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

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

Toma de decisiones para el tratamiento de caries oclusales en el sistema de salud público brasileño / Decision-making for the treatment of occlusal caries in the Brazilian public health system

ABSTRACT Introduction: Caries diagnosis errors have become a public health problem. Objective: Verify the consistency in terms of decision-making between Brazilian dentists from the country's public health system and the International Caries Detection and Assessment System (ICDAS), and evaluate the influence of professional experience on the management of the decay. Methods: There are 80 dentists in the public health service of Recife city, Brazil. All dentists were invited to participate in this cross-sectional study. Forty dentists agreed to answer questions about their decision-making in relation to the treatment of occlusal caries in low, moderate and high-risk caries situations. The time of clinical experience, the use of methods for the assessment of caries risk and the lesion activity were also inquired about. The T-test was applied with a significance level of 5 por ciento to compare the correlation between the International Caries Detection and Assessment System scores regarding the mean age of participants. Results: The disagreement between the dentists and the criteria used by the International Caries Detection and Assessment System for decision-making were mainly related to the sound surfaces or lesions restricted to the tooth enamel. It was thus verified that lack of consistency for the low-risk condition reached a score of 3 (32 percent), while moderate (95 percent) and high-risk (85 percent) conditions lay at a classification code of 0. The time of professional experience was not considered to have interfered with decision-making on any scale, regardless of the risk condition of the patient (p> 0.05). Conclusions: A divergence in terms of decision-making between dentists of the public health system and the International Caries Detection and Assessment System could be observed, specifically regarding sound surfaces or surfaces with lesions restricted to the tooth enamel. Furthermore, professional experience was seen as not influencing the management of caries(AU)

RESUMEN Introducción: Los errores de diagnóstico de caries se han convertido en un problema de salud pública. Objetivo: Verificar la concordancia de la toma de decisiones entre los dentistas brasileños del sistema de salud pública del país y el Sistema Internacional de Detección y Evaluación de Caries (ICDAS), así como evaluar la influencia de la experiencia profesional en el manejo de la caries. Métodos: De los 80 dentistas que existen en servicio público de salud en la ciudad de Recife, Brasil, todos fueron invitados a participar en este estudio transversal. Cuarenta dentistas acordaron responder sobre su toma de decisión en relación con el tratamiento de la caries oclusal en situaciones de caries de bajo, moderado y alto riesgo. El tiempo de experiencia clínica, el uso de métodos para la evaluación del riesgo de caries y la actividad de la lesión también fueron cuestionados. La prueba T, para un nivel de significancia del 5 por ciento, fue aplicada para comparar la correlación entre los escores del Sistema Internacional de Detección y Evaluación de Caries en relación con el promedio de edad de los participantes. Resultados: El desacuerdo entre los dentistas y los criterios utilizados por el ICDAS para la toma de decisiones se concentró en los códigos de clasificación que representan superficies sanas o lesiones restringidas al esmalte de los dientes. Se verificó así que la falta de consistencia para la condición de bajo riesgo se concentró en la puntuación de 3 (32 por ciento), mientras que las condiciones moderada (95 por ciento) y de alto riesgo (85 por ciento) se concentraron en los códigos de clasificación de 0. El factor tiempo de experiencia profesional no interfirió en la prevalencia de concordancia de la toma de decisión para cualquier escore, independientemente de la condición de riesgo del paciente (p> 0,05). Conclusiones: Se pudo observar una divergencia en cuanto a la toma de decisiones entre los dentistas del sistema de salud pública y el Sistema Internacional de Detección y Evaluación de Caries, específicamente con respecto a superficies sanas o superficies con lesiones restringidas al esmalte de los dientes. Además, la experiencia profesional no influyó en el manejo de la caries(AU)

Erro em antropometria aplicada à avaliação nutricional nos serviços de saúde: causas, consequências e métodos de mensuração / Error in anthropometry applied to nutritional assessment in health services: causes, consequences and methods of measurement

