the journal. The article was subjected to the standard procedures of the journal, with a review process independent of the editors and their research group., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of Scholar Media Publishing.)

Indigenous Peoples in Canada experience disproportionately high tuberculosis (TB) rates, and those living in the Prairie Provinces have the most advanced TB presentations (Health Canada, 2009). The community settings (i.e., urban centres, non-remote reserves, remote reserves, and isolated reserves) where Indigenous Peoples live can help explain high TB rates. Through qualitative description, we identify how community setting influenced Indigenous people’s experiences by (a) delaying accurate diagnoses; (b) perpetuating shame and stigma; and (c) limiting understanding of the disease. Participants living in urban centres experienced significant difficulties obtaining an accurate diagnosis. Reserve community participants feared being shamed and stigmatized. TB information had little impact on participants’ TB knowledge, regardless of where they lived. Multiple misdiagnoses (primarily among urban centre participants), being shamed for having the disease (primarily reserve community participants), and a lack of understanding of TB can all contribute to advanced presentations and high rates of the disease among Indigenous Peoples of the Prairie Provinces.

Background Pulmonary rehabilitation (PR) is formally indicated to all COPD patients in groups B and E. It positively impacts dyspnoea, health-related quality of life and exercise tolerance, reducing admissions among people with chronic obstructive pulmonary disease (COPD) who have had a recent exacerbation and symptoms of anxiety and depression. There is limited access to PR programmes in Portugal, partially due to insufficient resources or referrals. This study aims to characterise COPD patients and assess whether they have criteria for PR programmes. Data from this study may provide strategic information for healthcare organisations to differentiate and innovate their response to COPD patients. Methodology A cross-sectional study was conducted in an urban municipality in the northern region of Portugal. The sample was randomly extracted from the national primary electronic health records. The sample size (n = 339) was determined considering the population of COPD patients in this region (N = 2818), a 95% confidence level and a margin of error of 5%. Results In this population, the prevalence of COPD is 1.8%. Furthermore, in this sample, 40% (n = 136) of people diagnosed with COPD have a formal indication to participate in PR programmes, although only 14.2% (n = 48) of these patients had access to PR. Conclusion COPD is probably underdiagnosed in this Portuguese region. Most COPD patients have eligibility criteria to be offered PR programmes, although most of them do not benefit from this vital treatment. Investing in community and home-based programmes may increase PR access, reducing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admissions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Silva et al.)

Objectives The aim was to explore patient experiences and views of their symptoms, delays in diagnosis, misdiagnoses and medical support, to identify common experiences, preferences and unmet needs. Methods Following a review of LUPUS UK's online forum, a questionnaire was posted online during December 2018. This was an exploratory mixed methods study, with qualitative data analysed thematically and combined with descriptive and statistically analysed quantitative data. Results There were 233 eligible respondents. The mean time to diagnosis from first experiencing symptoms was 6 years 11 months. Seventy-six per cent reported at least one misdiagnosis for symptoms subsequently attributed to their systemic autoimmune rheumatic disease. Mental health/non-organic misdiagnoses constituted 47% of reported misdiagnoses and were indicated to have reduced trust in physicians and to have changed future health-care-seeking behaviour. Perceptions of physician knowledge and listening skills were highly correlated with patient ratings of trust. The symptom burden was high. Fatigue had the greatest impact on activities of daily living, yet the majority reported receiving no support or poor support in managing it. Assessing and treating patients holistically and with empathy was strongly felt to increase diagnostic accuracy and improve medical relationships. Conclusion Patient responses indicated that timely diagnosis could be facilitated if physicians had greater knowledge of lupus/related systemic autoimmune diseases and were more amenable to listening to and believing patient reports of their symptoms. Patient priorities included physicians viewing them holistically, with more emotional support and assistance in improving quality of life, especially in relation to fatigue. [ABSTRACT FROM AUTHOR]

Indigenous Peoples in Canada experience disproportionately high tuberculosis (TB) rates, and those living in the Prairie Provinces have the most advanced TB presentations (Health Canada, 2009). The community settings (i.e., urban centres, non-remote reserves, remote reserves, and isolated reserves) where Indigenous Peoples live can help explain high TB rates. Through qualitative description, we identify how community setting influenced Indigenous people's experiences by (a) delaying accurate diagnoses; (b) perpetuating shame and stigma; and (c) limiting understanding of the disease. Participants living in urban centres experienced significant difficulties obtaining an accurate diagnosis. Reserve community participants feared being shamed and stigmatized. TB information had little impact on participants' TB knowledge, regardless of where they lived. Multiple misdiagnoses (primarily among urban centre participants), being shamed for having the disease (primarily reserve community participants), and a lack of understanding of TB can all contribute to advanced presentations and high rates of the disease among Indigenous Peoples of the Prairie Provinces. [ABSTRACT FROM AUTHOR]

