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Patel SE, Chesnut SR. Relationships Among Pelvic Congestion Syndrome Pain, Daily Activities, and Quality of Life. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00043-1. [PMID: 38599242 DOI: 10.1016/j.jogn.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE To examine women's experiences of pelvic congestion syndrome (PCS) pain. DESIGN Descriptive, cross-sectional. SETTING Online questionnaires in a Facebook PCS support group. PARTICIPANTS Convenience sample of 143 women who self-identified as being diagnosed with PCS. METHODS We recruited women through a social media support group and invited them to participate in a self-reported questionnaire. We collected demographic information and used the McGill Pain Questionnaire to elicit responses related to pain quality, pain intensity, quality of life, and satisfaction with health care. We analyzed data using descriptive statistics and correlation coefficients. RESULTS Respondents characterized their PCS pain as exhausting, stabbing, sharp, shooting, and tender. Respondents indicated that 19 of 24 daily activities increased PCS pain, whereas only 5 reduced PCS pain. Pain intensity was negatively related to the quality of life, health satisfaction, sleep, and sexual relationships. CONCLUSION Chronic pelvic pain from PCS severely affected quality of life among respondents. These findings suggest a difference in the presentation of PCS from historical pain depictions and further highlight the need to identify pain profiles to increase timely and precise diagnosis. Further research is needed to evaluate interventions to increase the quality of life for women with PCS.
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Liu JJ, Feng YP, Liu ZD, Guo J. Impact of delayed diagnosis and treatment on tuberculosis infection within families: A case report. Medicine (Baltimore) 2024; 103:e37406. [PMID: 38489738 PMCID: PMC10939690 DOI: 10.1097/md.0000000000037406] [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: 11/12/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND A 32-year-old male patient was diagnosed with a 30% left pneumothorax on November 5, 2020, during which chest imaging indicated abnormalities. Despite this, pulmonary tuberculosis (TB) was not diagnosed or treated at that time due to a negative result in the MGIT960 culture. The patient experienced symptoms of cough and expectoration on April 24, 2022. Upon repeating the chest imaging, the condition had worsened, confirming the presence of pulmonary TB, leading to the patient's hospitalization. On September 1, 2022, the 11-year-old daughter of the patient was diagnosed with pulmonary tuberculosis accompanied by bronchial tuberculosis and tuberculous pleurisy. METHODS The diagnosis of pulmonary tuberculosis was confirmed through sputum smears and Gene Xpert MTB/RIF testing, for the patient and his 11-year-old daughter in 2022. The patient underwent a 6-month combination therapy (2HRZE/4HR) comprising isoniazid, rifampicin, pyrazinamide, and ethambutol. His daughter with pulmonary tuberculosis accompanied by bronchial tuberculosis and tuberculous pleurisy underwent a 12-month combination therapy. RESULTS Late diagnosis and treatment delays contribute to tuberculosis infections within families. Fortunately, after more than 3 months of antituberculosis treatment, the patient experienced relief from cough and sputum secretion, and there was improvement observed in the chest CT scan. Six months later, the patient was successfully cured of TB. 12 months later, his daughter also was successfully cured of TB. CONCLUSION SUBSECTIONS Early diagnosis and treatment of tuberculosis (TB) is vital to reduce transmission, morbidity, and mortality.
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Affiliation(s)
- Jian-Jun Liu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Yin-Ping Feng
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Zhong-Da Liu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Jing Guo
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
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Al-Mehmadi BA, Alelaiwi MMM, Alnumayr HSA, Alghamdi BS, Alomari BA, Alzahrani HS. Knowledge of Common Symptoms of Rheumatic Diseases and Causes of Delayed Diagnosis in Saudi Arabia. Patient Prefer Adherence 2024; 18:635-647. [PMID: 38476592 PMCID: PMC10929651 DOI: 10.2147/ppa.s448999] [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: 11/09/2023] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
Purpose The aim of this study is to determine the general population's knowledge on the different symptoms of rheumatic diseases, the key factors for diagnosis delays from the patient's perspective, the length of delay from the onset of symptoms to the diagnosis, and the effect this holds on the disease activity, response to therapy, and the development of complications and nonreversible deformities in patients diagnosed with rheumatic diseases. Patients and Methods This is a cross-sectional study. Our target study population were the residents of Saudi Arabia. Data were collected via an online questionnaire and analyzed with SPSS. Results The overall prevalence of rheumatic disease in our cohort was 8.7%. Joint pain (75.7%), joint swelling (47.1%) and morning stiffness (32.9%) were the first and most common presenting symptom. Persistence of symptoms (N=32, 45.7%) and symptom worsening (N=21, 30.0%) was the predominant cause to visit rheumatologist. The duration between first symptom and rheumatic disease diagnosis is significantly longer for patients aged <50 years compared to that of those with ≥50 years of age. Results show that 36.4% of patients aged ≥50 years had delayed diagnosis due to late appointment compared with 5.7% of patients aged <50 years. In addition, patients with longer duration of symptoms were likely to have more visits to the rheumatologist. Most of the participants of <50 years significantly agreed that rheumatologists treat autoimmune diseases, only a few approved that they treat muscle problems. Conclusion Most participants in our study have lesser knowledge about their symptoms and they did not know where to consult for the treatment of their disease. This caused unnecessary delays and worsening and aggravation of the symptoms. There is an increased need to organize an awareness campaign in the general population regarding autoimmune and rheumatic diseases.
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Affiliation(s)
- Bader A Al-Mehmadi
- Department of Internal Medicine, College of Medicine, Majmaah University, Al-Majmaah, 11952, Saudi Arabia
| | | | | | | | | | - Hayat Saleh Alzahrani
- Department of Family and Community Medicine, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Gandhi K, Ferdous S. Tetrad of Narcolepsy Type 1: Treatment and Management. Cureus 2024; 16:e55331. [PMID: 38562323 PMCID: PMC10982127 DOI: 10.7759/cureus.55331] [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: 07/24/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Narcolepsy is a chronic condition that brings about excessive daytime sleepiness. It can be classified into two types: narcolepsy type 1 (presence of cataplexy, which is marked by weakness of muscles) and narcolepsy type 2 (without cataplexy). It is generally underdiagnosed, which results in delayed diagnosis of the condition. It has more prevalence in the United States of America as compared to India. The narcoleptic tetrad consists of excessive daytime sleepiness (EDS), cataplexy, sleep paralysis, and hypnagogic hallucinations. Rapid eye movement (REM) sleep behavior disorder is another characteristic feature. Research about narcolepsy has been carried out for about 145-150 years, but it is only in the last 18-20 years that there has been advancement in the underlying pathophysiology, diagnosis, and, thus, availability of better treatment. Both pharmacological and non-pharmacological methods are preferred in treating narcolepsy, yet there is no cure for it. Since the knowledge regarding this condition is very limited, it is often misunderstood, and dealing with it is mentally and socially draining, often causing anxiety in the patients, feeling of social isolation, and other significant impacts on the quality of living. Raising awareness about narcolepsy is vital to prevent further medical attention delays.
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Affiliation(s)
- Kanishka Gandhi
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Suraiya Ferdous
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Xiong B, Zou J, Ali W, Daneshjou R, Williams J. Diagnosis and management of hidradenitis suppurativa: Analysis of US insurance claims data. JAAD Int 2024; 14:29-30. [PMID: 38058457 PMCID: PMC10696258 DOI: 10.1016/j.jdin.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Affiliation(s)
- Betty Xiong
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - James Zou
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | | | - Roxana Daneshjou
- Department of Biomedical Data Science and Dermatology, Stanford University, Stanford, California
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Lindeborg MM, Khalsa IK, Liao EN, Stephans JR, Chan DK. Risk Factors Associated with Delays in Hearing Loss Identification in Pediatric Patients. Otolaryngol Head Neck Surg 2024; 170:896-904. [PMID: 37925623 DOI: 10.1002/ohn.574] [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] [Received: 08/06/2023] [Revised: 09/21/2023] [Accepted: 10/08/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To identify sociodemographic factors associated with pediatric late-identified hearing loss (LIHL) and classify novel subgroups within the LIHL population. STUDY DESIGN Retrospective cohort. SETTING Tertiary children's hospital. METHODS Our cohort included children with permanent hearing loss (HL) between 2012 and 2020 (n = 1087). Patients with early-identified HL were compared to patients with LIHL (>6 months of age at diagnosis), and 3 subgroups: (1) late-identified congenital HL: failed NHS but had a diagnostic audiogram >6 months old; (2) late-onset HL: passed NHS and identified with HL after 6 months old; (3) late-identified, unknown-onset: unknown NHS results, identified after 6 months old. Geospatial analysis was performed using ArcGIS Pro. RESULTS Compared with early-identified children, children with LIHL were more likely to have more comorbidities (odds ratio [OR] = 1.12, [1.01, 1.23]), be an under-represented minority (URM) (OR = 1.92, [1.27, 2.93]) and have a higher social vulnerability index (SVI) (adjusted odds ratio [AOR] = 2.1, [1.14, 3.87]). However, subgroups in the LIHL cohort had variable associations. Children with late-identified unknown onset hearing loss were uniquely associated with a primarily non-English speaking household (AOR = 1.84, [1.04, 3.25]), whereas children with late-onset hearing loss were less likely to have public insurance (AOR = 0.47, [0.27, 0.81]. There were no significant associations for children with late-identified congenital hearing loss. Neighborhood disadvantage, as measured by SVI, had an increased association with late-identified unknown onset HL (AOR = 4.08, [2.01, 8.28]) and a decreased association with late-onset HL (AOR = 0.40, [0.22, 0.72]). CONCLUSION Sociodemographic factors serve as proxies for health care access, and these factors vary across LIHL pathways. Understanding the risk factors associated with each LIHL subgroup may help address disparities in pediatric HL identification.
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Affiliation(s)
| | | | - Elizabeth N Liao
- Department of Otolaryngology, University of California, San Francisco, USA
| | - Jihyun R Stephans
- Department of Otolaryngology, University of California, San Francisco, USA
| | - Dylan K Chan
- Department of Otolaryngology, University of California, San Francisco, USA
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Riva H, Hendricks A, Yoon T, Del Coro Amengual C, Maddox C. Decades Delayed in Diagnosis: Hidradenitis Suppurativa and a Review of Barriers to Care. Cureus 2024; 16:e56231. [PMID: 38618324 PMCID: PMC11016318 DOI: 10.7759/cureus.56231] [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: 02/05/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
We present a case of a 40-year-old female seen on the inpatient general surgery service in consultation for a suspected abdominal wall abscess or seroma. The history and examination were consistent with a diagnosis of hidradenitis suppurativa. The patient had a 25-year history of similar lesions present since her teenage years, not properly investigated and diagnosed, despite presenting with symptoms in multiple clinic and hospital settings since disease onset. As an accurate diagnosis of HS is often missed or delayed for years, it is important to increase awareness and clinical recognition of this condition among providers to improve outcomes for patients with the potentially debilitating disease of HS.
