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Tolaj I, Mehmeti M, Gashi H, Kasumi A. Determinants of late presentation of HIV positive individuals: a study in Kosovo. HIV Res Clin Pract 2024; 25:2298093. [PMID: 38149661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND In recent years, the global response to the HIV/AIDS pandemic has encountered significant challenges, impeding the collective aim of eliminating AIDS as a public health threat by 2030. A major concern undermining this goal is the delayed presentation (late presentation - LP) of individuals diagnosed with HIV/AIDS. METHODOLOGY This study includes 85 HIV positive individuals with available CD4 count and viral load (VL) data at the time of HIV diagnosis, out of 169 registered people living with HIV in Kosovo. Employing descriptive and frequency statistics, Chi-square tests, non-parametric Mann-Whitney tests, and logistic regression analyses using SPSS Version 29, we generated statistical results with 95% confidence intervals. RESULTS The prevalence of LP in HIV positive individuals included in the study was 50.59%, with 30.59% classified as very late presenters (VLP). Determinants associated with LP included male gender, young adulthood, MSM mode of transmission, and a high viral load (log10 4.1-5.0 copies/mL). Comparative analysis with studies on this subject indicated similar patterns of LP in adults, males, and viral load, but different transmission mode patterns. CONCLUSION This research illuminates the specific determinants of LP in Kosovo, offering valuable insights for tailoring interventions to enhance timely diagnosis and access to care for people living with HIV/AIDS.
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Affiliation(s)
- Ilir Tolaj
- Department of Infectious Diseases, Medical Faculty, Pristina, Kosovo
| | - Murat Mehmeti
- Department of Infectious Diseases, University Clinical Center, Pristina, Kosovo
| | - Hatixhe Gashi
- Department of Infectious Diseases, University Clinical Center, Pristina, Kosovo
| | - Arabana Kasumi
- Department of Infectious Diseases, University Clinical Center, Pristina, Kosovo
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Kubota K, Miyanaga S, Akao M, Mitsuyoshi K, Iwatani N, Higo K, Ohishi M. Association of delayed diagnosis of pulmonary arterial hypertension with its prognosis. J Cardiol 2024; 83:365-370. [PMID: 37579874 DOI: 10.1016/j.jjcc.2023.08.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Currently, pulmonary hypertension-targeted therapy has been shown to improve the survival of patients with pulmonary artery hypertension (PAH). However, the importance of early diagnosis has not been investigated. Therefore, this study aimed to investigate whether a delayed diagnosis of PAH is associated with its prognosis. METHODS AND RESULTS A total of 66 consecutive untreated patients were diagnosed with PAH from January 2008 to December 2021 at the Kagoshima University Hospital. The time from symptom onset to diagnosis correlated with brain natriuretic peptide levels (p < 0.001), right ventricle (RV) Tei index (p < 0.001), and the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio (p = 0.003). These findings suggest that in patients with PAH, RV function declines with increasing time from symptom onset to diagnosis. Furthermore, older patients with PAH appeared to have a longer time from symptom onset to diagnosis. Next, patients were divided into delayed diagnosis (>3 months) and early diagnosis (≤3 months) groups based on the time from symptom onset to diagnosis. Patients were categorized into three groups according to the European Society of Cardiology (or the European Respiratory Society) risk stratification guidelines. Patients diagnosed with PAH within 3 months of symptom onset were significantly in the low- or intermediate-risk groups (p < 0.001). A Kaplan-Meier analysis revealed that the cumulative event-free rate was significantly lower (p < 0.01) in the delayed diagnosis group than in the early diagnosis group. A delayed diagnosis was significantly associated with a worse outcome than an early diagnosis, after adjusting for different sets of confounding factors. CONCLUSIONS A delayed PAH diagnosis is associated with a poor prognosis. Early diagnosis of PAH may lead to a low-risk treatment. Furthermore, older patients need more careful screening for PAH.
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Affiliation(s)
- Kayoko Kubota
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Sunao Miyanaga
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsumasa Akao
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kokoro Mitsuyoshi
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Noriko Iwatani
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kenjuro Higo
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Ohishi
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Lukac S, Hancke K, Janni W, Pfister K, Schäffler H, Schmid M, Ebner F, Kloss T, Dayan D. Three-dimensional model for improvement of endometriosis care (3D-E). Int J Gynaecol Obstet 2024; 165:416-423. [PMID: 37795648 DOI: 10.1002/ijgo.15165] [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: 07/10/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Endometriosis affects approximately 10% of women of reproductive age and leads to significant morbidity and financial burden. Consequently, countries such as France and Germany are formulating strategies to combat endometriosis. In this study, we propose the implementation of our three-dimensional model (3D-E) to raise awareness about endometriosis and enhance timely diagnosis, treatment, and long-term care for affected patients. METHODS Based on the adapted Six Sigma Principle and the modified recommendation of Sales et al. for implementing evidence-based findings into a clinical routine, we first conducted a comprehensive investigation to identify risk factors leading to diagnostic delay of endometriosis. After identifying improvable factors, the applicable options were selected due to defined criteria such as integrability in the clinical routine, cost-effectiveness, and evidence-based-principle. Finally, solutions feasible for health care providers were integrated and the 3D-E model was established. RESULTS Some of the main risk factors contributing to diagnostic delays are symptoms acceptance and misinterpreted symptoms, especially if presenting to nongynecologists in cases of extragenital endometriosis with atypical presentation. Therefore, we tried to sensitize colleagues (first dimension) with a review paper in Germany's largest medical journal and started an elective for medical students (second dimension) at our university. In order to involve additional health care professionals in endometriosis care (third dimension), we are preparing the concept of the EndoNurse. CONCLUSION The 3D-E model is a relatively low-cost, comprehensive, and worldwide adaptable approach for facilitating knowledge transfer, sensitizing health care providers, and improving endometriosis diagnostics and therapy for patients with endometriosis who are in the center of the model.
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Affiliation(s)
- Stefan Lukac
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Katharina Hancke
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Kerstin Pfister
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Henning Schäffler
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Marinus Schmid
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Florian Ebner
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
- Gynäkologische Gemeinschaftspraxis Freising & Moosburg, Munich, Germany
| | - Tabea Kloss
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Davut Dayan
- Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
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Özkaya HD, Elazab K, Turan B, Nazlı A, Öztürk B, Pullukçu H, Gökengin D. Missed Opportunities in HIV Testing in Turkiye: Implications for Late Diagnoses. J Acquir Immune Defic Syndr 2024; 96:77-84. [PMID: 38346425 DOI: 10.1097/qai.0000000000003398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 01/19/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Late diagnosis of HIV infection is a major global problem. In Turkiye, only 41%-50% of people living with HIV are diagnosed, suggesting that many opportunities for HIV testing might be missed. SETTING The aim of this study was to determine the missed testing opportunities for HIV in healthcare settings in Turkiye and the predictors for missed opportunities (MOs). METHODS The study included patients with a new HIV diagnosis, presenting to care between January 2018 and December 2020. They were given a verbal questionnaire face to face, by a telephone call or an online meeting for visits to a health care setting within the year before their diagnosis. Electronic medical records were also examined. RESULTS The sample included 198 patients with at least 1 visit to any health care setting, with a total of 1677 visits. Patients had an indication for HIV testing in 51.3% (861/1677) of the visits; an HIV test was not offered in 77.9% (671/861) and was considered a MO. The highest number of MOs was in emergency departments (59.8%) (180/301). The most common reason for visiting was constitutional symptoms and indicator conditions (55.4%) (929/1677). University graduates and those with a CD4+ T-cell count <200/mm 3 were more likely to have a MO. CONCLUSIONS Many opportunities to diagnose HIV at an early stage are missed in health care settings in Turkiye. Considering the rapidly increasing number of new diagnoses in the last decade, urgent action needs to be taken.
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Affiliation(s)
- Hacer Deniz Özkaya
- Bakırçay University Çiğli Training and Research Hospital, Izmir, Turkiye
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Turanzas NJ, Mathiasen R, Heegaard S, Schmiegelow K, Sehested A, Holtz JK, Siersma V, Nissen KR, von Holstein SL. Ophthalmic symptoms, clinical signs and diagnostic delay in infants diagnosed with brain tumours in Denmark between 2007 and 2017. Acta Ophthalmol 2024; 102:334-341. [PMID: 37574657 DOI: 10.1111/aos.15745] [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] [Revised: 06/21/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE To investigate ophthalmic onset manifestations and the impact of diagnostic delay on the prognosis in infants (<1 year) diagnosed with a brain tumour. METHODS A retrospective population-based nationwide study of infants diagnosed with a brain tumour between 2007 and 2017 in Denmark. Data was retrieved from the Danish Childhood Cancer Registry, the National Danish Health registries, and medical files. Primary outcome measures included symptoms, clinical findings, time to diagnosis and survival. RESULTS Thirty-seven infants were diagnosed with a brain tumour in Denmark between 2007 and 2017. In total, 19/37 infants (51%, 95% CI: 34-68) had ophthalmic manifestations at any time prior to or at diagnosis; and in 6/37 (16%, 95% CI: 6-32) ophthalmic manifestations were the initial symptom. The most common ophthalmic manifestations were strabismus (n = 7), sunset eyes (n = 6), nystagmus (n = 4), reduced pupillary light reflex (n = 4), and/or decreased vision (n = 4). The median number of symptoms per infant at the time of diagnosis was three (range 0-9). The median diagnostic delay was 26 days (range 0-283, IQR: 6;90). 5-year survival rate was 75% (95% CI: 61-90) and all children with diagnostic delay > 100 days (n = 9, 24%) were still alive at the end of follow-up (median 6.3 years, range 2.2-10.2). CONCLUSION We provide an overview of symptoms and clinical signs in a nation-wide series of infants with CNS tumours and demonstrate that ophthalmic manifestations are frequently observed in infants prior to diagnosis, but, often in combination with other clinical signs. The diagnostic delay was substantial for a large part of the infants, but this was not associated with increased mortality.
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Affiliation(s)
- Nathali J Turanzas
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
| | - René Mathiasen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Sehested
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jeppe K Holtz
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla R Nissen
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sarah L von Holstein
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
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Kosaka S, Shimizu S, Nakayamada S, Nawata A, Shimono N, Tanaka M, Maruyama H, Osada Y, Tanaka Y. A delayed diagnosis of fascioliasis: The importance of appropriate fecal diagnostic method. J Infect Chemother 2024; 30:454-458. [PMID: 37944698 DOI: 10.1016/j.jiac.2023.11.006] [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: 04/12/2023] [Revised: 09/26/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
Fascioliasis, a zoonotic helminthiasis, occurs sporadically in Japan. In this report, we describe a case of fascioliasis that was initially difficult to diagnose because the fecal examination method was negative for the Fasciola sp. eggs. A 64-year-old man living in Shimonoseki City, Japan, presented with fatigue and anorexia. Laboratory tests showed hepatic dysfunction and eosinophilia. Abdominal dynamic contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography suggested intrahepatic biliary cysts. Thereafter, fever and night sweats persisted, and positron emission tomography and biopsy of the porta hepatis lymph node were performed on suspicion of malignancy. However, histopathological diagnosis found non-specific inflammation. As fascioliasis was suspected due to eosinophilia and the multiple hepatic masses, fecal egg examination was performed by an external private laboratory, which adopted the flotation method and reported the absence of parasite eggs. However, fecal examination was retried in our laboratory using the formalin-ether concentration method, and we detected Fasciola sp. eggs. This case suggests that misdiagnosis may occur depending on the fecal examination method; thus, it is necessary to choose a suitable method for certain parasite species.
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Affiliation(s)
- Shumpei Kosaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shoichi Shimizu
- Department of Immunology and Parasitology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Shingo Nakayamada
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Aya Nawata
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Nobuyuki Shimono
- Center for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Japan
| | - Mio Tanaka
- Department of Infectious Diseases, Division of Parasitology, Faculty of Medicine, University of Miyazaki, Japan
| | - Haruhiko Maruyama
- Department of Infectious Diseases, Division of Parasitology, Faculty of Medicine, University of Miyazaki, Japan
| | - Yoshio Osada
- Department of Immunology and Parasitology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Hay CA, Packham J, Prior JA, Mallen CD, Ryan S. Barriers and facilitators in diagnosing axial spondyloarthritis: a qualitative study. Rheumatol Int 2024; 44:863-884. [PMID: 38472441 PMCID: PMC10980652 DOI: 10.1007/s00296-024-05554-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Diagnosis of axial spondyloarthritis (axSpA) is frequently delayed for years after symptom onset. However, little is known about patient and healthcare professional (HCP) perspectives on barriers and facilitators in axSpA diagnosis. This study explored the experiences and perceptions of both groups regarding the factors affecting the timely diagnosis of axSpA. METHOD Semi-structured interviews with patients with axSpA and axSpA-interested HCPs from the United Kingdom (UK) were performed by telephone or Microsoft Teams and focussed on the individuals' perspective of the diagnostic journey for axSpA. Interview transcripts were thematically analysed. RESULTS Fourteen patients with axSpA (10 female, 4 male) and 14 UK based HCPs were recruited, the latter comprising of 5 physiotherapists, 4 General Practitioners, 3 rheumatologists, a nurse, and an occupational therapist. Barriers to diagnosis identified by patients and HCPs were: difficult to diagnose, a lack of awareness, unclear referral pathways, patient behaviour and patient/HCP communication. Patient-identified facilitators of diagnosis were patient advocacy, clear referral processes and pathways, increased awareness, and serendipity. HCPs identified promoting awareness as a facilitator of diagnosis, along with symptom recognition, improvements to healthcare practice and patient/HCP communications. CONCLUSION Poor communication and a lack of understanding of axSpA in the professional and public spheres undermine progress towards timely diagnosis of axSpA. Improving communication and awareness for patients and HCPs, along with systemic changes in healthcare (such as improved referral pathways) could reduce diagnostic delay.