The appropriate management of hematology patients depends first on correct diagnoses. Expert review is important in reaching accurate diagnoses. To improve diagnostic accuracy, the Taiwan Society of Pathology and the Taiwan Division of the International Academy of Pathology has been conducting an expert consultation program for general pathologists since 2001. As per this program, we have received a total of 395 cases (406 samples) for review. We found that meaningful diagnostic discrepancies occurred frequently in hematopathology reviews. Ambiguous or nondiagnostic original reports were the major causative factor for the major discrepancy cases, which demonstrates that diagnostic uncertainty is a big problem for referring pathologists. However, the World Health Organization lymphoma classification may be poorly reproducible in countries where extensive use of an ancillary technique is not used by general pathologists. This review is intended to report the misdiagnoses most commonly seen in the hematopathology practice in Taiwan. Awareness of the easily misinterpreted entities helps to achieve the right diagnosis and improve patient care.

Transthyretin amyloidosis (ATTR) is a rare, progressive, life-threatening, hereditary disorder caused by mutations in the transthyretin gene. Due to the phenotypic heterogeneity, ATTR is difficult to recognize and it is often diagnosed very late. In ATTR gastrointestinal (GI) disorders play an important role in the patients' morbidity and mortality. In some cases, GI symptoms are present even before the onset of the peripheral polyneuropathy. However, the complaints are various and it is really difficult to differentiate them from other GI disorders. We present a 61-year old male referred for diarrhea, unintentional weight loss and early satiety. He had hypotension after longstanding hypertension, numbness and tingling in the feet. We considered a broad differential diagnosis spectrum of chronic diarrhea syndrome and performed numerous laboratory, biochemical, imaging, endoscopic, histological and genetic tests. Transthyretin amyloidosis with a Glu89Gln mutation was diagnosed. Transthyretin amyloidosis is frequently misdiagnosed, representing a diagnostic challenge in GI practice. The presence of certain clinical combinations could help gastroenterologists to include ATTR in their diagnostic work-up. [ABSTRACT FROM AUTHOR]

Syringocystadenoma papilliferum (SCAP) is a rare skin tumour believed to arise from the apocrine or eccrine sweat glands. It appears predominantly in childhood, usually at birth. It is exceedingly rare for it to appear on the upper lip. We report a case of SCAP in a 10-year-old Omani girl who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in February 2012 with a non-tender, non-pruritic, solitary verrucous papule of 4 x 5 mm on the left side of the upper lip. It had been present since birth and had slowly been increasing in size over the years. It was occasionally associated with recurrent ulceration and bleeding and had previously been misdiagnosed and mismanaged. An excisional biopsy was performed and the whole lesion was removed. The surgical site was then sutured and the patient was discharged on the same day.

Phenytoin is a commonly prescribed antiepileptic drug. Due to its saturation (zero-order) pharmacokinetics, phenytoin carries a special risk of dose-related toxicity that is an important issue in emergency medicine. The purpose of this cross-sectional case-series study was to investigate the causes, symptoms, misdiagnoses, and outcomes of acute phenytoin intoxication. It was based on a retrospective chart review of 30 inpatients (mean age, 41.6 ± 22.8 years) with 36 episodes of acute phenytoin intoxication at our university hospital in the past 13 years. The average initial serum phenytoin level was 47.3 ± 9.7 μg/mL (range, 27.9-70.4 μg/mL). Excessive self-medication, misunderstanding of the prescription order, and probable drug interaction were the three leading causes of acute phenytoin intoxication. Unsteady gait, dizziness/vertigo, nausea/vomiting, general weakness, and drowsiness were the most common presenting symptoms. The tentative diagnostic accuracy was 67%. The most common initial misdiagnosis was brainstem or cerebellum stroke (14%). The clinical course in all patients was uneventful under temporary withdrawal of phenytoin and supportive care. We concluded that acute phenytoin intoxication was relatively under-diagnosed in the emergency service. Although acute phenytoin intoxication causes no mortality and has a good outcome, the unsteady gait increases the risk of injuries caused by falls. The management of acute phenytoin intoxication includes temporary withdrawal of phenytoin and supportive care.