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Affiliation(s)
- Hannah Riva
- Medical Education, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, USA
| | | | - Teresa Yoon
- Medical Education, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, USA
| | | | - Craig Maddox
- Dermatology, Mountain View Dermatology, El Paso, USA
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Aulakh G, Lewis R, Singh A, Marian V. A 40-Year-Old Man with a 7-Year History of Polyarthritis and a Late Diagnosis of Whipple Disease: A Journey to Resolve the Mystery. Am J Case Rep 2024; 25:e942896. [PMID: 38402412 PMCID: PMC10903923 DOI: 10.12659/ajcr.942896] [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: 02/26/2024]
Abstract
BACKGROUND Whipple disease (WD) is rare, with an incidence of only a few patients per million. It is caused by infection with the gram-positive bacterium Tropheryma whipplei, and presents with symptoms that include joint pain, fever, diarrhea, and weight loss. This report is of a 40-year-old man with a 7-year history of polyarthritis and a late diagnosis of Whipple disease. The atypical nature of his symptoms led to misdirection and misdiagnosis for years. CASE REPORT A middle-aged white man with seronegative migratory polyarticular arthritis underwent 7 years of treatment with steroids, disease-modifying anti-rheumatic drugs (DMARDs), and a TNF (tumor necrosis factor)-alpha inhibitor, all without any clinical improvement. Throughout this period, he had persistent loose stools and iron-deficiency anemia. Extensive diagnostic investigations for various possibilities yielded negative results. However, after 7 years, he began displaying clinical signs of malabsorption. This prompted further evaluation, including an upper-gastrointestinal endoscopy and biopsy, which revealed the presence of PAS (periodic acid-Schiff)-positive Treponema whipplei, which led to the diagnosis of WD. Following initiation of appropriate treatment, the patient experienced complete resolution of symptoms. Retrospectively, all the pieces of this puzzle fell into place, providing a comprehensive understanding of the prolonged medical challenge the patient faced. CONCLUSIONS This case illuminates the diagnostic challenge faced when dealing with migratory polyarticular inflammatory arthritis and fever. This report has highlighted that Whipple disease can be associated with multiple symptoms and signs, which can result in a delay in diagnosis. However, once the diagnosis is confirmed, antibiotic treatment is effective.
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Affiliation(s)
- Gagan Aulakh
- Department of Internal Medicine, Jersey City Medical Center, Jersey City, NJ, USA
| | - Rebekah Lewis
- Department of Internal Medicine, Jersey City Medical Center, Jersey City, NJ, USA
| | - Arshdeep Singh
- Department of Internal Medicine, Government Medical College, Medical Enclave, Amritsar, India
| | - Valentin Marian
- Department of Internal Medicine, Jersey City Medical Center, Jersey City, NJ, USA
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Swallow DMA, Murchie P, Counsell CE. Total Patient Delay: A Comparison of Patient and Clinician/Health System Delays in the Diagnosis of Progressive Supranuclear Palsy and Corticobasal Syndrome. Mov Disord Clin Pract 2024. [PMID: 38369623 DOI: 10.1002/mdc3.13990] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Early diagnosis in progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) is important for clinical care and key to developing successful disease-modifying agents. The patient-dependent phases of decision-making made before contact with a healthcare professional have been inadequately studied. OBJECTIVES To evaluate the patient-dependent phases of decision-making from symptom onset, comparing this to clinician and/or health system delays within the overall diagnostic pathway. METHODS Using the Anderson General Model of Total Patient Delay and a mixed-methods approach in participants with PSP/CBS and their caregivers recruited to the Scottish PSP and CBS cohort, we quantified and evaluated the determinants of "appraisal", "illness," and "behavioral" delay, comparing this to the clinician and/or health system delays ("treatment" delay) within the overall time from symptom onset to diagnosis. RESULTS The time from index symptom onset to diagnosis was 3.26 (interquartile range [IQR] = 2.42, 4.75) years in PSP and 2.58 (IQR = 1.69, 4.08) years in CBS. Patient appraisal delay was 24 (IQR = 6, 60) weeks in PSP and 8 (IQR = 5, 24) weeks in CBS, illness delay 0 (IQR = -14, 0) weeks in PSP and 0 (IQR = -4, 0) weeks in CBS, with little perceived behavioral delay. Determinants of delay included the non-specificity of symptoms, normalization of symptoms within the context of age or normal physiological variability, and the extent of insight into new somatic symptoms. CONCLUSIONS Although patient appraisal delay contributes to overall diagnostic delay in PSP/CBS, the greater proportion of overall diagnostic delay arises after contact with a healthcare professional (treatment delay).
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Affiliation(s)
- Diane M A Swallow
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Miller AC, Koeneman SH, Suneja M, Cavanaugh JE, Polgreen PM. Diurnal temperature variation and the implications for diagnosis and infectious disease screening: a population-based study. Diagnosis (Berl) 2024; 11:54-62. [PMID: 37697715 PMCID: PMC11005884 DOI: 10.1515/dx-2023-0074] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/26/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Fevers have been used as a marker of disease for hundreds of years and are frequently used for disease screening. However, body temperature varies over the course of a day and across individual characteristics; such variation may limit the detection of febrile episodes complicating the diagnostic process. Our objective was to describe individual variation in diurnal temperature patterns during episodes of febrile activity using millions of recorded temperatures and evaluate the probability of recording a fever by sex and for different age groups. METHODS We use timestamped deidentified temperature readings from thermometers across the US to construct illness episodes where continuous periods of activity in a single user included a febrile reading. We model the mean temperature recorded and probability of registering a fever across the course of a day using sinusoidal regression models while accounting for user age and sex. We then estimate the probability of recording a fever by time of day for children, working-age adults, and older adults. RESULTS We find wide variation in body temperatures over the course of a day and across individual characteristics. The diurnal temperature pattern differed between men and women, and average temperatures declined for older age groups. The likelihood of detecting a fever varied widely by the time of day and by an individual's age or sex. CONCLUSIONS Time of day and demographics should be considered when using body temperatures for diagnostic or screening purposes. Our results demonstrate the importance of follow-up thermometry readings if infectious diseases are suspected.
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Affiliation(s)
- Aaron C Miller
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Scott H Koeneman
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Manish Suneja
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Philip M Polgreen
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Silva-Rudberg JA, Carrión CI, Pérez-Palmer N, Li J, Mehta SK, Diab NS, Mecca AP, O'Dell RS. Assessment of disparities in timely diagnosis and comprehensive workup of cognitive impairment between English and Spanish speakers. Am J Geriatr Psychiatry 2024:S1064-7481(24)00041-1. [PMID: 38336573 DOI: 10.1016/j.jagp.2024.01.030] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Previous studies have examined disparities in dementia care that affect the U.S. Hispanic/Latino population, including clinician bias, lack of cultural responsiveness, and less access to health care. However, there is limited research that specifically investigates the impact of language barriers to health disparities in dementia diagnosis. METHODS In this retrospective cross-sectional study, 12,080 English- or Spanish- speaking patients who received an initial diagnosis of mild cognitive impairment (MCI) or dementia between July 2017 and June 2019 were identified in the Yale New Haven Health (YNHH) electronic medical record. To evaluate the timeliness of diagnosis, an initial diagnosis of MCI was classified as "timely", while an initial diagnosis of dementia was considered "delayed." Comprehensiveness of diagnosis was assessed by measuring the presence of laboratory studies, neuroimaging, specialist evaluation, and advanced diagnostics six months before or after diagnosis. Binomial logistic regressions were calculated with and without adjustment for age, legal sex, ethnicity, neighborhood disadvantage, and medical comorbidities. RESULTS Spanish speakers were less likely to receive a timely diagnosis when compared with English speakers both before (unadjusted OR, 0.65; 95% CI, 0.53-0.80, p <0.0001) and after adjusting for covariates (adjusted OR, 0.55; 95% CI, 0.40-0.75, p = 0.0001). Diagnostic services were provided equally between groups, except for referrals to geriatrics, which were more frequent among Spanish-speaking patients. A subgroup analysis revealed that Spanish-speaking Hispanic/Latino patients were less likely to receive a timely diagnosis compared to English-speaking Hispanic/Latino patients (adjusted OR, 0.53; 95% CI, 0.38-0.73, p = 0.0001). CONCLUSIONS Non-English language preference is likely to be a contributing factor to timely diagnosis of cognitive impairment. In this study, Spanish language preference rather than Hispanic/Latino ethnicity was a significant predictor of a less timely diagnosis of cognitive impairment. Policy changes are needed to reduce barriers in cognitive disorders care for Spanish-speaking patients.
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Affiliation(s)
- Jason A Silva-Rudberg
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Medicine (JAS-R,), University of California, San Francisco, San Francisco, CA
| | - Carmen I Carrión
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Neurology (CIC), Yale University School of Medicine, New Haven, CT
| | - Nicolás Pérez-Palmer
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (NP-P), Veteran's Affairs Connecticut Healthcare System, West Haven, CT
| | - Judy Li
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Sumarth K Mehta
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Nicholas S Diab
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Adam P Mecca
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Ryan S O'Dell
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT.
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Ortega V, Lovell R, Vanegas Acosta D. Eyelid Molluscum Contagiosum: A Sign of Advanced HIV Infection. Cureus 2024; 16:e53783. [PMID: 38465055 PMCID: PMC10923586 DOI: 10.7759/cureus.53783] [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] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
HIV infection can present with dermatologic pathologies, and molluscum contagiosum in the eyelid is a specific sign often related to advanced HIV. Herein, we present the case of an adult patient with eyelid molluscum contagiosum that had been present for the last five years. Despite previous healthcare evaluation, the patient was not tested for HIV infection until presenting to our healthcare facility. The patient was diagnosed with AIDS. Our case highlights the importance of recognizing indirect signs of immunosuppression and the need to promptly order an HIV test. Additionally, we want to emphasize the importance of raising awareness about routine HIV testing, aiming to reduce the social stigma surrounding this test.
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Affiliation(s)
| | - Roger Lovell
- Infectious Diseases, Piedmont Athens Regional Medical Center, Athens, USA
| | - Diego Vanegas Acosta
- Medicine, College of Medicine, University of Florida Shands Hospital, Gainesville, USA
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Wu Q, Pan J, Lin W, Zhao S, Chen M, Lu L, Chen X, Su J. Clinicopathologic features, delayed diagnosis, and survival in amelanotic acral melanoma: A comparative study with pigmented melanoma. J Am Acad Dermatol 2024; 90:369-372. [PMID: 37690705 DOI: 10.1016/j.jaad.2023.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Qingrong Wu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Jie Pan
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Wenrui Lin
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Shuang Zhao
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Mingliang Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Lixia Lu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Xiang Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Juan Su
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China.
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Giménez-Arufe V, Rotea-Salvo S, Martínez-Pradeda A, Mena-de-Cea Á, Margusino-Framiñán L, Suanzes-Hernández J, Martín Herranz MI, Cid-Silva P. Analysing Early Diagnosis Strategies for HIV Infection: A Retrospective Study of Missed Diagnostic Opportunities. Healthcare (Basel) 2024; 12:361. [PMID: 38338246 PMCID: PMC10855914 DOI: 10.3390/healthcare12030361] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Early diagnosis of a Human Immunodeficiency Virus (HIV)-infected person represents a cornerstone of HIV prevention, treatment, and care. Numerous publications have developed recommendations where HIV serology is indicated to reduce missed diagnostic opportunities (MDOs). This retrospective study analyses new HIV infection diagnoses and the relationship between late diagnosis (LD)/advanced HIV disease (AHD), baseline characteristics, and MDOs. Sociodemographic data and data related to contact with the health system in the 5 years before diagnosis were collected. Most of the 273 diagnoses were made in primary care (48.5%). Approximately 50.5% and 34.4% had LD and AHD criteria, respectively. Female sex was associated with a higher incidence of LD. Persons infected through the heterosexual route and those at an older age had a higher risk for LD and AHD. People with previous HIV serology presented a lower percentage of LD and AHD. In total, 10% of the health contact instances were classified as MDOs, mostly occurring in primary care. A significant increase in the median of MDOs was observed in patients with LD/AHD. Female sex and hepatitis C virus co-infection were associated with an increase in the number of MDOs. The high percentage of LD and AHD and the significant number of MDOs show that the current screening system should be improved.
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Affiliation(s)
- Víctor Giménez-Arufe
- Service of Pharmacy, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain; (V.G.-A.); (S.R.-S.); (A.M.-P.); (L.M.-F.); (M.I.M.H.)
| | - Sandra Rotea-Salvo
- Service of Pharmacy, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain; (V.G.-A.); (S.R.-S.); (A.M.-P.); (L.M.-F.); (M.I.M.H.)
| | - Alejandro Martínez-Pradeda
- Service of Pharmacy, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain; (V.G.-A.); (S.R.-S.); (A.M.-P.); (L.M.-F.); (M.I.M.H.)
| | - Álvaro Mena-de-Cea
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain;
- Service of Infectious Internal Medicine, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain
| | - Luis Margusino-Framiñán
- Service of Pharmacy, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain; (V.G.-A.); (S.R.-S.); (A.M.-P.); (L.M.-F.); (M.I.M.H.)
