Misdiagnosis of community-acquired pneumonia in patients admitted to respiratory wards, Penang General Hospital

INTRODUCTION

Pneumonia continues to be as one of the top causes of hospitalisations and deaths in Malaysia despite the advancement in prevention and treatment of pneumonia. One of the possible explanations is the frequent misdiagnosis of pneumonia which had been reported elsewhere but such data is not available locally.

OBJECTIVES

This is an audit project aiming to evaluate the proportion of misdiagnosis among hospitalised communityacquired pneumonia (CAP) patients in the Respiratory wards of Penang General Hospital based on their initial presentation data, and their associated outcomes.

METHODS

We reviewed the medical notes and initial chest radiographs of 188 CAP patients who were admitted to respiratory wards. Misdiagnosis was defined as cases which lack suggestive clinical features and/or chest radiograph changes. In-hospital mortality and length of stay (LOS) were the outcomes of interest.

RESULTS

The study found that 38.8% (n=73) of the hospitalised CAP patients were misdiagnosed. The most common alternative diagnosis was upper respiratory tract infection (32.8%, n=24). There was no statistical difference between misdiagnosis and CAP patients in the demographic and clinical variables collected. In terms of outcomes, misdiagnosed patients were discharged earlier (mean LOS= 3.5±3.28 days vs. 7.7±15.29 days, p=0.03) but the in-hospital mortality difference was not statistically significant (p=0.07).

CONCLUSIONS

One third of our CAP admissions were misdiagnosed. Although initial misdiagnosis of CAP in our study did not show any increase in mortality or morbidity, a proper diagnosis of CAP will be helpful in preventing inappropriate prescription of antibiotics and unnecessary admission.

Management of asthma in adults in primary care

Asthma is a chronic inflammatory disease of the airway which is often misdiagnosed and undertreated. Early diagnosis and vigilant asthma control are crucial to preventing permanent airway damage, improving quality of life and reducing healthcare burdens. The key approaches to asthma management should include patient empowerment through health education and self-management and, an effective patient-healthcare provider partnership.

Anticipated discrimination among people with schizophrenia

OBJECTIVE

The aim of this study was to evaluate the level of anticipated discrimination in people with schizophrenia (n = 732) from 27 countries in the International Study of Discrimination and Stigma Outcomes (INDIGO).

METHOD

Anticipated discrimination was assessed through four questions of Discrimination and Stigma Scale. Twenty-five individuals were identified at each site who were reasonably representative of all such treated cases within the local area.

RESULTS

Sixty-four per cent of the participants reported that they had stopped themselves from applying for work, training or education because of anticipated discrimination. Seventy-two per cent of them reported that they felt the need to conceal their diagnosis. Expecting to be avoided by others who know about their diagnosis was highly associated with decisions to conceal their diagnosis. Those who concealed their diagnosis were younger and more educated. The participants who perceived discrimination by others were more likely to stop themselves from looking for a close relationship. Anticipated discrimination in finding and keeping work was more common in the absence than in the presence of experienced discrimination, and the similar findings applied to intimate relationships.

CONCLUSION

This study shows that anticipated discrimination among people with schizophrenia is common, but is not necessarily associated with experienced discrimination.

Mitochondrial DNA variation among the Drosophila athabasca semispecies and Drosophila affinis

Morphology, allozymes, and levels of postreproductive isolation indicate that the semispecies of Drosophila athabasca are as recently diverged as typical populations within a Drosophila species. However, levels of behavioral isolation, divergence in male mating song, and divergence in X-chromosome inversions suggest a much more ancient divergence. In this article, we have examined mitochondrial DNA restriction site variation within and among the three semispecies. These data support the hypothesis that the three semispecies of Drosophila athabasca are at least as recently diverged as are typical populations within other species of Drosophila. Male mating song, behavioral isolation, and X-chromosome differences thus appear to have evolved very rapidly. In addition, hypothesized phylogenetic relationships of these three semispecies, based on our mtDNA data, are identical to those based on allozymes and chromosomal inversions. According to this phylogeny, recency of ancestry is not well correlated with levels of behavioral isolation, whereas patterns of sympatry and allopatry are. These patterns strongly implicate the action of selection in the rapid evolution of behavioral isolation and X-chromosome gene arrangement.

Molecular evolution of the period gene in Drosophila athabasca

We measured nucleotide variability within and between the three semispecies of the Drosophila athabasca complex, at the period (per) gene by using a polymerase chain reaction-based four-cutter restriction-enzyme analysis. The levels of polymorphism varied considerably between the three semispecies. Our results for per, combined with previous data for X-linked allozymes, suggest that the X chromosome in the western-northern semispecies is less variable than expected under an equilibrium-neutral model. Both the pattern of divergence between the semispecies and a cladistic clustering of per haplotypes support the previously hypothesized grouping of eastern A and eastern B as the two most recently diverged semispecies. A 21-bp in-frame segment in the region of per which shares sequence similarity with the neuronal development gene single minded is deleted in all eastern A and eastern B flies examined but is present in all of the western-northern flies and all other published per sequences. Despite these hints that there may be significant differences at the per gene between the semispecies, especially the western-northern group versus the two eastern groups, there is no compelling evidence that per is involved in the mating song differences between the semispecies.

Mandibular border positions and their relationships with peripheral joint mobility

Peripheral joint mobility was assessed in a group of fifty-one dental students using a modification of the Carter and Wilkinson Index. Mandibular border positions were measured both actively and passively with the aid of a millimetre ruler. The purpose of the investigation was to study possible relationships between generalized joint (hyper-)mobility and (hyper-)mobility of the temporomandibular joints. Only a few weak correlations were found between the mandibular border position measurements (active and passive mouth opening, active and passive, left and right, laterotrusions and active protrusion) and the peripheral joint mobility measurements. Differences between the sexes were illustrated in peripheral joint mobility with females showing a greater joint mobility than males, especially when only the passively measured joints were considered. The mandibular border positions were significantly correlated with each other (P less than 0.05-P less than 0.001) for the males, but few and then only weak relationships between these measurements could be found for the females in this group. The concept of temporomandibular joint 'end-feel' in relation to joint mobility is discussed.