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Ahmed R, Dulay MS, Liu A, Okafor J, Azzu A, Ramphul K, Baksi JA, Wechalekar K, Khattar R, Dar O, Collins P, Wells AU, Kouranos V, Sharma R. Comparing outcomes of an 'early' versus 'late' diagnosis of cardiac sarcoidosis following a baseline presentation of high-grade atrioventricular block. Curr Probl Cardiol 2024; 49:102577. [PMID: 38653441 DOI: 10.1016/j.cpcardiol.2024.102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND There is a paucity of evidence on impact of a delay in Cardiac Sarcoidosis (CS) diagnosis after high-grade atrioventricular-block (AVB) and this study aims to fill this void. METHODS Consecutive CS patients (n = 77) with high grade AVB referred to one specialist hospital in London between February 2007 to February 2023 were retrospectively reviewed. The median time from AVB to diagnosing CS (112 days) was used to define the Early (n = 38) and Late (n = 39) cohorts. The primary endpoint was a composite of all-cause mortality, cardiac transplantation, ventricular arrhythmic events or heart failure hospitalisation. Secondary endpoints included difference in maintenance prednisolone dose, need for cardiac device upgrade and device complications. RESULTS The mean age of the cohort was 54.4 (±10.6) years of whom 64 % were male and 81 % Caucasian. After a mean follow up of 54.9 (±45.3) months, the primary endpoint was reached by more patients from the Late cohort (16/39 vs. 6/38, p = 0.02; multivariable HR 6.9; 95 %CI 1.5-32.2, p = 0.01). Early Group were more likely to have received an Implantable Cardioverter Defibrillator or Cardiac Resynchronisation Therapy-defibrillator as index device after AVB (19/38 vs. 6/39; p < 0.01) and had fewer device upgrades (19/38 vs. 30/39, p = 0.01) and a trend towards fewer device complications (1 vs. 5, p = 0.20). The maintenance dose of prednisolone was significantly higher in Late Group [20.7(±9.7) mg vs. 15.3(±7.9) mg, p = 0.02]. CONCLUSION A late diagnosis of CS was associated with more adverse events, a greater probability of needing a device upgrade and required higher maintenance steroid dose.
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Affiliation(s)
- Raheel Ahmed
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom.
| | - Mansimran Singh Dulay
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, United Kingdom
| | - Alexander Liu
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joseph Okafor
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Alessia Azzu
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom
| | | | - John Arun Baksi
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kshama Wechalekar
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rajdeep Khattar
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Owais Dar
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, United Kingdom
| | - Peter Collins
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Athol Umfrey Wells
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vasilis Kouranos
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Rakesh Sharma
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom
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Mwenda V, Mwangi M, Gathecha G, Kibachio J, Too R, Gura Z, Temmerman M. Factors associated with late diagnosis of cervical cancer at two national referral hospitals, Kenya 2017: A case control study. Gynecol Oncol Rep 2024; 52:101355. [PMID: 38500641 PMCID: PMC10945120 DOI: 10.1016/j.gore.2024.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/01/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024] Open
Abstract
Background Cervical cancer is the leading cause of cancer mortality among women in Kenya. Two thirds of cervical cancer cases in Kenya are diagnosed in advanced stages. We aimed to identify factors associated with late diagnosis of cervical cancer, to guide policy interventions. Methods An unmatched case control study (ratio 1:2) was conducted among women aged ≥ 18 years with cervical cancer at Kenyatta National and Moi Teaching and Referral Hospitals. We defined a case as patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥ 2A and controls as those with stage ≤ 1B. A structured questionnaire was used to document exposure variables. We calculated adjusted odds ratio (aOR) to identify any associations. Results We enrolled 192 participants (64 cases, 128 controls). Mean age 39.2 (±9.3) years, 145 (76 %) were married, 77 (40 %) had primary level education, 168 (88 %) had their first pregnancy ≤ 24 years of age, 85 (44 %) were > para 3 and 150 (78 %) used contraceptives. Late diagnosis of cervical cancer was associated with cost of travel to cancer centres > USD 6.1 (aOR 6.43 95% CI [1.30, 31.72]), age > 50 years (aOR 4.71; 95% CI [1.18, 18.80]), anxiety over cost of cancer care (aOR 5.6; 95% CI [1.05, 32.72]) and ultrasound examination during evaluation of symptoms (aOR 4.89; 95% CI [1.07-22.42]). Previous treatment for gynecological infections (aOR 0.10; 95% CI [0.02, 0.47]) was protective against late diagnosis. Conclusion Cost of seeking care and the quality of the diagnostic process were important factors in this study. Decentralization of care, innovative health financing solutions and clear diagnostic and referral algorithms for women presenting with gynecological symptoms could reduce late-stage diagnosis in Kenya.
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Affiliation(s)
- Valerian Mwenda
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Martin Mwangi
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Gladwell Gathecha
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Joseph Kibachio
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Robert Too
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
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Long AM, Davidson JR, Tyraskis A, Knight M, De Coppi P. A Population-Based Cohort Study on Diagnosis and Early Management of Anorectal Malformation in the UK and Ireland. J Pediatr Surg 2024:S0022-3468(24)00160-X. [PMID: 38580547 DOI: 10.1016/j.jpedsurg.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND This study describes the presentation and initial management of anorectal malformation (ARM); evaluating the frequency, causes and consequences of late diagnosis. METHODS A prospective, population cohort study was undertaken for newly diagnosed ARMs in the UK and Ireland from 01/10/2015 and 30/09/2016. Follow-up was completed at one year. Data are presented as n (%), appropriate statistical methods used. Factors associated with late diagnosis; defined as: detection of ARM either following discharge or more than 72 h after birth were assessed with univariable logistic regression. RESULTS Twenty six centres reported on 174 cases, 158 of which were classified according to the type of malformation and 154 had completed surgical data. Overall, perineal fistula was the most commonly detected anomaly 43/158 (27%); of the 41 of these children undergoing surgery, 15 (37%) had a stoma formed. 21/154 (14%, CI95{9-20}) patients undergoing surgery experienced post-operative complications. Thirty-nine (22%) were diagnosed late and 12 (7%) were detected >30 days after birth. Factors associated with late diagnosis included female sex (OR 2.06; 1.0-4.26), having a visible perineal opening (OR 2.63; 1.21-5.67) and anomalies leading to visible meconium on the perineum (OR 18.74; 2.47-141.73). 56/174 (32%) had a diagnosis of VACTERL association (vertebral, anorectal, cardiac, tracheal, oesophageal, renal and limb); however, not all infants were investigated for commonly associated anomalies. 51/140 (36%) had a cardiac anomaly detected on echocardiogram. CONCLUSION There is room for improvement within the care for infants born with ARM in the UK and Ireland. Upskilling those performing neonatal examination to allow timely diagnosis, instruction of universal screening for associated anomalies and further analysis of the factors leading to clinically unnecessary stoma formation are warranted. LEVEL OF EVIDENCE II (Prospective Cohort Study <80% follow-up).
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Affiliation(s)
- Anna-May Long
- Department of Paediatric Surgery, Cambridge University Hospitals, United Kingdom; National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Joseph R Davidson
- Department of Stem Cells and Regenerative Medicine, UCL-GOS Institute of Child Health, London, United Kingdom; NIHR Biomedical Research Centre and Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Paolo De Coppi
- Department of Stem Cells and Regenerative Medicine, UCL-GOS Institute of Child Health, London, United Kingdom; NIHR Biomedical Research Centre and Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.
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Quelhas D, Kingma SD, Jonckheere AI, Smeets-Peels CS, Gomes DC, Duro J, Oliveira A, Matthijs G, Steinbusch LK, Jaeken J, Rivera I, Rubio-Gozalbo E. Natural history of three late-diagnosed classic Galactosemia patients. Mol Genet Metab Rep 2024; 38:101057. [PMID: 38469096 PMCID: PMC10926220 DOI: 10.1016/j.ymgmr.2024.101057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 03/13/2024] Open
Abstract
The authors report the natural history of three patients with late-diagnosed Classic Galactosemia (CG) (at 16, 19 and 28 years). This was due to a combination of factors: absence of neonatal screening, absence of some typical acute neonatal symptoms, and negative galactosemia screening. This report underlines the value of neonatal screening and the importance of further diagnostic testing in case of late-onset manifestations.
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Affiliation(s)
- Dulce Quelhas
- Unidade de Bioquímica Genética, Centro de Genética Médica, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, ICBAS, UP, Porto, Portugal
- Centro Referência Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Sandra D.K. Kingma
- Mosakids Children's Hospital, Maastricht University Medical Center, Maastricht, the Netherlands
- Centre for Metabolic Diseases, University Hospital Antwerp, University of Antwerp, Edegem, Antwerp, Belgium
| | - An I. Jonckheere
- Centre for Metabolic Diseases, University Hospital Antwerp, University of Antwerp, Edegem, Antwerp, Belgium
| | | | - Daniel Costa Gomes
- Centro de Referȇncia de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - José Duro
- Centro de Referȇncia de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - Anabela Oliveira
- Centro de Referȇncia de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - Gert Matthijs
- Laboratory for Molecular Diagnosis, Center for Human Genetics, KU Leuven, 3000 Leuven, Belgium
| | - Laura K.M. Steinbusch
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jaak Jaeken
- Department of Development and Regeneration, Woman and Child Unit, Center for Metabolic Diseases, KU Leuven, Leuven, Belgium
| | - Isabel Rivera
- Research Institute for Medicines (iMed.ULisboa), Department of Pharmaceutical Sciences and Medicines, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Estela Rubio-Gozalbo
- Mosakids Children's Hospital, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
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Ostertag-Hill CA, Nandivada P, Dickie BH. Late Diagnosis of Hirschsprung Disease: Clinical Presentation and Long-Term Functional Outcomes. J Pediatr Surg 2024; 59:220-224. [PMID: 37981542 DOI: 10.1016/j.jpedsurg.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Hirschsprung Disease (HD) is typically diagnosed in the neonatal period. A small subset of patients have a prolonged course of abdominal distention and constipation prior to diagnosis. Late HD is defined as having been diagnosed at greater than or equal to one year of age. The literature is limited and offers conflicting data on the implications of a late diagnosis. We aim to investigate the presentation, operative approach, and functional outcomes of a large cohort of patients with a late HD diagnosis. METHODS All patients with a late diagnosis of HD (after 1 year of age) at our institution between 1997 and 2021 were included. RESULTS Twenty-eight patients were diagnosed with HD at a median age of 3.4 years. Chronic constipation, failure to thrive, and enterocolitis occurred in 100 %, 31 %, and 14 %, respectively. All patients underwent contrast enema and biopsies during their workup, identifying primarily rectosigmoid disease (n = 27) and total colonic aganglionosis (n = 1). Surgical intervention was performed in 27 patients, with 4 patients (15 %) needing a stoma (3 with plan for staged pull-through, 1 long-term stoma) and 23 patients (85 %) undergoing a single-stage pull-through. Postoperative complications included Hirschsprung-associated enterocolitis (n = 5), ostomy prolapse and revision (n = 2), abdominal distention requiring ileostomy creation (n = 2), redo pull-through (n = 2), retroperitoneal hematoma (n = 1), and cecostomy tube placement (n = 1). At a median follow-up of 5.4 years, 83 % of eligible patients achieved fecal continence with 43 % needing laxatives for persistent constipation. CONCLUSION Recognizing a late presentation of HD requires a high index of suspicion. Patients with a late diagnosis did not experience an increased rate of permanent stoma, complications, or redo surgery compared to rates reported for the larger HD population. Similar long-term functional outcomes were achieved compared to the larger HD population. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Belinda H Dickie
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
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Hernando Sebastián V, Ruiz-Algueró M, Simón Méndez L, Díaz Franco A. [Impacto de la pandemia de la COVID-19 en los sistemas de vigilancia epidemiologica de la infección por vih en España.]. Rev Esp Salud Publica 2023; 97:e202311093. [PMID: 37929838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/11/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic indirectly affected other communicable diseases, such as human immunodeficiency virus (HIV) infection. The aim of this paper was to evaluate the impact of the COVID-19 pandemic on the epidemiological surveillance of HIV through epidemiological indicators. METHODS Data collected in the New HIV Diagnosis Information System (SINIVIH, acronym in Spanish) in the period 2013-2021 was analyzed. The epidemiological indicators analyzed were: 1) Reporting delay of new diagnoses; 2) Under diagnosis of cases, calculated per month of diagnosis and for each year of diagnosis; 3) Late diagnosis, cases diagnosed with less than 350 CD4 cell/mm3. RESULTS Regarding the reporting delay of new diagnoses, in 2022 2,770 diagnoses were reported in 2020, 43.8% more than those reported in 2021 for that year. The cases diagnosed per month between 2016 and 2019 followed a constant trend. In 2020, a significant decrease in diagnoses was observed between March and May that was not recovered after correcting for reporting delay. When comparing the rates of cases diagnosed in 2013 with the successive years, a continuous decrease was interrupted in the last year of the study period. The percentage of cases with late diagnosis had remained stable in the study period (between 46% and 50%), and a decrease in this percentage was observed after correcting for reporting delay. CONCLUSIONS The epidemiological surveillance of HIV suffered a significant reporting delay. A decrease in cases diagnosed is confirmed, partly due to lockdown and lack of access to the health system. Changes on late diagnosis is not observed.