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain;
| | - Jorge Suanzes-Hernández
- Clinical Epidemiology and Biostatistics Unit, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain;
| | - María Isabel Martín Herranz
- Service of Pharmacy, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain; (V.G.-A.); (S.R.-S.); (A.M.-P.); (L.M.-F.); (M.I.M.H.)
| | - Purificación Cid-Silva
- Service of Pharmacy, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain; (V.G.-A.); (S.R.-S.); (A.M.-P.); (L.M.-F.); (M.I.M.H.)
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), 15006 A Coruña, Spain;
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15
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Li J, Balbuena-Merle R, Hrones M, Gibson CE. Uncovering Primary Extranodal Diffuse Large B Cell Lymphoma in the Adrenal and Thyroid Glands. Am J Case Rep 2024; 25:e942659. [PMID: 38287660 PMCID: PMC10838563 DOI: 10.12659/ajcr.942659] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/21/2023] [Accepted: 12/11/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Primary extranodal diffuse large B-cell lymphoma (DLBCL) is a rare, yet highly aggressive and invasive malignancy that can masquerade as a solid organ tumor. Timely diagnosis is critical for improving prognosis; however, it is challenging to achieve. CASE REPORT We report 2 cases treated at Yale New Haven Hospital (New Haven, CT, USA) and the West Haven Veteran's Affairs Medical Center (West Haven, CT, USA) in 2023. Case 1 describes a 69-year-old woman who presented with a large left adrenal mass that was suspicious for adrenocortical carcinoma and was found to have primary adrenal DLBCL following surgical resection. Case 2 describes a 59-year-old woman with Hashimoto's thyroiditis and goiter who was found to have primary thyroid DLBCL following partial thyroidectomy. CONCLUSIONS Primary extranodal DLBCL should be included in the differential diagnosis of solid adrenal and thyroid tumors. The risks of biopsy, given currently available techniques, should be weighed against the benefits of achieving a definite diagnosis, allowing for timely initiation of systemic immunochemotherapy. When biopsy can be safely performed, techniques designed to evaluate for DLBCL should be incorporated.
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Affiliation(s)
- Judy Li
- Section of Endocrine Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT USA
| | | | - Morgan Hrones
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
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16
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Ulus SA, Yiğit Ş, Özkul E. Comparative Outcomes of Early, Elective, and Delayed Treatment for Lateral Condyle Fracture of the Humerus in Children: A Retrospective Study from a Single Center in Turkey (2013-2021). Med Sci Monit 2024; 30:e942728. [PMID: 38247165 PMCID: PMC10811962 DOI: 10.12659/msm.942728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Lateral condyle fracture of the humerus in children should be diagnosed and treated quickly to avoid the complications of malunion and varus deformity of the elbow. Worldwide, pediatric orthopedic departments experienced delays in patient diagnosis and treatment during the COVID-19 pandemic. This retrospective study from a single center in Turkey aimed to compare outcomes from early treatment, elective treatment, and delayed treatment in 140 children with lateral condyle fracture of the humerus between 2013 and 2021. MATERIAL AND METHODS In the study, 140 patients with Milch type 2 fractures were included. Patients underwent fixation with K-wires or screws after open or closed reduction. Data collected included age, sex, trauma details, surgery timing, operating conditions, perioperative issues, and rehabilitation outcomes. Fracture union and complications were monitored through clinical examinations and X-rays. Clinical outcomes were evaluated using the Mayo Elbow Performance Score (MEPS). RESULTS There were 58 patients in the early group, 52 in the elective group, and 30 in the delayed group. Surgery durations varied among the groups (P=0.000). The early and delayed groups as well as the early and elective groups had significantly different incision sizes (P=0.000 for both). The early and delayed groups and the early and elective groups had significantly different MEPS scores (P=0.002 and P=0.011, respectively). CONCLUSIONS In patients with late-presenting lateral condyle fractures, although complications increase, surgical treatment does not yield worse outcomes. Standardization of fracture management should be maintained during periods such as COVID-19.
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Pastelín-Martínez MDL, Gallardo-Pérez MM, Gómez-de-León A, Olivares-Gazca JC, Hernández-Flores EJ, Sánchez-Bonilla D, Montes-Robles M, Robles-Nasta M, Ocaña-Ramm G, Soto-Olvera S, Gómez-Almaguer D, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation. Diagnosis (Berl) 2024; 0:dx-2023-0157. [PMID: 38230519 DOI: 10.1515/dx-2023-0157] [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: 11/06/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVES We have analyzed the association of delayed both diagnosis and treatment of persons with MS with the long-term results of patients given aHSCT. METHODS Patients with MS referred to the HSCT-Mexico program were included in the study; in 103, detailed pre- and post-transplant evolution could be recorded. Two groups of patients were analyzed according to the time of evolution between the onset of symptoms and the definite diagnosis of MS: more than 8 months (delayed diagnosis, DD), or less than 8 months (non-delayed diagnosis, NDD). The progression of MS was assessed by changes in the expanded disability status scale (EDSS). RESULTS The time elapsed between the onset of symptoms and the correct diagnosis was lower for the NDD group (1.55 vs. 35.87 months, p<0.05). Both groups of patients showed a similar EDSS score at diagnosis (1.5 vs. 1.5); however, the EDSS at the time of the transplant was higher in the DD group (4.5 vs. 3.0, p=0.3) and the response of the EDSS score to the transplant was significantly better for the NDD group, the last EDSS scores being 2.5 vs. 4.25 (p=0.03). Both groups of patients responded to aHSCT by diminishing the EDSS, but the response was significantly better in the NDD group. CONCLUSIONS These data indicate that both the pre-transplant progression of the disease and the response to aHSCT were significantly worse in the DD group. An early diagnosis and an early aHSCT intervention are critical for a good prognosis, in terms of lowering and stabilizing the motor disability in MS patients given autografts.
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Affiliation(s)
| | - Moisés Manuel Gallardo-Pérez
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | | | - Juan Carlos Olivares-Gazca
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Edgar Jared Hernández-Flores
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Daniela Sánchez-Bonilla
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Merittzel Montes-Robles
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Anáhuac de Puebla, Puebla, México
| | - Max Robles-Nasta
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Guillermo Ocaña-Ramm
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Silvia Soto-Olvera
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Laboratorios RUIZ, SYNLAB, Puebla, México
| | | | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Guillermo J Ruiz-Argüelles
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
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18
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Watari T, Gupta A, Amano Y, Tokuda Y. Japanese Internists' Most Memorable Diagnostic Error Cases: A Self-reflection Survey. Intern Med 2024; 63:221-229. [PMID: 37286507 PMCID: PMC10864084 DOI: 10.2169/internalmedicine.1494-22] [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: 12/21/2022] [Accepted: 04/23/2023] [Indexed: 06/09/2023] Open
Abstract
Objective The etiologies of diagnostic errors among internal medicine physicians are unclear. To understand the causes and characteristics of diagnostic errors through reflection by those involved in them. Methods We conducted a cross-sectional study using a web-based questionnaire in Japan in January 2019. Over a 10-day period, a total of 2,220 participants agreed to participate in the study, of whom 687 internists were included in the final analysis. Participants were asked about their most memorable diagnostic error cases, in which the time course, situational factors, and psychosocial context could be most vividly recalled and where the participant provided care. We categorized diagnostic errors and identified contributing factors (i.e., situational factors, data collection/interpretation factors, and cognitive biases). Results Two-thirds of the identified diagnostic errors occurred in the clinic or emergency department. Errors were most frequently categorized as wrong diagnoses, followed by delayed and missed diagnoses. Errors most often involved diagnoses related to malignancy, circulatory system disorders, or infectious diseases. Situational factors were the most cited error cause, followed by data collection factors and cognitive bias. Common situational factors included limited consultation during office hours and weekends and barriers that prevented consultation with a supervisor or another department. Conclusion Internists reported situational factors as a significant cause of diagnostic errors. Other factors, such as cognitive biases, were also evident, although the difference in clinical settings may have influenced the proportions of the etiologies of the errors that were observed. Furthermore, wrong, delayed, and missed diagnoses may have distinctive associated cognitive biases.
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Affiliation(s)
- Takashi Watari
- General Medicine Center, Shimane University Hospital, Japan
- Medicine Service, VA Ann Arbor Healthcare System, USA
- Department of Medicine, University of Michigan Medical School, USA
| | - Ashwin Gupta
- Medicine Service, VA Ann Arbor Healthcare System, USA
- Department of Medicine, University of Michigan Medical School, USA
| | - Yu Amano
- Faculty of Medicine, Shimane University, Japan
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Santos GMCD, Byrne RL, Cubas-Atienzar AI, Santos VS. Factors associated with delayed diagnosis of leprosy in an endemic area in Northeastern Brazil: a cross-sectional study. CAD SAUDE PUBLICA 2024; 40:e00113123. [PMID: 38198383 PMCID: PMC10775965 DOI: 10.1590/0102-311xen113123] [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] [Received: 06/20/2023] [Revised: 08/19/2023] [Accepted: 10/05/2023] [Indexed: 01/12/2024] Open
Abstract
This study aimed to investigate the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy in an endemic area in the Northeastern Brazil. This is a cross-sectional study of 120 individuals with leprosy. Demographic and clinical data and information on the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy were obtained. Delayed diagnosis in months was estimated for each participant by interviews. A multivariate Poisson's regression analysis was performed between the outcome and the independent variables. The median delay in the diagnosis of leprosy was 10.5 (4.0-24.0) months. Approximately 12.6% of participants had grade 2 disability (G2D) at the time of diagnosis. In the multivariate Poisson regression analysis, males, older age, low schooling level, residing in urban areas, multibacellar or tuberculoid leprosy, not seeking healthcare immediately after symptom onset, suspected leprosy, excessive referrals, and the need for three or more consultations to confirm the diagnosis were associated with longer diagnostic delay. This study found a significant delay in the diagnosis of leprosy in Arapiraca, Northeastern Brazil, which may explain the continuously high rate of G2D among new cases. Factors related to the individual and the health system were associated with longer diagnostic delay. Interventions to raise awareness of the disease among the general population and strengthen primary health care are urgently needed.
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Rosina E, Pezzani L, Apuril E, Pezzoli L, Marchetti D, Bellini M, Lucca C, Meossi C, Massimello M, Mariani M, Scatigno A, Cattaneo E, Colombo L, Maitz S, Cereda A, Milani D, Spaccini L, Bedeschi MF, Selicorni A, Iascone M. Comparison of first-tier whole-exome sequencing with a multi-step traditional approach for diagnosing paediatric outpatients: An Italian prospective study. Mol Genet Genomic Med 2024; 12:e2316. [PMID: 38041506 PMCID: PMC10767581 DOI: 10.1002/mgg3.2316] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/11/2023] [Accepted: 10/22/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The recent guidelines suggest the use of genome-wide analyses, such as whole exome sequencing (WES), at the beginning of the diagnostic approach for cases with suspected genetic conditions. However, in many realities it still provides for the execution of a multi-step pathway, thus requiring several genetic tests to end the so-called 'diagnostic odyssey'. METHODS We reported the results of GENE Project (Genomic analysis Evaluation NEtwork): a multicentre prospective cohort study on 125 paediatric outpatients with a suspected genetic disease in which we performed first-tier trio-WES, including exome-based copy number variation analysis, in parallel to a 'traditional approach' of two/three sequential genetic tests. RESULTS First-tier trio-WES detected a conclusive diagnosis in 41.6% of patients, way above what was found with routine genetic testing (25%), with a time-to-result of about 50 days. Notably, the study showed that 44% of WES-reached diagnoses would be missed with the traditional approach. The diagnostic rate (DR) of the two approaches varied in relation to the phenotypic class of referral and to the proportion of cases with a defined diagnostic suspect, proving the major difference for neurodevelopmental disorders. Moreover, trio-WES analysis detected variants in candidate genes of unknown significance (EPHA4, DTNA, SYNCRIP, NCOR1, TFDP1, SPRED3, EDA2R, PHF12, PPP1R12A, WDR91, CDC42BPG, CSNK1D, EIF3H, TMEM63B, RIPPLY3) in 19.4% of undiagnosed cases. CONCLUSION Our findings represent real-practice evidence of how first-tier genome-wide sequencing tests significantly improve the DR for paediatric outpatients with a suspected underlying genetic aetiology, thereby allowing a time-saving setting of the correct management, follow-up and family planning.
