To determine the diagnostic bias between clinical and forensic radiology in cases of nonfatal hanging and determine and describe typical underreported imaging findings. In a retrospective, single-center study, all patients admitted for attempted suicide with near-hanging or fatal hanging between January 2008 and December 2020 who received CT or MRI of head and neck were reviewed and missed findings in the original report were documented. A binary regression with disagreement as dependent variable was fitted for the imaging modality, fatality, age, and sex. A total of 123 hanging incidents were retrospectively analyzed. The vast majority (n = 108; 87.8%) had attempted suicide with a nonfatal outcome. Fatal outcome occurred in 15 (12.0%). The extra- and intracranial injuries documented on CT and MRI scans were laryngeal (n = 8; 6.5%), soft tissue (n = 42; 34.1%), and vascular injuries (n = 1; 0.8%). Intracranial pathology was evident on 18 (14.6%) scans. Disagreement occurred in 36 (29.3%) cases and represented 52 (69.2%) of all cases with a radiological finding. Disagreement was strongly associated with fatality (OR: 2.7-44.9.4, p = 0.0012). In most cases, nonfatal hangings cause no or only minor injuries. Fatal cases are associated with a greater probability of missed minor imaging findings. This suggests that findings deemed clinically irrelevant are probably not reported in such severe emergency cases. This association indicates that minor abnormalities are underreported when major pathologies are evident on imaging in victims of strangulation.

Studies reporting distressing deathbed visions (DBVs) are reviewed to determine whether these experiences are rare, misunderstood, or underreported. Possible explanations for distressing DBVs are explored and possible reasons why distressing DBVs might be underreported are offered. Given the paucity of information on distressing DBVs, more research is needed to determine their prevalence, types, meaning, and impact on dying persons and their families.

Conidiobolomycosis is an uncommon, chronic, localized subcutaneous mycosis primarily affecting rhinofacial region. It is reported mainly from tropical and subtropical countries. The condition is underreported due to the lack of clinical suspicion and usually mismanaged. This rare mycosis is due to the genus Conidiobolus within the order Entomophthorales of class Zygomycetes. Here we present 3 cases of rhinofacial conidiobolomycosis in otherwise healthy adults from different parts of Sri Lanka over 1-year period. All patients had disfiguring subcutaneous lesions in the rhinofacial area. The diagnoses were based on isolation of Conidiobolus coronatus in clinical specimens.

OBJECTIVE: Latent errors in an incident reporting system pose threats to accident and near-miss prevention in hospitals. The aims of this study were to gain insight into the incident reporting system by exploring and investigating the refinement of unreported and under-reported (near-miss) patterns and by estimating under-reported annual hospital accidents over three months in one hospital.
METHODS: Sequential mixed-method research was undertaken using both qualitative and quantitative approaches. 120 health care providers were selected from 13 departments of a selected study hospital. Self-reported questionnaires, information from annual reports and focus group interviews among stakeholders were employed. Based on a quantitative mixed-model approach, estimation of lost cases from near-miss incidents was made.
RESULTS: In 2015, 20% of accidents had been reported to the hospital center while under-reported accidents and near-miss incidents by self-report over 3 months equaled 18% and 25.9%, respectively. Recent trends were positive, driven by changing values about incident reporting. However, confusion and fear still remain among practitioners about near-miss reporting due to old beliefs. This study confirms that incident reporting needs improvement so that there is an enhanced organizational culture of safety, raised awareness for individual reporting, and recovery of lost cases using mixed-model estimation of near-misses.

The most important and unique adverse effect of abacavir (ABC) is fatal hypersensitivity reaction (HSR). The objective of this report is to describe a case of ABC induced HSR that occurred in an Indian HIV patient during treatment. Although this adverse effect is not uncommon, it is perhaps underreported or has never been reported so far in an Indian case scenario. A 44-year-old known case of HIV-1 was admitted in view of his worsening condition and very low CD4 cell counts 3 cells/μL. He was on anti-retroviral therapy since three years but not regular. On the basis of treatment failure, non-compliance and progressive low CD4 counts, the anti HIV regime was switched over to abacavir 600 mg+ atazanavir/ ritonavir 300mg/100mg Two weeks after ABC therapy he presented with maculopapular rash, headache and signs of hepatic damage (serum AST, ALP and ALT increased to 3-4 fold) suggestive of hypersensitivity reaction. As we know discontinuation of the drug is the ultimate litmus test to confirm diagnosis of drug induced adverse reaction. We did confirm ABC induced HSR by de-challenge wherein, rash disappeared within 2-3 days and LFT came back to normal within 5 days. However, no rechallenge was done. HSR was more in favour of ABC because atazanavir failed to produce any similar reaction after re-challenge.