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Affiliation(s)
| | - Jon Packham
- School of Medicine, Keele University, Keele, UK
- Academic Unit of Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - James A Prior
- School of Medicine, Keele University, Keele, UK
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - Christian D Mallen
- School of Medicine, Keele University, Keele, UK
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - Sarah Ryan
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
- School of Nursing and Midwifery, Keele University, Keele, UK
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Udry S, Latino JO, Perez SM, Belizna C, Aranda F, Esteve-Valverde E, Wingeyer SP, Romero DSF, Alijotas-Reig J, de Larrañaga G. Loss of opportunities in the diagnosis and treatment of primary obstetric antiphospholipid syndrome (POAPS): from theory to reality. Clin Rheumatol 2024; 43:1615-1622. [PMID: 38436770 DOI: 10.1007/s10067-023-06846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVES (I) To identify and measure the clinical consequences of a delayed diagnosis in patients with primary obstetric antiphospholipid syndrome (POAPS), in terms of time and events associated to antiphospholipid syndrome (APS), and (II) to evaluate the impact of their treatment status on perinatal outcomes, before and after diagnosis. METHODS This retrospective multicentre study included 99 POAPS women who were separated in two groups of timelines based on their diagnostic status: group 1: women who met the clinical criteria for POAPS; group 2: included the same patients from group 1 since they meet the laboratory criteria for APS. In group 1, we assessed the following variables: obstetric events, thrombotic events and time (years) to diagnosis of APS. We also compared perinatal outcomes between patients in group 1 vs. group 2. Women in group 2 were treated with standard of care for POAPS. Simple and multivariable logistic regression analyses were performed. RESULTS Regarding the impact of the delay on diagnosis, a total of 87 APS-related events were recorded: 46 miscarriages, 32 foetal losses and 9 premature deliveries before the 34th week due to preeclampsia, and one thrombosis. The estimated rate of preventable events was 20.58 per year/100 patients. The mean diagnostic delay time was 4.27 years. When we compared both groups during pregnancy, we found that patients in group 1 (no treatment) had a higher association with pregnancy losses [OR = 6.71 (95% CI: 3.59-12.55), p < 0.0001]. CONCLUSION Our findings emphasize the negative impact of POAPS underdiagnosis on patient health and the critical importance of a timely intervention to improve pregnancy outcomes. Key Points •Our study shows the relevance of underdiagnosis on primary obstetric antiphospholipid syndrome (POAPS). •These patients presented a high risk of APS-related events with each passing year. •Shorter diagnostic delay time was observed in the reference centres.
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Affiliation(s)
- Sebastián Udry
- Research Center "Fundación Respirar", Av. Cabildo 1548, C1426AEN, City of Buenos Aires, Argentina
- Autoimmune Thrombophilic Diseases and Pregnancy Section, Acute Hospital "Dr. Carlos G. Durand", Av. DíazVélez 5044, C1405AEN, City of Buenos Aires, Argentina
- Haemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr, Francisco J. Muñiz", 2272, C1282AEN, UspallataCity of Buenos Aires, Argentina
| | - José O Latino
- Autoimmune Thrombophilic Diseases and Pregnancy Section, Acute Hospital "Dr. Carlos G. Durand", Av. DíazVélez 5044, C1405AEN, City of Buenos Aires, Argentina
| | - Stephanie Morales Perez
- Systemic Autoimmune Disease Unit, Internal Medicine Department, Parc Tauli University Hospital, Sabadell, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Cristina Belizna
- Internal Medicine Department Clinique de L'Anjou, 9 Rue de L'Hirondelle, 49000, Angers, France
- Vascular and Coagulation Department, University Hospital Angers, 4 Rue Larrey, 49000, Angers, France
- UMR CNRS 6015, INSERM U1083, University of Angers, Rue Haute de Reculée, 49045, Angers, France
| | - Federico Aranda
- Haemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr, Francisco J. Muñiz", 2272, C1282AEN, UspallataCity of Buenos Aires, Argentina
| | - Enrique Esteve-Valverde
- Systemic Autoimmune Disease Unit, Internal Medicine Department, Parc Tauli University Hospital, Sabadell, Spain
| | - Silvia Perés Wingeyer
- Haemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr, Francisco J. Muñiz", 2272, C1282AEN, UspallataCity of Buenos Aires, Argentina
| | - Diego S Fernández Romero
- Autoimmune Thrombophilic Diseases and Pregnancy Section, Acute Hospital "Dr. Carlos G. Durand", Av. DíazVélez 5044, C1405AEN, City of Buenos Aires, Argentina
| | - Jaume Alijotas-Reig
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital Campus, Barcelona, Spain.
- Vall d'Hebron Research Unit, Vall d'Hebron University Hospital Campus, Barcelona, Spain.
| | - Gabriela de Larrañaga
- Haemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr, Francisco J. Muñiz", 2272, C1282AEN, UspallataCity of Buenos Aires, Argentina
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Sriram S, Shahid N, Mysliwiec D D, Lichter-Konecki U, Yatsenko SA, Garibaldi LR. Late diagnosis of the X-linked MCT8 deficiency (Allan-Herndon-Dudley syndrome) in a teenage girl with primary ovarian insufficiency. J Pediatr Endocrinol Metab 2024; 37:371-374. [PMID: 38345890 DOI: 10.1515/jpem-2023-0070] [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: 02/16/2023] [Accepted: 11/27/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To report an unusual case of MCT8 deficiency (Allan-Herndon-Dudley syndrome), an X-linked condition caused by pathogenic variants in the SLC16A2 gene. Defective transport of thyroid hormones (THs) in this condition leads to severe neurodevelopmental impairment in males, while heterozygous females are usually asymptomatic or have mild TH abnormalities. CASE PRESENTATION A girl with profound developmental delay, epilepsy, primary amenorrhea, elevated T3, low T4 and free T4 levels was diagnosed with MCT8-deficiency at age 17 years, during evaluation for primary ovarian insufficiency (POI). Cytogenetic analysis demonstrated balanced t(X;16)(q13.2;q12.1) translocation with a breakpoint disrupting SLC16A2. X-chromosome inactivation studies revealed a skewed inactivation of the normal X chromosome. CONCLUSIONS MCT8-deficiency can manifest clinically and phenotypically in women with SLC16A2 aberrations when nonrandom X inactivation occurs, while lack of X chromosome integrity due to translocation can cause POI.
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Affiliation(s)
- Swetha Sriram
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nabiha Shahid
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diana Mysliwiec D
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Uta Lichter-Konecki
- Division of Genetics and Inborn Errors of Metabolism, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Svetlana A Yatsenko
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luigi R Garibaldi
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
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D'souza B, Glover A, Bavor C, Brown B, Dodd RH, Lee JC, Millar J, Miller JA, Zalcberg JR, Serpell J, Ioannou LJ, Nickel B. The impact of delayed diagnosis and treatment due to COVID-19 on Australian thyroid cancer patients: a qualitative interview study. BMJ Open 2024; 14:e069236. [PMID: 38626980 DOI: 10.1136/bmjopen-2022-069236] [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] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The study aims to investigate the perceptions of patients with thyroid cancer on the potential impact of diagnosis and treatment delays during the COVID-19 pandemic. DESIGN This study involved qualitative semi-structured telephone interviews. The interviews were transcribed verbatim, analysed using the thematic framework analysis method and reported using the Consolidated Criteria for Reporting Qualitative Research. SETTING Participants in the study were treated and/or managed at hospital sites across New South Wales and Victoria, Australia. PARTICIPANTS 17 patients with thyroid cancer were interviewed and included in the analysis (14 females and 3 males). RESULTS The delays experienced by patients ranged from <3 months to >12 months. The patients reported about delays to diagnostic tests, delays to surgery and radioactive iodine treatment, perceived disease progression and, for some, the financial burden of choosing to go through private treatment to minimise the delay. Most patients also reported not wanting to experience delays any longer than they did, due to unease and anxiety. CONCLUSIONS This study highlights an increased psychological burden in patients with thyroid cancer who experienced delayed diagnosis and/or treatment during COVID-19. The impacts experienced by patients during this time may be similar in the case of other unexpected delays and highlight the need for regular clinical review during delays to diagnosis or treatment.
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Affiliation(s)
- Bianka D'souza
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Anthony Glover
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Australian and New Zealand Endocrine Surgeons, St Leonards, New South Wales, Australia
| | - Claire Bavor
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Benjamin Brown
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Rachael H Dodd
- The University of Sydney School of Public Health, Sydney, New South Wales, Australia
- The Daffodil Centre, Kings Cross, New South Wales, Australia
| | - James C Lee
- Department of Surgery, Monash University, Clayton, Victoria, Australia
- Monash University Endocrine Unit, The Alfred Hospital & Monash Health, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Radiation Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Julie A Miller
- Endocrine Surgery Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Epworth Hospital Network, Melbourne, Victoria, Australia
| | - John R Zalcberg
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Department of Surgery, Monash University, Clayton, Victoria, Australia
- Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Liane J Ioannou
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Brooke Nickel
- The University of Sydney School of Public Health, Sydney, New South Wales, Australia
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11
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Williams PJ, Buttery SC, Laverty AA, Hopkinson NS. Lung Disease and Social Justice: Chronic Obstructive Pulmonary Disease as a Manifestation of Structural Violence. Am J Respir Crit Care Med 2024; 209:938-946. [PMID: 38300144 DOI: 10.1164/rccm.202309-1650ci] [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: 09/20/2023] [Accepted: 02/01/2024] [Indexed: 02/02/2024] Open
Abstract
Lung health, the development of lung disease, and how well a person with lung disease is able to live all depend on a wide range of societal factors. These systemic factors that adversely affect people and cause injustice can be thought of as "structural violence." To make the causal processes relating to chronic obstructive pulmonary disease (COPD) more apparent, and the responsibility to interrupt or alleviate them clearer, we have developed a taxonomy to describe this. It contains five domains: 1) avoidable lung harms (processes impacting lung development, processes that disadvantage lung health in particular groups across the life course), 2) diagnostic delay (healthcare factors; norms and attitudes that mean COPD is not diagnosed in a timely way, denying people with COPD effective treatment), 3) inadequate COPD care (ways in which the provision of care for people with COPD falls short of what is needed to ensure they are able to enjoy the best possible health, considered as healthcare resource allocation and norms and attitudes influencing clinical practice), 4) low status of COPD (ways COPD as a condition and people with COPD are held in less regard and considered less of a priority than other comparable health problems), and 5) lack of support (factors that make living with COPD more difficult than it should be, i.e., socioenvironmental factors and factors that promote social isolation). This model has relevance for policymakers, healthcare professionals, and the public as an educational resource to change clinical practices and priorities and stimulate advocacy and activism with the goal of the elimination of COPD.
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Affiliation(s)
| | | | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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12
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Coello K, Kuchinke OV, Kjærstad HL, Miskowiak KW, Faurholt-Jepsen M, Vinberg M, Kessing LV. Differences in clinical presentation between newly diagnosed bipolar I and II disorders: A naturalistic study. J Affect Disord 2024; 351:95-102. [PMID: 38244799 DOI: 10.1016/j.jad.2024.01.139] [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: 07/07/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
AIM This naturalistic clinical study aims to investigate differences between newly diagnosed patients with bipolar type I (BDI) and bipolar type II (BDII) disorders in socio-demographic and clinical characteristics, affective symptoms, cognition, functioning and comorbidity with personality disorders. METHODS The BD diagnosis and type were confirmed using the Schedules for Clinical Assessment in Neuropsychiatry. Affective symptoms were assessed with the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Major Depressive Index, and the Altman Self-Rating Mania Scale. Functional impairment was assessed with the Functional Assessment Short Test. Cognitive impairment was evaluated by the Screen for Cognitive Impairment in Psychiatry and the Cognitive Complaints in Bipolar Disorder Rating Assessment. Finally, comorbid personality disorders were assessed with the Standardized Assessment of Personality-Abbreviated Scale and structured interview Structured Clinical Interview for DSM-disorders. RESULTS 383 newly diagnosed patients were included (BDI: n = 125; BDII: n = 258). Against expectations, we found no more depressive symptoms in BDII compared with BDI nor any differences in cognitive, childhood trauma or overall functional impairment. The only difference was lower occupational impairment in the BDII group. LIMITATIONS The self-reported measures of cognitive difficulties and childhood trauma involved potential bias (recall or other). Despite BD being newly diagnosed a diagnostic delay was observed. CONCLUSION Patients newly diagnosed with BDII and BDI had similar burdens of depressive symptoms and cognitive and overall functional impairment, however patients with BDI had lower occupational functioning. No statistically significant difference was found in prevalence of comorbid personality disorders between patients with BDI and BDII.
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Affiliation(s)
- Klara Coello
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Oscar Vittorio Kuchinke
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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13
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Yildirim H, Bins AD, van den Hurk C, van Moorselaar RJA, van Oijen MGH, Bex A, Zondervan PJ, Aben KKH. The impact of the COVID-19 pandemic on renal cancer care. World J Urol 2024; 42:231. [PMID: 38613582 PMCID: PMC11016011 DOI: 10.1007/s00345-024-04925-2] [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: 07/27/2023] [Accepted: 03/06/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE To evaluate the impact of the COVID-19 pandemic on renal cell carcinoma (RCC) care in the Netherlands. METHODS Newly diagnosed RCCs between 2018 and 2021 were selected from the Netherlands Cancer Registry; 2020-2021 was defined as COVID period and 2018-2019 as reference period. Numbers of RCCs were evaluated using 3-week-moving averages, overall and by disease stage and age. Changes in treatment were evaluated with logistic regression analyses. To evaluate possible delays in care, time to start of treatment was assessed. The cumulative number of metastatic RCC (mRCC) over time was assessed to evaluate stage shift. RESULTS During the 1st COVID wave (weeks 9-22, 2020), the number of new RCC diagnoses decreased with 15%. Numbers restored partially in 2020, but remained 10% lower compared to 2018/2019. The decline was mostly due to a drop in T1a/T1b RCCs and in age > 70 years. 2021 showed similar numbers of new RCC diagnoses compared to 2018/2019 without an increase due to previously missed RCCs. Treatment-related changes during the 1st COVID wave were limited and temporarily; less surgery in T1a RCCs in favor of more active surveillance, and in mRCC targeted therapy was preferred over immunotherapy. Time to start of firstline treatment was not prolonged during the 1st COVID wave. No increase in mRCC was found until the end of 2021. CONCLUSIONS The COVID-19 pandemic resulted in fewer RCC diagnoses, especially T1a/T1b tumors. Treatment-related changes appeared to be limited, temporarily and in accordance with the adapted guidelines. The diagnostic delay could lead to more advanced RCCs in later years but there are no indications for this yet.