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Affiliation(s)
- Erica Rosina
- Laboratory of Medical GeneticsASST Papa Giovanni XXIIIBergamoItaly
| | | | - Erika Apuril
- Laboratory of Medical GeneticsASST Papa Giovanni XXIIIBergamoItaly
| | - Laura Pezzoli
- Laboratory of Medical GeneticsASST Papa Giovanni XXIIIBergamoItaly
| | | | - Matteo Bellini
- Laboratory of Medical GeneticsASST Papa Giovanni XXIIIBergamoItaly
| | - Camilla Lucca
- Laboratory of Medical GeneticsASST Papa Giovanni XXIIIBergamoItaly
| | - Camilla Meossi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Marta Massimello
- Department of PediatricsFondazione IRCCS San Gerardo dei TintoriMonzaItaly
| | - Milena Mariani
- Department of PediatricsASST Lariana Sant' Anna HospitalComoItaly
| | | | - Elisa Cattaneo
- Clinical Genetics Unit, Department of Obstetrics and GynecologyV. Buzzi Children's Hospital, University of MilanMilanItaly
| | - Lorenzo Colombo
- Neonatal Intensive Care Unit (NICU)Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Silvia Maitz
- Medical Genetics ServiceIOSI, Ente Ospedaliero CantonaleLuganoSwitzerland
| | - Anna Cereda
- Paediatric UnitASST Papa Giovanni XXIIIBergamoItaly
| | - Donatella Milani
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Luigina Spaccini
- Clinical Genetics Unit, Department of Obstetrics and GynecologyV. Buzzi Children's Hospital, University of MilanMilanItaly
| | | | - Angelo Selicorni
- Department of PediatricsASST Lariana Sant' Anna HospitalComoItaly
| | - Maria Iascone
- Laboratory of Medical GeneticsASST Papa Giovanni XXIIIBergamoItaly
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Pervez T, Malik M. Tertiary Trauma Survey on Emergency Department Observational Units: A Systematic Literature Review. Cureus 2024; 16:e53187. [PMID: 38425587 PMCID: PMC10901675 DOI: 10.7759/cureus.53187] [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] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
In today's competitive world with a fast-paced lifestyle, trauma is on the rise and is globally recognized as the leading cause of mortality, morbidity, and disability. Despite the development of major trauma centers and the introduction of advanced trauma training courses and management guidelines, there remains a substantial risk of missed or delayed diagnosis of injuries with potentially life-changing physical, emotional, and financial implications. The proportion of such incidents is potentially higher in busy emergency departments and developing countries with fewer dedicated major trauma centers or where focused emergency and trauma training and skills development is still in its infancy. In the last decade, tertiary trauma surveys have been recognized as an important re-assessment protocol in reducing such missed injuries or delayed diagnoses in patients involved in major trauma. This naturally leads to the presumption that tertiary trauma surveys could also play an important role in observational medicine. This also brings into question whether a standardized tertiary trauma survey of major trauma patients on emergency observation units could reduce missed injuries, especially in low-income countries with fewer resources and trauma expertise. Thus, the purpose of this systematic literature review is to explore the potential role of tertiary trauma survey as a tool to reducing missed or delayed diagnosis in the emergency observation units and its applicability and feasibility in less-developed healthcare systems and in low- and middle-income countries. A broad-based systematic literature review was conducted to include electronic databases, grey literature, reference lists, and bibliographies using the keywords: tertiary trauma survey, major trauma, observational medicine, emergency observation units, clinical decision unit, adult, missed injuries, and delayed diagnosis. Over 19,000 citations were identified on initial search. Following a review of abstracts, application of inclusion and exclusion criteria, and review of the full article, 19 publications were finally selected for the purpose of this systematic literature review. Current evidence shows a general trend that tertiary trauma surveys performed 24 hours after admission play an important role in identifying injuries missed at the time of initial primary and secondary survey, and its implementation in observational medicine could prove beneficial, especially in resource-depleted healthcare systems.
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Affiliation(s)
- Tamkeen Pervez
- Emergency Medicine, Combined Military Hospital, Rawalpindi, PAK
| | - Mehreen Malik
- Family Medicine, Heavy Industries Taxila (HIT) Hospital, Taxila, PAK
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22
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Dudhani S, Sinha AK, Kumar B, Kumar A, Anant M. Giant Colpolithiasis in Urogenital Sinus Anomaly with Urethral Duplication: A Case Report and Review of Literature. Afr J Paediatr Surg 2024; 21:69-72. [PMID: 38259025 PMCID: PMC10903723 DOI: 10.4103/ajps.ajps_89_22] [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: 07/08/2022] [Revised: 09/03/2022] [Accepted: 10/10/2022] [Indexed: 01/22/2023] Open
Abstract
ABSTRACT Primary vaginal calculi are uncommon in children. Urethral duplication in females is seen to occur in association with complex congenital malformations. We report the case of perianal persistent urogenital sinus with a hypertrophied clitoris with phallic urethra, scrotum-like pouch, uterus didelphys with obstructed hemivagina, and giant colpolithiasis in 46XX female. A 16-year-old presented with pain abdomen and cyclic passage of blood clots per rectum. She had a tender lump in left iliac region, a phallus like protrusion and a ruggous sac below it. Vaginal opening was absent. Computed tomography showed two uterine horns with a separate cervix and distended non-communicating hemivaginas with a large calcified oval mass in the left hemivagina. On exploration, calculus was extracted from the left hemivagina. The large calculus found in the left hemivagina appears to be the cause of all presenting symptoms. It obstructed the left hemivagina, filling the left uterine horn with menstrual blood causing its gradual enlargement and secondary infection. The early diagnosis and prompt referral of such an anomaly can only be ensured in institutional deliveries. For a significant proportion of newborns in the developing world, the ability to afford or even be referred to institutes which deal with such cases is a luxurious affair. We hope to bridge bridging the knowledge, attitude and practice gap that exists in our health-care system with this report.
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Affiliation(s)
| | | | - Bindey Kumar
- Department of Pediatric Surgery, AIIMS, Patna, Bihar, India
| | - Amit Kumar
- Department of Pediatric Surgery, AIIMS, Patna, Bihar, India
| | - Monika Anant
- Department of Obstetrics and Gynecology, AIIMS, Patna, Bihar, India
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Kim CS, Cho HS, Lee OJ, Ahn SY, Yoo JY. Primary pulmonary synovial sarcoma with delayed diagnosis in a 69-year-old man: A case report. Medicine (Baltimore) 2023; 102:e36620. [PMID: 38134089 PMCID: PMC10735115 DOI: 10.1097/md.0000000000036620] [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: 09/12/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
RATIONALE Primary pulmonary synovial sarcoma is a rare malignant pulmonary tumor accompanied by calcifications in approximately 15% of cases. These calcifications usually have a fine, stippled appearance; coarse shapes have seldom been reported. Moreover, the presence of coarse calcifications often suggests benign tumors, which vastly differ in treatment. We present a rare case of primary pulmonary sarcoma with coarse intratumoral calcifications, the diagnosis of which was delayed because of its radiologic appearance. PATIENT CONCERNS A computed tomography (CT) scan of a 69-year-old man with right upper quadrant (RUQ) pain revealed an incidental mass at the base of the right lower lobe, the margin of which was not well described with respect to the liver, and intratumoral coarse calcification was noted. Initially, the lesion was believed to be hepatic, and magnetic resonance imaging (MRI) was performed. Based on its imaging features, the mass was thought to be a pulmonary lesion, and a preliminary diagnosis of a benign lesion, such as a hamartoma or granuloma, was made. Four months after the initial CT scan, the patient's RUQ pain had aggravated; however, no change in the mass was observed on follow-up CT. DIAGNOSIS The final diagnosis was primary pulmonary sarcoma, proven by surgical biopsy. INTERVENTIONS Wedge resection of the right lower lobe was performed, and the patient received adjuvant chemotherapy. OUTCOMES The patient's RUQ pain improved, and no recurrence or metastasis has been reported to date. LESSONS This case describes a rare presentation of a primary pulmonary synovial sarcoma with coarse intratumoral calcifications and the MRI features of the lesion. Intratumoral coarse calcifications often suggest benign lesions, such as hamartomas or post-inflammatory granulomas; however, as malignant lesions cannot be completely excluded, other radiologic and clinical features should be considered carefully. Focal areas of enhancement and eccentric calcification distribution might suggest malignant lesions such as primary pulmonary synovial sarcoma. Furthermore, despite not being used routinely, MRI scans might be helpful because advanced MRI techniques, such as diffusion-weighted imaging, can help distinguish malignant lesions from benign lesions. If the clinical course of a patient suggests malignancy, a more aggressive biopsy strategy should be considered.
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Affiliation(s)
- Chan Seop Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Hye Soo Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ok Jun Lee
- Department of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Su Yeon Ahn
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jin Young Yoo
- Department of Radiology, Chungbuk National University College of Medicine and Hospital, Cheongju, Korea
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24
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Xiong DD, Bordeaux J. The impact of the COVID-19 pandemic in 2020 on the diagnosis, treatment, and outcomes of invasive cutaneous melanoma: A retrospective national cohort study. J Am Acad Dermatol 2023; 89:1167-1176. [PMID: 37625699 DOI: 10.1016/j.jaad.2023.08.040] [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] [Received: 05/01/2023] [Revised: 07/24/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Prior multiinstitutional studies demonstrate that patients diagnosed with melanoma during the Coronavirus Disease 2019 (COVID-19) pandemic presented with more advanced melanomas. OBJECTIVES To further characterize patients diagnosed with melanoma during the COVID-19 pandemic. METHODS Retrospective population-based cohort study of the Surveillance, Epidemiology, and End-Results (SEER) registry of patients diagnosed with cutaneous melanoma from 2018-2020. RESULTS Patients diagnosed with melanoma in 2020 were more likely to have increased Breslow depth, more ulceration, nodular tumors, and more advanced stage at diagnosis despite less treatment delays. Patients tended to be from wealthier, more urban areas. Primary surgical treatment was more likely to be with Mohs surgery. Diagnosis in the year 2020 was not correlated with overall or disease specific survival. LIMITATIONS This is a retrospective cohort review and limited by short follow-up times, which could affect survival outcomes. There was a 15.5% drop in melanoma diagnosis in 2020 compared to prior years, which could relate to delayed presentation. CONCLUSIONS AND RELEVANCE Patients diagnosed with melanoma in 2020 tended to have thicker, more ulcerated, and more advanced tumors, but this was not associated with survival. Further studies are needed to characterize outcomes for patients diagnosed with melanoma during the COVID-19 pandemic.
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Affiliation(s)
- David D Xiong
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Jeremy Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
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25
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Mercuri E, Pane M, Cicala G, Brogna C, Ciafaloni E. Detecting early signs in Duchenne muscular dystrophy: comprehensive review and diagnostic implications. Front Pediatr 2023; 11:1276144. [PMID: 38027286 PMCID: PMC10667703 DOI: 10.3389/fped.2023.1276144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Despite the early onset of clinical signs suggestive of Duchenne muscular dystrophy (DMD), a diagnosis is often not made until four years of age or older, with a diagnostic delay of up to two years from the appearance of the first symptoms. As disease-modifying therapies for DMD become available that are ideally started early before irreversible muscle damage occurs, the importance of avoiding diagnostic delay increases. Shortening the time to a definite diagnosis in DMD allows timely genetic counseling and assessment of carrier status, initiation of multidisciplinary standard care, timely initiation of appropriate treatments, and precise genetic mutation characterization to assess suitability for access to drugs targeted at specific mutations while reducing the emotional and psychological family burden of the disease. This comprehensive literature review describes the early signs of impairment in DMD and highlights the bottlenecks related to the different diagnostic steps. In summary, the evidence suggests that the best mitigation strategy for improving the age at diagnosis is to increase awareness of the early symptoms of DMD and encourage early clinical screening with an inexpensive and sensitive serum creatine kinase test in all boys who present signs of developmental delay and specific motor test abnormality at routine pediatrician visits.