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Affiliation(s)
- Victoria Hernando Sebastián
- Centro Nacional de Epidemiología; Instituto de Salud Carlos III. Madrid. España
- CIBER de Enfermedades Infecciosas (CIBERINFEC);Instituto de Salud Carlos III. Madrid. España
| | - Marta Ruiz-Algueró
- Centro Nacional de Epidemiología; Instituto de Salud Carlos III. Madrid. España
- CIBER de Enfermedades Infecciosas (CIBERINFEC);Instituto de Salud Carlos III. Madrid. España
| | - Lorena Simón Méndez
- Centro Nacional de Epidemiología; Instituto de Salud Carlos III. Madrid. España
| | - Asunción Díaz Franco
- Centro Nacional de Epidemiología; Instituto de Salud Carlos III. Madrid. España
- CIBER de Enfermedades Infecciosas (CIBERINFEC);Instituto de Salud Carlos III. Madrid. España
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Belcher HL, Morein-Zamir S, Stagg SD, Ford RM. Shining a Light on a Hidden Population: Social Functioning and Mental Health in Women Reporting Autistic Traits But Lacking Diagnosis. J Autism Dev Disord 2023; 53:3118-3132. [PMID: 35593995 PMCID: PMC10313531 DOI: 10.1007/s10803-022-05583-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 12/28/2022]
Abstract
Female Phenotype Theory (FPT) suggests that autistic women often present with less obvious social impairments than autistic men. We examined the possibility of an exaggerated female phenotype among undiagnosed but probably autistic women. In two nationwide online surveys, we compared self-reported social functioning and mental health between diagnosed autistic women and women without diagnosis who scored ≥ 32 on the Autism Quotient. Compared to diagnosed autistic women, probably autistic women had higher empathy and general social functioning, and were more likely to have received a diagnosis of Borderline Personality Disorder. Autistic women had typically received more mental health diagnoses prior to their ASC diagnosis than autistic men. These findings shed light on the history of misdiagnosis experienced by many autistic women.
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Affiliation(s)
- Hannah L Belcher
- IOPPN, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK.
| | - Sharon Morein-Zamir
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, CB1 1PT, UK
| | - Steven D Stagg
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, CB1 1PT, UK
| | - Ruth M Ford
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, CB1 1PT, UK
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Mezzomo TR, Messaggi Gomes Dias MR, Pereira RM. Adults with early diagnosis of phenylketonuria have higher resting energy expenditure than adults with late diagnosis. Clin Nutr ESPEN 2023; 56:166-172. [PMID: 37344068 DOI: 10.1016/j.clnesp.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/29/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION To date, there is a gap regarding resting energy expenditure (REE) in adults with phenylketonuria (PKU), whether PKU type and time of diagnosis interfere with REE, and whether the available predictive equations are valid in this population. OBJECTIVE To compare the REE of adult subjects with PKU with healthy subjects and secondarily, examine the REE of adults with PKU according to type and time of diagnosis, and check the agreement of commonly used predictive equations of REE. METHODS Concordance study with adults with PKU and a comparison group (CG) with healthy adults. Anthropometric and body composition assessments and REE assessment by indirect calorimetry (IC) were performed. The results obtained by IC were compared with predictive equations. RESULTS Sixty-nine adults were evaluated (PKU: 36; CG: 33). The REE of adults with mild and classic PKU is similar (p>.05) and similar to CG (p>.05). The REE of individuals with early diagnosis is higher (p < .05) than the REE of individuals with late diagnosis. The REE obtained by IC differed (p < .05) from all estimated REE. CONCLUSION Late diagnosis of PKU showed lower REE compared to individuals with early diagnosis. The REE of adults with PKU does not differ in relation to the type of PKU, nor does it differ from the CG. Predictive equations overestimate REE.
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Affiliation(s)
- Thais Regina Mezzomo
- Master's and Doctoral Program in Child and Adolescent Health Sector of Health Sciences University Federal of Parana Curitiba, PR, Brazil.
| | | | - Rosana Marques Pereira
- Master's and Doctoral Program in Child and Adolescent Health Sector of Health Sciences University Federal of Parana Curitiba, PR, Brazil
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Ghanouni P, Seaker L. What does receiving autism diagnosis in adulthood look like? Stakeholders' experiences and inputs. Int J Ment Health Syst 2023; 17:16. [PMID: 37291614 DOI: 10.1186/s13033-023-00587-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION The age of diagnosis is crucial for optimal health outcomes; however, some individuals with Autism Spectrum Disorder (ASD) may not be diagnosed until adulthood. Limited information is available about the lived experience of receiving a diagnosis during adulthood. Thus, we aimed to investigate stakeholders' experiences about the ASD diagnosis during adulthood. METHOD We interviewed 18 individuals including 13 adults with ASD who had received a late diagnosis during adulthood and 5 parents of individuals with ASD from various Canadian provinces. RESULTS Using a thematic analysis, three main themes emerged: (a) noticing differences and similarities, (b) hindering elements to diagnosis, and (c) emotional response to diagnostic odyssey. CONCLUSION This study adds to the literature about experiences of receiving ASD diagnosis in adulthood. Given the impact of diagnosis on individuals, it is important to minimize the barriers to ensure individuals who require ASD-related supports can access them in a timely and effective manner. This study highlights the importance of receiving an ASD diagnosis and facilitates positive health outcomes. The findings from the current study can be used to guide adult diagnostic processes and practices to help make ASD diagnosis more accessible.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Liam Seaker
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada
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Owusu MW, Krankowska DC, Lourida P, Weis N. Late HIV diagnosis among migrant women living in Europe - a systematic review of barriers to HIV testing. IJID Reg 2023; 7:206-215. [PMID: 37128290 PMCID: PMC10148112 DOI: 10.1016/j.ijregi.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023]
Abstract
Objectives HIV transmission persists in Europe, with migrants accounting for over two-fifths of new diagnoses. Over half of all women in Europe are diagnosed late - particularly migrant women. Therefore, an updated understanding of migrant women's needs is crucial to inform inclusive and relevant HIV research, services, and policies. Methods A systematic review relating to factors influencing late HIV diagnoses among migrant women living in Europe in 2011-2021 was conducted, based on data from 12 papers relating to 13 European Union (EU) countries and three non-EU countries. Results The studies revealed a range of individual, sociocultural, and structural barriers to HIV diagnosis. Individual barriers included low perceived risk of HIV, lack of knowledge about HIV symptoms and HIV services, lack of trust in healthcare systems, and fear of societal implications of an HIV diagnosis. Sociocultural barriers included language and communication challenges, stigma, and lack of community testing opportunities. Structural factors included poverty, poor living conditions, unclear legal rights, administrative barriers to healthcare access, and lack of testing opportunities. Conclusions Barriers varied according to resident country, healthcare system, and country/region of origin. The studies highlighted the importance of inclusive research and service design and development, to address the needs of migrant women and reduce inequalities, especially given the current climate in Europe and the everchanging patterns of migration.
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Affiliation(s)
| | - Dagny Clea Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Panagiota Lourida
- Department of Infectious Diseases and HIV, Evaggelismos General Hospital, Athens, Greece
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Correspondence to: Prof Nina Weis, PhD, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark, Tel: +45 2636 3881
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Hakim K, Benothman R, Mekki N, Msaad H, Ouarda F. Paucisymptomatic Tetralogy of Fallot diagnosed in a 56-year-old patient: a case report. Egypt Heart J 2023; 75:42. [PMID: 37233917 DOI: 10.1186/s43044-023-00372-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/20/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. It is generally diagnosed and surgically repaired early in life, with good overall outcomes. CASE PRESENTATION We report the case of a patient incidentally diagnosed with paucisymptomatic TOF at the age of 56 years old, during investigations for carbon monoxide poisoning. The patient had a history of thyroidectomy, arterial hypertension, and four uncomplicated vaginal deliveries. CONCLUSIONS This case shows us that some patients with TOF can reach older ages without surgical correction. Late surgical repair should be meticulously decided on a case basis.
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Affiliation(s)
- Kaouthar Hakim
- Pediatric Cardiology Department, La Rabta University Hospital of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Rihab Benothman
- Pediatric Cardiology Department, La Rabta University Hospital of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Nouha Mekki
- Pediatric Cardiology Department, La Rabta University Hospital of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Hela Msaad
- Pediatric Cardiology Department, La Rabta University Hospital of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Fatma Ouarda
- Pediatric Cardiology Department, La Rabta University Hospital of Tunis, Tunis El Manar University, Tunis, Tunisia
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Darré T, Tchandikou L, Simgban P, Bombone M, Djiwa T, N’Timon B, Sama B, Ketevi A, Douaguibe B, N’Bortche BK, Seddoh Y, Tchaou M, Napo-Koura G. Factors associated with late diagnosis of breast cancer in women in Togo, Sub-Saharan Africa. BMC Womens Health 2023; 23:106. [PMID: 36918873 PMCID: PMC10012487 DOI: 10.1186/s12905-023-02257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Breast cancer is the most frequently diagnosed cancer in women worldwide. The objective of this study was to identify factors associated with late diagnosis of breast cancer in Togolese women. METHODS We conducted a prospective cross-sectional study with descriptive and analytical purposes on cases of breast cancer in women in 2021, in Togo. The patients included in this study were women followed in the gynecology department for stages III and IV breast cancer. RESULTS We included 62 cases of breast cancer. The average age of the patients was 38.6 ± 12.5 years with extremes of 17 and 76 years. The breast nodule was the most common reason for consultation in 75.8% of cases. The histological types diagnosed were invasive carcinoma of non-specific type (58; 93.55%), mucinous carcinoma (3; 4.84%) and lobular carcinoma (1; 1.61%). For the stage of the cancer, 43 patients were stage III (69.4%) and 19 stage IV (30.6%). In multivariate analysis, the factors associated with late diagnosis of breast cancer were: fear of diagnosis (aOR = 1.29; p = 0.0014), long delay in diagnosis (aOR = 2.62; p = 0.0001) and failure to perform breast self-examination (aOR = 1.68; p = 0.0022). CONCLUSION The fear of the diagnosis, the absence of self-examination of the breasts and the use of traditional treatment and self-medication in first intention constituted the essential factors of the late diagnosis of breast cancer. Strategies should be put in place at the national level to impact on these factors for an early diagnosis of breast cancer.