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Affiliation(s)
- Hilin Yildirim
- Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 4F, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
| | - Adriaan D Bins
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Corina van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | - Martijn G H van Oijen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- The Royal Free London NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Patricia J Zondervan
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Katja K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
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14
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Namsrai T, Phillips C, Parkinson A, Gregory D, Kelly E, Cook M, Desborough J. Diagnostic delay of sarcoidosis: an integrated systematic review. Orphanet J Rare Dis 2024; 19:156. [PMID: 38605384 PMCID: PMC11010435 DOI: 10.1186/s13023-024-03152-7] [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: 03/23/2023] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Sarcoidosis is a chronic inflammatory granulomatous disease of unknown cause. Delays in diagnosis can result in disease progression and poorer outcomes for patients. Our aim was to review the current literature to determine the overall diagnostic delay of sarcoidosis, factors associated with diagnostic delay, and the experiences of people with sarcoidosis of diagnostic delay. METHODS Three databases (PubMed/Medline, Scopus, and ProQuest) and grey literature sources were searched. Random effects inverse variance meta-analysis was used to pool mean diagnostic delay in all types of sarcoidosis subgroup analysis. Diagnostic delay was defined as the time from reported onset of symptoms to diagnosis of sarcoidosis. RESULTS We identified 374 titles, of which 29 studies were included in the review, with an overall sample of 1531 (694 females, 837 males). The overall mean diagnostic delay in all types of sarcoidosis was 7.93 months (95% CI 1.21 to 14.64 months). Meta-aggregation of factors related to diagnostic delay in the included studies identified three categories: (1) the complex and rare features of sarcoidosis, (2) healthcare factors and (3) patient-centred factors. Meta-aggregation of outcomes reported in case studies revealed that the three most frequent outcomes associated with diagnostic delay were: (1) incorrect diagnosis, (2) incorrect treatment and (3) development of complications/disease progression. There was no significant difference in diagnostic delay between countries with gatekeeper health systems (where consumers are referred from a primary care clinician to specialist care) and countries with non-gatekeeper systems. No qualitative studies examining people's experiences of diagnostic delay were identified. CONCLUSION The mean diagnostic delay for sarcoidosis is almost 8 months, which has objective consequences for patient management. On the other hand, there is a paucity of evidence about the experience of diagnostic delay in sarcoidosis and factors related to this. Gaining an understanding of people's experiences while seeking a diagnosis of sarcoidosis is vital to gain insight into factors that may contribute to delays, and subsequently inform strategies, tools and training activities aimed at increasing clinician and public awareness about this rare condition. TRIAL REGISTRATION PROSPERO Registration number: CRD42022307236.
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Affiliation(s)
- Tergel Namsrai
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
| | - Christine Phillips
- School of Medicine and Psychology, The Australian National University, Canberra, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
| | - Dianne Gregory
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
- Sarcoidosis Lyme Australia, Camden, Australia
| | - Elaine Kelly
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
- Sarcoidosis Lyme Australia, Camden, Australia
| | - Matthew Cook
- John Curtin School of Medical Research, The Australian National University, Canberra, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia.
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Roberts E, Ng WY, Sanjeewa M, De Silva J. Acute primary CMV infection complicated by pneumonitis and ITP in young immunocompetent woman in a regional Queensland Hospital. BMJ Case Rep 2024; 17:e259136. [PMID: 38594194 PMCID: PMC11015259 DOI: 10.1136/bcr-2023-259136] [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: 04/11/2024] Open
Abstract
We present the first published case of simultaneous pneumonitis and immune thrombocytopenic purpura secondary to primary cytomegalovirus (CMV) infection in an immunocompetent patient. Treatment with oral valganciclovir for 2 weeks successfully led to complete clinical recovery. CMV is traditionally associated with infection in immunocompromised patients and neonates; however, evidence of severe CMV infections in immunocompetent hosts is emerging. It is important to highlight the broad range of clinical presentations of CMV infections to prevent diagnostic delay and associated morbidity and expense.
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Affiliation(s)
- Emma Roberts
- Queensland Health, Mackay, Queensland, Australia
| | - Wei Yao Ng
- Queensland Health, Mackay, Queensland, Australia
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16
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Mahmoud M, Ballouz T, Lahoud C, Adnan J, Habib PA, Saab R, Farhat H, Hussein ME, Rizk N. Late presentations and missed opportunities among newly diagnosed HIV patients presenting to a specialty clinic in Lebanon. Sci Rep 2024; 14:8296. [PMID: 38594292 PMCID: PMC11004126 DOI: 10.1038/s41598-024-55277-1] [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: 09/04/2023] [Accepted: 02/22/2024] [Indexed: 04/11/2024] Open
Abstract
Late presentation to medical care of individuals infected with the human immunodeficiency virus (HIV) is linked to poor outcomes and increased morbidity and mortality. Missed opportunities for a prompt diagnosis are frequently reported among late presenters. We aimed to estimate the proportion of late presenters and missed opportunities in diagnosis among newly diagnosed HIV-positive subjects presenting to a specialty clinic in Lebanon. This is a retrospective chart review of all newly diagnosed adult HIV-positive subjects presenting to clinic from 2012 to 2022. Demographic, laboratory, and clinical data were collected at initial HIV diagnosis or presentation to medical care. We defined late presentation as having a CD4 count < 350 or AIDS-defining event regardless of CD4 count. Advanced disease is defined as having a CD4 count below 200 cells/μL or the presence of an AIDS-defining illness, regardless of the CD4 count. A missed opportunity was defined as the presence of an indicator condition (IC) that suggests infection with HIV/AIDS during 3 years preceding the actual HIV diagnosis and not followed by a recommendation for HIV testing. The proportions for demographic, epidemiological, and clinical characteristics are calculated by excluding cases with missing information from the denominator. Our cohort included 150 subjects (92.7% males; 63.6% men who have sex with men (MSM); 33.3% heterosexuals; median age 30.5 years at diagnosis). 77 (51.3%) were late presenters and 53 (35.3% of all subjects, 68.8% of late presenters) had advanced HIV on presentation. Up to 76.5% of late presenters had a presentation with an HIV-related condition at a healthcare provider without getting HIV test within the previous 3 years. The most frequent ICs were weight loss, generalized lymphadenopathy, constitutional symptoms, and chronic idiopathic diarrhea. Overall mortality rate was 4% (6/150 individuals). All-cause mortality among those who presented with AIDS was 15.4% (6/39 subjects). In our setting, late presentations and missed opportunities for HIV diagnosis are common. In the Middle East, AIDS mortality remains high with a large gap in HIV testing. To effectively influence policies, comprehensive analyses should focus on estimating the preventable health and financial burdens of late HIV presentations. Another concern pertains to healthcare providers' attitudes and competencies.
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Affiliation(s)
- Maya Mahmoud
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Chloe Lahoud
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jana Adnan
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Paola Abi Habib
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Reem Saab
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Haya Farhat
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad El Hussein
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nesrine Rizk
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon.
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17
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Lee CY, Lin YP, Lin CY, Lu PL, Liang FW. Enhancing indicator condition-guided HIV testing in Taiwan: a nationwide case-control study from 2009 to 2015. BMC Public Health 2024; 24:967. [PMID: 38580963 PMCID: PMC10998297 DOI: 10.1186/s12889-024-18499-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/02/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Although indicator condition (IC)-guided HIV testing (IC-HIVT) is effective at facilitating timely HIV diagnosis, research on IC categories and the related HIV risk in Taiwan is limited. To improve the adoption and spread of IC-HIVT in Taiwan, this study compared the IC categories of people living with HIV (PLWH) and non-HIV controls and investigated delays in the diagnosis of HIV infection. METHODS This nationwide, retrospective, 1:10-matched case-control study analyzed data from the Notifiable Diseases Surveillance System and National Health Insurance Research Database to evaluate 42 ICs for the 5-year period preceding a matched HIV diagnostic date from 2009 to 2015. The ICs were divided into category 1 ICs (AIDS-defining opportunistic illnesses [AOIs]), category 2 ICs (diseases associated with impaired immunity or malignancy but not AOIs), category 3 ICs (ICs associated with sexual behaviors), and category 4 ICs (mononucleosis or mononucleosis-like syndrome). Logistic regression was used to evaluate the HIV risk associated with each IC category (at the overall and annual levels) before the index date. Wilcoxon rank-sum test was performed to assess changes in diagnostic delays following an incident IC category by HIV transmission routes. RESULTS Fourteen thousand three hundred forty-seven PLWH were matched with 143,470 non-HIV controls. The prevalence results for all ICs and category 1-4 ICs were, respectively, 42.59%, 11.16%, 15.68%, 26.48%, and 0.97% among PLWH and 8.73%, 1.05%, 4.53%, 3.69%, and 0.02% among non-HIV controls (all P < 0.001). Each IC category posed a significantly higher risk of HIV infection overall and annually. The median (interquartile range) potential delay in HIV diagnosis was 15 (7-44), 324.5 (36-947), 234 (13-976), and 74 (33-476) days for category 1-4 ICs, respectively. Except for category 1 for men who have sex with men, these values remained stable across 2009-2015, regardless of the HIV transmission route. CONCLUSIONS Given the ongoing HIV diagnostic delay, IC-HIVT should be upgraded and adapted to each IC category to enhance early HIV diagnosis.
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Affiliation(s)
- Chun-Yuan Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
- M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Yi-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C
- M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Chun-Yu Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C
| | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Fu-Wen Liang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C..
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C..
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C..
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18
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Iankova V, Sparber P, Rohani M, Dusek P, Büchner B, Karin I, Schneider SA, Gorriz JM, Kmiec T, Klopstock T. Phenotype and natural history of mitochondrial membrane protein-associated neurodegeneration. Brain 2024; 147:1389-1398. [PMID: 37831662 DOI: 10.1093/brain/awad357] [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: 06/02/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Mitochondrial membrane protein-associated neurodegeneration (MPAN) is an ultraorphan neurogenetic disease from the group of neurodegeneration with brain iron accumulation (NBIA) disorders. Here we report cross-sectional and longitudinal data to define the phenotype, to assess disease progression and to estimate sample sizes for clinical trials. We enrolled patients with genetically confirmed MPAN from the Treat Iron-Related Childhood-Onset Neurodegeneration (TIRCON) registry and cohort study, and from additional sites. Linear mixed-effect modelling (LMEM) was used to calculate annual progression rates for the Unified Parkinson's Disease Rating Scale (UPDRS), Barry-Albright Dystonia (BAD) scale, Schwab and England Activities of Daily Living (SE-ADL) scale and the Pediatric Quality of Life Inventory (PedsQL). We investigated 85 MPAN patients cross-sectionally, with functional outcome data collected in 45. Median age at onset was 9 years and the median diagnostic delay was 5 years. The most common findings were gait disturbance (99%), pyramidal involvement (95%), dysarthria (90%), vision disturbances (82%), with all but dysarthria presenting early in the disease course. After 16 years with the disease, 50% of patients were wheelchair dependent. LMEM showed an annual progression rate of 4.5 points in total UPDRS. The total BAD scale score showed no significant progression over time. The SE-ADL scale and the patient- and parent-reported PedsQL showed a decline of 3.9%, 2.14 and 2.05 points, respectively. No patient subpopulations were identified based on longitudinal trajectories. Our cross-sectional results define the order of onset and frequency of symptoms in MPAN, which will inform the diagnostic process, help to shorten diagnostic delay and aid in counselling patients, parents and caregivers. Our longitudinal findings define the natural history of MPAN, reveal the most responsive outcomes and highlight the need for an MPAN-specific rating approach. Our sample size estimations inform the design of upcoming clinical trials.
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Affiliation(s)
- Vassilena Iankova
- Department of Neurology with Friedrich-Baur-Institute, University Hospital of Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Peter Sparber
- Research Centre for Medical Genetics, 115522 Moscow, Russia
| | - Mohammad Rohani
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, 1449614535 Tehran, Iran
| | - Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, 121 08 Prague, Czech Republic
| | - Boriana Büchner
- Department of Neurology with Friedrich-Baur-Institute, University Hospital of Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Ivan Karin
- Department of Neurology with Friedrich-Baur-Institute, University Hospital of Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Susanne A Schneider
- Department of Neurology with Friedrich-Baur-Institute, University Hospital of Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Juan M Gorriz
- Data Science and Computational Intelligence Institute, University of Granada, Granada CP 18071, Spain
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Tomasz Kmiec
- Children's Memorial Health Institute, Child Neurology Department, 04-730 Warsaw, Poland
| | - Thomas Klopstock
- Department of Neurology with Friedrich-Baur-Institute, University Hospital of Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
- Munich Cluster for Systems Neurology, 81377 Munich, Germany
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Swift B, Taneri B, Becker CM, Basarir H, Naci H, Missmer SA, Zondervan KT, Rahmioglu N. Prevalence, diagnostic delay and economic burden of endometriosis and its impact on quality of life: results from an Eastern Mediterranean population. Eur J Public Health 2024; 34:244-252. [PMID: 38070492 PMCID: PMC10990517 DOI: 10.1093/eurpub/ckad216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND There are limited data on endometriosis from the Eastern Mediterranean region. This study for the first time estimates the prevalence and impact of endometriosis on women in Northern Cyprus, an under-represented region in Europe. METHODS Cyprus Women's Health Research Initiative, a cross-sectional study recruited 7646 women aged 18-55 in Northern Cyprus between January 2018 and February 2020. Cases were identified using self-reported and ultrasound data and two control groups were defined, with (n = 2922) and without (n = 4314) pain. Standardized tools, including the 11-point Numerical Rating Scale and the Short Form 36 Health Survey version 2, were used to assess pain and quality of life, respectively. RESULTS Prevalence and median diagnostic delay of endometriosis were 5.4% [95% confidence interval (CI): 4.9-5.9%, n = 410] and 7 (interquartile range 15.5) years. Endometriosis cases experienced a higher prevalence of bladder pain compared with asymptomatic pain controls (6.3% vs. 1.0%, P < 0.001) and irritable bowel syndrome relating to pelvic pain compared with symptomatic (4.6% vs. 2.6%, P = 0.027) and asymptomatic (0.3%, P < 0.001) controls. The odds of endometriosis cases reporting an anxiety diagnosis was 1.56 (95% CI: 1.03-2.38) higher than the symptomatic and 1.95 (95% CI: 1.30-2.92) times higher than the asymptomatic controls. The physical component score of the health-related quality-of-life instrument suggested a significant difference between the endometriosis cases and the symptomatic controls (46.8 vs. 48.5, P = 0.034). Average annual economic cost of endometriosis cases was Int$9864 (95% CI: $8811-$10 917) including healthcare, costs relating to absence and loss of productivity at work. CONCLUSION Prevalence was lower than the global 10% estimate, and substantial proportion of women without endometriosis reported moderate/severe pelvic pain hinting at many undiagnosed cases within this population. Coupled with lower quality of life, significant economic burden and underutilized pain management options, the study highlights multiple opportunities to improve care for endometriosis patients and women with pelvic pain.