OBJECTIVE: To discuss anthropometric errors in health services, their implications in nutritional diagnosis, main causes, and methods of measurement. METHODS: To subsidize the discussion, we considered the anthropometric data of preschool children collected by three health professionals and a Supervisor (gold standard) during training in anthropometry. We also reviewed national and international literature on the subject. RESULTS: Errors in anthropometry may be derived from the equipment used, adequacy of the measurement environment, training level of the health professional, and issues inherent to the individual assessed. The most commonly used methods to measure such errors are Standardization and the Technical Error of Measurement, which are distinguished by the rigor in the evaluation of professionals, interpretation of results, and the possibility of multiple analysis of measurement quality. Such distinctions were observed in this study, in which the degree of precision and accuracy varied for the three evaluators, according to the method adopted. The choice of the method will depend on the public involved and the intended purpose. CONCLUSIONS: Evaluation of measurement errors in anthropometry is an important tool to highlight the need for training and qualification of professionals in nutritional assessment

OBJETIVO: Discutir acerca dos erros em antropometria nos serviços de saúde, suas implicações no diagnóstico nutricional, principais causas, e métodos de mensuração. MÉTODOS: Para subsidiar a discussão, consideraram-se os dados antropométricos de crianças em idade pré-escolar coletados por três profissionais de saúde e um supervisor (padrão-ouro) durante capacitação em antropometria. Procedeu-se também a revisão na literatura nacional e internacional acerca do tema. RESULTADOS: Erros em antropometria podem ser causados pelos equipamentos utilizados, pela adequação do ambiente de medição, pelo grau de treinamento do avaliador (profissional de saúde) e por questões inerentes ao próprio indivíduo avaliado. Os métodos mais empregados para mensurar erros são a Padronização e o Erro Técnico de Medição, que se distinguem quanto ao rigor na avaliação, interpretação dos resultados e possibilidade de desdobramento nas análises da qualidade das mensurações. Tais distinções foram evidenciadas neste estudo, em que o grau de precisão e exatidão variou, para os três antropometristas, segundo o método adotado. A escolha do método dependerá do público-alvo envolvido e do objetivo pretendido. CONCLUSÕES: Avaliar erros de mensuração em antropometria é uma importante ferramenta para apontar a necessidade de capacitação e qualificação de profissionais em avaliação nutricional

Segurança do paciente: como a enfermagem vem contribuindo para a questão? / Seguridad del paciente: cómo la enfermería viene contribuiendo a la cuestión? / Patient safety: how nursing is contributing to the issue?

Objectives: Characterizing the scientific production in nursing journals on patient safety and identifying the contributions of these productions for the same. Method: Integrative review in the databases of the Virtual Library of Nursing using the following health descriptors: nursing, patient safety, iatrogenic disease and adverse events. Results: We identified 6 categories: Culture of patient safety, adverse events, nursing care, education, reporting and ethical aspects. Conclusion: therefore, we checked the focal point of the researches, their contributions and advancements needed.

Objetivos: Caracterizar as produções científicas em periódicos de enfermagem sobre segurança do paciente e identificar as contribuições dessas produções para a mesma. Método: Revisão integrativa nas bases de dados da Biblioteca Virtual de Enfermagem utilizando os descritores em saúde: enfermagem, segurança do paciente, doença iatrogênica e eventos adversos. Resultados: Identificamos 6 categorias: Cultura de segurança do paciente, eventos adversos, Assistência de Enfermagem, educação, notificação e aspectos éticos. Conclusão: Verificamos, assim, os focos das pesquisas, suas contribuições e os avanços necessários.

Objetivos: Caracterizar la producción científica en revistas de enfermería a cerca de la seguridad del paciente e identificar las contribuciones de estas producciones para el mismo. Método: revisión Integral en las bases de datos de la Biblioteca Virtual de Enfermería utilizando los descriptores en la salud: enfermería, seguridad del paciente, las enfermedades iatrogénicas y los eventos adversos. Resultados: identificamos 6 categorías: Cultura de la seguridad del paciente, los efectos adversos, la atención de enfermería, la educación, la información y los aspectos éticos. Conclusión: Tomamos nota, también, de los focos de la investigación, sus aportaciones y avances necesitados.