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Affiliation(s)
- Tchin Darré
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
- grid.12364.320000 0004 0647 9497Faculty of Health Sciences, University of Lomé, BP 1515, Lomé, Togo
| | - Lantam Tchandikou
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Panakinao Simgban
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Mayi Bombone
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Toukilnan Djiwa
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Bidamin N’Timon
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Lomé, Togo
| | - Bagassam Sama
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Ayoko Ketevi
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Baguilane Douaguibe
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Bingo K. N’Bortche
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Yao Seddoh
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Mazamaesso Tchaou
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Lomé, Togo
| | - Gado Napo-Koura
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
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Montiel-Jarquín ÁJ, Santiago-Carrillo MA, García-Galicia A, López-Bernal CA, Miranda-Martínez MA, Loria-Castellanos J. Análisis del coste directo de la atención médica y quirúrgica del cáncer de mama. Estudio comparativo entre etapas temprana y tardía en tercer nivel de atención. CIR CIR 2023; 91:28-33. [PMID: 36787613 DOI: 10.24875/ciru.21000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Management of breast cancer is increased by late diagnoses. OBJECTIVE To analyse direct costs of breast cancer in early and advanced stage in a third level medical facility at Mexican Social Security Institute. METHOD Observational study, direct costs of care in breast cancer in initial and advanced clinical stages are compared. Variables analysed were laboratory and diagnostic imaging studies, drugs, as well as hospitalization costs. The evaluated period included from the first care to the completion of the treatment. Costs were determined according to the table of Unit Costs by Level of Medical Care for the year 2019 of the Mexican Social Security Institute. Student's t test was used to determinate differences between groups, as well as descriptive statistics. RESULTS The advanced stage compared to the initial stage, causes a greater number of laboratory-cabinet studies, surgeries, day/bed and interconsultations. The average cost of breast cancer care per patient is $99,280.36 (US$5,230.78) and $148,023.60 (US$7,789.92) for the initial and advanced stages, respectively (p = 0.024). CONCLUSIONS Cost of medical attention in the initial stage is lower than that of the advanced stage.
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Affiliation(s)
- Álvaro J Montiel-Jarquín
- Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, Centro Médico Nacional "General de División Manuel Ávila Camacho", Instituto Mexicano del Seguro Social
| | - Marco A Santiago-Carrillo
- Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, Centro Médico Nacional "General de División Manuel Ávila Camacho", Instituto Mexicano del Seguro Social.,Facultad de Medicina, Benemérita Universidad Autónoma de Puebla
| | - Arturo García-Galicia
- Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, Centro Médico Nacional "General de División Manuel Ávila Camacho", Instituto Mexicano del Seguro Social
| | - Carlos A López-Bernal
- Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, Centro Médico Nacional "General de División Manuel Ávila Camacho", Instituto Mexicano del Seguro Social
| | - Miriam A Miranda-Martínez
- Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, Centro Médico Nacional "General de División Manuel Ávila Camacho", Instituto Mexicano del Seguro Social
| | - Jorge Loria-Castellanos
- Coordinación de Proyectos Especiales en Salud, Instituto Mexicano del Seguro Social. Puebla, Pue., México
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Abu Shqara R, Or S, Wiener Y, Lowenstein L, Frank Wolf M. Clinical implications of the 100-g oral glucose tolerance test in the third trimester. Arch Gynecol Obstet 2023; 307:421-9. [PMID: 35344083 DOI: 10.1007/s00404-022-06520-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/09/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The clinical implications of gestational diabetes mellitus (GDM) diagnosed in the third trimester are not well established and controversy continues regarding the performance of diagnostic tests beyond 28-week gestation. This study aimed to evaluate the incidence of abnormal third trimester oral glucose tolerance test (OGTT) results in women at high risk and to compare the obstetric and neonatal outcomes with those of women with normal OGTT results. METHODS The study included 372 women who completed late (>29 weeks) 100-g OGTT due to suspected fetal macrosomia, polyhydramnios or a personal risk factor for GDM, diagnosed according to the Carpenter & Coustan criteria. Women with only one abnormal OGTT value were diagnosed with GDM by abnormal glucose follow-up and analyzed separately. Obstetric and neonatal outcomes were compared between the GDM and the non-GDM groups. RESULTS GDM was diagnosed in 85/372 (22%) women, including 35 (59.3%) women with one abnormal OGTT value who were later diagnosed with GDM. Of 200 women who had a normal 1-h 50-g glucose challenge test at 24-28 weeks, late GDM was diagnosed in 33 (16.5%). Seventy-six (89.5%) of those with GDM were treated by dietary therapy and 9 (10.5%) by pharmacological therapy. Among women with GDM, large-for-gestational-age fetuses, labor induction and elective cesarean section were more prevalent than for those without GDM. Significant differences were not found between the groups in macrosomia and neonatal outcomes. CONCLUSIONS The performance of OGTT in women with risk factors during the third trimester should be considered following further prospective trials.
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Zhao B, Song W, Kang M, Dong X, Li X, Wang L, Liu J, Tian W, Ding H, Chu Z, Wang L, Qiu Y, Han X, Shang H. Molecular Network Analysis Discloses the Limited Contribution to HIV Transmission for Patients with Late HIV Diagnosis in Northeast China. Arch Sex Behav 2023; 52:679-687. [PMID: 36539633 PMCID: PMC9886604 DOI: 10.1007/s10508-022-02492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
In the "treat all" era, the high rate of late HIV diagnosis (LHD) worldwide remains an impediment to ending the HIV epidemic. In this study, we analyzed LHD in newly diagnosed people living with HIV (PLWH) and its impact on HIV transmission in Northeast China. Sociodemographic information, baseline clinical data, and plasma samples obtained from all newly diagnosed PLWH in Shenyang, the largest city in Northeast China, between 2016 and 2019 were evaluated. Multivariate logistic regression analysis was performed to identify risk factors associated with LHD. A molecular network based on the HIV pol gene was constructed to assess the risk of HIV transmission with LHD. A total of 2882 PLWH, including 882 (30.6%) patients with LHD and 1390 (48.2%) patients with non-LHD, were enrolled. The risk factors for LHD were older age (≥ 30 years: p < .01) and diagnosis in the general population through physical examination (p < .0001). Moreover, the molecular network analysis revealed that the clustering rate (p < .0001), the fraction of individuals with ≥ 4 links (p = .0847), and the fraction of individuals linked to recent HIV infection (p < .0001) for LHD were significantly or marginally significantly lower than those recorded for non-LHD. Our study indicates the major risk factors associated with LHD in Shenyang and their limited contribution to HIV transmission, revealing that the peak of HIV transmission of LHD at diagnosis may have been missed. Early detection, diagnosis, and timely intervention for LHD may prevent HIV transmission.
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Affiliation(s)
- Bin Zhao
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wei Song
- Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang, China
| | - Mingming Kang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xue Dong
- Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang, China
| | - Xin Li
- Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang, China
| | - Lu Wang
- Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang, China
| | - Jianmin Liu
- Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang, China
| | - Wen Tian
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhenxing Chu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Lin Wang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yu Qiu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaoxu Han
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China.
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China.
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
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Getaneh Y, Ayalew J, He Q, Tayachew A, Rashid A, Kassa D, Leulseged S, Liao L, Yi F, Shao Y. Universal HIV testing and the impact of late diagnosis on disease stage among adults in urban Ethiopia. Trop Med Health 2023; 51:4. [PMID: 36653851 PMCID: PMC9847167 DOI: 10.1186/s41182-023-00494-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Treatment as prevention evolved into the universal HIV test-and-treat (UTT) strategy, which entails testing to the general population and treatment to every people living with HIV. We investigated universal testing (UT) performance and its determinants in urban Ethiopia and explore magnitude of late diagnosis and its impact on disease stages. METHOD We used data from the Ethiopia Population Based HIV Impact assessment (EPHIA), conducted in 2017/2018 which was a cross-sectional and household-based study. For current analysis, we considered self-report first diagnosis to estimate universal testing irrespective of their serostatus and also consider HIV LAg avidity vs viral load vs plasma antiretroviral drug level algorithm to categorize the late diagnosis. We finally evaluate disease stages using CD4 count and viral load. A 2-level multilevel mixed-effect logistic regression model was employed. The effects of individual-level predictors were quantified by the estimates from the fixed-effect part of the model with p-value < 0.05. RESULT Data were collected from 18,926 adults among those 29.4% of people living in Urban Ethiopia were never tested for HIV. Never tested females was 26.4% (95% CI = 25.3; 27.5). Never tested among divorced and widowed were 19.4% (95% CI: 17.3; 21.8) and 28.3% (95% CI: 24.6; 32.2), respectively. Never tested among elderly and youth were high (28.3% among 45-54 years old) to (41.2% among 55-64 years old) to 47.8% among 15-24 years old. Overall, late HIV diagnosis among adults in urban Ethiopia was 25.9% (95% CI: 21.7, 30.2). Late diagnosis varies by region ranged from 38.1% in the Gambella to 5.8% in Benishangul Gumuz. Advanced immune suppression (CD4 count < 350 cells/µl) among newly diagnosed long-term infection were significantly higher compared to those who were recently infected which accounted 47.8% (95%CI = 33.2-52.1) and 30.9% (95%CI = 21.3-32.2), respectively. Moreover, Viral load suppression were significantly lower among those who were late diagnosed 26.1% (95%CI = 13.6-33.8) compared to those of newly infected 89.6% (95%CI = 76.2; 93.4). CONCLUSION With the aim of UT for high risk and priority population, the low rate of HIV testing among widowed, elderly, young adolescent and women in urban Ethiopia calls for enhanced HIV testing. Moreover, the low HIV testing and high late diagnosis among the high-burden regions calls for region-specific intervention. Advanced disease stages as a result of the high proportion of late diagnosis may impact on fueling community transmission and hinder treatment outcome among PLHIV.
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Affiliation(s)
- Yimam Getaneh
- grid.13402.340000 0004 1759 700XState Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China ,grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Jemal Ayalew
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Qianxin He
- grid.13402.340000 0004 1759 700XState Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Adamu Tayachew
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abdur Rashid
- grid.216938.70000 0000 9878 7032School of Medicine, Nankai University, Tianjin, China
| | - Desta Kassa
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sileshi Leulseged
- grid.7123.70000 0001 1250 5688College of Health Science, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lingjie Liao
- grid.508379.00000 0004 1756 6326State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206 China
| | - Feng Yi
- grid.508379.00000 0004 1756 6326State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206 China
| | - Yiming Shao
- grid.13402.340000 0004 1759 700XState Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China ,grid.508379.00000 0004 1756 6326State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206 China
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Delahunty L, O'Hare A, Marryat L, Stewart TM, McKenzie K, Murray G, Kaza N. Short Report: Exploring the extent to which Intellectual Disability is undiagnosed within children attending developmental paediatric clinics. Res Dev Disabil 2022; 131:104359. [PMID: 36219958 DOI: 10.1016/j.ridd.2022.104359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/30/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Intellectual Disability is under-ascertained worldwide and is associated with greater physical and mental health difficulties. This research aimed to identify clinical features and characteristics of children with Intellectual Disability in a population of 126 6-18 year olds in mainstream school, attending paediatric developmental clinics. Intellectual Disability was defined according to the DSM-5 (deficits in intellectual and adaptive functioning, present during childhood). Measures used to assess this were WISC-IV IQ (score <70) and ABAS adaptive behaviour (score =<70). Clinical features were compared from a structured clinical records investigation and logistic regression explored which factors were associated with Intellectual Disability. Twenty-eight children (22%) met the criteria for Intellectual Disability. Five variables were associated with higher odds of having Intellectual Disability: no other neurodevelopmental diagnosis, multiple other health problems, prior genetic testing, maternal smoking during pregnancy, and parental unemployment. Routinely-collected paediatric data only predicted Intellectual Disability correctly in two out of five cases. Further research is needed to verify these findings and improve identification. WHAT THIS PAPER ADDS?: Many children with Intellectual Disability, particularly a milder version, still reach adulthood without a diagnosis, despite evidence indicating that diagnosis is generally well received by children and families, and that early intervention leads to improvements in outcomes. This short report, based on a small sample of 126 children aged 6-18 in mainstream school who attended a paediatric development clinic in South East Scotland, provides tentative data on the clinical features and characteristics which are associated with Intellectual Disability. This tentative evidence suggests that the combination of a) having multiple concerns and investigations, alongside b) one or both parents being out of work (which may be related to familial undiagnosed Intellectual Disability), should raise a flag for paediatricians to further investigate the possibility of an Intellectual Disability diagnosis among these children and young people. Further research with larger samples is needed to explore this more robustly, with the potential to create an algorithm to highlight to paediatricians cases requiring formal screening for Intellectual Disability.