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Affiliation(s)
- Bethan Swift
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Bahar Taneri
- Faculty of Arts and Sciences, Department of Biological Sciences, Eastern Mediterranean University, Famagusta, Northern Cyprus
- Cyprus Women’s Health Research Society (CoHERS), Nicosia, Northern Cyprus
| | - Christian M Becker
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | | | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Stacey A Missmer
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Krina T Zondervan
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Nilufer Rahmioglu
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Cyprus Women’s Health Research Society (CoHERS), Nicosia, Northern Cyprus
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20
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Jing S, Xue L, Wang H, Peng Z. Global analysis of an age-structured tuberculosis model with an application to Jiangsu, China. J Math Biol 2024; 88:52. [PMID: 38563991 DOI: 10.1007/s00285-024-02066-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 08/31/2023] [Accepted: 02/18/2024] [Indexed: 04/04/2024]
Abstract
Diagnostic delay for TB infected individuals and the lack of TB vaccines for adults are the main challenges to achieve the goals of WHO by 2050. In order to evaluate the impacts of diagnostic delay and vaccination for adults on prevalence of TB, we propose an age-structured model with latent age and infection age, and we incorporate Mycobacterium TB in the environment and vaccination into the model. Diagnostic delay is indicated by the age of infection before receiving treatment. The threshold dynamics are established in terms of the basic reproduction number R 0 . WhenR 0 < 1 , the disease-free equilibrium is globally asymptotically stable, which means that TB epidemic will die out; WhenR 0 = 1 , the disease-free equilibrium is globally attractive; there exists a unique endemic equilibrium and the endemic equilibrium is globally attractive whenR 0 > 1 . We estimate that the basic reproduction numberR 0 = 0.5320 (95% CI (0.3060, 0.7556)) in Jiangsu Province, which means that TB epidemic will die out. However, we find that the annual number of new TB cases by 2050 is 1,151 (95%CI: (138, 8,014)), which means that it is challenging to achieve the goal of WHO by 2050. To this end, we evaluate the possibility of achieving the goals of WHO if we start vaccinating adults and reduce diagnostic delay in 2025. Our results demonstrate that when the diagnostic delay is reduced from longer than four months to four months, or 20% adults are vaccinated, the goal of WHO in 2050 can be achieved, and 73,137 (95%CI: (23,906, 234,086)) and 54,828 (95%CI: (15,811, 206,468)) individuals will be prevented from being infected from 2025 to 2050, respectively. The modeling approaches and simulation results used in this work can help policymakers design control measures to reduce the prevalence of TB.
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Affiliation(s)
- Shuanglin Jing
- College of Mathematical Sciences, Harbin Engineering University, Harbin, 150001, Heilongjiang, China
| | - Ling Xue
- College of Mathematical Sciences, Harbin Engineering University, Harbin, 150001, Heilongjiang, China.
| | - Hao Wang
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, T6G 2G1, Canada.
| | - Zhihang Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
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21
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Marco DN, Omaña-Iglesias O, Caballero G, Marco F. Delayed diagnosis of HIV in migrant patient suffering from opportunistic imported infection. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:225-226. [PMID: 38388316 DOI: 10.1016/j.eimce.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Daniel N Marco
- Servicio Enfermedades Infecciosas, Hospital Clínic Barcelona, Barcelona, Spain.
| | | | - Gabriela Caballero
- Servicio de Anatomía Patológica, Hospital Clínic Barcelona, Barcelona, Spain
| | - Francesc Marco
- Servicio de Microbiología Clínica, Hospital Clínic Barcelona, Barcelona, Spain
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22
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Michelson KA, Rees CA, Florin TA, Bachur RG. Emergency Department Volume and Delayed Diagnosis of Serious Pediatric Conditions. JAMA Pediatr 2024; 178:362-368. [PMID: 38345811 PMCID: PMC10862268 DOI: 10.1001/jamapediatrics.2023.6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024]
Abstract
Importance Diagnostic delays are common in the emergency department (ED) and may predispose to worse outcomes. Objective To evaluate the association of annual pediatric volume in the ED with delayed diagnosis. Design, Setting, and Participants This retrospective cohort study included all children younger than 18 years treated at 954 EDs in 8 states with a first-time diagnosis of any of 23 acute, serious conditions: bacterial meningitis, compartment syndrome, complicated pneumonia, craniospinal abscess, deep neck infection, ectopic pregnancy, encephalitis, intussusception, Kawasaki disease, mastoiditis, myocarditis, necrotizing fasciitis, nontraumatic intracranial hemorrhage, orbital cellulitis, osteomyelitis, ovarian torsion, pulmonary embolism, pyloric stenosis, septic arthritis, sinus venous thrombosis, slipped capital femoral epiphysis, stroke, or testicular torsion. Patients were identified using the Healthcare Cost and Utilization Project State ED and Inpatient Databases. Data were collected from January 2015 to December 2019, and data were analyzed from July to December 2023. Exposure Annual volume of children at the first ED visited. Main Outcomes and Measures Possible delayed diagnosis, defined as a patient with an ED discharge within 7 days prior to diagnosis. A secondary outcome was condition-specific complications. Rates of possible delayed diagnosis and complications were determined. The association of volume with delayed diagnosis across conditions was evaluated using conditional logistic regression matching on condition, age, and medical complexity. Condition-specific volume-delay associations were tested using hierarchical logistic models with log volume as the exposure, adjusting for age, sex, payer, medical complexity, and hospital urbanicity. The association of delayed diagnosis with complications by condition was then examined using logistic regressions. Results Of 58 998 included children, 37 211 (63.1%) were male, and the mean (SD) age was 7.1 (5.8) years. A total of 6709 (11.4%) had a complex chronic condition. Delayed diagnosis occurred in 9296 (15.8%; 95% CI, 15.5-16.1). Each 2-fold increase in annual pediatric volume was associated with a 26.7% (95% CI, 22.5-30.7) decrease in possible delayed diagnosis. For 21 of 23 conditions (all except ectopic pregnancy and sinus venous thrombosis), there were decreased rates of possible delayed diagnosis with increasing ED volume. Condition-specific complications were 11.2% (95% CI, 3.1-20.0) more likely among patients with a possible delayed diagnosis compared with those without. Conclusions and Relevance EDs with fewer pediatric encounters had more possible delayed diagnoses across 23 serious conditions. Tools to support timely diagnosis in low-volume EDs are needed.
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Affiliation(s)
- Kenneth A. Michelson
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Todd A. Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G. Bachur
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
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23
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Kulasekere DA, Royan R, Shan Y, Reyes AM, Thomas AC, Lundberg AL, Feinglass JM, Stey AM. Appendicitis Hospitalization Care Costs Among Patients With Delayed Diagnosis of Appendicitis. JAMA Netw Open 2024; 7:e246721. [PMID: 38619839 PMCID: PMC11019393 DOI: 10.1001/jamanetworkopen.2024.6721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/17/2024] [Indexed: 04/16/2024] Open
Abstract
Importance Delayed appendicitis diagnosis is associated with worse outcomes. Appendicitis hospital care costs associated with delayed diagnosis are unknown. Objective To determine whether delayed appendicitis diagnosis was associated with increased appendicitis hospital care costs. Design, Setting, and Participants This cohort study used data from patients receiving an appendectomy aged 18 to 64 years in 5 states (Florida, Maryland, Massachusetts, New York, Wisconsin) that were captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department databases for the years 2016 and 2017 with no additional follow-up. Data were analyzed January through April 2023. Exposures Delayed diagnosis was defined as a previous emergency department or inpatient hospital encounter with an abdominal diagnosis other than appendicitis, and no intervention 7 days prior to appendectomy encounter. Main Outcomes and Measures The main outcome was appendicitis hospital care costs. This was calculated from aggregated charges of encounters 7 days prior to appendectomy, the appendectomy encounter, and 30 days postoperatively. Cost-to-charge ratios were applied to charges to obtain costs, which were then adjusted for wage index, inflation to 2022 US dollar, and with extreme outliers winsorized. A multivariable Poisson regression estimated appendicitis hospital care costs associated with a delayed diagnosis while controlling for age, sex, race and ethnicity, insurance status, care discontinuity, income quartile, hospital size, teaching status, medical school affiliation, percentage of Black and Hispanic patient discharges, core-based statistical area, and state. Results There were 76 183 patients (38 939 female [51.1%]; 2192 Asian or Pacific Islander [2.9%], 14 132 Hispanic [18.5%], 8195 non-Hispanic Black [10.8%], 46 949 non-Hispanic White [61.6%]) underwent appendectomy, and 2045 (2.7%) had a delayed diagnosis. Delayed diagnosis patients had median (IQR) unadjusted cost of $11 099 ($6752-$17 740) compared with $9177 ($5575-$14 481) for nondelayed (P < .001). Patients with delayed diagnosis had 1.23 times (95% CI, 1.16-1.28 times) adjusted increased appendicitis hospital care costs. The mean marginal cost of delayed diagnosis was $2712 (95% CI, $2083-$3342). Even controlling for delayed diagnosis, non-Hispanic Black patients had 1.22 times (95% CI, 1.17-1.28 times) the adjusted increased appendicitis hospital care costs compared with non-Hispanic White patients. Conclusions and Relevance In this cohort study, delayed diagnosis of appendicitis was associated with increased hospital care costs.
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Affiliation(s)
| | - Regina Royan
- Department of Emergency Medicine, University of Michigan, Ann Arbor
| | - Ying Shan
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ana M. Reyes
- Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | | | - Alexander L. Lundberg
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joe M. Feinglass
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anne M. Stey
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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24
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Lucijanic M, Likic R, Krecak I. Delayed diagnosis of nonspecific symptoms requiring overdiagnosis and overtreatment? Wien Klin Wochenschr 2024; 136:239-240. [PMID: 38478084 DOI: 10.1007/s00508-024-02339-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Marko Lucijanic
- Division of Hematology, Department of Internal Medicine, Clinical hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia.
- Department of Internal Medicine, School of medicine University of Zagreb, Salata 3, 10000, Zagreb, Croatia.
- Hematology Department, University Hospital Dubrava, University of Zagreb School of Medicine, Av. Gojka Suska 6, 10000, Zagreb, Croatia.
| | - Robert Likic
- Department of Internal Medicine, School of medicine University of Zagreb, Salata 3, 10000, Zagreb, Croatia
- Division of Clinical Pharmacology and Therapeutics, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Ivan Krecak
- Department of Internal Medicine, General hospital of Sibenik-Knin county, Ul. Stjepana Radica 83, 22000, Sibenik, Croatia
- Department of Internal Medicine, Faculty of medicine, University of Rijeka, Ul. Brace Branchetta 20/1, 51000, Rijeka, Croatia
- Polytechnic of Sibenik, Trg Andrije Hebranga 11, 22000, Sibenik, Croatia
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25
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Tinker RJ, Fisher M, Gimeno AF, Gill K, Ivey C, Peterson JF, Bastarache L. Diagnostic delay in monogenic disease: A scoping review. Genet Med 2024; 26:101074. [PMID: 38243783 DOI: 10.1016/j.gim.2024.101074] [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: 09/13/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Abstract
PURPOSE Diagnostic delay in monogenic disease is reportedly common. We conducted a scoping review investigating variability in study design, results, and conclusions. METHODS We searched the academic literature on January 17, 2023, for original peer reviewed journals and conference articles that quantified diagnostic delay in monogenic disease. We abstracted the reported diagnostic delay, relevant study design features, and definitions. RESULTS Our search identified 259 articles quantifying diagnostic delay in 111 distinct monogenetic diseases. Median reported diagnostic delay for all studies collectively in monogenetic diseases was 5.0 years (IQR 2-10). There was major variation in the reported delay within individual monogenetic diseases. Shorter delay was associated with disorders of childhood metabolism, immunity, and development. The majority (67.6%) of articles that studied delay reported an improvement with calendar time. Study design and definitions of delay were highly heterogenous. Three gaps were identified: (1) no studies were conducted in the least developed countries, (2) delay has not been studied for the majority of known, or (3) most prevalent genetic diseases. CONCLUSION Heterogenous study design and definitions of diagnostic delay inhibit comparison across studies. Future efforts should focus on standardizing delay measurements, while expanding the research to low-income countries.