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Affiliation(s)
- Eugenio Mercuri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marika Pane
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianpaolo Cicala
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Emma Ciafaloni
- Department of Neurology, University of Rochester, Rochester, NY, United States
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26
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Davis M, Stephens A, Butaney M, Morrison C, Corsi N, Sood A, Levin AM, Cole A, Trinh QD, Rogers C, Abdollah F. Trends in Prostate Cancer Screening in the Pre- and Peri-COVID-19 Pandemic Period. Urol Pract 2023; 10:631-637. [PMID: 37647197 DOI: 10.1097/upj.0000000000000452] [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: 07/10/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION This study sought to examine PSA testing rates before, early in, and later in the COVID-19 pandemic. METHODS Our cohort included test results from men >45 years who received PSA testing at least once at our institution from November 2018 to September 2021 and were alive at the end of that period. Monthly trends were evaluated for 3 periods: pre-COVID (November 2018-February 2020), early-COVID (March-May 2020), and late-COVID (June 2020-September 2021). Univariable and multivariable analysis tested the impact of these periods on PSA testing rate, after accounting for available confounders. All analyses were stratified by prostate cancer diagnosis status. RESULTS A total of 141,777 PSA tests met inclusion criteria. The monthly number of tests in men without prostate cancer declined from 3,669 pre-COVID to 1,760 early-COVID (52% decrease; P = .0086) before increasing to 4,171 (14% increase from pre-COVID; P < .0001) late-COVID. The monthly average of first-time tests declined from 805 pre-COVID to 315 early-COVID (61% decrease; P = .008) before rebounding to 795 (1% decrease from pre-COVID; P = .7) late-COVID. The monthly number of tests in prostate cancer patients declined from 343 pre-COVID to 195 early-COVID (43% decrease; P = .008) before partially rebounding to 313 (9% decrease; P = .03) late-COVID. These differences remained within multivariable models. CONCLUSIONS A number of men have forgone first-time PSA testing opportunities following the COVID-19 outbreak; thus, early cancer diagnoses in some individuals might have been missed. Likewise, many prostate cancer patients have forgone follow-up in the late-COVID period, which might compromise their oncologic outcomes.
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Affiliation(s)
- Matthew Davis
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Alex Stephens
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Mohit Butaney
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Chase Morrison
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Nicholas Corsi
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
| | | | - Albert M Levin
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | | | | | - Craig Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan
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Miyazaki K, Kodama T, Aida Y, Sato S, Satoh H. Impact of COVID-19 Pandemic on Advanced Non-small Cell Lung Cancer Treatment at a Japanese Hospital. Cancer Diagn Progn 2023; 3:716-720. [PMID: 37927803 PMCID: PMC10619572 DOI: 10.21873/cdp.10276] [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] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/04/2023] [Indexed: 11/07/2023]
Abstract
Background/Aim The COVID-19 pandemic has forced medical institutions to scale back their practice. Changes in patient behavior seemed to be having an impact. We conducted a survey with the aim of reviewing lung cancer treatment during the pandemic period and identifying problems. Patients and Methods We examined the medical records of all patients pathologically diagnosed with non-small cell lung cancer (NSCLC) in our hospital from 2017 to 2022. NSCLC patients were divided into two groups: those diagnosed between 2017 and 2019 (first period) and those diagnosed between 2020 and 2022 (second period). Results Within the study period, 267 NSCLC patients (first period: 147 patients, second period: 121 patients) were diagnosed in our hospital. The patients in the two study periods did not differ significantly in age (p=0.613), ECOG performance status (p=0.125), and clinical stage (p=0.354). Tumor size was significantly larger in the second period with a mean of 5.88 cm ± 3.02, compared to 4.24 cm ± 1.76 in the first period (p<0.001). In the standard treatment group, the median survival time was 457 days in the first period and 313 days in the second period (p=0.063). In the best supportive care group, median survival time was 122 days in the first period and 57 days in the second period (p=0.004). Conclusion Patients themselves refrained from seeking consultation for lung cancer treatment during the pandemic period. It is inconclusive how to reduce the delay due to the suppression of consultations, but this is an important issue for the future.
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Affiliation(s)
- Kunihiko Miyazaki
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Takahide Kodama
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Yuka Aida
- Division of Respiratory Medicine, Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
- Division of Medical Oncology, Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shinya Sato
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Japan
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Pereira-Elizeu AV, de Ávila-Panisset J, Silva MLRD, da Silva-Paz LP, da Costa-Cunha K, da Silva ML, Monsores N. Factors associated with the time taken for diagnosis of amyotrophic lateral sclerosis (ALS) in Brazil. An online population-based inquiry. Rev Neurol 2023; 77:177-183. [PMID: 37807882 PMCID: PMC10831762 DOI: 10.33588/rn.7708.2023210] [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] [Received: 09/15/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE This study evaluated factors associated with the time, in months, between the onset of symptoms and the diagnosis (time taken for diagnosis) of ALS for patients in Brazil, in the year 2014. PATIENTS AND METHODS An electronic questionnaire composed of 38 questions was developed and applied through internet-based social networks of patients. From the 210 replies, 194 were considered (86 from women, 108 from men). Most respondents were 51 to 60 years old. The Mann-Whitney test was used to compare the time taken for diagnosis between the strata of the sample. RESULTS The mean time taken for diagnosis was 14.21 (±16.87) months. There was a statistically significant difference only for higher education conditions (p = 0.009) and low education status (p = 0.042). There was no statistically significant difference between sexes, bulbar onset, age groups, and the presence of spouse, or 'partnership with ALS patients associations or exchange of experiences'. CONCLUSION These data suggest that the time taken for diagnosis of ALS is influenced by socioeconomic conditions that promote access to information and/or health services.
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Affiliation(s)
- Alisson V. Pereira-Elizeu
- Observatory of Rare Diseases. Faculty of Health Sciences. Campus Universitário Darcy Ribeiro. Brasilia, BrazilCampus Universitário Darcy RibeiroCampus Universitário Darcy RibeiroBrasiliaBrazil
| | - Juliana de Ávila-Panisset
- Observatory of Rare Diseases. Faculty of Health Sciences. Campus Universitário Darcy Ribeiro. Brasilia, BrazilCampus Universitário Darcy RibeiroCampus Universitário Darcy RibeiroBrasiliaBrazil
| | - Miguel L. Rodrigues-da Silva
- Centre for Biological and Health Sciences. Universidade do Estado do Pará. Amapá, Marabá, BrazilUniversidade do Estado do ParáUniversidade do Estado do ParáMarabáBrazil
| | - Leonardo P. da Silva-Paz
- Health and Health Sciences Technologies Programme. Universidade de Brasilia. Brasilia, BrazilUniversidade de BrasiliaUniversidade de BrasiliaBrasiliaBrazil
| | - Katiane da Costa-Cunha
- Centre for Biological and Health Sciences. Universidade do Estado do Pará. Amapá, Marabá, BrazilUniversidade do Estado do ParáUniversidade do Estado do ParáMarabáBrazil
| | - Marianne L. da Silva
- Department of Collective Health. Collective Health Course. Universidade de Brasilia. Brasilia, BrazilUniversidade de BrasiliaUniversidade de BrasiliaBrasiliaBrazil
| | - Natan Monsores
- Observatory of Rare Diseases. Faculty of Health Sciences. Campus Universitário Darcy Ribeiro. Brasilia, BrazilCampus Universitário Darcy RibeiroCampus Universitário Darcy RibeiroBrasiliaBrazil
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Segovia Chacón S, Karlsson P, Cesta CE. Detection of major congenital malformations depends on length of follow-up in Swedish National Health Register Data: Implications for pharmacoepidemiological research on medication safety in pregnancy. Paediatr Perinat Epidemiol 2023. [PMID: 37818747 DOI: 10.1111/ppe.13011] [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: 05/13/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND In observational medication pregnancy safety studies, children are often followed from birth to 1 year of age. However, some major congenital malformations (MCM) may take longer to diagnose. OBJECTIVES We aimed to investigate the proportion of children with detected MCMs at different lengths of follow-up and compare them to the proportion detected at 1 year after birth. METHODS This population-based register study included all singleton children liveborn in Sweden from 2006 to 2016. MCM were identified by ICD-10 codes in the Medical Birth Register and National Patient Register, aligned to the EUROCAT classification system. Cumulative proportion of children with detected MCM at birth, 90 days, 1, 2, and 3 years was calculated and compared between children born preterm and at term. RESULTS In 1,138,113 liveborn children, the cumulative proportion of children with a detected MCM increased from 1.9% at birth to 3.1%, 3.9%, 4.4% and 4.7% at 90 days, 1, 2, and 3 years after birth, respectively, and varied by MCM subgroup. MCMs of the eye, ear-face-neck, nervous system and genitals were detected with the longest delay, with 31%-59% more detected at 3- versus 1-year follow-up. Compared to children born at term, the proportion of children with any MCM was 2.5 times higher amongst preterm children, with a higher proportion detected over the first 90 days for most MCM subgroups. CONCLUSIONS The proportion of children with a detected MCM varied by MCM subgroup and follow-up time. In pharmacoepidemiology studies of medication safety in pregnancy using Swedish national data, the length of child follow-up should be chosen in accordance with the expected age at detection if a specific subgroup of MCM is under investigation, for example, eye and genital MCM require longer follow-up for detection than abdominal wall and digestive system MCM. However, in most circumstances, 1 year of follow-up is sufficient.
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Affiliation(s)
- Silvia Segovia Chacón
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Pär Karlsson
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Carolyn E Cesta
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Kwok MMK, Wong A, Prasad J. Factors affecting timeliness in management of head and neck cancer. ANZ J Surg 2023; 93:2388-2393. [PMID: 37209403 DOI: 10.1111/ans.18521] [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] [Received: 02/16/2023] [Revised: 04/20/2023] [Accepted: 05/07/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Timeliness in the management of patients with head and neck cancer (HNC) can be affected by both patient and non-patient related factors. This study aims to investigate the factors associated with the timeliness of managing HNC. METHODS A retrospective review was conducted on Western Health medical records including all new patients presenting to the Western Health HNC surgical outpatient clinic in the five-year period from first January 2017 to 31st December 2021 with the diagnosis of a HNC. Both patient and non-patient related factors were compared with the duration between a patient's referral to a HNC service and the commencement of their treatment. RESULTS Two hundred and twenty-eight patients were included in this study. The median duration from referral to the commencement of treatment was 48 days. Lack of radiological or pathological investigations prior to referral to a HNC service as well as early staging were found to significantly impact timeliness in management. Socioeconomic factors such as non-English speaking backgrounds, distance from the hospital and lack of social supports were not found to negatively impact timeliness of management. CONCLUSION The management of patients with HNC require careful consideration of all patient and non-patient related factors which may affect timeliness in management, particularly investigations performed prior to their referral to a HNC service.