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Affiliation(s)
- Lauren Delahunty
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, UK; NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Anne O'Hare
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, UK
| | - Louise Marryat
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, UK; School of Health Sciences, University of Dundee, Dundee, UK.
| | - Tracy M Stewart
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, UK; Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Karen McKenzie
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | | | - Nandita Kaza
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, UK
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Mansour S, Derkach E, Abergil V, Khuri S. Carcinosarcoma of the Gallbladder: A Rare Tumor. World J Oncol 2022; 13:103-106. [PMID: 35837320 PMCID: PMC9239502 DOI: 10.14740/wjon1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023] Open
Abstract
Malignant tumors of the gallbladder are rare, with adenocarcinoma being the most common histological subtype. Carcinosarcoma of the gallbladder, first described in 1907 by Landsteiner, is an extremely rare tumor which comprises less than 1% of the uncommon gallbladder cancers. This unique type of tumor can develop at any major organ, with the uterus being the most common one. Being a tumor that contains epithelial and mesenchymal components, histopathological diagnosis of such rare tumor is a challenging issue. Up to date, there are less than 100 cases of gallbladder carcinoasarocoma reported in the English literature. Therefore, experience and knowledge regarding this rare disease are very limited. Due to the fact that gallbladder carcinosarcoma is a rare and highly forgotten tumor, this article aims to review the English literature to increase awareness of the treating physician to improve diagnosis, management, as well as overall survival.
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Affiliation(s)
- Subhi Mansour
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Elena Derkach
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | | | - Safi Khuri
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel
- HPB and Surgical Oncology Unit, Surgery Department, Rambam Health Care Campus, Haifa, Israel
- Corresponding Author: Safi Khuri, HPB and Surgical Oncology Unit, General Surgery Department, Rambam Health Care Campus, Haa’leya Hashniya, Haifa 31096, Israel.
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Mattern J, Letendre I, Sibiude J, Pénager C, Jnifen A, Souare F, Ayel S, Nguyen T, Mandelbrot L. Diagnosis of advanced cervical cancer, missed opportunities? BMC Womens Health 2022; 22:97. [PMID: 35354463 PMCID: PMC8969332 DOI: 10.1186/s12905-022-01668-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Cervical cancer is common worldwide. Despite the existence of primary and secondary prevention strategies, the survival rate is decreasing in France due to an increasing proportion of advanced-stage cancer. Our objective was to determine the factors associated with a diagnosis of cervical cancer at advanced stages in an urban population in France. Methods A retrospective study was conducted on all consecutive records of patients diagnosed with cervical cancer between January 2006 and December 2018 in a single center in Paris. The data collected were demographic characteristics, medical and gynecological history, circumstances of diagnosis, diagnostic and therapeutic management. The patients were divided into two groups according to the FIGO 2018 stage at diagnosis: group A stages IA1 to IB2 and group B advanced stages IB3 to IVB. Results Among 96 patients who were diagnosed with cervical cancer, 25 (26%) were in group A and 71 (74%) in group B. Women in group B had less frequently received regular gynecological care than in group A (36% vs 84.2%, p < 0.001) and fewer had Pap test screening in the previous 3 years (30.4% vs 95.0%, p < 0.001). Parity greater than 3 was more frequent in group B (69.6% vs 42.9%, p = 0.031). The diagnosis was made during a routine examination or cervical smear in only 9.23% and 16.18% respectively in group B, versus 60% of cases in 45.82% of cases in group A (p < 0.001 and p = 0.003). Vaginal bleeding was observed in 85.29% in group B versus 36% in group A (p < 0.001). Histological type was squamous cell carcinoma 87.32% of group B and 56% of group A (p < 0.001). Conclusion Diagnosis of cervical cancers at advanced stages occurred mostly in women who did not benefit from the recommended screening. Universal access to screening is necessary for the prevention and early treatment of cervical cancer.
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Affiliation(s)
- Jérémie Mattern
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.,Université de Paris, Paris, France
| | - Irène Letendre
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - Jeanne Sibiude
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.,Université de Paris, Paris, France.,Inserm IAME 1137, Paris, France
| | - Cécile Pénager
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France.,Université de Paris, Paris, France
| | - Asma Jnifen
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - Fatoumata Souare
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - Sophie Ayel
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - Thuy Nguyen
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France. .,Université de Paris, Paris, France. .,Inserm IAME 1137, Paris, France.
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20
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Rødgaard EM, Jensen K, Miskowiak KW, Mottron L. Childhood diagnoses in individuals identified as autistics in adulthood. Mol Autism 2021; 12:73. [PMID: 34903278 PMCID: PMC8670291 DOI: 10.1186/s13229-021-00478-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Autism is a developmental condition, where symptoms are expected to occur in childhood, but a significant number of individuals are diagnosed with autism for the first time in adulthood. Here, we examine diagnoses given in childhood among individuals that are diagnosed with autism in adulthood, to investigate whether the late autism diagnosis might be explained by misdiagnosis in childhood or diagnostic overshadowing.
Methods Through the Danish National Patient Registry, we identified individuals diagnosed with autism in adulthood (N = 2199), as well as a control sample with no records of an autism diagnosis (N = 460,798) and calculated how many had received different psychiatric or neurological diagnoses in childhood. Results We found that most childhood diagnoses were overrepresented in those with an adult autism diagnosis, and attention-deficit hyperactivity disorder, affective disorders, anxiety, and stress disorders were the most prevalent childhood conditions in this group. However, 69% of males and 61% of females with adult autism diagnoses were not found to have received any of the investigated diagnoses before 18 years of age, and most childhood diagnoses were given after the age of 12. Limitations Milder to moderate cases of psychiatric conditions that have been solely treated by family physicians or school psychologists may not be fully included in our dataset. The study is based on data from the Danish health care system, and further research is needed to assess whether the findings can be generalized to other countries. Conclusion A majority of those with an adult autism diagnosis had no records of having received any of the investigated diagnoses in childhood. In these cases, the late autism diagnosis is therefore unlikely to be explained by either misdiagnosis or overshadowing. This result is at odds with the prevailing notion that autistic symptoms tend to diminish with age. Therefore, further research is warranted to examine how and if early signs of autism may have manifested among these individuals, and how similar they are to autistic people diagnosed earlier in their development. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00478-y.
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Affiliation(s)
- Eya-Mist Rødgaard
- Department of Psychology, University of Copenhagen, 1353, Copenhagen K, Denmark
| | - Kristian Jensen
- Department of Psychiatry and Addictology, Université de Montreal, Montreal, QC, H3T 1J4, Canada
| | - Kamilla Woznica Miskowiak
- Department of Psychology, University of Copenhagen, 1353, Copenhagen K, Denmark.,Psychiatric Centre Copenhagen, Rigshospitalet, 2100, Copenhagen Ø, Denmark
| | - Laurent Mottron
- Department of Psychiatry and Addictology, Université de Montreal, Montreal, QC, H3T 1J4, Canada. .,Centre de Recherche du CIUSSS-NIM, Hôpital Rivière-des-Prairies, Montreal, QC, H1E 1A4, Canada.
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21
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Azamar-Alonso A, Bautista-Arredondo SA, Smaill F, Mbuagbaw L, Costa AP, Tarride JE. Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study. AIDS Res Ther 2021; 18:84. [PMID: 34774077 PMCID: PMC8590317 DOI: 10.1186/s12981-021-00409-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 2007-2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013-2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Still, late HIV diagnosis is a major concern in Mexico due to its association with the development of AIDS development and mortality. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013-2017 National HIV program. METHODS Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. RESULTS The study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45 to 43% (P < 0.001) between 2008 and 2012 and 2013-2017 (i.e. before and after the implementation of the 2013-2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013 and 2017 (odds ratio [OR] = 0.96 [95% Confidence interval [CI] [0.93, 0.98]) or in health facilities specialized in HIV care (OR = 0.64 [95% CI 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis. CONCLUSIONS The results of this study indicate that the 2013-2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico. We identified several predictors of late diagnosis which could help establishing health policies. The main determinants for late diagnosis were being male, older than 29 years old, and being diagnosed in a Hospital or National Institute.
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Affiliation(s)
- Amilcar Azamar-Alonso
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 201, 1280 Main St West, Hamilton, ON, L8S 4K1, Canada.
- Gilead Sciences Mexico S. de R.L. de C.V, Mexico, USA.
| | | | - Fiona Smaill
- ChB Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 201, 1280 Main St West, Hamilton, ON, L8S 4K1, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 201, 1280 Main St West, Hamilton, ON, L8S 4K1, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 201, 1280 Main St West, Hamilton, ON, L8S 4K1, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Canada
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Mazidimoradi A, Momenimovahed Z, Salehiniya H. Barriers and Facilitators Associated with Delays in the Diagnosis and Treatment of Gastric Cancer: a Systematic Review. J Gastrointest Cancer 2021; 53:782-796. [PMID: 34499307 DOI: 10.1007/s12029-021-00673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The present study was conducted to identify barriers and facilitators of early diagnosis and treatment of gastric cancer. METHODS Comprehensive search was conducted on 2021 in various databases, including Medline, Web of science, and Scopus. Keywords such as gastric cancer, screening programs, endoscopy, barriers, facilitators, and factor were used for the search, as single or in combination. Also a manual search was done in valid scientific journals to find related full-text articles. The search results were entered into the Endonote-X8 software, which automatically removes duplicate articles. Then, the title and the abstract and finally, the text of the articles were studied. Articles that addressed barriers and facilitators of early diagnosis and treatment of gastric cancer were included. RESULTS In according to the results of 22 included articles, delay time in the diagnosis and treatment of gastric cancer were high, and factors such as age, sex, race and ethnicity, economic and social status, access to diagnostic services, implementation of screening programs, type and accuracy of screening methods, use of insurance services, error in care services, and presence of gastrointestinal symptoms were considered to be contributing factors in this regard. CONCLUSIONS It seems that to reduce delay in the diagnosis and treatment of gastric cancer, factors such as implementing screening programs using acceptable methods with high sensitivity and accuracy with a high level of participation, increasing insurance coverage and reducing the share of people in payments, increasing people's access to diagnostic services, educating people about the symptoms and risks of gastric cancer, undertaking proper follow-up in patients and suspects cases identified in screening, as well as increasing patients' access to medical services through financial and insurance support are significantly important.
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Affiliation(s)
| | | | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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23
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Arvanitaki A, Januszewska K, Malec E, Baumgartner H, Kehl HG, Lammers AE. Against all odds-late repair of multiple shunt lesions in a patient with Down syndrome: a case report. Eur Heart J Case Rep 2021; 5:ytab234. [PMID: 34377902 PMCID: PMC8343471 DOI: 10.1093/ehjcr/ytab234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/22/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022]
Abstract
Background Children with congenital heart defects (CHD) usually undergo elective surgical repair of haemodynamically relevant shunt lesions within the first year of life. Due to susceptibility for pulmonary arterial hypertension (PAH) in patients with Down syndrome, repair is usually aimed for no later than 6 months of life. However, with rising immigration from developing countries to Europe, more patients with unrepaired CHD are diagnosed at a later age. Anatomical repair may be precluded, when advanced pulmonary vascular disease has been established. Case summary We report a 39-month-old male patient with Down syndrome with a large non-restrictive perimembranous ventricular septal defect, a large patent ductus arteriosus, and a secundum-type atrial septal defect with a prominent left-to-right shunting. Haemodynamic assessment revealed only a mild increase of pulmonary artery pressures (mPAP) with low pulmonary vascular resistance index (PVRi). Vasodilator testing led to a further increase of the left-to-right shunt and decrease of PVRi, suggesting operability. After careful consideration, the patient underwent complete surgical repair with a good post-operative clinical outcome. Cardiac catheterization 6 months after corrective repair showed a normal mPAP. No signs of PAH have been detected in the medium-term follow-up. Discussion Expertise, increased physician awareness, and a thorough pre-operative multidisciplinary evaluation are paramount to determine the best treatment approach for patients, who may present late with multiple shunts, and—in our case—underlying Down syndrome. Long-term close post-surgical follow-up in an expert centre is warranted to promptly diagnose and treat a possible late presentation of PAH appropriately.