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Affiliation(s)
- Rory J Tinker
- Division of Medical Genetics and Genomic Medicine, Vanderbilt University Medical Center, Nashville, TN.
| | - Miles Fisher
- Vanderbilt University Medical Center, Department of Child Neurology, Nashville, TN
| | - Alex F Gimeno
- Vanderbilt University School of Medicine, Nashville, TN
| | - Kayce Gill
- Annette and Irwin Eskind Family Biomedical Library and Learning Center, Vanderbilt University, Nashville, TN
| | - Camille Ivey
- Annette and Irwin Eskind Family Biomedical Library and Learning Center, Vanderbilt University, Nashville, TN
| | - Josh F Peterson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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26
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McDermott GC, Monshizadeh A, Selzer F, Zhao SS, Ermann J, Katz JN. Factors Associated With Diagnostic Delay in Axial Spondyloarthritis: Impact of Clinical Factors and Social Vulnerability. Arthritis Care Res (Hoboken) 2024; 76:541-549. [PMID: 37881826 PMCID: PMC10963166 DOI: 10.1002/acr.25264] [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: 03/13/2023] [Revised: 08/23/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Patients with axial spondyloarthritis (axSpA) often experience significant delay between symptom onset and diagnosis for reasons that are incompletely understood. We investigated associations between demographic, medical, and socioeconomic factors and axSpA diagnostic delay. METHODS We identified patients meeting modified New York criteria for ankylosing spondylitis (AS) or 2009 Assessment of Spondyloarthritis International Society criteria for axSpA in the Mass General Brigham health care system between December 1990 and October 2021. We determined the duration of diagnostic delay, defined as the duration of back pain symptoms reported at diagnosis, as well as disease manifestations and specialty care prior to diagnosis from the electronic health record. We obtained each patient's Social Vulnerability Index (SVI) by mapping their address to the US Centers for Disease Control SVI Atlas. We examined associations among disease manifestations, SVI, and diagnostic delay using ordinal logistic regression. RESULTS Among 554 patients with axSpA who had a median diagnostic delay of 3.8 years (interquartile range 1.1-10), peripheral arthritis (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.45-0.93) and older age at symptom onset (OR 0.83, 95% CI 0.78-0.88 per five years) were associated with shorter delay. AS at diagnosis (OR 1.85, 95% CI 1.30-2.63), a history of uveitis prior to diagnosis (OR 2.77, 95% CI 1.73-4.52), and higher social vulnerability (defined as national SVI 80th to 99th percentiles; OR 1.99, 95% CI 1.06-3.84) were associated with longer diagnostic delay. CONCLUSION Older age at back pain onset and peripheral arthritis were associated with shorter delay, whereas uveitis was associated with longer diagnostic delay. Patients with higher socioeconomic vulnerability had longer diagnostic delay independent of clinical factors.
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Affiliation(s)
- Gregory C McDermott
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Faith Selzer
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Joerg Ermann
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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27
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Bianchi PI, Lenti MV, Petrucci C, Gambini G, Aronico N, Varallo M, Rossi CM, Pozzi E, Groppali E, Siccardo F, Franchino G, Zuccotti GV, Di Leo G, Zanchi C, Cristofori F, Francavilla R, Aloi M, Gagliostro G, Montuori M, Romaggioli S, Strisciuglio C, Crocco M, Zampatti N, Calvi A, Auricchio R, De Giacomo C, Caimmi SME, Carraro C, Staiano A, Cenni S, Congia M, Schirru E, Ferretti F, Ciacci C, Vecchione N, Latorre MA, Resuli S, Moltisanti GC, Abruzzese GM, Quadrelli A, Saglio S, Canu P, Ruggeri D, De Silvestri A, Klersy C, Marseglia GL, Corazza GR, Di Sabatino A. Diagnostic Delay of Celiac Disease in Childhood. JAMA Netw Open 2024; 7:e245671. [PMID: 38592719 PMCID: PMC11004829 DOI: 10.1001/jamanetworkopen.2024.5671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/31/2024] [Indexed: 04/10/2024] Open
Abstract
Importance The extent and factors associated with risk of diagnostic delay in pediatric celiac disease (CD) are poorly understood. Objectives To investigate the diagnostic delay of CD in childhood, and to assess factors associated with this delay. Design, Setting, and Participants Multicenter, retrospective, cross-sectional study (2010-2019) of pediatric (aged 0-18 years) patients with CD from 13 pediatric tertiary referral centers in Italy. Data were analyzed from January to June 2023. Main Outcomes and Measures The overall diagnostic delay (ie, the time lapse occurring from the first symptoms or clinical data indicative of CD and the definitive diagnosis), further split into preconsultation and postconsultation diagnostic delay, were described. Univariable and multivariable linear regression models for factors associated with diagnostic delay were fitted. Factors associated with extreme diagnostic delay (ie, 1.5 × 75th percentile) and misdiagnosis were assessed. Results A total of 3171 patients with CD were included. The mean (SD) age was 6.2 (3.9) years; 2010 patients (63.4%) were female; and 10 patients (0.3%) were Asian, 41 (1.3%) were Northern African, and 3115 (98.3%) were White. The median (IQR) overall diagnostic delay was 5 (2-11) months, and preconsultation and postconsultation diagnostic delay were 2 (0-6) months and 1 (0-3) month, respectively. The median (IQR) extreme overall diagnostic delay (586 cases [18.5%]) was 11 (5-131) months, and the preconsultation and postconsultation delays were 6 (2-120) and 3 (1-131) months, respectively. Patients who had a first diagnosis when aged less than 3 years (650 patients [20.5%]) showed a shorter diagnostic delay, both overall (median [IQR], 4 [1-7] months for patients aged less than 3 years vs 5 [2-12] months for others) and postconsultation (median [IQR], 1 [0-2] month for patients aged less than 3 years vs 2 [0-4] months for others). A shorter delay was registered in male patients, both overall (median [IQR], 4 [1-10] months for male patients vs 5 [2-12] months for female patients) and preconsultation (median [IQR], 1 [0-6] month for male patients vs 2 [0-6] months for female patients). Family history of CD was associated with lower preconsultation delay (odds ratio [OR], 0.59; 95% CI, 0.47-0.74) and lower overall extreme diagnostic delay (OR, 0.75; 95% CI, 0.56-0.99). Neurological symptoms (78 patients [21.5%]; OR, 1.35; 95% CI, 1.03-1.78), gastroesophageal reflux (9 patients [28.1%]; OR, 1.87; 95% CI, 1.02-3.42), and failure to thrive (215 patients [22.6%]; OR, 1.62; 95% CI, 1.31-2.00) showed a more frequent extreme diagnostic delay. A previous misdiagnosis (124 patients [4.0%]) was more frequently associated with gastroesophageal reflux disease, diarrhea, bloating, abdominal pain, constipation, fatigue, osteopenia, and villous atrophy (Marsh 3 classification). Conclusions and Relevance In this cross-sectional study of pediatric CD, the diagnostic delay was rather short. Some factors associated with risk for longer diagnostic delay and misdiagnosis emerged, and these should be addressed in future studies.
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Affiliation(s)
- Paola Ilaria Bianchi
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Clarissa Petrucci
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Giulia Gambini
- Biostatistics and Clinical Trial Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Nicola Aronico
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
| | - Matteo Varallo
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Carlo Maria Rossi
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Elena Pozzi
- Department of Pediatrics, Buzzi Children’s Hospital, Milan, Italy
| | - Elena Groppali
- Department of Pediatrics, Buzzi Children’s Hospital, Milan, Italy
| | | | - Giulia Franchino
- Department of Pediatrics, Azienda Socio Sanitaria Territoriale Lariana, San Fermo della Battaglia, Como, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Grazia Di Leo
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy
| | - Chiara Zanchi
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy
| | - Fernanda Cristofori
- Interdisciplinary Department of Medicine—Pediatric Section, Aldo Moro University of Bari, Bari, Italy
| | - Ruggiero Francavilla
- Interdisciplinary Department of Medicine—Pediatric Section, Aldo Moro University of Bari, Bari, Italy
| | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Department of Women’s and Children’s Health, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - Giulia Gagliostro
- Pediatric Gastroenterology and Liver Unit, Department of Women’s and Children’s Health, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - Monica Montuori
- Pediatric Gastroenterology and Liver Unit, Department of Women’s and Children’s Health, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - Sara Romaggioli
- Pediatric Gastroenterology and Liver Unit, Department of Women’s and Children’s Health, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - Caterina Strisciuglio
- Università della Campania Luigi Vanvitelli, Dipartimento della donna, del bambino e della chirurgia generale e specialistica, Naples, Italy
| | - Marco Crocco
- ”Pediatric Gastroenterology and Endoscopy Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini Institute, Genoa, Italy
| | - Noemi Zampatti
- ”Pediatric Gastroenterology and Endoscopy Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini Institute, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health, University of Genoa, Genoa, Italy
| | - Angela Calvi
- ”Pediatric Gastroenterology and Endoscopy Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini Institute, Genoa, Italy
| | - Renata Auricchio
- Deparment of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Istituto Europeo per lo Studio delle Malattie correlate ad Alimenti, Naples, Italy
| | - Costantino De Giacomo
- Division of Pediatrics, Department of Mother and Child Health, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Maria Elena Caimmi
- Paediatric Clinic, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Carolina Carraro
- Paediatric Clinic, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Annamaria Staiano
- Deparment of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Sabrina Cenni
- Università della Campania Luigi Vanvitelli, Dipartimento della donna, del bambino e della chirurgia generale e specialistica, Naples, Italy
- Deparment of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Mauro Congia
- Gastroenterologia Pediatrica Clinica Pediatrica e Malattie Rare Ospedale Pediatrico Microcitemico Antonio Cao, Azienda Sanitaria Locale 8, Cagliari, Italy
| | - Enrico Schirru
- Centro Servizi di Ateneo per gli Stabulari, Università degli Studi di Cagliari, Cittadella Universitaria, Monserrato, Cagliari, Italy
| | - Francesca Ferretti
- UO di Gastroenterologia e Riabilitazione Nutrizionale, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Carolina Ciacci
- University of Salerno Azienda Ospedaliero-Universitaria San Giovanni di Dio e Ruggi d’Aragona of Salerno, Salerno, Italy
| | - Nicoletta Vecchione
- University of Salerno Azienda Ospedaliero-Universitaria San Giovanni di Dio e Ruggi d’Aragona of Salerno, Salerno, Italy
| | - Mario Andrea Latorre
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Semela Resuli
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Giusy Cinzia Moltisanti
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Giulia Maria Abruzzese
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Andrea Quadrelli
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Simone Saglio
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Pietro Canu
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Damiano Ruggeri
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Annalisa De Silvestri
- Biostatistics and Clinical Trial Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biostatistics and Clinical Trial Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Paediatric Clinic, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
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28
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Saenger JA, Hunger J, Boss A, Richter J. Delayed diagnosis of a transient ischemic attack caused by ChatGPT. Wien Klin Wochenschr 2024; 136:236-238. [PMID: 38305909 PMCID: PMC11006786 DOI: 10.1007/s00508-024-02329-1] [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: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Abstract
Techniques of artificial intelligence (AI) are increasingly used in the treatment of patients, such as providing a diagnosis in radiological imaging, improving workflow by triaging patients or providing an expert opinion based on clinical symptoms; however, such AI techniques also hold intrinsic risks as AI algorithms may point in the wrong direction and constitute a black box without explaining the reason for the decision-making process.This article outlines a case where an erroneous ChatGPT diagnosis, relied upon by the patient to evaluate symptoms, led to a significant treatment delay and a potentially life-threatening situation. With this case, we would like to point out the typical risks posed by the widespread application of AI tools not intended for medical decision-making.
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Affiliation(s)
- Jonathan A Saenger
- Diagnostic and interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland.
- Institute of Radiology and Nuclear Medicine, GZO Hospital Wetzikon, Wetzikon, Switzerland.
| | - Jonathan Hunger
- Department of Internal Medicine, GZO Hospital Wetzikon, Wetzikon, Switzerland
| | - Andreas Boss
- Diagnostic and interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland.
- Institute of Radiology and Nuclear Medicine, GZO Hospital Wetzikon, Wetzikon, Switzerland.
| | - Johannes Richter
- Institute of Radiology and Nuclear Medicine, GZO Hospital Wetzikon, Wetzikon, Switzerland
- Neurology and Stroke Unit, GZO Hospital Wetzikon, Wetzikon, Switzerland
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29
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Visaggi P, Del Corso G, Baiano Svizzero F, Ghisa M, Bardelli S, Venturini A, Stefani Donati D, Barberio B, Marciano E, Bellini M, Dunn J, Wong T, de Bortoli N, Savarino EV, Zeki S. Artificial Intelligence Tools for the Diagnosis of Eosinophilic Esophagitis in Adults Reporting Dysphagia: Development, External Validation, and Software Creation for Point-of-Care Use. The Journal of Allergy and Clinical Immunology: In Practice 2024; 12:1008-1016.e1. [PMID: 38154556 DOI: 10.1016/j.jaip.2023.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/23/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Despite increased awareness of eosinophilic esophagitis (EoE), the diagnostic delay has remained stable over the past 3 decades. There is a need to improve the diagnostic performance and optimize resources allocation in the setting of EoE. OBJECTIVE We developed and validated 2 point-of-care machine learning (ML) tools to predict a diagnosis of EoE before histology results during office visits. METHODS We conducted a multicenter study in 3 European tertiary referral centers for EoE. We built predictive ML models using retrospectively extracted clinical and esophagogastroduodenoscopy (EGDS) data collected from 273 EoE and 55 non-EoE dysphagia patients. We validated the models on an independent cohort of 93 consecutive patients with dysphagia undergoing EGDS with biopsies at 2 different centers. Models' performance was assessed by area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values (PPV and NPV). The models were integrated into a point-of-care software package. RESULTS The model trained on clinical data alone showed an AUC of 0.90 and a sensitivity, specificity, PPV, and NPV of 0.90, 0.75, 0.80, and 0.87, respectively, for the diagnosis of EoE in the external validation cohort. The model trained on a combination of clinical and endoscopic data showed an AUC of 0.94, and a sensitivity, specificity, PPV, and NPV of 0.94, 0.68, 0.77, and 0.91, respectively, in the external validation cohort. CONCLUSION Our software-integrated models (https://webapplicationing.shinyapps.io/PointOfCare-EoE/) can be used at point-of-care to improve the diagnostic workup of EoE and optimize resources allocation.