by Scott Korotkin • Telemedicine is an important aspect of medical care that is only going to continue to grow, both in usage and importance. In terms of evaluating telemedicine ethically, I think the two most important principles to consider are beneficence and nonmaleficence. I agree that the major argument for beneficence is improved access to healthcare in remote areas. I do have some concerns, however, about potential harms. Telemedicine is difficult for diagnosing because a physician does not have any way of physically examining the patient. This is not a problem for radiologists who only need the MRI or X-ray to examine, but I imagine it can be difficult for primary physicians to diagnose conditions remotely. For this reason, I think that potential misdiagnoses need to be considered as potential harms to the patient. Madeline Goldberg mentions using telemedicine as a secondary confirmation for healthcare workers or physicians in remote or developing countries. This can be a useful tool, but once again, practicing good telemedical primary care is going to be dependent on the individual assisting the physician who is not physically there. In weighing these arguments, I think that the improved access to medical care is more important, but practically there are other barriers, as mentioned, that are going to hinder acceptance and application. Goldberg did an excellent job in identifying barriers to telemedicine and I agree that cost of treatment and liability are the two main issues that need to be addressed. I liked the idea of medical students helping with diagnosing, but once again I foresee the difficulties in diagnosing without physically being there. Experience might help reduce the number of misdiagnosis. I imagine that organizations like Doctors Without Borders would be able to help answer or figure out solutions to questions about liability and getting physicians involved. They are things that I am sure they deal with already. by Gabriella Foe Telemedicine is able to improve efficiency and possibly the diagnosis of patients in developing nations, as Goldberg points out. With increased collaboration and communication between doctors and specialists world-wide, physicians in developing nations can gain confidence in their diagnostic ability, thus benefiting patients and appealing to the principle of beneficence. It will also create a more just global society in terms of access to health care, as correctly mentioned by Goldberg, since patients in developing nations can, in a way, have contact with the minds and opinions of distinguished physicians and specialists around the world. A thought that may be worth pondering, however, is how patients in developing nations would realistically react when they find out that physicians can now diagnose from a distance. Currently, my relatives in Indonesia will only obtain medical care in Singapore due to their distrust of physicians practicing in Indonesia. Although it is possible that they would be more willing to seek health care in Indonesia if telemedicine was implemented, in reality, they are more likely to request Singaporean physicians to practice medicine from a distance (at least until procedures such as surgery must be done, at which point they will travel to Singapore). The result would then be a decrease in patients going to local physicians. This would impede the goal of improving self-sufficiency and diagnostic confidence of local health care workers. The development of a regulation to ensure this doesn’t occur must be thought of before telemedicine is implemented in developing nations.

Purpose: Central nervous system tumors account for the largest number of cancer deaths in childhood. Brain tumors in infants less than 3 years of age are rare; symptoms and signs are often non-specific. Patent anterior fontanelles/unfused cranial sutures in infants can accommodate rising intracranial pressure without acutely compromising the neurological status. We hypothesize that vomiting as the initial symptom, in infants with brain tumors, can possibly lead to extensive gastrointestinal evaluation, delaying the diagnosis of intracranial pathology. Methods: We conducted a retrospective chart review of infants less than 3 years of age diagnosed with brain tumors over the period of 4.7 years from February 2008 to October 2012 at Inova Children's Hospital, Virginia. Results: We identified three of 21 patients (14.3 %) who presented with vomiting and underwent initial or extensive abdominal imaging investigations. All patients were relatively young (median age, 5.4 months). Working diagnoses were pyloric stenosis, viral gastritis, or gastroesophageal reflux. All patients eventually had computed tomography of the head to rule out increased intracranial pressure and were found to have large brain tumors with obstructive hydrocephalus. Tumor locations were cerebral hemispheres (2/3) and posterior fossa (1/3). All patients had biologically aggressive high-grade tumors (glioblastoma multiforme, atypical teratoid rhabdoid tumor, and anaplastic/large cell medulloblastoma) and died within weeks of diagnosis. Conclusions: Our study highlights a clinical challenge of persistent vomiting in infants, which in the absence of convincing gastrointestinal pathology after evaluation should raise the physician's suspicion of an underlying intracranial pathology even if neurological features are absent. [ABSTRACT FROM AUTHOR]

The appropriate management of hematology patients depends first on correct diagnoses. Expert review is important in reaching accurate diagnoses. To improve diagnostic accuracy, the Taiwan Society of Pathology and the Taiwan Division of the International Academy of Pathology has been conducting an expert consultation program for general pathologists since 2001. As per this program, we have received a total of 395 cases (406 samples) for review. We found that meaningful diagnostic discrepancies occurred frequently in hematopathology reviews. Ambiguous or nondiagnostic original reports were the major causative factor for the major discrepancy cases, which demonstrates that diagnostic uncertainty is a big problem for referring pathologists. However, the World Health Organization lymphoma classification may be poorly reproducible in countries where extensive use of an ancillary technique is not used by general pathologists. This review is intended to report the misdiagnoses most commonly seen in the hematopathology practice in Taiwan. Awareness of the easily misinterpreted entities helps to achieve the right diagnosis and improve patient care. [Copyright &y& Elsevier]