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Affiliation(s)
- Alexandra Arvanitaki
- Division of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.,Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, SW3 6NP London, UK
| | - Katarzyna Januszewska
- Division of Paediatric Cardiac Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Edward Malec
- Division of Paediatric Cardiac Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Helmut Baumgartner
- Division of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Hans-Gerd Kehl
- Division of Paediatric Cardiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Astrid Elisabeth Lammers
- Division of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.,Division of Paediatric Cardiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Bostan H, Sencar ME, Calapkulu M, Hepsen S, Duger H, Ozturk Unsal I, Ozbek M, Cakal E. Two Important Issues in Subacute Thyroiditis Management: Delayed Diagnosis and Inappropriate Use of Antibiotics. Eur Thyroid J 2021; 10:323-329. [PMID: 34395304 PMCID: PMC8314756 DOI: 10.1159/000513745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subacute thyroiditis (SAT) is a rare inflammatory disease of the thyroid gland. It has been noticed that patients with a diagnosis of SAT visit more other clinics and receive antibiotics unnecessarily. Therefore, the aim of this study was to reveal the degree of delay in the diagnosis of SAT, prediagnosis antibiotic use rates, and the awareness of clinics for the diagnosis of SAT. METHODS A total of 121 patients with SAT were enrolled in the study. A retrospective analysis was made of the history of patient symptoms during the diagnosis, which physicians they visited, antibiotic use, laboratory test results, and ultrasonographic findings. RESULTS The median age of the patients was 41 years. Neck pain radiating to the jaw/ear was seen in most patients (71.1%). The median time from symptom onset to a diagnosis of SAT was 23 days (range, 6-70 days). Antibiotics were erroneously prescribed to 71 patients (58.7%) before the diagnosis. The median time to diagnosis was 28 days in patients using antibiotics and 20 days in the group not using antibiotics (p < 0.001). Two or more physicians had been visited before SAT diagnosis by 89 (73.6%) patients, and more antibiotics were prescribed to these patients than the group who visited fewer physicians (p < 0.05). The frequency of prescribing antibiotics by physicians was 73.7% by emergency physicians, 53.1% by family doctors, 51.1% by ENT specialists, and 35.4% by internal medicine specialists. CONCLUSION The diagnosis of SAT is often delayed, and misdiagnosis leads to erroneous antibiotic overuse. Physicians should increase their awareness of the diagnosis of SAT in patients with neck pain.
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Affiliation(s)
- Hayri Bostan
- *Hayri Bostan, Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mahallesi, Şht. Ömer Halisdemir Blv No. 1, Altındağ/Ankara 06110 (Turkey),
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Abstract
TRASH lesions are a group of special injuries around the elbow resulting from high energy trauma that are routinely missed at initial presentation because of seemingly normal X-rays. These are a group of osteochondral injuries having a high propensity for surgical intervention and usually have poor outcomes if not treated adequately. Prompt diagnosis warrants a high index of suspicion even when a radiograph appears to be normal with a disproportionately swollen elbow in a child. TRASH lesions include radial head osteochondral fractures, medial condylar fractures in unossified elbow, transphyseal separations of the distal humerus, monteggia lesions, entrapped incarcerated medial epicondylar fractures, capitellar shear fractures, lateral condylar fractures extending to the cartilage. This article attempts to review in brief, the approach to early diagnosis and management with literature review and case examples.
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Affiliation(s)
- Sandeep Patwardhan
- grid.489159.80000 0004 1767 0852Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, 16 Shivajinagar, Pune, 411005 India
| | - Sujith Omkaram
- grid.489159.80000 0004 1767 0852Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, 16 Shivajinagar, Pune, 411005 India
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Sitta A, Guerreiro G, de Moura Coelho D, da Rocha VV, Dos Reis BG, Sousa C, Vilarinho L, Wajner M, Vargas CR. Clinical, biochemical and molecular findings of 24 Brazilian patients with glutaric acidemia type 1: 4 novel mutations in the GCDH gene. Metab Brain Dis 2021; 36:205-212. [PMID: 33064266 DOI: 10.1007/s11011-020-00632-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/11/2020] [Indexed: 11/25/2022]
Abstract
Glutaric aciduria type 1 (GA-1) is a rare but treatable inherited disease caused by deficiency of glutaryl-CoA dehydrogenase activity due to GCDH gene mutations. In this study, we report 24 symptomatic GA-1 Brazilian patients, and present their clinical, biochemical, and molecular findings. Patients were diagnosed by high levels of glutaric and/or 3-hydroxyglutaric and glutarylcarnitine. Diagnosis was confirmed by genetic analysis. Most patients had the early-onset severe form of the disease and the main features were neurological deterioration, seizures and dystonia, usually following an episode of metabolic decompensation. Despite the early symptomatology, diagnosis took a long time for most patients. We identified 13 variants in the GCDH gene, four of them were novel: c.91 + 5G > A, c.167T > G, c.257C > T, and c.10A > T. The most common mutation was c.1204C > T (p.R402W). Surprisingly, the second most frequent mutation was the new mutation c.91 + 5G > A (IVS1 ds G-A + 5). Our results allowed a complete characterization of the GA-1 Brazilian patients. Besides, they expand the mutational spectrum of GA-1, with the description of four new mutations. This work reinforces the importance of awareness of GA-1 among doctors in order to allow early diagnosis and treatment in countries like Brazil where the disease has not been included in newborn screening programs.
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Affiliation(s)
- Angela Sitta
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil.
| | - Gilian Guerreiro
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Ipiranga, 2752, 90610-000, Porto Alegre, RS, Brazil
| | - Daniella de Moura Coelho
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil
| | - Vitoria Volfart da Rocha
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil
| | - Bianca Gomes Dos Reis
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil
| | - Carmen Sousa
- Newborn Screening, Metabolism & Genetics Unit, Human Genetics Department, National Institute of Health Dr Ricardo Jorge, Alexandre Herculano, 321, 4000-055, Porto, Portugal
| | - Laura Vilarinho
- Newborn Screening, Metabolism & Genetics Unit, Human Genetics Department, National Institute of Health Dr Ricardo Jorge, Alexandre Herculano, 321, 4000-055, Porto, Portugal
| | - Moacir Wajner
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal de Rio Grande do Sul, Ramiro Barcelos, 2600, Porto Alegre, RS, 90035-003, Brazil
| | - Carmen Regla Vargas
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Ipiranga, 2752, 90610-000, Porto Alegre, RS, Brazil.
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal de Rio Grande do Sul, Ramiro Barcelos, 2600, Porto Alegre, RS, 90035-003, Brazil.
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Vergara-Fernández O, Trejo-Avila M, Santes O, Solórzano-Vicuña D, Moctezuma-Velázquez P, Sainz JC, Alvarez-Bautista F, Salgado-Nesme N. Sociodemographic factors related with emergency colorectal cancer surgery at a referral center in Mexico. CIR CIR 2021; 89:83-88. [PMID: 33498067 DOI: 10.24875/ciru.20000042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Diagnosis of colorectal cancer (CRC) after emergency presentation is associated with a worse prognosis. Aim The aim of the study was to determine the sociodemographic factors related with emergency CRC surgery at our institution. Methods From January 2009 to December 2017, patients that underwent CRC surgery at our institution were included in the study. Univariate and multivariate logistic regression were used to determine the effect of the potential risk factors on the rate of emergency surgery. Results A total of 247 patients underwent CRC surgery at our institution. The rate of emergency surgery was 7.7%. On univariate analysis, patients without a family history of cancer (odds ratio [OR]: 4.95), living in a rural area (OR: 3.7), and late clinical cancer stage (OR: 5.06) were associated with emergent surgery. Mid-income status was a protective factor for emergency surgery (OR: 0.14, p = 0.003). On multivariate analysis, late clinical cancer stage (OR: 4.41, 95% CI 1.21-16.05, p = 0.024) and mid-income economic status (OR: 0.41, 95% CI 0.04-0.55, p = 0.004) were identified as independent risk factors for emergency surgery. Conclusion Social, economic, and demographic factors were identified as predictors for emergent CRC surgery.
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Affiliation(s)
- Omar Vergara-Fernández
- Departamento de Cirugía de Colon y Recto, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mario Trejo-Avila
- Departamento de Cirugía de Colon y Recto, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Oscar Santes
- Departamento de Cirugía de Colon y Recto, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Danilo Solórzano-Vicuña
- Departamento de Cirugía de Colon y Recto, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paulina Moctezuma-Velázquez
- Departamento de Cirugía de Colon y Recto, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan C Sainz
- Departamento de Cirugía de Colon y Recto, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francisco Alvarez-Bautista
- Departamento de Cirugía de Colon y Recto, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Noel Salgado-Nesme
- Departamento de Cirugía de Colon y Recto, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Muelas Fernandez M, Rojas Lievano JF, Perez Vidal R, Flor Perez A, Tapiz Reula A, Mallolas Masferrer J. Prevalence of late diagnosis of HIV infection. Med Clin (Barc) 2020; 155:388-91. [PMID: 32354555 DOI: 10.1016/j.medcli.2020.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/18/2020] [Accepted: 01/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prevalence of late diagnosis (LD) and identifying missed opportunities. METHODS Retrospective observational study of new HIV diagnoses between 2013 and 2018 in our referral area. Sociodemographic and clinical-analytical variables were analysed at the time of diagnosis. The patient's clinical history in the last 5 years before the HIV diagnoses was reviewed to identify missed opportunities for early diagnosis. RESULTS Seventy-four patients were included. The prevalence of LD was 44.6%, and 23% as an advanced disease. A tendency for LD was observed in patients older than 40 years, especially among Spaniards. Being tested 11for HIV protected against LD. All patients who had previous contact with the health system had clinical indicators or risk factors associated with HIV, but only 50% had ever been tested in their lifetime of HIV. CONCLUSIONS In spite of multiple contacts with our health system, almost half of the new cases of HIV infection are diagnosticated late. Different strategies should be implemented to improve the identification of the risk factors and clinical indicators of possible HIV infection.
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Palacios-Baena ZR, Martín-Ortega M, Ríos-Villegas MJ. Profile of new HIV diagnoses and risk factors associated with late diagnosis in a specialized outpatient clinic during the 2014-2018 period. Med Clin (Barc) 2020; 155:482-487. [PMID: 32418627 DOI: 10.1016/j.medcli.2020.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/21/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Late diagnosis (LD) of HIV infection is associated with an increase in morbidity and mortality and transmissibility. The aim of this study was to define the clinical characteristics of new diagnoses and clarify the risk factors (RF) associated with LD with or without advanced disease (AD) between 2014 and 2018. METHODS Patients with a new diagnosis of HIV infection treated in a specialised outpatient clinic of a third level hospital were included. LD with or without AD was defined as aCD4 count < 350 cel/mm3 or CD4 < 200 cel/mm3 respectively and/or the presence of any AIDS condition on diagnosis. An analysis was performed using binary logistic regression to analyse the RF associated with LD and the AD. RESULTS Of the 205 new diagnoses, 102 (50%) were LD. Age ≥ 32 years [(OR, 95% CI); 2.92 (1.52-5.59)], transmission different than in men who have sex with men [3.39 (1.56-7.34)] and hospitalisation on diagnosis [9.68 (2.63-35.68)] were RF associated with LD. On the other hand, having a concomitant sexually transmitted disease (STD) [.37 (.17-.77)] was associated with an early diagnosis. The results were similar when analysing the LD with AD except for the STD. CONCLUSION Knowledge of the clinical and epidemiological characteristics of new diagnoses of HIV infection and of the RF for LD with or without AD provides an opportunity for early diagnosis and to reduce transmissibility.
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Affiliation(s)
- Zaira R Palacios-Baena
- Unidad de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva. Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBIS), Sevilla, España.
| | - Miguel Martín-Ortega
- Unidad de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva. Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBIS), Sevilla, España
| | - M José Ríos-Villegas
- Unidad de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva. Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBIS), Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España
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Abstract
BACKGROUND Lung cancer remains a major cause of death worldwide. While in the past it was considered to primarily afflict males, in recent decades the number of female patients has risen, such that rates among females are similar to those among males. Nevertheless, it has been found previously (e.g., in cardiovascular disease) that when there is a sex-specific stereotype to a disease, it may remain entrenched in medical diagnostic processes, so as to cause belated diagnosis among the other sex. Gender-based differences in incidence and diagnosis are likely to exist with respect to lung cancer because of smoking habits and stereotypes, geographic and socioeconomic differences, and past epidemiologic differences between the sexes. Here we aim to characterize the effects of gender on lung cancer diagnosis and whether such effects have changed over time. METHODS The SEER (Statistics, Epidemiology, and End Results) database was used to check for sex-based differences by tumor type and stage at diagnosis and to investigate whether these patterns have changed with time by comparing staging data in different age cohorts over time. Results were stratified by location and analyzed with data regarding possible confounders such as smoking and socioeconomic factors. RESULTS We examined 458,132 cases of lung cancer from the years 2004-2012; 243,021 (53%) in males and 215,111 (47%) in females. Lung cancer rates were 73.8 (73.5-74.1) per 100k in males and 51.6 (51.4-51.8) per 100k in females. Of these, 400,800 had the stage listed, 214,479 (54%) in males, and 186,321 (46%) in females. Total lung cancer rates were higher in males than females at all disease stages. Male patients were more likely than female patients to be diagnosed at stage 3-4, consistent across lung cancer types, cancer registries, smoking, and socioeconomic backgrounds. The difference between the percentage of males versus females diagnosed in stages 3-4 correlated negatively with increased female ever-smokers and with squamous and small cell carcinoma and were not correlated with the rate of cancer in females, or the difference between male and female cancer rates. CONCLUSIONS Our study showed that there is no belated diagnosis of lung cancer in females. Results appear to point to the fact that smoking females are more likely to be diagnosed at later stages, which is consistent with the current literature.