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Affiliation(s)
- Pierfrancesco Visaggi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Centre for Oesophageal Diseases, Guy's and St. Thomas Hospital, London, United Kingdom
| | - Giulio Del Corso
- Institute of Information Science and Technologies "A. Faedo", National Research Council of Italy (CNR), Pisa, Italy
| | - Federica Baiano Svizzero
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Ghisa
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Serena Bardelli
- Neonatal Learning and Simulation Centre "NINA", Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Arianna Venturini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Delio Stefani Donati
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Brigida Barberio
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Emanuele Marciano
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Massimo Bellini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Jason Dunn
- Centre for Oesophageal Diseases, Guy's and St. Thomas Hospital, London, United Kingdom
| | - Terry Wong
- Centre for Oesophageal Diseases, Guy's and St. Thomas Hospital, London, United Kingdom
| | - Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Edoardo V Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Sebastian Zeki
- Centre for Oesophageal Diseases, Guy's and St. Thomas Hospital, London, United Kingdom
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30
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D'Costa ZU, Neibart SS, Jones LE, Shah MK, Page K, Jacob S. Delayed Diagnosis of Human Immunodeficiency Virus in the Latino Population at a Federally Qualified Community Health Center in New Jersey. J Immigr Minor Health 2024; 26:294-303. [PMID: 38147283 DOI: 10.1007/s10903-023-01544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 12/27/2023]
Abstract
Late diagnosis of human immunodeficiency virus (HIV) is associated with early progression to acquired immunodeficiency syndrome (AIDS). We examined racial/ethnic differences in presentation with advanced HIV/AIDS at a community health center in New Jersey. Records of patients diagnosed with HIV between 1990 and 2018 were reviewed. Odds ratios (OR) of presenting with AIDS at HIV diagnosis were computed in unadjusted and adjusted models. There were 182 (48.3%) Latino, 48 (12.7%) non-Latino White (NLW), 130 (34.5%) non-Latino Black, and 17 (4.5%) non-Latino of other race/ethnicity included in the analysis. Over 75% of the Latinos were foreign-born. Latino patients had higher odds of presentation with AIDS at time of HIV diagnosis than NLW in unadjusted (OR = 4.85, 95% confidence interval (95% CI): 2.28-10.31) and adjusted models (OR = 3.71, 95%CI: 1.60-8.59). Latino patients, particularly foreign-born and bisexual, had higher odds of being diagnosed with AIDS at presentation with HIV in this cohort.
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Affiliation(s)
- Zoee U D'Costa
- Robert Wood Johnson Medical School, Rutgers University, 277 George St, Piscataway, NJ, 08901, USA
| | - Shane S Neibart
- Robert Wood Johnson Medical School, Rutgers University, 277 George St, Piscataway, NJ, 08901, USA
| | - Laura E Jones
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Mansi K Shah
- School of Arts and Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Kathleen Page
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sneha Jacob
- Robert Wood Johnson Medical School, Rutgers University, 277 George St, Piscataway, NJ, 08901, USA.
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31
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Farkas N, O’Brien JW, Palyvos L, Maclean W, Benton S, Rockall T, Jourdan I. The increasing burden of the 2-week wait colorectal cancer pathway in a single centre: the impact of faecal immunochemical tests. Ann R Coll Surg Engl 2024; 106:338-343. [PMID: 36688865 PMCID: PMC10981981 DOI: 10.1308/rcsann.2022.0138] [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] [Accepted: 10/20/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Two-week wait (TWW) volume and colorectal cancer (CRC) detection pose an increasing challenge for NHS cancer services. Primary aims were to assess the introduction of faecal immunochemical tests (FIT) into clinical practice at our centre, the impact on TWW referral volume and CRC diagnoses, and to provide an update to previously published work. A secondary aim was to correlate FIT value and investigation. METHODS TWW CRC data following incorporation of FIT into clinical practice were analysed (1 June 2019-31 July 2021). Parameters assessed were monthly referral volume, CRC detection, primary care FIT volume and secondary care investigations. Referrals and CRC detection rates were compared with previously published data (2009-2019). Data relating to primary care FIT were collated from Berkshire and Surrey Pathology Services. RESULTS TWW referrals increased 360% (2009-2020). CRC incidence decreased from 8.87% to 3.24%. Following incorporation into clinical practice, primary care FIT requests have increased to >450/month and accompanied 1,722/4,796 referrals. CRC incidence is static (3-4%). Patients with FIT <10µg Hb/g faeces undergo radiological imaging more commonly, whereas FIT-positive patients are more likely to undergo endoscopy, although the difference is not statistically significant. CONCLUSIONS No significant change in CRC diagnosis was observed, despite increasing TWW referrals. Increasing utilisation of FIT in both primary and secondary care has helped maintain CRC detection while avoiding diagnostic delay. This study supports growing evidence highlighting the value of FIT in triage, referral and TWW investigation. FIT appears increasingly important for allocating secondary care resources (endoscopy), while guiding primary care referral. Additional low-cost strategies to determine prioritisation or reassurance (e.g. repeat FIT) require further evaluation.
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Affiliation(s)
- N Farkas
- Royal Surrey NHS Foundation Trust, UK
| | | | - L Palyvos
- Royal Surrey NHS Foundation Trust, UK
| | - W Maclean
- Royal Surrey NHS Foundation Trust, UK
| | - S Benton
- Royal Surrey NHS Foundation Trust, UK
| | - T Rockall
- Royal Surrey NHS Foundation Trust, UK
| | - I Jourdan
- Royal Surrey NHS Foundation Trust, UK
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32
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Young SW, Jha P, Chamié L, Rodgers S, Kho RM, Horrow MM, Glanc P, Feldman M, Groszmann Y, Khan Z, Young SL, Poder L, Burnett TL, Hu EM, Egan S, VanBuren W. Society of Radiologists in Ultrasound Consensus on Routine Pelvic US for Endometriosis. Radiology 2024; 311:e232191. [PMID: 38591980 DOI: 10.1148/radiol.232191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Endometriosis is a prevalent and potentially debilitating condition that mostly affects individuals of reproductive age, and often has a substantial diagnostic delay. US is usually the first-line imaging modality used when patients report chronic pelvic pain or have issues of infertility, both common symptoms of endometriosis. Other than the visualization of an endometrioma, sonologists frequently do not appreciate endometriosis on routine transvaginal US images. Given a substantial body of literature describing techniques to depict endometriosis at US, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to make recommendations aimed at improving the screening process for endometriosis. The panel was composed of experts in the imaging and management of endometriosis, including radiologists, sonographers, gynecologists, reproductive endocrinologists, and minimally invasive gynecologic surgeons. A comprehensive literature review combined with a modified Delphi technique achieved a consensus. This statement defines the targeted screening population, describes techniques for augmenting pelvic US, establishes direct and indirect observations for endometriosis at US, creates an observational grading and reporting system, and makes recommendations for additional imaging and patient management. The panel recommends transvaginal US of the posterior compartment, observation of the relative positioning of the uterus and ovaries, and the uterine sliding sign maneuver to improve the detection of endometriosis. These additional techniques can be performed in 5 minutes or less and could ultimately decrease the delay of an endometriosis diagnosis in at-risk patients.
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Affiliation(s)
- Scott W Young
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Priyanka Jha
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Luciana Chamié
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Shuchi Rodgers
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Rosanne M Kho
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Mindy M Horrow
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Phyllis Glanc
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Myra Feldman
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Yvette Groszmann
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Zaraq Khan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Steven L Young
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Liina Poder
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Tatnai L Burnett
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Eric M Hu
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Susan Egan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
| | - Wendaline VanBuren
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.); Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz (R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (S.L.Y.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology, Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ (S.E.)
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Zaheer S, Zhou AL, Gross JM, Kilic A. Unusual presentation and delayed diagnosis of cardiac angiosarcoma. J Cardiothorac Surg 2024; 19:161. [PMID: 38549142 PMCID: PMC10979550 DOI: 10.1186/s13019-024-02555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 01/30/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Primary cardiac angiosarcomas are very rare and present aggressively with high rates of metastasis. Given the poor prognosis, particularly once disease has spread, early diagnosis and multidisciplinary treatment is essential. CASE PRESENTATION We present the case of a 46-year-old male who presented with chest pain, intermittent fevers, and dyspnea. Workup with computed tomography scan and transesophageal echocardiography demonstrated a right atrial pseudoaneurysm. Given the concern for rupture, the patient was taken to the operating room, where resection of the pseudoaneurysm and repair using a bovine pericardial patch was performed. Histopathology report initially demonstrated perivascular lymphocyte infiltrate. Six weeks later, the patient represented with chest pain and new word finding difficulty. Workup revealed multiple solid lung, pericardial, brain, and bone nodules. Eventual biopsy of a cardiophrenic nodule demonstrated angiosarcoma, and rereview of the original pathology slides confirmed the diagnosis of primary cardiac angiosarcoma. CONCLUSIONS Primary cardiac angiosarcomas are often misdiagnosed given the rarity of these tumors, but early diagnosis and initiation of treatment is essential. The unique presentation of our case demonstrates that clinical suspicion for cardiac angiosarcoma should be maintained for spontaneous pseudoaneurysm originating from the right atrium.
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Affiliation(s)
- Salman Zaheer
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Alice L Zhou
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - John M Gross
- Bone and Soft Tissue Pathology, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower Suite 7107, Baltimore, MD, 21287, USA
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
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Lo ES, Kwok HM, Pan NY. Imaging spectrum and complications of otogenic infections: insights into delayed diagnosis. Br J Radiol 2024; 97:726-733. [PMID: 38335140 DOI: 10.1093/bjr/tqae015] [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: 12/06/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
Skull base osteomyelitis (SBO) is a late manifestation of complicated otogenic infections that presents a diagnostic challenge. Delayed or missed diagnoses lead to high morbidity and mortality and can be attributed to non-specific symptoms, subtle early radiologic findings, radiologic mimicry of nasopharyngeal carcinoma (NPC), and under-recognition from clinician and radiologists. This pictorial review aims to emphasize on early imaging recognition and distinction between SBO and NPC.
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Affiliation(s)
- Eugene Sean Lo
- Diagnostic Radiology Department, Princess Margaret Hospital, Kowloon, 2-10 Princess Margaret Hospital Road, Hong Kong
| | - Hoi Ming Kwok
- Diagnostic Radiology Department, Princess Margaret Hospital, Kowloon, 2-10 Princess Margaret Hospital Road, Hong Kong
| | - Nin Yuan Pan
- Diagnostic Radiology Department, Princess Margaret Hospital, Kowloon, 2-10 Princess Margaret Hospital Road, Hong Kong
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Iacovantuono M, Ferrigno S, Conigliaro P, Triggianese P, D'Antonio A, Spinelli FR, Bergamini A, Chimenti MS. Evaluation of diagnostic and therapeutic delay in patients with rheumatoid arthritis and psoriatic arthritis. Reumatismo 2024; 76. [PMID: 38523584 DOI: 10.4081/reumatismo.2024.1607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/04/2023] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE A monocentric cross-sectional study recruiting rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients residing in the Lazio region, Italy, to assess factors related to diagnostic delay and treatment accessibility. METHODS Clinical/serological data, including the time between symptom onset, diagnosis, and the beginning of treatment, were collected. Residence, referral to a rheumatologic center, physician who made the diagnosis, and previous misdiagnosis were also evaluated. RESULTS A higher diagnostic delay (p=0.003), and time between symptom onset and the start of I-line therapy (p=0.006) were observed in PsA compared to RA. A delayed start of II-line therapy was observed in RA compared to PsA (p=0.0007). Higher diagnostic delay (p=0.02), and time between symptom onset and the start of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) (p=0.02) were observed among residents of small-medium cities for both groups. Patients who have been diagnosed by another physician rather than a rheumatologist had a longer diagnostic delay (p=0.034) and a delayed start of I-line therapy (p=0.019). Patients who received a different previous diagnosis experienced greater diagnostic delay (p=0.03 and p=0.003) and time of start of csDMARDs (p=0.05 and p=0.01) compared with those receiving RA or PsA as the first diagnosis. PsA had a delay in starting targeted synthetic disease-modifying anti-rheumatic drugs (p=0.0004) compared to RA. Seronegative RA had delayed diagnosis (p=0.02) and beginning of therapies (p=0.03; p=0.04) compared to seropositive ones. CONCLUSIONS According to our results, greater diagnostic delay was found in PsA compared to RA, in patients living in small-medium cities, in those who did not receive the diagnosis from a rheumatologist, in those who were previously misdiagnosed, and in seronegative RA.
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Affiliation(s)
- M Iacovantuono
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Tor Vergata University, Rome.
| | - S Ferrigno
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Tor Vergata University, Rome.
| | - P Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Tor Vergata University, Rome.
| | - P Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Tor Vergata University, Rome.
| | - A D'Antonio
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Tor Vergata University, Rome.
| | - F R Spinelli
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome.
| | - A Bergamini
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Tor Vergata University, Rome.
| | - M S Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, Tor Vergata University, Rome.
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Kumar Jindal A, Basu S, Tyagi R, Barman P, Sil A, Chawla S, Kaur A, Tyagi R, Jangra I, Machhua S, Sendhil Kumaran M, Dogra S, Vinay K, Bishnoi A, Sharma R, Garg R, Saka R, Suri D, Pandiarajan V, Pilania R, Dhaliwal M, Sharma S, Rawat A, Singh S. Delay in diagnosis is the most important proximate reason for mortality in hereditary angio-oedema: our experience at Chandigarh, India. Clin Exp Dermatol 2024; 49:368-374. [PMID: 38039144 DOI: 10.1093/ced/llad428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Hereditary angio-oedema (HAE) is a rare autosomal dominant disorder characterized clinically by recurrent episodes of nonpruritic subcutaneous and/or submucosal oedema. Laryngeal oedema is the commonest cause of mortality in patients with HAE. Prior to the availability of first-line treatment options for the management of HAE, mortality was as high as 30%. Mortality has significantly declined in countries where first-line treatment options are available and patients can access these therapies. There is a paucity of literature on the outcomes of patients with HAE in developing countries where availability of and access to first-line treatment options are still a challenge. OBJECTIVES To report our experience on mortality in patients with HAE and to report factors associated with the death of these patients. METHODS We carried out a record review of all patients diagnosed with HAE between January 1996 and August 2022. Families with HAE who had reported the death of at least one family member/relative from laryngeal oedema were studied in detail. RESULTS Of the 65 families (170 patients) registered in the clinic, 16 families reported the death of at least one family member/relative from laryngeal oedema (total of 36 deaths). Of these 16 families, 14 reported that 1 or more family members had experienced at least 1 attack of laryngeal oedema. One patient died during follow-up when she was taking long-term prophylaxis with stanozolol and tranexamic acid, while the remaining 35 patients were not diagnosed with HAE at the time of their death. At the time of death of all 36 patients, at least 1 other family member had symptoms suggestive of HAE, but the diagnosis was not established for the family. CONCLUSIONS To our knowledge, this is the largest single-centre cohort of patients with HAE in India reporting mortality data and factors associated with death in these families. The delay in diagnosis is the most important reason for mortality.