Diverticulitis exclusiva de ciego / Unique diverticulitis of the cecum

La diverticulitis cecal es una rara entidad de difícil diagnóstico que con frecuencia se confunde con un proceso apendicular agudo. Los divertículos primarios o de origen congénito, generalmente son únicos, suelen presentarse en una edad más temprana que la enfermedad diverticular cólica (divertículos secundarios). La presencia de estos en el colon derecho se reporta con menor frecuencia, su diagnóstico es en muchas ocasiones indistinguible de la apendicitis aguda y se realiza en la mayoría de los casos durante la laparotomía, el tratamiento es variable, según la literatura abarca desde la resección del divertículo hasta la hemicolectomía derecha. El objetivo de esta presentación es referir la dificultad diagnostica y la alta frecuencia de error diagnóstico que presenta esta entidad

The cecal diverticulitis is a strange disease, difficult to be diagnosed, frequently confused with acute appendicular process. The primary diverticula or those of congenital origin are generally unique; they usually appear at younger age than the colic diverticular disease (secondary diverticula). Their presence in the right colon is less frequently reported, the diagnosis is often confused with that of acute appendicitis and most of cases undergo laparatomy. According to the scientific literature, the treatment is variable, ranging from diverticular resection to right hemi-cholectomy. The objective of this paper was to present the difficulties and the high frequency of errors in diagnosing this disease

Fuchs' Uveitis: Failure to associate vitritis and disc hyperfluorescence with the disease is the major factor for misdiagnosis and diagnostic delay

Fuchs' uveitis is often diagnosed with substantial delay at the origin of deleterious consequences such as unnecessary treatment. The aim of the study was to analyze the type and frequency of posterior inflammatory and fluorescein angiographic signs in Fuchs' uveitis in conjunction with the other clinical signs and evaluate their respective importane in the diagnosis of the disease. In particular, diagnostic delay and erroneous diagnosis were investigated. Patients seen in our centers between 1995 and 2008 with the diagnosis of Fuchs' uveitis were analyzed. The data collected included age, initial and final visual acuities; clinical findings at presentation, mean diagnostic delay, erroneous diagnosis, laser flare photometry values, fundus and fluorescein angiography manifestations and ocular complications. One hundred and five patients were included. The mean age at diagnosis was 34 years. Twelve patients [11.4%] had bilateral involvement. The mean diagnostic delay was 3.04 +/- 4.30 years. The most frequent clinical signs were vitreous infiltration [97.40%], typical Fuchs' keratic precipitates [94.90%], crystalline lens opacities or cataract [47%], heterochromia [42.60%], ocular hypertension or glaucoma [12.80%]. The mean laser flare photometry value at presentation was 9.85 +/- 6.28 ph/ms. Thirty-nine patients [37.14%] had undergone fluorescein angiography showing disc hyperfluorescence in 97.7% and peripheral retinal vascular leakage in 13.6%. Fuchs' uveitis is significantly underdiagnosed likely because vitreous involvement was previously described but not commonly recognized as an association with Fuchs' uveitis in the clinician's mind and therefore has often been given a different diagnostic label, Moreover, the very frequent inflammatory signs on fluorescein angiography such as disc hyperfluorescence and more rarely peripheral retinal vascular leakage, which has not been typically associated with Fuchs' uveitis, appear to represent an additional factors leading to misdiagnosis. Such clinical findings need to be publicized in order to reduce misdiagnosis, and diagnostic delay