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Affiliation(s)
| | - Roni Gillis
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Be'er Sheva, Israel; Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Nir Peled
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Be'er Sheva, Israel; Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
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Abstract
Being seriously affected by a rheumatic disease at the age of 16 seems a catastrophe that somehow must be learned to manage. And the challenges that come up when the illness worsens in the life course have to be coped with. So, this article tries to outline some of the points I have experienced and find relevant for patients with ankylosing spondylitis.
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Lapointe-Shaw L, Austin PC, Chung H, Sander B, Kwong JC, Feld JJ. Pitfalls in measuring temporal trends for late diagnosis of viral hepatitis. J Hepatol 2019; 71:1251-4. [PMID: 31648817 DOI: 10.1016/j.jhep.2019.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 01/27/2023]
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Álvarez Cabo D, Alemany A, Martínez Sesmero JM, Moreno Guillén S. Healthcare and economic impact. Enferm Infecc Microbiol Clin 2019; 36 Suppl 1:19-25. [PMID: 30115403 DOI: 10.1016/s0213-005x(18)30242-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This chapter reviews the current model of HIV patient care and its economic impact. There are clinical and geographical differences in the care HIV patients receive and a need to develop new models of comprehen-sive HIV care has been identified. HIV infection in Spain is an important and expensive public health problem. The main costs are due to an-tiretroviral therapy, indirect costs and the cost of admission, consultation and diagnostic testing. A strong correlation between severity and cost has been identified. Patients diagnosed late have a poorer clinical course, increased mortality and require more medical and therapeutic resources. Early detection of the disease significantly improves the clinical outcomes of patients. The increased number of patients receiving treatment and their progressive ageing will increase costs of HIV healthcare in the coming years.
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Affiliation(s)
- Daniel Álvarez Cabo
- Dirección General, Fundación de la Clínica Universitaria, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
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Abstract
There is broad agreement on the impact that underdiagnosis and late diagnosis of HIV infection have on the health of people with HIV and on the persistence of the epidemic due to an inadvertent increase in transmission. The need to develop strategies that increase the number of diagnoses, and specifically the number of early diagnoses, is therefore urgent. Many such strategies have been launched in other countries and, in Spain, have been recommended by the Ministry of Health, Social Services and Equality (MSSSI). The multidisciplinary group recommends the review and implementation of different measures in both health and community settings.
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Affiliation(s)
- Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España.
| | - Juan Berenguer
- Unidad de Enfermedades Infecciosas-VIH, Hospital General Universitario Gregorio Marañón, Madrid, España
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de Mendoza C, Caballero E, Aguilera A, Benito R, Maciá D, García-Costa J, Soriano V; Spanish HTLV Network. HIV co-infection in HTLV-1 carriers in Spain. Virus Res 2019; 266:48-51. [PMID: 30998953 DOI: 10.1016/j.virusres.2019.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Human retroviruses HIV and HTLV share transmission routes. HIV widely spread in Spain during the 80 s through injection drug use and sex, and nowadays HIV rates in Spain account for one of the largest in Europe. In contrast, HTLV-1 is not endemic in Spain, despite hosting huge numbers of migrants from highly endemic regions. Herein, we report the rate and main features of the HIV-HTLV co-infected population in Spain. METHODS A national registry exists in Spain for HTLV since year 1989. Data from standardized case report forms and one centralized lab repository were reviewed, especially for the subset with HTLV-HIV co-infection. RESULTS Up to December 2018, a total of 369 individuals with HTLV-1 had been diagnosed in Spain. 64% of the population were females, and Latin American individuals accounted for 64.5%. Classical HTLV-associated illnesses were found in 12.7% (myelopathy) and 7.6% (leukemia). HIV coinfection was found in 12 (3.2%). Of those, 3 patients (25%) were female and 39 (75%) were of non-Spanish origin. All but two harbored HIV-1 subtype B, being non-B variants found in the two West Africans. Exposure had been sexual in most cases, being 4 homosexual men. Seven HTLV-HIV co-infected patients had developed AIDS and two had developed myelopathy. There was no evidence for increased HTLV-1 clinical pathogenicity due to HIV coinfection. CONCLUSION HIV coinfection is infrequent (<5%) among HTLV-1 carriers in Spain. More than half of co-infected patients come from Latin America. Sexual contact is the most frequent risk behavior, being MSM one third of cases. Late diagnosis explains the high rate (9/12) of clinical manifestations in our HIV-HTLV co-infected population.
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Welsner M, Straßburg S, Taube C, Sutharsan S. Use of ivacaftor in late diagnosed cystic fibrosis monozygotic twins heterozygous for F508del and R117H-7T - a case report. BMC Pulm Med 2019; 19:76. [PMID: 30975115 PMCID: PMC6458608 DOI: 10.1186/s12890-019-0840-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND CFTR modulator therapy with ivacaftor is a treatment option for Cystic Fibrosis (CF) patients with at least one copy of a R117H-7T mutation in the CFTR gene. Desirable effects of this therapy are improvement of lung function, decrease in exacerbation rate, normalization or reduction of sweat chloride and weight gain. Monogenetic CF-twins carry identical genetic information, so therapy response and side effects are expected to be nearly identical under this specific therapy. CASE PRESENTATION In monozygotic twins, at the age of 55, two pathogenic variants in the CFTR gene (F508del and R117H-7T) were detected. Both patients presented with a borderline sweat test (30-59 mmol/L) and despite the same genetic information and similar life circumstances the disease proceeds completely different. While one patient has severe pulmonary involvement with chronic P. aeruginosa infection, her twin sister is almost unimpaired. Liver or pancreatic involvement was not seen in either patient. Due to the presence of one copy of a R117H-7T mutation, CFTR modulator therapy with ivacaftor was initiated in both. Response and side effects were significantly different. In the less affected patient, we observed an improvement in lung function and a normalization of sweat chloride. In the severely affected patient, no functional response to treatment was seen, but stabilization of the disease state with a decrease in exacerbation and hospitalization rate and weight gain as well as a normalization of sweat chloride. There was an increase in liver enzymes in the less affected patient, which normalized after halving the dose of ivacaftor, while the therapeutic effect was maintained. CONCLUSIONS Despite nearly identical genetic information, as in monogenetic twins, therapy response and onset of side effects of CFTR modulating therapy are very different. In patients with late diagnosis and severe pulmonary involvement, ivacaftor does not seem to improve lung function, whereas in patients with late diagnosis and low disease severity a relevant therapy response was obtained. In addition to lung function, additional clinical parameters such as reduction of exacerbation and hospitalization rate and weight gain should be used to assess therapy response, especially in severely affected patients.
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Affiliation(s)
- Matthias Welsner
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Tueschener Weg 40, 45329, Essen, Germany.
| | - Svenja Straßburg
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Tueschener Weg 40, 45329, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Tueschener Weg 40, 45329, Essen, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Tueschener Weg 40, 45329, Essen, Germany
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Yue Q, Liu YF, Li J, Zang CP. [Analysis on late HIV diagnosis among newly reported human immunodeficiency virus/acquired immunodeficiency syndrome cases between 2009 and 2017 in medical institutions]. Zhonghua Yu Fang Yi Xue Za Zhi 2018; 52:1248-53. [PMID: 30522225 DOI: 10.3760/cma.j.issn.0253-9624.2018.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the proportion of late HIV diagnosis and the factors associated with late HIV diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) cases newly reported by medical institutions in China from 2009 to 2017. Methods: Data of adult HIV/AIDS cases newly reported by medical institutions in China from 2009 to 2017 were downloaded from the AIDS prevention and control information system of China's disease prevention and control information system. The basic information, sample source, transmission route, flow of HIV/AIDS patients and the first CD4(+) T lymphocyte count were analyzed in 293 187 cases who had been tested for CD4(+) T lymphocyte count within 91 days of diagnosis. The multivariate logistic regression was used to analyze the late HIV diagnosis relevant factors. Results: A total of 293 187 newly reported HIV/AIDS cases in medical institutions were analyzed, and the mean age was (44.7±15.6) years. The proportion of late diagnosis in all cases was 68.4% (200 503 cases). From 2009 to 2017, the proportions of late diagnosis were 71.7% (6 263/8 737), 69.5% (8 283/11 917), 69.2% (13 230/19 116), 67.0% (17 186/25 669), 66.5% (21 833/32 834), 66.4% (26 541/39 944), 67.2% (31 257/46 536), 69.6% (35 920/51 646) and 70.4% (39 990/56 789) respectively. Compare with female cases, the OR (95%CI) of male cases with late diagnosis was 1.18 (1.15-1.20). Compared with the 18 to 29 years old group, the 30 to 39 years, 40 to 49 years, 50 to 59 years and 60 years old and over groups have higher risk of late diagnosis with OR (95%CI) values about 1.65 (1.61-1.69), 2.13 (2.08-2.19), 2.25 (2.18-2.31) and 2.33 (2.26-2.39) respectively. Compared with the college education level and above group, OR (95% CI) values of junior middle school and below group was 1.11 (1.08-1.14); and OR (95%CI) values of senior high school and equal level education group was 1.08 (1.04-1.11). Compared with the migrant population, the resident population has higher risk of late diagnosis (OR=1.06, 95%CI: 1.04-1.08). Compared with other national minorities, Han nationality has higher risk of late diagnosis (OR=1.33, 95%CI: 1.30-1.36). Compared with divorce, widowed and other marital status, married spouse have higher risk of late diagnosis (OR=1.08, 95%CI: 1.06-1.10). Compared with patients receiving other testing services, the OR (95%CI) values of examination before blood transfusion or blood products, pregnancy and childbirth examination, STD clinic and preoperative examination were 1.16 (1.08-1.25), 0.52 (0.50-0.54), 0.63 (0.61-0.64), 0.66 (0.65-0.68) respectively. Conclusion: The proportion of late HIV diagnosis of newly reported HIV/AIDS cases in medical institutions in China was relatively high from 2009 to 2017 and the factors associated with late HIV diagnosis included male, Han nationality, old age group, low educational level, married spouse, other testing services and resident population.
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Scognamiglio P, Navarra A, Orchi N, De Carli G, Pittalis S, Mastrorosa I, Visco Comandini U, Agrati C, Antinori A, Puro V, Ippolito G, Girardi E. Unawareness of HCV serostatus among persons newly diagnosed with HIV. J Infect Public Health 2019; 12:733-737. [PMID: 30737128 DOI: 10.1016/j.jiph.2019.01.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/27/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022] Open
Abstract
Treatment of chronic HCV infection with direct acting antivirals can achieve high rates of sustained viral response in persons with HIV. In the perspective of HCV elimination in this population, high rates of HCV detection will be needed. We evaluated the unawareness of HCV infection in 2927 persons newly diagnosed with HIV during 2004-2015 in Rome, Italy. Two-hundred-fifty persons (8.5%) were anti-HCV positive. The proportion of HCV-unaware individuals at the time of HIV diagnosis was 58.0% (145/250), without significant variations over time, 17.2% showed an advanced fibrosis stage. The absence of previous HIV testing was significantly associated with HCV unawareness.