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Affiliation(s)
- Ankur Kumar Jindal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suprit Basu
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reva Tyagi
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabal Barman
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Archan Sil
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanchi Chawla
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anit Kaur
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Tyagi
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Isheeta Jangra
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanghamitra Machhua
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajni Sharma
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravinder Garg
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ruchi Saka
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vignesh Pandiarajan
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Pilania
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Dhaliwal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saniya Sharma
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Buch Kjeldgaard A, Kinder-Klausen MS, Nerstrøm M, Cohen J, Henriksen BM, Thorup JM. The impact of ultrasound on testicular loss in cases of testicular torsion in children. Pediatr Surg Int 2024; 40:83. [PMID: 38507099 PMCID: PMC10954916 DOI: 10.1007/s00383-024-05663-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Ultrasound as a diagnostic tool in suspicion of testicular torsion is still highly debated. In this investigation, we aimed to evaluate whether time spent on scrotal ultrasonography had a negative impact on testicular loss. METHODS Patients' records containing a scrotal ultrasound and/or surgical procedure codes for testicular interventions on suspicion of testicular torsion were examined. Patients aged 0-15 years admitted during 2015-2019 at Copenhagen University Hospital, Rigshospitalet were included. RESULTS In total, 1566 patients underwent an ultrasound and 142 of these proceeded to surgery while 13 patients proceeded directly to surgery without an ultrasound. The rate of testicular loss with a preceding ultrasound was 23% versus 42% without (p = 0.18). Four cases of testicular torsion were misdiagnosed by ultrasound resulting in a sensitivity of 95.4% and specificity of 95.6%. The mean diagnostic delay from ultrasound examination was 55 ± 39 min, and the mean time from ultrasound to surgery was at 169 ± 76 min versus 171 ± 72 min without ultrasound. CONCLUSION In a clinical setting, ultrasound provided a reliable tool for the diagnosis of testicular torsion and did not seem to increase the orchiectomy rate.
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Affiliation(s)
- Anastasia Buch Kjeldgaard
- Department of Pediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Laboratory of Tissue Engineering, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | | | - Malene Nerstrøm
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jonathan Cohen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birthe Merete Henriksen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Mogens Thorup
- Department of Pediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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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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Crisafulli S, Fontana A, L'Abbate L, Vitturi G, Cozzolino A, Gianfrilli D, De Martino MC, Amico B, Combi C, Trifirò G. Machine learning-based algorithms applied to drug prescriptions and other healthcare services in the Sicilian claims database to identify acromegaly as a model for the earlier diagnosis of rare diseases. Sci Rep 2024; 14:6186. [PMID: 38485706 PMCID: PMC10940660 DOI: 10.1038/s41598-024-56240-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
Acromegaly is a rare disease characterized by a diagnostic delay ranging from 5 to 10 years from the symptoms' onset. The aim of this study was to develop and internally validate machine-learning algorithms to identify a combination of variables for the early diagnosis of acromegaly. This retrospective population-based study was conducted between 2011 and 2018 using data from the claims databases of Sicily Region, in Southern Italy. To identify combinations of potential predictors of acromegaly diagnosis, conditional and unconditional penalized multivariable logistic regression models and three machine learning algorithms (i.e., the Recursive Partitioning and Regression Tree, the Random Forest and the Support Vector Machine) were used, and their performance was evaluated. The random forest (RF) algorithm achieved the highest Area under the ROC Curve value of 0.83 (95% CI 0.79-0.87). The sensitivity in the test set, computed at the optimal threshold of predicted probabilities, ranged from 28% for the unconditional logistic regression model to 69% for the RF. Overall, the only diagnosis predictor selected by all five models and algorithms was the number of immunosuppressants-related pharmacy claims. The other predictors selected by at least two models were eventually combined in an unconditional logistic regression to develop a meta-score that achieved an acceptable discrimination accuracy (AUC = 0.71, 95% CI 0.66-0.75). Findings of this study showed that data-driven machine learning algorithms may play a role in supporting the early diagnosis of rare diseases such as acromegaly.
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Affiliation(s)
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Luca L'Abbate
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giacomo Vitturi
- Department of Diagnostics and Public Health, University of Verona, P.Le L.A. Scuro 10, 37124, Verona, Italy
| | - Alessia Cozzolino
- Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniele Gianfrilli
- Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Beatrice Amico
- Department of Computer Science, University of Verona, Verona, Italy
| | - Carlo Combi
- Department of Computer Science, University of Verona, Verona, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, P.Le L.A. Scuro 10, 37124, Verona, Italy.
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Verhoeven JI, Kramer J, Seeger J, Molenaar JP, Braakman H, Kamsteeg EJ, Rodenburg RJ, Kusters B, Koudijs S, Van Engelen BG, Erasmus CE, Voermans NC. Brody Disease, an Early-Onset Myopathy With Delayed Relaxation and Abnormal Gait: A Case Series of 9 Children. Neurology 2024; 102:e209164. [PMID: 38373275 DOI: 10.1212/wnl.0000000000209164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/18/2023] [Indexed: 02/21/2024] Open
Abstract
Brody disease is a rare autosomal recessive myopathy, caused by pathogenic variants in the ATP2A1 gene. It is characterized by an exercise-induced delay in muscle relaxation, often reported as muscle stiffness. Children may manifest with an abnormal gait and difficulty running. Delayed relaxation is commonly undetected, resulting in a long diagnostic delay. Almost all published cases so far were adults with childhood onset and adult diagnosis. With diagnostic next-generation sequencing, an increasing number of patients are diagnosed in childhood. We describe the clinical and genetic features of 9 children from 6 families with Brody disease. All presented with exercise-induced delayed relaxation, reported as difficulty running and performing sports. Muscle strength and mass was normal, and several children even had an athletic appearance. However, the walking and running patterns were abnormal. The diagnostic delay ranged between 2 and 7 years. Uniformly, a wide range of other disorders were considered before genetic testing was performed, revealing pathogenic genetic variants in ATP2A1. To conclude, this case series is expected to improve clinical recognition and timely diagnosis of Brody disease in children. We propose that ATP2A1 should be added to gene panels for congenital myopathies, developmental and movement disorders, and muscle channelopathies.
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Affiliation(s)
- Jamie I Verhoeven
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jasper Kramer
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Juergen Seeger
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joery P Molenaar
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hilde Braakman
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Erik-Jan Kamsteeg
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Richard J Rodenburg
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Benno Kusters
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Suzanne Koudijs
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Baziel G Van Engelen
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Corrie E Erasmus
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicol C Voermans
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
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Pini Prato A, Erculiani M, Novi ML, Caraccia M, Grandi A, Casella S, Giacometti L, Montobbio G, Mottadelli G. Delayed diagnosis in Hirschsprung disease. Pediatr Surg Int 2024; 40:65. [PMID: 38436753 DOI: 10.1007/s00383-024-05657-5] [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] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Diagnostic delay in Hirschsprung disease is uncommon. Different definitions have been proposed but that of a diagnosis achieved after 12 months of age seems to be the most reliable and resorted to. Some authors reported a worse outcome in case of delay. Our study aims at providing the most relevant features of a series of patients who received a delayed diagnosis of Hirschsprung disease. MATERIALS AND METHODS All consecutive patients admitted to our Center with a delayed diagnosis of Hirschsprung diseases between January 2017 and July 2023 have been retrospectively enrolled. Demographic data, phenotype, genotype, surgical complications, and outcome were assessed and compared to those of literature. A number of variables were also compared to those of a series of patients admitted during the same study period without a delayed diagnosis. RESULTS A total of 45 patients were included (16.4% out of a series of 346 patients with data regarding age at diagnosis). Male to female ratio was 3.1:1. Median age at diagnosis was 41 months with a wide variation (range between 17 months and 58 years). All patients but 2 suffered from classic rectosigmoid aganglionosis. Normal meconium passage (58%) was reported in a significantly higher number of patients compared to what observed in a series without diagnostic delay (p = 0.0140). All other variables (associated anomalies, preoperative enterocolitis, complications, and functional outcome) proved not to have statistically significant differences compared to a series of patients without a diagnostic delay. CONCLUSIONS The results of our study underline that a significant percentage of patients are basically missed in the neonatal period mostly due to mild symptoms. Overall outcome does not differ from that of patients without diagnostic delay. Nonetheless, we underline the importance of a throughout investigation of all patients with meconium delay/failure and that of adopting a low threshold for performing rectal suction biopsies in constipated children to avoid misdiagnosis to serve the best for our patients.
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Affiliation(s)
- Alessio Pini Prato
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e Cesare Arrigo, Spalto Marengo, 46, 15121, Alessandria, Italy.
| | - M Erculiani
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e Cesare Arrigo, Spalto Marengo, 46, 15121, Alessandria, Italy
| | - M L Novi
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e Cesare Arrigo, Spalto Marengo, 46, 15121, Alessandria, Italy
| | - M Caraccia
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e Cesare Arrigo, Spalto Marengo, 46, 15121, Alessandria, Italy
| | - A Grandi
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e Cesare Arrigo, Spalto Marengo, 46, 15121, Alessandria, Italy
| | - S Casella
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e Cesare Arrigo, Spalto Marengo, 46, 15121, Alessandria, Italy
| | - L Giacometti
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e Cesare Arrigo, Spalto Marengo, 46, 15121, Alessandria, Italy
| | - G Montobbio
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e Cesare Arrigo, Spalto Marengo, 46, 15121, Alessandria, Italy
| | - G Mottadelli
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e Cesare Arrigo, Spalto Marengo, 46, 15121, Alessandria, Italy
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Mühlmann L, Pimentel FF, Tiezzi DG, Carrara HHA, de Andrade JM, Candido Dos Reis FJ. Delayed diagnosis and increased mortality risk: Assessing the effects of the COVID-19 pandemic on breast cancer recurrence. Clinics (Sao Paulo) 2024; 79:100340. [PMID: 38432122 PMCID: PMC10914555 DOI: 10.1016/j.clinsp.2024.100340] [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: 07/30/2023] [Revised: 12/30/2023] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic has had a significant global impact since its declaration in March 2020. The COVID-19 pandemic has disproportionately impacted cancer patients, particularly those with breast cancer. This study aims to analyze the effects of the pandemic on women diagnosed with breast cancer recurrence. METHODS A cohort study was conducted at a tertiary public hospital in São Paulo State, Brazil. Data were collected from electronic records. Patients diagnosed with breast cancer and experiencing recurrence between January 2011 and March 2022 were included. Survival analysis was performed using the Kaplan-Meier estimator and Cox regression. RESULTS The study included 187 patients, 45 in the pandemic group (recurrence after March 23, 2020) and 142 in the pre-pandemic group. Distant recurrences were more frequent in both groups (pre-pandemic: 62.7 %, pandemic: 75.5 %). Compared to the pre-pandemic group (1.8 years), the pandemic group experienced a longer mean time to recurrence detection (2.9 years) and significantly decreased median survival (9 months vs. 22 months). The Cox regression analysis confirmed an increased risk of death for women diagnosed with breast cancer recurrence during the pandemic period (HR = 1.92, 95 % CI 1.19‒3.12). CONCLUSION The present study is among the first to investigate the pandemic's specific effects on breast cancer recurrence, revealing concerning delays in detection and a decrease in survival rates. Prompt diagnosis, timely treatment initiation, and comprehensive support are crucial during public health crises. These findings urge healthcare systems to prioritize tailored care for breast cancer patients during pandemics.
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Affiliation(s)
- Lindson Mühlmann
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Franklin Fernandes Pimentel
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniel Guimarães Tiezzi
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Hélio Humberto Angotti Carrara
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Jurandyr Moreira de Andrade
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Francisco José Candido Dos Reis
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
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Gercek O, Ulusoy K, Yazar VM, Topal K. Effects of delayed diagnosis on tumor size, stage and grade in bladder cancer. Int Urol Nephrol 2024; 56:935-940. [PMID: 37847325 DOI: 10.1007/s11255-023-03829-1] [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: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE This study is planned based on the hypothesis that if bladder cancer is detected early, the disease would be less advanced and the possibility of treatment will increase, at least the recurrence-free survival will be longer. Regarding this hypothesis, it is aimed to investigate the effect of delayed diagnosis primarily on the disease factors. MATERIALS AND METHODS The study included 169 patients, who underwent TUR-BT with the suspicion of bladder cancer in the urology clinic of Afyonkarahisar Faculty of Medicine between April 2018 and April 2023. Demographic and clinical data of the patients were recorded and compared. RESULTS It was observed that the delay in diagnosis was significantly longer in patients with tumors larger than 3 cm compared to patients with tumors smaller than 3 cm (p < 0.001). In the correlation analysis between tumor size, duration of diagnosis delay, age, T stage, and tumor grade, a low level of positive correlation was observed between tumor size and duration of diagnosis delay, and it was statistically significant (r = 0.215, p = 0.005). CONCLUSION In our study, it was shown that the tumor size increases as the duration of diagnosis delay increases and this increase causes an increase of 0.088 mm in the pathological size of the tumor in the 1-day delay period. Considering that tumor size changes the risk group of the disease in bladder tumors, and relatedly the follow-up and treatment process changes, we believe that these data will be valuable in the management of bladder cancer.