Condutas inadequadas em uveítes / Inadequate uveitis management

Objetivo: Relatar os principais equívocos no diagnóstico e conduta das uveítes, suas implicações no tratamento e prognóstico, e alertar aos oftalmologistas para a importância de uma abordagem e conduta iniciais apropriadas. Material e Métodos: Realizou-se estudo retrospectivo de prontuários de 105 pacientes, atendidos no Setro de Uveítes da Sociedade de Assistência aos Cegos no período de julho de 1999 a julho de 2002. Os prontuários foram escolhidos de forma aleatória. Desses, foram selecionados 34, nos quais havia algum equívoco na pesquisa do diagnóstico ou conduta inicial, antes de chegarem ao serviço. Analisou-se entre outros dados: período entre o início das queixas e chegada ao Serviço; acuidade visual; exames solicitados antes da primeira consulta, terapêutica inicial instituída e sua eficácia. Resultados: Dos 34 casos avaliados, 26 (76, 47 por cento) chegaram ao Serviço com um ou mais meses de evolução da doença; 17 (50 por cento) apresentavam lesão em pólo posterior, ativa, compatível com toxoplasmose, não estando em uso de tratamento específico. Quanto ao uso de corticóides tópicos ou sistêmicos, 8 (23,52 por cento) estavam fazendo uso de subdoses. No que se refere a pedido de exames, 14 (41,17 por cento) pacientes não tinham nenhum exame solicitado quando chegaram ao serviço e 6 (17,64 por cento) apresentavam diagnóstico equivocado. Conclusão: Esta investigação chama atenção para condutas iniciais inadequadas em uveítes e as graves consequências que muitas vezes poderiam ser evitadas ou atenuadas se procedimentos corretos fossem instituídos no início da doença. Apesar da importância do tema, não encontramos estudos semelhantes na literatura consultada.

Misdiagnosis in vertebral osteomyelitis: problems and factors.

One hundred and one cases diagnosed with vertebral osteomyelitis were evaluated for misdiagnosis and both factors and outcomes of misdiagnosis were assessed. There were 67 patients with tuberculous spondylitis and 34 patients with pyogenic vertebral osteomyelitis. Misdiagnosis occurred in 33.7 per cent of the cases. The average delayed diagnosis time was 2.6 months (range, 0.2 to 12). Age between 60 to 70 years was the most frequent group for misdiagnosis, while the most frequent area of misdiagnosis was the lumbar spine. Metastatic carcinoma, spinal stenosis, herniated nucleus palposus and back strain were common initial misdiagnoses. The factors, age group, absence of fever and positive straight leg raising test (SLRT) were associated with misdiagnosis in univariate analysis and multivariate analysis (odds ratio 3.40 (95%CI:1.07-11.94), 3.47 (95%CI:1.20-10.05), and 24.47 (95%CI:2.18-274.28), respectively) Misdiagnosis was statistically significantly associated with the result of treatment. This paper emphasizes that the elderly age group, absence of fever and positive SLRT are the independent factors which increase the risk of misdiagnosis of vertebral osteomyelitis.

Punción transtorácica por aspiración en el diagnóstico del cáncer de pulmón / Transthoracic aspiration puncture in the diagnosis of lung cancer

La biopsia transtorácica por aspiración con aguja fina constituye un método antiguo, pero en ocasiones olvidado para el estudio de lesiones pleuropulmonares. El objetivo de este trabajo es evaluar la efectividad de esta técnica diagnóstica, donde se analizan 182 historias clínicas de pacientes con cáncer de pulmón, desde 1987 hasta 1999, diagnosticados todos por punción. Se obtuvo el 81,3 porciento de positividad, y el 18,7 porciento de error diagnóstico por falsos negativos; el tipo hístico más frecuente fue el carcinoma epidermoide, 50,5 porciento y el adenocarcinoma, 31,3 porciento; todas las lesiones eran periféricas, el neumotórax fue la complicación más frecuente en el 65 porciento. No existió mortalidad atribuible al proceder. La fluoroscopia de tórax fue el complementario que más se utilizó, 90 porciento. Se concluye en que la punción aspirativa con aguja fina es un método ideal en las lesiones periféricas del pulmón y constituye el primer paso en el estudio de las opacidades pulmonares(AU)

Transthoracic fine needle aspiration biopsy is an old method that sometimes is forgotten in the study of pleuropulmonary lesions. The objective of this paper is to evaluate the effectiveness of this diagnostic technique. 182 medical histories of patients with lung cancer were analyzed from 1987 to 1999. All the cases were diagnosed by puncture. 81.3 percent of positivity and 18,7 percent of diagnostic error by false negative were obtained. The most frequent histic type was the epidermoid carcinoma, 50,5 percent and the adenocarcinoma, 31,3 percent. All the lesions were peripheral. Pneumothorax was the commonest complication in 65 percent of the cases. There was no mortality attributable to the procedure. Thorax fluoroscopy was the most used complementary, 90 percent. It was concluded that fine needle aspiration puncture is an ideal method in lung peripheral lesions and that it is the first step in the study of pulmonary opacities(AU)