Optic neuritis (ON) may rarely mimic optic nerve tumor, index of suspicion should be kept high. A 34-year-old woman presented to a major academic institute with a history of right-sided ocular pain and progressive visual loss in the same eye. Her magnetic resonance imaging showed markedly thickened optic nerve; her workup for inflammatory pathology was negative; she was diagnosed as a case of optic nerve tumor and was planned for surgery. Patient for second opinion came to a tertiary care institute where on proper history taking and evaluation she was diagnosed and treated on the lines of ON and she improved. The diagnosis of ON is a clinical one, it may mimic optic nerve tumor in rare cases. [ABSTRACT FROM AUTHOR]

The article focuses on the relation of brown recluse spiders' population distribution in the southern and eastern area of U.S. to the diagnosis of laxoscelism. According to the conducted study, the diagnoses of loxoscelism are often conducted on the areas where the spiders are uncommon and rare. It discusses the clinical study on the connection of spiders in necrotic skin lesion. It presents the clinical importance of spiders in the medical field as an anti-venom on poisons.

Spiders have been incriminated as causes of human suffering for centuries, but few species worldwide cause medically significant envenomation. Widow spiders (Latrodectus spp.) occur worldwide and cause latrodectism, which is characterized by pain (local and generalized) associated with nonspecific systemic effects, diaphoresis, and less commonly other autonomic and neurological effects. Recluse spiders (Loxosceles spp.) are distributed mostly through the tropical and subtropical Western Hemisphere and can cause severe skin lesions and rarely systemic effects; most bites are unremarkable. Highly dangerous spiders in South America (armed spiders) and Australia (funnel-web spiders) cause rare but severe envenomation requiring medical intervention and sometimes antivenom. Most other spiders involved in verified bites cause minor, transient effects. Many spiders blamed for causing medical mischief have been elevated to medical significance via circumstantial evidence, poor reporting, and repetitive citation in the literature; several species have been shown to be harmless with more stringent scientific evidence involving verified bites in humans. [ABSTRACT FROM AUTHOR]

Community-acquired bacterial meningitis (CABM) morbidity and mortality remains high in those infected. Rapid diagnosis and treatment is paramount to reducing mortality and improving outcome. This retrospective cohort study aims to assess the time from presentation to diagnosis and treatment of vaccine preventable CABM as well as identify possible factors associated with delays in diagnosis and antibiotic administration. A retrospective chart review was conducted of individuals who presented to Columbia University Irving Medical Center (CUIMC), Children's Hospital of New York (CHONY), Mount Sinai Medical Center, and Weill Cornell Medical Center with BM due to Haemophilus influenzae type B, Streptococcus pneumoniae, and Neisseria meningitidis between January 1, 2012 and December 31, 2017. Diagnosis was delayed by more than 8 hours in 13 patients (36.1%) and 5 individuals (13.9%) had a delay of 4 hours or more from presentation to the administration of antibiotics with appropriate CNS coverage. All of these patients were also initially misdiagnosed at an outpatient clinic, outside hospital, or emergency department. This retrospective study identified febrile and/or viral infections not otherwise specified and otitis media as the most common misdiagnoses underlying delays from presentation to diagnosis and to antibiotic treatment in those with BM., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Abstract: Stomach cancer is the fourth most common malignancy worldwide. Endoscopy (with biopsies) is the gold standard for its diagnosis but missed oesophageal and gastric cancers are not infrequent in patients who have undergone previous endoscopy. Errors by the endoscopist account for the majority of these missed lesions. The following report describes an incident in which there was a diagnostic error that led to a failed diagnosis of gastric cancer at first endoscopy. The implications for clinical and endoscopic practice are discussed. [Copyright &y& Elsevier]

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., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Syringocystadenoma papilliferum (SCAP) is a rare skin tumour believed to arise from the apocrine or eccrine sweat glands. It appears predominantly in childhood, usually at birth. It is exceedingly rare for it to appear on the upper lip. We report a case of SCAP in a 10-year-old Omani girl who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in February 2012 with a non-tender, non-pruritic, solitary verrucous papule of 4 × 5 mm on the left side of the upper lip. It had been present since birth and had slowly been increasing in size over the years. It was occasionally associated with recurrent ulceration and bleeding and had previously been misdiagnosed and mismanaged. An excisional biopsy was performed and the whole lesion was removed. The surgical site was then sutured and the patient was discharged on the same day.