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Affiliation(s)
- Matthew Ming Kei Kwok
- Department of Otolaryngology Head and Neck Surgery, Footscray Hospital, Western Health, Melbourne, Victoria, Australia
| | - Amy Wong
- Department of Otolaryngology Head and Neck Surgery, Footscray Hospital, Western Health, Melbourne, Victoria, Australia
| | - Jessica Prasad
- Department of Otolaryngology Head and Neck Surgery, Footscray Hospital, Western Health, Melbourne, Victoria, Australia
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Acurio K, Chuquilin M. Neuro-Sweet Syndrome: A Diagnostic Conundrum. Neurohospitalist 2023; 13:406-409. [PMID: 37701247 PMCID: PMC10494816 DOI: 10.1177/19418744231174949] [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: 09/14/2023] Open
Abstract
Sweet Syndrome presents as acute fever, leucocytosis and characteristic skin plaques. It can involve many organ systems but rarely affects the nervous system. We report the case of a 51-year-old female that presented with fever, rash, headache and encephalopathy. Brain magnetic resonance imaging showed extensive T2 hyperintensities involving cerebral hemispheres, cerebellum, and brainstem. A skin biopsy revealed dermal infiltration by neutrophils consistent with Sweet Syndrome. She started steroid treatment with a good clinical response. Further questioning revealed that she had a similar episode 10 years prior that had been diagnosed as acute disseminated encephalomyelitis. Neuro-Sweet Syndrome can present with a great array of symptoms and relapses over long periods of time making the diagnosis difficult without a high degree of suspicion. Clinicians should consider this syndrome in the setting of acute encephalitis with white matter lesions that are highly responsive to steroids particularly in the presence of previous similar symptoms.
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Affiliation(s)
- Karlos Acurio
- School of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Miguel Chuquilin
- Department of Neurology, University of Florida, Gainesville, FL, USA
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Ohno T, Kanazawa M, Nakano T, Takemoto M, Ito T. Tetanus Overlooked Due to the Involvement of Multiple Departments: A Case Report. Cureus 2023; 15:e48066. [PMID: 38046504 PMCID: PMC10689120 DOI: 10.7759/cureus.48066] [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] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Tetanus is a fatal disease caused by a neurotoxin produced by the biotrophic anaerobic bacterium Clostridium tetani, which causes muscle hypertonia and autonomic neuropathy. The diagnosis is based on clinical findings and not the result of specific blood and imaging tests; hence, it is very difficult to diagnose at first sight, despite typical initial findings such as lockjaw, muscle spasms, and neck pain and stiffness. This article discusses the case of a 79-year-old woman who first consulted her local doctor because of a lack of jaw opening. Seeing no improvement, she visited our hospital and was suspected of having tetanus after consulting with nine different departments over seven days from the initial visit. In developed countries, tetanus prevalence has declined due to immunization, leading to clinicians' lack of experience in diagnosing it. Furthermore, the increasing specialization in general hospitals poses a risk of missing a tetanus diagnosis when a patient consults multiple departments.
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Affiliation(s)
- Takanori Ohno
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Masashi Kanazawa
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Takaaki Nakano
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Masaaki Takemoto
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Toshitaka Ito
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
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Bhutani J, Rengan V, Pansari V, Kannan D. Sacral Agenesis: Late Presentation and the Psychological Impact of Delayed Diagnosis. Cureus 2023; 15:e47456. [PMID: 38021544 PMCID: PMC10660888 DOI: 10.7759/cureus.47456] [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] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Sacral agenesis (SA) is a rare condition characterized by the absence of one or more lower sacral vertebral bodies. In India, children with this condition often present late with symptoms primarily related to urinary and bowel dysfunction. Maternal diabetes is the only confirmed risk factor, significantly elevating the incidence rate. We discuss a case of a nine-year-old female who presented to the pediatric outpatient department (OPD) with chronic constipation and urinary retention, having experienced symptoms since infancy. Initial investigations at peripheral hospitals had yielded no clear diagnosis, leading to undue psychological distress to the child and family. The child had been born to a mother with diabetes mellitus during pregnancy. Physical examination revealed mild dehydration, anemia, and sacral dimpling. Further evaluation showed renal injury and SA confirmed by MRI, along with other associated findings. This case report highlights the importance of early diagnosis and intervention in pediatric SA, especially given the risk of renal disease progression. The treatment in this case included clean intermittent self-catheterization (CIC), dietary management, and counseling on renal health. Crucially, uncovering the root cause provided immense psychological relief to the child and her family. Pediatric SA remains a diagnostic challenge, often leading to psychological distress in affected individuals who present late. Early recognition and comprehensive management are crucial, especially in cases associated with maternal diabetes, to mitigate the risk of renal complications and improve the overall quality of life for affected children.
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Kizhakkayil Tency N, Camarena JA, Roy A, Pradeep M. A Case Report of Plasmacytoma in a 28-Year-Old Patient: Bridging the Age Gap in a Rare Presentation. Cureus 2023; 15:e47671. [PMID: 38022027 PMCID: PMC10672403 DOI: 10.7759/cureus.47671] [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] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Plasmacytoma, an uncommon malignancy originating from plasma cells, predominantly manifests in the elderly demographic. However, its incidence among young adults remains infrequent. Herein, we present a case involving a 28-year-old young adult diagnosed with solitary bone plasmacytoma. The patient presented with acute exacerbation of chronic lower back pain of two years, which, upon hospitalization, was attributed to a lumbar spine compression fracture. Comprehensive blood analysis, imaging studies, and pathology assessments suggested the likelihood of solitary plasmacytoma, devoid of indicators characteristic of multiple myeloma (MM). The patient was given symptomatic treatment and underwent surgical spine decompression, followed by the commencement of radiation therapy to address the malignancy. Subsequent to radiotherapeutic intervention, a noteworthy amelioration in pain and overall condition was observed. This case report assumes importance due to the insight it provides into the natural progression of solitary plasmacytoma. Patients with pathological fractures warrant thorough assessment for solitary plasmacytoma, necessitating vigilant monitoring for its potential evolution into MM. This case serves as a pertinent illustration of the need to expand our existing knowledge of solitary bone plasmacytoma, moving beyond the conventional notion that it predominantly afflicts the elderly population.
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Affiliation(s)
| | - Julieanna A Camarena
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, USA
| | - Archa Roy
- Department of Internal Medicine, Government T D Medical College, Alappuzha, IND
| | - Mini Pradeep
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, USA
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Mehmetoğlu F. Patient Query in Adolescent Testicular Torsion Cases: "Was it Necessary to Mention My Scrotal Pain?". Cureus 2023; 15:e47386. [PMID: 37869046 PMCID: PMC10588814 DOI: 10.7759/cureus.47386] [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] [Accepted: 10/17/2023] [Indexed: 10/24/2023] Open
Abstract
Objective This study investigates the reasons for the failure to diagnose testicular torsion (TT) in different healthcare facilities (HCFs) and by various physicians. Method We retrospectively analyzed all male patients who underwent TT surgery within the adolescent age group between 2015 and 2023. Healthy adolescent patients who initially presented or were referred to an HCF and were subsequently diagnosed at our hospital for TT surgery were analyzed, focusing on why they were not diagnosed earlier. Results A total of 11 patients aged 10 to 17 who were surgically confirmed to have TT at our hospital between 2015 and 2023 were analyzed retrospectively. These patients had been admitted to various public and private HCFs due to the sudden onset of symptoms such as abdominal pain, vomiting, fainting, sweating, and walking difficulties during and after working hours. Four patients had previously been admitted to one HCF, while seven had been admitted two to six times to an HCF. All patients were healthy, and all but one had received age-appropriate education. However, only two of them had reported experiencing scrotal pain. Laboratory tests and/or radiological examinations were conducted on eight patients, and nine patients received medical treatment and/or prescriptions. None of the patients were initially diagnosed with acute scrotum. Conclusion Despite having unrestricted and free access to well-equipped HCFs, the early diagnosis and treatment of TT are not ensured. Factors contributing to this delay include patients' concealment of, or failure to fully disclose, scrotal complaints, as well as physicians' incomplete history taking and genital examinations. The physician's male gender was not found to contribute to an earlier diagnosis of TT. A mandatory genital examination should be included in the emergency assessment protocol for male patients.
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Ochom E, Robsky KO, Gupta AJ, Tamale A, Kungu J, Turimumahoro P, Nakasendwa S, Rwego IB, Muttamba W, Joloba M, Ssengooba W, Davis JL, Katamba A. Geographic distribution and predictors of diagnostic delays among possible TB patients in Uganda. Public Health Action 2023; 13:70-76. [PMID: 37736583 PMCID: PMC10446659 DOI: 10.5588/pha.23.0010] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/20/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Understanding the geographic distribution and factors associated with delayed TB diagnosis may help target interventions to reduce delays and improve patient outcomes. METHODS We conducted a secondary analysis of adults undergoing TB evaluation within a public health demonstration project in Uganda. Using Global Moran's I (GMI) and Getis-Ord GI* statistics, we evaluated for residential clustering and hotspots associated with patient-related and health system-related delays. We performed multivariate logistic regression to identify individual predictors of both types of delays. RESULTS Of 996 adults undergoing TB evaluation (median age: 37 years, IQR 28-49), 333 (33%) experienced patient delays, and 568 (57%) experienced health system delays. Participants were clustered (GMI 0.47-0.64, P ⩽ 0.001) at the sub-county level, but there were no statistically significant hotspots for patient or health system delays. Married individuals were less likely to experience patient delays (OR 0.6, 95% CI 0.48-0.75; P < 0.001). Those aged 38-57 years (OR 1.2, 95% CI 1.07-1.38; P = 0.002) were more likely than those aged ⩾58 years to experience patient delays. Knowledge about TB (OR 0.8, 95% CI 0.63-0.98; P = 0.03) protected against health system delays. CONCLUSIONS We did not identify geographic hotspots for TB diagnostic delays. Instead, delays were associated with individual factors such as age, marital status and TB knowledge.
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Affiliation(s)
- E Ochom
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - K O Robsky
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - A J Gupta
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Tamale
- Departments of Veterinary Medicine and Animal Resources
| | - J Kungu
- Biotechnical and Biolab Sciences, and
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - S Nakasendwa
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - I B Rwego
- Biosecurity, Ecosystem and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - M Joloba
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - W Ssengooba
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - J L Davis
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
- Pulmonary, Critical Care and Sleep Medicine Section, Yale School of Medicine, New Haven, CT, USA
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Clinical Epidemiology Unit, Makerere University, College of Health Sciences, Kampala, Uganda
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Peacock HM, De Gendt C, Silversmit G, Nuyts S, Casselman J, Machiels JP, Giusti F, van Gool B, Vander Poorten V, Van Eycken L. Stage shift and relative survival for head and neck cancer during the 2020 COVID-19 pandemic: a population-based study of temporal trends. Front Oncol 2023; 13:1253968. [PMID: 37799467 PMCID: PMC10548264 DOI: 10.3389/fonc.2023.1253968] [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: 07/06/2023] [Accepted: 08/09/2023] [Indexed: 10/07/2023] Open
Abstract
Objective During the first wave of the COVID-19 pandemic in 2020, non-essential health services were suspended in Belgium, and the public was ordered to socially isolate. Underdiagnosis of cancer during this period was reported worldwide. Certain risk factors for head and neck cancer (HNC) overlap with those for COVID-19 incidence and mortality, making underdiagnosis and subsequent stage shift of this potentially rapidly progressing cancer a major concern. We aimed to analyze incidence, clinical stage at presentation, and survival of patients diagnosed with HNC in 2020 in Belgium, considering recent temporal trends. Methods Using population-based data from the Belgian Cancer Registry (BCR), we extrapolated 2017-2019 trends in incidence, clinical stage, and 1-year relative survival (1yRS) of HNC to create an expected value for 2020 and compared this to the observed value. Results There were 9.5% fewer HNCs diagnosed in 2020, compared to the predicted incidence. Underdiagnosis was larger for males (-11.8%), patients aged 50-64 (-11.2%) and 65-79 (-11.1%), and for oral cavity cancer (-17.6%). Shifts to more advanced stages were observed in larynx and oropharynx tumors and for (male) patients aged 80+. A 2.4 percentage point decline in 1yRS was observed, relative to the increasing trends in 1yRS (2017-2019). Conclusion The COVID-19 pandemic led to underdiagnosis of HNC, resulting in shifts to more advanced stage at presentation in certain subgroups. A stage shift can be expected for the 9.5% of tumors not yet diagnosed at the end of 2020. HNC patients diagnosed in 2020 suffered higher than expected mortality.