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Affiliation(s)
- Paola Scognamiglio
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Assunta Navarra
- Clinical Epidemiology Unit - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy.
| | - Nicoletta Orchi
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Gabriella De Carli
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Silvia Pittalis
- Clinical Epidemiology Unit - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Ilaria Mastrorosa
- Clinical Division of HIV/AIDS - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Ubaldo Visco Comandini
- Clinical Division of Hepatology - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Chiara Agrati
- Laboratory of Virology - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical Division of HIV/AIDS - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Vincenzo Puro
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- Office of the Scientific Director - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Enrico Girardi
- Clinical Epidemiology Unit - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
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Guss D, Sherigar J, Mohanty SR. Missed Diagnosis of Liver Cirrhosis Leads to Disparities in Care for Older Patients. Gastroenterology Res 2018; 11:333-339. [PMID: 30344803 PMCID: PMC6188034 DOI: 10.14740/gr1074w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background Cirrhosis of the liver is often not recognized until late in the disease state, when patients decompensate or develop hepatocellular carcinoma (HCC). This inquiry considered factors associated with undiagnosed cirrhosis. Methods Patients with undiagnosed cirrhosis were compared to patients with known diagnosis of cirrhosis, to evaluate the differences between these two groups. The study population is patients with confirmed diagnosis of HCC, stratified into patients with known diagnosis of cirrhosis (n = 36) and patients without the known diagnosis of cirrhosis who have features of cirrhosis (n = 36). Results There was no significant difference in insurance, gender, race, etiology of liver disease, presence of splenomegaly, model for end stage liver disease (MELD) score, fibrosis-4 index (FIB-4) or aspartate aminotransferase (AST) to platelet ratio index (APRI) scores between groups. However, the strongest predictor of the diagnosis of cirrhosis was age, with older patients being less likely to be diagnosed with cirrhosis (OR: 0.924, P = 0.012). Furthermore, tumor size in patients without known cirrhosis was larger than those diagnosed with cirrhosis (median: 4.9 cm versus 3.5 cm, P = 0.015). Of note, 50% of cases with cirrhosis were undiagnosed. Conclusion Older age was the most significant predictor of the missed diagnosis of liver cirrhosis. This led to a larger tumor size at diagnosis, which may imply worse prognosis in these patients. Further evaluation of health disparities related to older age and outcomes of older patients with liver cirrhosis should guide the development of guidelines to prevent the missed diagnosis of cirrhosis.
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Affiliation(s)
- Debra Guss
- New York Presbyterian-Brooklyn Methodist Hospital, Department of Gastroenterology and Hepatobiliary Diseases, Brooklyn, NY 11215, USA
| | - Jagannath Sherigar
- New York Presbyterian-Brooklyn Methodist Hospital, Department of Gastroenterology and Hepatobiliary Diseases, Brooklyn, NY 11215, USA
| | - Smruti R Mohanty
- New York Presbyterian-Brooklyn Methodist Hospital, Department of Gastroenterology and Hepatobiliary Diseases, Brooklyn, NY 11215, USA
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Khan A, Khan K, Raza A, Din Qureshi ZU, Sultan B, Khan FA. Patient Self Delay Among Women With Breast Cancer. J Ayub Med Coll Abbottabad 2018; 30:558-561. [PMID: 30632337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Delay in the diagnosis of carcinoma breast has important prognostic, clinical and medico-legal implications. This study assesses the frequency and causes of patient delay in women with breast cancer presenting to a breast clinic run by a specialist surgical unit in a tertiary care hospital. METHODS For this study all women, aged between 16-90 years, who presented with primary breast carcinoma of any histological type, diagnosed between June 2016 to September 2017 were eligible. Structured interviews were administered during the first visit with a confirmed diagnosis or the first hospitalization due to carcinoma breast, and the frequencies of the factors for delay analysed.. RESULTS 84% of the patients presenting with primary carcinoma breast present with a significant patient delay, of which older patients who are illiterate, poor, coming from rural areas and unaware of carcinoma breast as a disease, among other factors, have a higher tendency to delay consultation. CONCLUSIONS Healthcare advice-seeking behaviour in women suffering from breast cancer in Pakistan is alarming with a vast majority of patients presenting late leading to delayed treatment and probable worse outcomes and survival.
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Affiliation(s)
- Ayesha Khan
- Department of Surgery, Ayub Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Khalid Khan
- Department of Surgery, Ayub Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Ali Raza
- Department of Surgery, Ayub Ayub Teaching Hospital, Abbottabad, Pakistan
| | | | - Babar Sultan
- Department of Surgery, Ayub Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Fahad Ali Khan
- Department of Surgery, Ayub Ayub Teaching Hospital, Abbottabad, Pakistan
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van Opstal SEM, van der Zwan JS, Wagener MN, Been SK, Miedema HS, Roelofs PDDM, van Gorp ECM. Late Presentation of HIV Infection in the Netherlands: Reasons for Late Diagnoses and Impact on Vocational Functioning. AIDS Behav 2018; 22:2593-2603. [PMID: 29550940 PMCID: PMC6097719 DOI: 10.1007/s10461-018-2082-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Late diagnosis of HIV remains a major challenge in the HIV epidemic. In Europe, about 50% of all people living with HIV are diagnosed late after infection has occurred. Insight into the reasons for late diagnoses is necessary to increase the number of early diagnoses and optimize treatment options. This qualitative study explored the experiences of 34 late-presenters through in-depth semi-structured interviews. A variety of reasons for late diagnoses emerged from our data and led to a division into four groups, characterized by two dimensions. Regarding vocational functioning, the consequences of late diagnoses were health-related problems prior to and since diagnosis, and problems concealing the HIV status. Healthcare providers should offer HIV tests to groups at risk, and be alert for clinical HIV indicator conditions. It is recommended to increase awareness of HIV transmission routes, symptoms and tests, and the benefits of early testing and early entry to HIV care.
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Affiliation(s)
- S E M van Opstal
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands.
- Erasmus MC, Department of Viroscience, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - J S van der Zwan
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - M N Wagener
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - S K Been
- Erasmus MC, Department of Internal Medicine and Infectious Diseases, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H S Miedema
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - P D D M Roelofs
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - E C M van Gorp
- Erasmus MC, Department of Viroscience, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Jin L, Cheng XL, Qin YZ, Su B. [Analysis of the influential factors of late diagnosis among newly identified HIV/AIDS cases in Anhui Province, 2011-2015]. Zhonghua Yu Fang Yi Xue Za Zhi 2018; 52:415-418. [PMID: 29614610 DOI: 10.3760/cma.j.issn.0253-9624.2018.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the base situation and influential factors of late diagnosis among newly identified HIV/AIDS cases in Anhui Province from 2011 to 2015. Methods: Database information of the newly identified HIV/AIDS cases in Anhui Province from 2011 to 2015 were downloaded from the National HIV/AIDS Comprehensive Information System of China's disease prevention and control information system. To analyze the data including basic information, sample source, route of HIV transmission, population mobility, venereal disease, death and first CD4 count; and the number of 7 073 cases were classified according to late diagnosis and non-late diagnosis criteria. The Chi-square test and logistic regression analysis were used to analyze the influential factors of HIV late diagnosis. Results: A total of 7 073 newly identified HIV/AIDS cases were analyzed, and the mean age was (38.5±15.0) years. The proportion of late diagnosis in all counted cases was 41.7% (2 949/7 073); from 2011 to 2015, the proportions of late diagnosis were 59.7% (485/812), 46.5% (531/1 141), 42.7% (587/1 376), 36.1% (609/1 686), and 35.8% (737/2 058), respectively. Compared with the 0 to 19 years group, the 40 to 59 years group and over 60 years old group have higher risk of late diagnosis (OR=2.68, 95%CI: 1.94-3.71; OR=2.18, 95%CI: 1.53-3.10, respectively). Compared with the high education group, the illiterate and primary school education group have higher risk of late diagnosis (OR=1.74, 95%CI: 1.36-2.22; OR=1.64, 95%CI: 1.34-2.01, respectively). Compared with other sample sources, medical institutions have higher risk of late diagnosis (OR=2.64, 95%CI: 2.28-3.05). Compared with migrant population, the resident population have higher risk of late diagnosis (OR=1.80, 95%CI: 1.53-2.11). Conclusion: The proportion of late diagnosis among newly identified HIV/AIDS cases in Anhui province was relatively high from 2011 to 2015. The main risk factors of late diagnosis included cases reported by medical institutions, resident population, over 40 years old age group and low education level.
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Affiliation(s)
- L Jin
- AIDS Department of Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
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Tang H, Mao Y, Tang W, Han J, Xu J, Li J. "Late for testing, early for antiretroviral therapy, less likely to die": results from a large HIV cohort study in China, 2006-2014. BMC Infect Dis 2018; 18:272. [PMID: 29895275 PMCID: PMC5998580 DOI: 10.1186/s12879-018-3158-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely HIV testing and initiation of antiretroviral therapy are two major determinants of survival for HIV-infected individuals. Our study aimed to explore the trend of late HIV/AIDS diagnoses and to assess the factors associated with these late diagnoses in China between 2006 and 2014. METHODS We used data from the Chinese Comprehensive Response Information Management System of HIV/AIDS (CRIMS). All individuals who tested positive for HIV between 2006 and 2014 in China and were at least 15 years of age were included. A late diagnosis was defined as an instance in which an individual was diagnosed as having AIDS or WHO stage 3 or 4 HIV/AIDS, or had a CD4 cell count less than 200 cells/mm3 at the time of diagnosis. RESULTS Among the 528,234 individuals (≥15 years old) newly diagnosed with HIV between 2006 and 2014, 179,700 (34.0%) people were considered to have received late diagnoses. The late diagnosis rate decreased from 33.9% in 2006 to 29.7% in 2014 (P < 0.01). Late diagnoses were more likely to be found among those who were 45-54 years old (adjusted odds ratio [aOR]: 3.25, 95% confidence interval [CI]: 3.17-3.34) or 55+ years old (OR: 2.94, 95% CI: 2.86-3.02), male (aOR: 1.15, 95% CI: 1.13,1.17), employed as a farmer or rural laborer (aOR: 1.13, 95% CI: 1.11-1.14), infected through blood or plasma transfusion (aOR: 4.18, 95% CI: 4.02, 4.35), diagnosed at hospitals (OR: 1.17, 95% CI: 1.15, 1.19), of Han ethnicity (aOR: 1.30, 95% CI: 1.28, 1.32), and married (OR: 1.12, 95% CI: 1.11,1.13). Of those people living with HIV (PLHIV) who received late diagnoses, 7.4%(8637) and 46.1%(28,462) ultimately died with or without receiving antiretroviral therapy within a year of diagnosis, respectively. CONCLUSION A large proportion of individuals with HIV/AIDS receive late diagnoses, and this proportion has witnessed a slight decline in recent years. Expanded testing is needed to increase early HIV diagnosis and antiretroviral therapy should be recommended to all diagnosed individuals as early as possible to reduce AIDS-related death.
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Affiliation(s)
- Houlin Tang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yurong Mao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jing Han
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Juan Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jian Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Zbiba W, Abdesslem NB. Acanthamoeba keratitis: An emerging disease among microbial keratitis in the Cap Bon region of Tunisia. Exp Parasitol 2018; 192:42-45. [PMID: 29859227 DOI: 10.1016/j.exppara.2018.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 05/02/2018] [Accepted: 05/29/2018] [Indexed: 10/16/2022]
Abstract
INTRODUCTION The aim of this study was to describe the prevalence of AK among microbial keratitis as well as their clinical features and to compare their risk factors to those of other infectious keratitis, over the last five years in a referral center in the region of Cap Bon, Tunisia, North Africa. METHODS A retrospective review of the charts of 230 patients (230 eyes) diagnosed with presumed infectious keratitis between January 2011 and December 2016 at the department of ophthalmology of the university hospital of Nabeul in Tunisia. After a detailed ocular examination using standard technique, corneal scrapes were performed under aseptic conditions from each ulcer. Plates were incubated at 30 °C and screened daily for Amoeba. The treatment was adjusted according to the results of microbiological findings and the response of initial treatment. The mean follow up was 11.4 months (1 month-26 months). RESULTS A total of 230 corneas were scraped. The prevalence of Acanthamoeba keratitis was 6% (14 cases of 230). All cases of Acanthamoeba keratitis with a history of contact lenses were diagnosed thanks to the test of Contact lenses, their cases or their storage solution, while their corneal scrapings were negative. The corneal scraping was positive for Acanthamoeba only in 4 cases of 14. Acanthamoeba was identified more in young patients (92.8%). Significantly, more patients (54 of 74; 73%) with fungal keratitis and Acanthamoeba keratitis (11 of14; 78.6%) were rural population The most cases of Acanthamoeba keratitis (10 of 14; 71.4%) used contact lenses. Ocular injury was identified in 4 cases of 14 AK (28,5%). Coexistent ocular disease was seen in seven cases of 14 (50%). Of the 230 microbial keratitis, an early diagnosis (≤30 days) was done in 200 cases (86.95%), while a late diagnosis (≥30 days) was made in 30 cases (13%). In AK, most cases (11 of 14; 78,5%) were diagnosed with a delay of more than 30 days. Slit-lamp examination showed stromal infiltrate in 12 cases (85,7%), hypopion in 2 cases (14,3%), immunitary ring in 2 cases (14,3%) and radial keratoneuritis in one case (7,1%). CONCLUSION Contact lenses were identified as the main risk factor of Acanthamoeba keratitis in our study. The diagnosis of AK should be considered in case of atypical keratitis especially among CL wearers in the rural regions of CapBon where the rules of hygiene are not respected.
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Affiliation(s)
- W Zbiba
- Department of Ophthalmology, Taher Maamouri Hospital, Nabeul, Tunisia.
| | - N Ben Abdesslem
- Department of Ophthalmology, Taher Maamouri Hospital, Nabeul, Tunisia.
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Gargallo-Bernad C, Sangrós-González FJ, Arazo-Garcés P, Martínez-Álvarez R, Malo-Aznar C, Gargallo-Bernad A, Ballester-Luna A, Cabrero-Pascual LE, Gil-Orna P, Abadía-Gallego VJ, Torres-Peña I, Ordiz-Suárez H. Missed opportunities in the diagnosis of human immunodeficiency virus infection in the Region of Aragon. Late diagnosis importance. Enferm Infecc Microbiol Clin 2018; 37:100-108. [PMID: 29724618 DOI: 10.1016/j.eimc.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/11/2018] [Accepted: 03/24/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Late Diagnosis (LD) of Human Immunodeficiency Virus (HIV) infection (CD4 lymphocytes <350/μl at diagnosis of the disease), deteriorates the condition of those affected and increases the probability of transmission. The objective of the present study was to analyse the prevalence of LD, to identify missed diagnostic opportunities (MDO) and to find out which level of the health care delivery system they took place. METHODS Retrospective, observational and descriptive study of the population diagnosed with infection of HIV/AIDS in the period 2011-2015 in Aragon. MDO were identified during the 3 years prior to diagnosis of the disease in all levels of the health care delivery system as well as frequentation of consultations. The indicator conditions (IC) that generated more MDO were analysed according to the latest recommendations for early diagnosis of HIV in the health care setting. RESULTS 435 newly diagnosed HIV/AIDS cases were analysed. 45.1% were diagnosed in Primary Healthcare (PH). 49.4% presented criteria of LD and 61.1% were infected through heterosexual contact. The majority of MDO (68.5%) were given in PH. The IC that generated the most MDO were seborrheic dermatitis/exanthema (19.4%) and fever of unknown origin (10.3%). However, the IC that were associated with higher LD were pneumonia acquired in the community and unjustified weight loss. CONCLUSION In Aragon, prevalence of LD is high, the main route of infection is heterosexual and most of MDO go unnoticed in PH. The dissemination of current guidelines for requesting IC guided HIV testing and HIV screening across the preoperative period will result in an effective measure to decrease the LD.
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Affiliation(s)
| | | | - Piedad Arazo-Garcés
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Rosa Martínez-Álvarez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - Alba Ballester-Luna
- Servicio de Medicina Interna, Hospital Ernest Lluch Martín, Calatayud, Zaragoza, España
| | | | - Pablo Gil-Orna
- Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España
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Sheehan DM, Trepka MJ, Fennie KP, Prado G, Madhivanan P, Dillon FR, Maddox LM. Individual and Neighborhood Determinants of Late HIV Diagnosis Among Latinos, Florida, 2007-2011. J Immigr Minor Health 2018; 19:825-834. [PMID: 27119364 DOI: 10.1007/s10903-016-0422-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The objective of this study was to examine individual and neighborhood determinants of late HIV diagnosis by gender and birthplace among Latinos. Florida HIV surveillance data for 2007-2011 were merged with American Community Survey data to estimate the odds of late HIV diagnosis (AIDS within 3 months of HIV diagnosis). Of 5522 HIV-positive Latinos, 26.5 % were diagnosed late. The odds ratio (OR) for late diagnosis was 1.39 times higher for males than females [95 % confidence interval (CI) 1.14-1.69]. Neighborhood-level factors associated with late diagnosis included residing in the 3 highest quartiles of neighborhood unemployment for males. The OR was 1.22 times higher for foreign- than US-born Latinos (95 % CI 1.07-1.40). Among foreign-born, residing in areas in the 2nd and 3rd quartiles of unemployment, in rural areas, and areas with <25 % Hispanic/Latino population were associated with late diagnosis. Population-based HIV testing campaigns may require tailoring to ensure that they effectively reach male Latinos in areas with high unemployment and foreign-born Latinos in rural and predominantly non-Latino areas.
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Affiliation(s)
- Diana M Sheehan
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.,Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 478, Miami, FL, 33199, USA
| | - Mary Jo Trepka
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA. .,Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 478, Miami, FL, 33199, USA.
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 478, Miami, FL, 33199, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 478, Miami, FL, 33199, USA
| | - Frank R Dillon
- Department of Educational and Counseling Psychology, School of Education, University at Albany - State University of New York, 1400 Washington Ave, Albany, NY, 12222, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, FL, 32399, USA
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McNamara B, Same A, Rosenwax L, Kelly B. Palliative care for people with schizophrenia: a qualitative study of an under-serviced group in need. BMC Palliat Care 2018; 17:53. [PMID: 29580230 PMCID: PMC5870335 DOI: 10.1186/s12904-018-0309-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background People with schizophrenia are at risk of receiving poorer end of life care than other patients. They are often undertreated, avoid treatment and are about half as likely to access palliative care. There are limited options for end of life care for this under-serviced group in need. This study aims to address the paucity of research by documenting possible need, experiences of health care service use and factors affecting palliative care use for people with schizophrenia who have advanced life limiting illness. Methods Semi-structured interviews were undertaken with 16 experienced health professionals caring for people with schizophrenia in Western Australia. The interviews focussed on their perceptions and experiences of end of life care, their patients’ unmet needs, palliative care options, and suggested services to support this vulnerable group and improve health care provision. The research used a qualitative design and thematic analyses. Results The participants all advocated strongly for their patients and recognised their extreme vulnerability. They identified a range of challenges and unmet needs experienced by people with schizophrenia at the end of life including: illness factors such as the impact of schizophrenia on information processing and communication; social factors such as stigma, isolation and the absence of a carer; and health care factors such as late diagnosis, delayed access to care, and mismanagement in care. Four themes were organised into two domains with the first exploring the individual and social circumstances of people with schizophrenia, including the challenges they experience in the health care system. The second domain covers themes that discuss barriers and facilitators to people with schizophrenia receiving palliative care and key features in palliative care provision, including recognising declining health, communication and planning, and collaboration and capacity building in the broader health, mental health and palliative care sectors. Conclusions To ensure people with schizophrenia are well supported at the end of life a model of palliative care is required that offers both specialised services and capacity building within the pre-existing health workforce. Resources are needed to address the stigma and lack of services faced by this vulnerable group.
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Affiliation(s)
- Beverley McNamara
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Kent Street, Bentley, WA, Australia.
| | - Anne Same
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Kent Street, Bentley, WA, Australia
| | - Lorna Rosenwax
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Kent Street, Bentley, WA, Australia
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
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Giaquinta A, Mociskyte D, D'Arrigo G, Barbagallo G, Certo F, Veroux M, Veroux P. Penetrating aortic injury left untreated for 20 days: a case report. BMC Surg 2018; 18:6. [PMID: 29374465 PMCID: PMC5787315 DOI: 10.1186/s12893-018-0337-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Penetrating aortic trauma remains one of the most challenging injuries with a high mortality rate if left untreated, or if the surgical treatment is delayed. We present an uncommon case of a late diagnosed abdominal firearm injury, in which the bullet partially penetrated the wall of the aorta, creating a plug that prevented immediate death due to massive bleeding. CASE PRESENTATION A 26-year-old Libyan man was a victim of a firearm wound, with a bullet penetrating his abdominal wall from the left to right side. After the assault, the victim, spent up to 20 days crossing the Mediterranean Sea to leave his country of origin. Abdominal radiography revealed the presence of a bullet located anteriorly to the second lumbar vertebra, while computed tomography angiography, unexpectedly, demonstrated that the bullet penetrated partially into the aortic wall at the level of the left renal artery. The bullet penetrated the aortic wall for half of its length, creating a plug that avoided immediate life-threatening bleeding at the time of the gunshot injury. The bullet was removed and the aortic lesion was repaired. The patient was discharged 6 days after the surgical procedure, in good health. CONCLUSIONS We presented a very rare case of late diagnosis of aortic injury caused by a gunshot lesion, in which the particular trajectory of the bullet helped avoid immediate life-threatening bleeding and, probably, saved the patient's life.
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Affiliation(s)
- Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, University Hospital of Catania, Via Santa Sofia, 84 95123, Catania, Italy
| | - Dovile Mociskyte
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, University Hospital of Catania, Via Santa Sofia, 84 95123, Catania, Italy
| | - Giuseppe D'Arrigo
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, University Hospital of Catania, Via Santa Sofia, 84 95123, Catania, Italy
| | - Giuseppe Barbagallo
- Neurosurgery Unit, Department of Surgery, University Hospital of Catania, Catania, Italy
| | - Francesco Certo
- Neurosurgery Unit, Department of Surgery, University Hospital of Catania, Catania, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, University Hospital of Catania, Via Santa Sofia, 84 95123, Catania, Italy.
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, University Hospital of Catania, Via Santa Sofia, 84 95123, Catania, Italy
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Abstract
In many parts of the world, mostly low- and middle-income countries, timely diagnosis and repair of congenital heart diseases (CHDs) is not feasible for a variety of reasons. In these regions, economic growth has enabled the development of cardiac units that manage patients with CHD presenting later than would be ideal, often after the window for early stabilisation - transposition of the great arteries, coarctation of the aorta - or for lower-risk surgery in infancy - left-to-right shunts or cyanotic conditions. As a result, patients may have suffered organ dysfunction, manifest signs of pulmonary vascular disease, or the sequelae of profound cyanosis and polycythaemia. Late presentation poses unique clinical and ethical challenges in decision making regarding operability or surgical candidacy, surgical strategy, and perioperative intensive care management.
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Grenouillet F, Cimon B, Pana-Katatali H, Person C, Gainet-Brun M, Malinge MC, Le Govic Y, Richaud-Thiriez B, Bouchara JP. Exophiala dermatitidis Revealing Cystic Fibrosis in Adult Patients with Chronic Pulmonary Disease. Mycopathologia. 2018;183:71-79. [PMID: 29094263 DOI: 10.1007/s11046-017-0218-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/20/2017] [Indexed: 12/20/2022]
Abstract
Cystic fibrosis (CF) is a genetic inherited disease due to mutations in the gene cystic fibrosis transmembrane conductance regulator (CFTR). Because of the huge diversity of CFTR mutations, the CF phenotypes are highly heterogeneous, varying from typical to mild form of CF, also called atypical CF. These atypical features are more frequently diagnosed at adolescence or adulthood, and among clinical signs and symptoms leading to suspect a mild form of CF, colonization or infection of the respiratory tract due to well-known CF pathogens should be a warning signal. Exophiala dermatitidis is a melanized dimorphic fungus commonly detected in respiratory specimens from CF patients, but only very rarely from respiratory specimens from non-CF patients. We described here two cases of chronic colonization of the airways by E. dermatitidis, with recurrent pneumonia and hemoptysis in one patient, which led clinicians to diagnose mild forms of CF in these elderly patients who were 68- and 87-year-old. These cases of late CF diagnosis suggest that airway colonization or respiratory infections due to E. dermatitidis in patients with bronchiectasis should led to search for a mild form of CF, regardless of the age and associated symptoms. On a broader level, in patients with chronic respiratory disease and recurrent pulmonary infections, an allergic bronchopulmonary mycosis or an airway colonization by CF-related fungi like E. dermatitidis or some Aspergillus, Scedosporium or Rasamsonia species, should be considered as potential markers of atypical CF and should led clinicians to conduct investigations for CF diagnosis.
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