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Affiliation(s)
| | | | | | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jan Casselman
- Department of Radiology, AZ St-Jan Brugge-Oostende, Bruges, Belgium
| | - Jean-Pascal Machiels
- Department of Medical Oncology, Institut Roi Albert II, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Clinique et Expérimentale, UCLouvain, Brussels, Belgium
| | | | | | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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Vigneswaran N, Parnis R, Lowbridge C, Townsend D, Ralph AP. Factors leading to diagnostic delay in tuberculosis in the tropical north of Australia. Intern Med J 2023. [PMID: 37688576 DOI: 10.1111/imj.16223] [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: 05/29/2023] [Accepted: 08/07/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Tuberculosis (TB) incidence is decreasing in the Northern Territory (NT) but still exceeds rates elsewhere in Australia. Deaths and morbidity from advanced TB continue, with delay in diagnosis a contributor to adverse outcomes. AIMS We aimed to describe the delay in diagnosis of TB, identify risk factors for delay and examine the associations between delay and clinical outcomes. METHODS We conducted a historical cohort analysis which included adult inpatients diagnosed with TB at the Royal Darwin Hospital from 2010 to 2020. Patient delay was measured as time from symptom onset to first seeking care, and health system delay was quantified as time from first relevant clinical contact to diagnosis. The sum of these two periods was the total delay. Ethics approval was granted by NT HREC (2020-3852). RESULTS Eighty-four cases were included; the median total delay was 90 days (interquartile range (IQR): 60-121), patient delay was 53 days (IQR: 30-90), and health system delay was 21 days (IQR: 12-45). Patient delay was longer among patients with extrapulmonary (median: 100 days (IQR: 90-105) compared with pulmonary TB patients (39 days (IQR: 27-54), P < 0.0001). Health system delay was longer in those aged ≥45 years (30 days (IQR: 16-51) vs younger patients (14 days (IQR: 8-30), P = 0.007) and among non-smokers (31 days (IQR: 21-55) vs 21 days (IQR: 10-40), P = 0.048). Median delay was longer among patients with non-drug-related complications of disease (P < 0.0001), those admitted to critical care (P < 0.0001), and those with respiratory failure (P = 0.001). CONCLUSION The patient delays we report are longer than reported elsewhere in Australia. The next steps will require concerted efforts to improve community awareness of TB and strategies to strengthen health systems through better resourcing and healthcare provider support.
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Affiliation(s)
- Nilanthy Vigneswaran
- Department of Infectious Diseases, Royal Darwin Hospital, Northern Territory, Darwin, Australia
| | - Roger Parnis
- Department of Infectious Diseases, Royal Darwin Hospital, Northern Territory, Darwin, Australia
| | - Christopher Lowbridge
- Department of Infectious Diseases, Royal Darwin Hospital, Northern Territory, Darwin, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - David Townsend
- Department of Infectious Diseases, Royal Darwin Hospital, Northern Territory, Darwin, Australia
| | - Anna P Ralph
- Department of Infectious Diseases, Royal Darwin Hospital, Northern Territory, Darwin, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Tadisina S, Asad R, Varakantam A, Weide L, Drees B. Thyrotoxic Periodic Paralysis as an Ongoing Diagnostic Challenge: A Case Report and Literature Review. Cureus 2023; 15:e46272. [PMID: 37908931 PMCID: PMC10615357 DOI: 10.7759/cureus.46272] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
Thyrotoxic periodic paralysis (TPP) is a rare condition that presents with episodic periodic paralysis due to hypokalemia that develops from hyperthyroidism. Timely diagnosis is still an ongoing challenge due to lack of awareness, self-resolving episodes, and the fact that it clinically mimics familial hypokalemic periodic paralysis (FHPP), which is more common in the West. TPP is more commonly seen among Asians but has been emerging in Western countries due to globalization. We present a case of a 24-year-old Hispanic male who presented with bilateral lower extremity weakness. He had five such episodes in the past year, which resolved on their own. The current episode of weakness was worse, and he required a wheelchair to ambulate. Despite extensive work, it took over four months to make a definitive diagnosis and treat his hyperthyroidism. A literature review reported that most cases of TPP are usually diagnosed after multiple episodes, and the causes of diagnostic error were studied. Through this review, we present a case of TPP with diagnostic delay, a literature review discussing the etiology, pathogenesis, clinical manifestations, and management, with an emphasis on the diagnostic challenge of TPP. Awareness of this condition, timely evaluation for hyperthyroidism as a cause for hypokalemic periodic paralysis, and understanding the factors that contribute to its diagnostic challenge will aid in timely recognition and treatment.
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Affiliation(s)
- Shourya Tadisina
- Endocrinology, Diabetes and Metabolism, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Reda Asad
- Endocrinology, Diabetes and Metabolism, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | | | - Lamont Weide
- Endocrinology, Diabetes and Metabolism, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Betty Drees
- Endocrinology, Diabetes and Metabolism, University of Missouri Kansas City School of Medicine, Kansas City, USA
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Pinheiro TN, Desideri Vieira AJ, Salino AV, de Oliveira Aranha Ribeiro E, Felipe do Vale H, de Souza Leitão R, Carlos R, Tavares Ângelo Cintra L. Multiple oral sinus tract and trismus leading to a surprising diagnosis of osteopetrosis: Case report. Spec Care Dentist 2023; 43:671-678. [PMID: 36316790 DOI: 10.1111/scd.12798] [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: 08/02/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
AIMS We report a rare case of late diagnosis of malignant osteopetrosis in a 36-year-old male patient due to multiple intraoral sinus tracts and trismus. CASE REPORT The patient reported a history of facial scars that could not be attributed to the older external fistulas that were present and various complicated dental extractions since infancy. In addition, the patient had not been previously diagnosed with any other significant diseases other than blindness since infancy. Computed tomography revealed a marble-like sclerotic pattern of all cranial bones, a thickened parietal bone, and a narrowing of the encephalic space and the optic canal. Further laboratory and imaging studies revealed complete sclerosed bone of the chest and pelvis, anemia, reticulocitosis, extramedular hematopoiesis, altered dehydrogenasis lactate, and acid phosphatasis. An interdisciplinary treatment was initiated with medical and dental care monitoring. The patient is still receiving attention after 4 years of follow-up. CONCLUSIONS The outcome of this case represents the daily challenges faced by interdisciplinary care providers and reveals pearls and pitfalls that can serve as a reference for professional practice in such cases.
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Affiliation(s)
- Tiago Novaes Pinheiro
- Department of Oral Pathology and Oral Medicine, Dental School, of Amazonas State University, Manaus, Amazonas, Brazil
| | - Ana Julia Desideri Vieira
- Undergraduate Dentistry Student, Dental School of Amazonas State University, Manaus, Amazonas, Brazil
| | - Alessandra Valle Salino
- Department Special Care Dentistry, Dental School of Amazonas State University, Manaus, Amazonas, Brazil
| | | | - Hugo Felipe do Vale
- Department of Periodontics, Dental School of Amazonas State University, Manaus, Amazonas, Brazil
| | | | - Roman Carlos
- Oral and Maxillofacial Pathology, Hospital Herrera-Llerandi, Guatemala City, Guatemala
| | - Luciano Tavares Ângelo Cintra
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
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Gwathmey KG, Corcia P, McDermott CJ, Genge A, Sennfält S, de Carvalho M, Ingre C. Diagnostic delay in amyotrophic lateral sclerosis. Eur J Neurol 2023; 30:2595-2601. [PMID: 37209406 DOI: 10.1111/ene.15874] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease, and the time from symptom onset to diagnosis remains long. With the advent of disease-modifying treatments, the need to identify and diagnose ALS in a timely fashion has never been greater. METHODS We reviewed the literature to define the severity of ALS diagnostic delay, the various factors that contribute to this delay (including patient and physician factors), and the role that site of symptom onset plays in a patient's diagnostic journey. RESULTS Diagnostic delay is influenced by general practitioners' lack of recognition of ALS due to disease rarity and heterogenous presentations. As a result, patients are referred to non-neurologists, have unnecessary diagnostic testing, and may ultimately be misdiagnosed. Patient factors include their illness behavior-which impacts diagnostic delay-and their site of symptom onset. Limb-onset patients have the greatest diagnostic delay because they are frequently misdiagnosed with degenerative spine disease or peripheral neuropathy. CONCLUSION Prompt ALS diagnosis results in more effective clinical management, with earlier access to disease-modifying therapies, multidisciplinary care, and, if desired, clinical trial involvement. Due to lack of commercially available ALS biomarkers, alternative strategies to identify and triage patients who likely have ALS must be employed. Several diagnostic tools have been developed to encourage general practitioners to consider ALS and make an urgent referral to ALS specialists, bypassing unnecessary referrals to non-neurologists and unnecessary diagnostic workup.
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Affiliation(s)
- Kelly G Gwathmey
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Philippe Corcia
- CRMR SLA, CHU Tours, Tours, France
- UMR1253 iBrain UMR, Université de Tours, INSERM, Tours, France
| | - Chris J McDermott
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Angela Genge
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Stefan Sennfält
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mamede de Carvalho
- Institute of Physiology, Instituto de Medicina Molecular João Lobo Antunes, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa-Norte, Lisbon, Portugal
| | - Caroline Ingre
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Alam A, Ashraf H, Khan K, Ahmed A. Uncovering Congenital Hypothyroidism in Adulthood: A Case Study Emphasizing the Urgency of Screening and Clinical Awareness. Cureus 2023; 15:e45611. [PMID: 37868446 PMCID: PMC10588732 DOI: 10.7759/cureus.45611] [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] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Congenital hypothyroidism (CH) is an endocrine disorder primarily diagnosed during the neonatal period through routine screening. Screening programs have been established in most developed countries. However, routine neonatal screening is not available in India, and the mainstay for diagnosis is clinical awareness. In this report, we present a case of CH diagnosed for the first time in a 20-year-old male who sought medical attention at our hospital's emergency department due to fever and altered sensorium. This case report elucidates the implications of a delayed diagnosis of CH, shedding light on the pivotal role of neonatal screening and the need for enhanced awareness within the healthcare community and among families.
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Affiliation(s)
- Ahmad Alam
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Hamid Ashraf
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Kaynat Khan
- Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
| | - Absar Ahmed
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, IND
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Söğüt Ö, Ergenc H, Yigit Y. Untangling Tetanus: A Comprehensive Case Report Describing Its Diagnosis and Treatment. Cureus 2023; 15:e44702. [PMID: 37809177 PMCID: PMC10552333 DOI: 10.7759/cureus.44702] [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: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Tetanus, caused by a grave and potentially lethal bacteria, is a medical condition that severely affects the central nervous system and demands vigilant attention and comprehensive preventive measures to safeguard public health. The onset of this condition is sudden and characterized by the emergence of intense tonic muscle spasms, underscoring its critical nature. In Türkiye, around 50 cases are officially reported each year; however, it is widely suspected that numerous cases remain unreported, contributing to an even more significant impact. This report aims to shed light on a remarkable case involving a 24-year-old male patient. Despite having a complete vaccination history, this individual contracted tetanus and required intensive care and mechanical ventilation due to the severity of his tetanus infection. This case serves as a poignant reminder of the importance of booster administration, highlighting the significance of continued and timely reinforcement of vaccinations.
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Affiliation(s)
- Özgür Söğüt
- Emergency Medicine, Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, TUR
| | - Hüseyin Ergenc
- Emergency Medicine, Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, TUR
| | - Yavuz Yigit
- Emergency Medicine, Department of Emergency Medicine, Hamad Medical Corporation, Doha, QAT
- Blizard Institute, Queen Mary University, London, GBR
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Sayedin H, Chalokia R, Woderich R. Hydrocele Masking Testicular Tumour With Extensive Nodal Disease: A Case Report and Literature Review. Cureus 2023; 15:e43455. [PMID: 37711955 PMCID: PMC10498657 DOI: 10.7759/cureus.43455] [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] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Hydrocele is one of the most common causes of scrotal swellings. Fluid accumulation within the tunica vaginalis, a remnant of the peritoneum covering the testicle, leads to scrotal swelling. It is known to be a benign condition with no subsequent complications apart from increasing in size causing discomfort. Some patients could cope with the swelling effect and continue their life with no desire for further management while others are not fit for surgical intervention and would be treated conservatively with the same concept. However, once the testicle becomes swollen by the surrounding fluid, it would be difficult to examine the testicle itself even by an expert physician. We present here a 46-year-old patient who has been diagnosed with right hydrocele for a long time. The patient noticed general weakness and loss of weight. Initial investigations showed iron deficiency anemia and imaging showed retroperitoneal lymphadenopathy. Eventually, testicular ultrasonography showed a right testicular tumour that was masked by a hydrocele, resulting in delayed presentation of metastatic testicular cancer.
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Affiliation(s)
- Hani Sayedin
- Urology, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, GBR
| | - Ramandeep Chalokia
- Urology, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, GBR
| | - Rene Woderich
- Urology, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, GBR
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Liberman AL, Wang Z, Zhu Y, Hassoon A, Choi J, Austin JM, Johansen MC, Newman-Toker DE. Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity. Diagnosis (Berl) 2023; 10:225-234. [PMID: 37018487 PMCID: PMC10659025 DOI: 10.1515/dx-2022-0130] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023]
Abstract
Diagnostic errors in medicine represent a significant public health problem but continue to be challenging to measure accurately, reliably, and efficiently. The recently developed Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) approach measures misdiagnosis related harms using electronic health records or administrative claims data. The approach is clinically valid, methodologically sound, statistically robust, and operationally viable without the requirement for manual chart review. This paper clarifies aspects of the SPADE analysis to assure that researchers apply this method to yield valid results with a particular emphasis on defining appropriate comparator groups and analytical strategies for balancing differences between these groups. We discuss four distinct types of comparators (intra-group and inter-group for both look-back and look-forward analyses), detailing the rationale for choosing one over the other and inferences that can be drawn from these comparative analyses. Our aim is that these additional analytical practices will improve the validity of SPADE and related approaches to quantify diagnostic error in medicine.
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Affiliation(s)
- Ava L. Liberman
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine
| | - Zheyu Wang
- The Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Division of Biostatistics and Bioinformatics
- The Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics
| | - Yuxin Zhu
- The Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Division of Biostatistics and Bioinformatics
- The Johns Hopkins University School of Medicine, Department of Neurology and the Armstrong Institute Center for Diagnostic Excellence
| | - Ahmed Hassoon
- The Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics
| | - Justin Choi
- Department of Internal Medicine, Weill Cornell Medicine
| | - J. Matthew Austin
- The Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine and the Armstrong Institute Center for Diagnostic Excellence
| | - Michelle C. Johansen
- The Johns Hopkins University School of Medicine, Department of Neurology and the Armstrong Institute Center for Diagnostic Excellence
| | - David E. Newman-Toker
- The Johns Hopkins University School of Medicine, Department of Neurology and the Armstrong Institute Center for Diagnostic Excellence
- The Johns Hopkins Bloomberg School of Public Health, Departments of Epidemiology and Health Policy & Management
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Vega MD, Alissa R, Rathore M. A Case of Congenital Syphilis Diagnosed in an Infant Past the Newborn Period. Cureus 2023; 15:e44102. [PMID: 37750150 PMCID: PMC10518138 DOI: 10.7759/cureus.44102] [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] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
This case report highlights the need for syphilis re-testing during pregnancy and at labor and delivery when there are high-risk factors present. Our patient, an infant, was evaluated for non-accidental trauma because of the presence of multiple fractures, which could be one of the presentations of congenital syphilis. A high index of suspicion is required for syphilis when an infant presents with multiple fractures. Syphilis testing and re-testing guidelines should be followed strictly so that pregnant women are appropriately treated to prevent congenital syphilis.
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Affiliation(s)
- Melanie D Vega
- Pediatric Infectious Diseases, University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES), Jacksonville, USA
- Pediatric Infectious Diseases, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, USA
- Pediatric Infectious Diseases, Wolfson Children's Hospital/Baptist Health, Jacksonville, USA
| | - Rana Alissa
- Pediatrics, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, USA
| | - Mobeen Rathore
- Pediatrics/Infectious Disease, University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES), Jacksonville, USA
- Pediatric Infectious Diseases, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, USA
- Pediatric Infectious Diseases, Wolfson Children's Hospital/Baptist Health, Jacksonville, USA
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47
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Snyder CL, Chen SX, Porter ML. Obstacles to Early Diagnosis and Treatment of Hidradenitis Suppurativa: Current Perspectives on Improving Clinical Management. Clin Cosmet Investig Dermatol 2023; 16:1833-1841. [PMID: 37483473 PMCID: PMC10361090 DOI: 10.2147/ccid.s301794] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that can progress to significant tunnels and scars that affect quality of life, especially if diagnosis and treatment are delayed. Average delay after initial presentation of HS symptoms can range from 3 to 10 years in adults and 1 to 2 years in children. Factors associated with diagnostic delay include female gender, non-white race, and greater disease severity at diagnosis. Contributing factors include misdiagnoses, difficulty accessing a dermatologist, hesitation in seeking care due to the stigmatizing nature of the disease, and lack of awareness among providers and patients. While efforts to increase awareness include academic talks at conferences and by foundations geared toward HS, social media offers the opportunity to reach young audiences. Many patients report dissatisfaction with their HS treatments. Better understanding of HS pathophysiology and implementation of clinically focused phenotypes and endotypes can lead to development of more targeted and efficacious therapies. FDA approval of medications for HS beyond adalimumab will increase access to a wider selection of therapies, and implementation of therapeutic drug monitoring may maximize the use of biologics for HS.
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Affiliation(s)
- Corey L Snyder
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Dermatology, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Stella X Chen
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Harvard Combined Dermatology Residency Program, Boston, MA, USA
| | - Martina L Porter
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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48
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Zheng J, Heidenreich PA, Kohsaka S, Fearon WF, Sandhu AT. Long-Term Outcomes of Early Coronary Artery Disease Testing After New-Onset Heart Failure. Circ Heart Fail 2023; 16:e010426. [PMID: 37212148 PMCID: PMC10523905 DOI: 10.1161/circheartfailure.122.010426] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/07/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) testing remains underutilized in patients with newly diagnosed heart failure (HF). The longitudinal clinical impact of early CAD testing has not been well-characterized. We investigated changes in clinical management and long-term outcomes after early CAD evaluation in patients with incident HF. METHODS We identified Medicare patients with incident HF from 2006 to 2018. The exposure variable was early CAD testing within 1 month of initial HF diagnosis. Covariate-adjusted rates of cardiovascular interventions after testing, including CAD-related management, were modeled using mixed-effects regression with clinician as a random intercept. We assessed mortality and hospitalization outcomes using landmark analyses with inverse probability-weighted Cox proportional hazards models. Falsification end points and mediation analysis were employed for bias assessment. RESULTS Among 309 559 patients with new-onset HF without prior CAD, 15.7% underwent early CAD testing. Patients who underwent prompt CAD evaluation had higher adjusted rates of subsequent antiplatelet/statin prescriptions and revascularization, guideline-directed therapy for HF, and stroke prophylaxis for atrial fibrillation/flutter than controls. In weighted Cox models, 1-month CAD testing was associated with significantly reduced all-cause mortality (hazard ratio, 0.93 [95% CI, 0.91-0.96]). Mediation analyses indicated that ≈70% of this association was explained by CAD management, largely from new statin prescriptions. Falsification end points (outpatient diagnoses of urinary tract infection and hospitalizations for hip/vertebral fracture) were nonsignificant. CONCLUSIONS Early CAD testing after incident HF was associated with a modest mortality benefit, driven mostly by subsequent statin therapy. Further investigation on clinician barriers to testing and treating high-risk patients may improve adherence to guideline-recommended cardiovascular interventions.
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Affiliation(s)
- Jimmy Zheng
- Stanford University School of Medicine, Stanford, CA
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA
- Department of Medicine, Palo Alto VA Veteran’s Affairs Hospitals, Palo Alto, CA
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - William F Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA
- Department of Medicine, Palo Alto VA Veteran’s Affairs Hospitals, Palo Alto, CA
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA
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Roure S, Vallès X, Sopena N, Benítez RM, Reynaga EA, Bracke C, Loste C, Mateu L, Antuori A, Baena T, Portela G, Llussà J, Flamarich C, Soldevila L, Tenesa M, Pérez R, Plasencia E, Bechini J, Pedro-Botet ML, Clotet B, Vilaplana C. Corrigendum: Disseminated tuberculosis and diagnosis delay during the COVID-19 era in a Western European country: a case series analysis. Front Public Health 2023; 11:1236874. [PMID: 37457256 PMCID: PMC10338823 DOI: 10.3389/fpubh.2023.1236874] [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: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2023.1175482.].
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Affiliation(s)
- Sílvia Roure
- Unitat de Salut Internacional Metropolitana Nord, PROSICS Metropolitana Nord, Badalona, Spain
- Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Xavier Vallès
- Unitat de Salut Internacional Metropolitana Nord, PROSICS Metropolitana Nord, Badalona, Spain
- Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Nieves Sopena
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Rosa Maria Benítez
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Esteban A. Reynaga
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carmen Bracke
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cora Loste
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lourdes Mateu
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Adrián Antuori
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Tania Baena
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Germán Portela
- Equip Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain
| | - Judith Llussà
- Equip Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain
| | - Clara Flamarich
- Equip Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain
| | - Laura Soldevila
- Unitat de Salut Internacional Metropolitana Nord, PROSICS Metropolitana Nord, Badalona, Spain
- Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain
| | - Montserrat Tenesa
- Servei de Radiodiagnòstic de l'Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Direcció Clínica de Diagnòstic per la imatge de la Gerència Territorial Metropolitana Nord, Badalona, Spain
| | - Ricard Pérez
- Servei de Radiodiagnòstic de l'Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Elsa Plasencia
- Departament de Salut, Subdirecció General de Vigilancia i Resposta a Emergències de Salut Pública, Barcelona, Catalonia, Spain
| | - Jordi Bechini
- Servei de Radiodiagnòstic de l'Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Direcció Clínica de Diagnòstic per la imatge de la Gerència Territorial Metropolitana Nord, Badalona, Spain
| | - Maria Lluïsa Pedro-Botet
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Bonaventura Clotet
- Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Cristina Vilaplana
- Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Unitat de Tuberculosi Experimental, Microbiology Department, Germans Trias i Pujol, Badalona, Spain
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50
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Acosta LA, Aamer S, Becher M, Cucalon Calderon J. Juvenile Ossifying Fibroma and Socioeconomic Barriers to Specialty Care: A Pediatric Case Study. Cureus 2023; 15:e40059. [PMID: 37425522 PMCID: PMC10325821 DOI: 10.7759/cureus.40059] [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] [Accepted: 05/28/2023] [Indexed: 07/11/2023] Open
Abstract
Juvenile ossifying fibroma (JOF) is a rare benign neoplastic fibro-osseous tumor commonly found in the maxilla and mandible of children usually between the ages of five and 15. Patients often present with aggressive, painless growth which is well demarcated from surrounding bone resulting in severe facial asymmetry. JOFs have high recurrence rates if not completely resected and should therefore be treated by a multidisciplinary team of physicians including a neurosurgeon to assess cranial nerve function. This case describes a child who presented to the ED after being referred by his primary care provider for facial swelling. The patient was diagnosed with JOF and had a delay in care due to a lack of access to multidisciplinary specialties to provide care due to payer difficulties which placed the patient at high risk of complications.
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Affiliation(s)
- Lizeth A Acosta
- Pediatrics and Child Health, University of Nevada Reno School of Medicine, Reno, USA
| | - Sarah Aamer
- Pediatrics and Child Health, University of Nevada Reno School of Medicine, Reno, USA
| | - Monica Becher
- Pediatrics and Child Health, University of Nevada Reno School of Medicine, Reno, USA
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