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Affiliation(s)
- O Gercek
- Department of Urology, Afyonkarahisar Health Sciences University, 03100, Afyonkarahisar, Turkey.
| | - K Ulusoy
- Department of Urology, Afyonkarahisar Health Sciences University, 03100, Afyonkarahisar, Turkey
| | - V M Yazar
- Department of Urology, Afyonkarahisar Health Sciences University, 03100, Afyonkarahisar, Turkey
| | - K Topal
- Department of Urology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
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Czarnywojtek A, Agaimy A, Pietrończyk K, Nixon IJ, Vander Poorten V, Mäkitie AA, Zafereo M, Florek E, Sawicka-Gutaj N, Ruchała M, Ferlito A. IgG4-related disease: an update on pathology and diagnostic criteria with a focus on salivary gland manifestations. Virchows Arch 2024; 484:381-399. [PMID: 38316669 DOI: 10.1007/s00428-024-03757-0] [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: 12/01/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a multi-organ disorder characterized by a highly variable clinical presentation depending on the affected organ/s, extent of tumefactive fibroinflammatory lesions, and associated functional impairment. The disease pursues a chronic, relapsing, often asymptomatic course and hence may pose a significant diagnostic challenge. Diagnostic delay can lead to progressive fibrosis and irreversible organ damage resulting into significant morbidity and even mortality. Given its broad clinical spectrum, physicians of all specialties may be the first clinicians facing this diagnostic challenge. Outside the pancreatobiliary system, the head and neck represents the major site of IgG4-RD with variable organ-specific diffuse or mass-forming lesions. In up to 75% of cases, elevated serum IgG4 levels are observed, but this figure possibly underestimates the fraction of seronegative cases, as the disease manifestations may present metachronously with significant intervals. Together with negative serology, this can lead to misdiagnosis of seronegative cases. A standardized nomenclature and diagnostic criteria for IgG4-RD were established in 2012 and revised in 2020 facilitating scientific research and expanding the range of diseases associated with IgG4 abnormalities. In addition to orbital pseudotumor, dacryoadenitis, Riedel thyroiditis, sinonasal manifestations, and rare miscellaneous conditions, IgG4-related sialadenitis is one of the most frequent presentations in the head and neck region. However, controversy still exists regarding the relationship between sialadenitis and IgG4-RD. This review focuses on the clinicopathological features of IgG4-related sialadenitis and its contemporary diagnostic criteria.
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Affiliation(s)
- Agata Czarnywojtek
- Department of Pharmacology, Poznan University of Medical Sciences, 60-806, Poznan, Poland
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355, Poznan, Poland
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | | | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, EH8 9YL, UK
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, KU Leuven University Hospitals, 3000, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, 3000, Leuven, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, and the Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014, Helsinki, Finland
| | - Mark Zafereo
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX, 77005, USA
| | - Ewa Florek
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, 60-806, Poznan, Poland.
| | - Nadia Sawicka-Gutaj
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355, Poznan, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355, Poznan, Poland
| | - Alfio Ferlito
- International Head and Neck Scientific Group, 35100, Padua, Italy
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Seabra B, Duarte R. Tuberculosis national registries and data on diagnosis delay - Is there room for improvement? Pulmonology 2024; 30:130-136. [PMID: 34167933 DOI: 10.1016/j.pulmoe.2021.05.004] [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: 01/18/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Excessive delay in the diagnosis of Tuberculosis may have a negative impact on the epidemiological control and elimination of this disease. An accurate determination and analysis of delay times may help identify where and how to improve Tuberculosis diagnosis according to local needs. The Portuguese Tuberculosis Surveillance System - SVIG-TB - is the main source of data regarding diagnosis delay. However, to our knowledge, there has been no recent evaluation of its data. This study's primary aim was to conduct a thorough quantitative and qualitative evaluation of data obtained from the SVIG-TB registry concerning the delay in Tuberculosis diagnosis in Matosinhos, a Portuguese municipality. METHODS All patients living in the Matosinhos municipality diagnosed with Tuberculosis between January 1st 2012 and December 31st 2019 were identified and individual SVIG-TB records retrieved. Patient-related, Healthcare-related and Total delay in Tuberculosis diagnosis were determined based on data obtained from this source and compared to data recovered from patient record review. Missing data, registering errors and differences in diagnosis delay between these two sources were analysed and compared. Subsequently, diagnosis delay data from a recent Portuguese nationwide SVIG-TB paper, covering years 2010 to 2014, was compared to local SVIG-TB and patient record review data. RESULTS This study identified a significantly greater percentage of cases with missing data on delay in SVIG-TB records when compared to Patient Record Review (57.2% versus 1.11%). The median patient-related, healthcare-related and Total delay in Tuberculosis diagnosis were of 17, 30 and 68 days, respectively, in the SVIG-TB based data. A significant underestimation of healthcare-related and total Tuberculosis diagnosis delay was identified in SVIG-TB data when compared to Patient Record Review. There was no significant difference between Patient-related delays determined from these two sources. Compared to the national study results, missing values were more common in this data set (57.2 vs 44.6%), mainly due to the absence of patient-related delay data. Median Total and Healthcare-related delays were significantly greater in Matosinhos Municipality, regardless of the data source (SVIG-TB or Patient Record Review). The patient-related delay was, conversely, shorter. CONCLUSIONS SVIG-TB has been crucial in guiding National Public Health policies on the path towards Tuberculosis elimination in Portugal. However, there is still room for improvement. These results provide a basis for further reflection on the shortcomings and potential of SVIG-TB in guiding the national Tuberculosis program.
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Affiliation(s)
- Bárbara Seabra
- Pulmonology Department, Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal; TB Outpatient Clinic (CDP) Matosinhos - Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
| | - Raquel Duarte
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho; TB Outpatient Clinic (CDP) Vila Nova de Gaia, Vila Nova de Gaia Portugal; Faculty of Medicine of the University of Porto (FMUP), Porto Portugal; Institute of Public Health (ISPUP), University of Porto, Porto Portugal
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Snyder DL, Dellon ES. Flipping the Script: Diagnostic Delay, Distensibility, and EoE Progression. Clin Gastroenterol Hepatol 2024; 22:484-485. [PMID: 37453594 DOI: 10.1016/j.cgh.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Diana L Snyder
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Boyce RM, Pretsch P, Tyrlik K, Schulz A, Giandomenico DA, Barbarin AM, Williams C. Delayed Diagnosis of Locally Acquired Lyme Disease, Central North Carolina, USA. Emerg Infect Dis 2024; 30:564-567. [PMID: 38407256 PMCID: PMC10902532 DOI: 10.3201/eid3003.231302] [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] [Indexed: 02/27/2024] Open
Abstract
Healthcare providers in North Carolina, USA, have limited experience diagnosing and managing Lyme disease because few cases occur annually statewide. We outline the prolonged diagnostic course for a patient with locally acquired Lyme disease in North Carolina. This case highlights the need for greater awareness and professional education.
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Beloshevski B, Shimshy-Kramer M, Yekutiel M, Levinsohn-Tavor O, Eisenberg N, Smorgick N. Delayed diagnosis and treatment of adolescents and young women with suspected endometriosis. J Gynecol Obstet Hum Reprod 2024; 53:102737. [PMID: 38280457 DOI: 10.1016/j.jogoh.2024.102737] [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: 09/25/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 01/29/2024]
Abstract
STUDY OBJECTIVE Early diagnosis and treatment of endometriosis in adolescents and young women is considered essential for improving their quality of life and for prevention of long-term complications. In adult women with endometriosis, significant delays in diagnosis and medical or surgical treatment have been described. Our study aimed to investigate the delay in diagnosis and treatment of adolescents and young women with suspected endometriosis. METHODS A retrospective study of adolescents and young women (12-22 years-old) who were evaluated for suspected endometriosis at the endometriosis clinic in the Shamir medical center between January 2017 and December 2022. All patients were referred by their primary care gynecologists. The evaluation in the endometriosis clinic included targeted history, physical exam and a focused ultrasound survey for endometriosis (performed trans-abdominally in all cases, and trans-vaginally in sexually active women). RESULTS Out of 400 women with suspected endometriosis evaluated in our endometriosis clinic during the study period, 68 were adolescents and young women <22 years old. Their mean age at time of evaluation for endometriosis was 18 ± 2.5 years, and the mean time-period from onset of symptoms to the endometriosis evaluation was 4.0 ± 2.9 years. Their most common symptoms were dysmenorrhea (in 61 cases, 89.7 %), followed by gastrointestinal symptoms (in 32 cases, 47.1 %). In 30 (44.1 %) cases, hormonal treatment was prescribed by the primary care gynecologist prior to their appointment in the endometriosis clinic. On comparison of patients with delay of <4 years (N = 31) versus ≥4 years (N = 37) from symptom onset to the endometriosis evaluation, patients with shorter duration of symptoms were more likely to decline any hormonal treatment for endometriosis while patients with longer duration of symptoms were more likely to accept the recommendation for hormonal treatment (16.2 % versus 0 %, p = 0.02, and 83.8 % versus 100 %, p = 0.03, respectively). CONCLUSION Adolescents and young women with suspected endometriosis may experience significant delays in diagnosis and medical care, similar to adult patients.
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Affiliation(s)
- Boris Beloshevski
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, (affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel), Beer Yaakov, Zerifin 70300, Israel
| | - Miriam Shimshy-Kramer
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, (affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel), Beer Yaakov, Zerifin 70300, Israel
| | - Matar Yekutiel
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, (affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel), Beer Yaakov, Zerifin 70300, Israel
| | - Orna Levinsohn-Tavor
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, (affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel), Beer Yaakov, Zerifin 70300, Israel
| | - Neta Eisenberg
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, (affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel), Beer Yaakov, Zerifin 70300, Israel
| | - Noam Smorgick
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, (affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel), Beer Yaakov, Zerifin 70300, Israel.
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Araujo IK, Shehata C, Hirano I, Gonsalves N, Kahrilas PJ, Tetreault MP, Schauer JM, Farina D, Peterson S, Kou W, Pandolfino JE, Carlson DA. The Severity of Reduced Esophageal Distensibility Parallels Eosinophilic Esophagitis Disease Duration. Clin Gastroenterol Hepatol 2024; 22:513-522.e1. [PMID: 37164112 PMCID: PMC10630533 DOI: 10.1016/j.cgh.2023.04.027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND & AIMS Chronic inflammation of eosinophilic esophagitis (EoE) results in progressive, fibrostenotic remodeling of the esophageal wall. This study aimed to demonstrate objective changes in esophageal distensibility relative to duration of EoE disease using a functional lumen imaging probe (FLIP). METHODS Adult patients with EoE who completed a 16-cm FLIP protocol during endoscopy were evaluated in a cross-sectional study. FLIP analysis focused on distensibility plateau (DP) of the esophageal body. The time from onset of symptoms to time of endoscopy with FLIP was assessed, as was time from symptom onset to EoE diagnosis (ie, diagnostic delay). RESULTS A total of 171 patients (mean age 38 ± 12 years; 31% female) were included; the median symptom duration was 8 (interquartile range, 3-15) years and diagnostic delay was 4 (interquartile range, 1-12) years. At the time of endoscopy with FLIP, there were 54 patients (39%) in histologic remission (<15 eosinophils per high-power field [eos/hpf]). Symptom duration and diagnostic delay were negatively correlated with DP (rho = -0.326 and -0.309; P values < .001). Abnormal esophageal distensibility (DP ≤17 mm) was more prevalent with increased duration of symptoms (P < .004): 23% at <5 years to 64% at ≥25 years. When stratifying the cohort based on mucosal eosinophil density, patients with ≥15 eos/hpf had significantly lower DP with greater symptom duration (P = .004), while there was not a significant difference among patients with <15 eos/hpf (P = .060). CONCLUSIONS Esophageal distensibility objectively measured with FLIP was reduced in EoE patients with greater symptom duration and diagnostic delay. This supports that EoE is a progressive, fibrostenotic disease and that FLIP may be a useful tool to monitor disease progression in EoE.
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Affiliation(s)
- Isis K Araujo
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Cristina Shehata
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nimala Gonsalves
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Peter J Kahrilas
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Marie-Pier Tetreault
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jacob M Schauer
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Domenico Farina
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stephanie Peterson
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Wenjun Kou
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dustin A Carlson
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Rotstein DL, Freedman MS, Lee L, Marrie RA, Morrow SA, McCombe JA, Parks NE, Smyth P, Konig A, Vyas MV. Predicting time to serologic diagnosis of AQP4+ NMOSD based on clinical factors and social determinants of health. Mult Scler Relat Disord 2024; 83:105434. [PMID: 38242051 DOI: 10.1016/j.msard.2024.105434] [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: 09/03/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Early serologic diagnosis and initiation of targeted therapy are associated with better outcomes in aquaporin-4 IgG positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD). OBJECTIVE To determine predictors of time to serologic diagnosis of AQP4+ NMOSD. METHODS In CANOPTICS, a multi-centre, Canadian cohort study of NMOSD, we retrospectively evaluated time from the first clinical attack to first positive AQP4-IgG serology. We used a multivariable negative binomial regression model to evaluate possible predictors of time to diagnosis. RESULTS We identified 129 participants with AQP4+ NMOSD from 7 centres. Diagnostic delay of >1 month was observed in 82 (63.6 %). Asian compared to European (White) ethnicity (IRR:0.40, 95 % CI:0.21-0.78), female sex (IRR:0.56, 95 % CI:0.32-0.99), later calendar year (IRR:0.84, 95 % CI:0.81-0.86), and hospitalization for the first attack (IRR:0.35, 95 % CI:0.20-0.62) were associated with shorter times to serologic diagnosis. We did not observe any overall effect of Afro-Caribbean ethnicity, but in exploratory analyses, Afro-Caribbean individuals with low income had longer times to diagnosis. CONCLUSION More than 60 % of patients with NMOSD experienced delays to AQP4-IgG serologic diagnosis in this cohort. Given evidence of more adverse long-term outcomes in Afro-Caribbean individuals with NMOSD, intersectional effects of ethnicity and social determinants of health merit further study.
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Affiliation(s)
- Dalia L Rotstein
- St. Michael's Hospital, 30 Bond St., Toronto, Ontario M5B 1W8, Canada; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, 3rd floor, Toronto, Ontario M5S 3H2, Canada.
| | - Mark S Freedman
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Liesly Lee
- Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, 3rd floor, Toronto, Ontario M5S 3H2, Canada; Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah A Morrow
- Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Andrea Konig
- St. Michael's Hospital, 30 Bond St., Toronto, Ontario M5B 1W8, Canada
| | - Manav V Vyas
- St. Michael's Hospital, 30 Bond St., Toronto, Ontario M5B 1W8, Canada; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, 3rd floor, Toronto, Ontario M5S 3H2, Canada
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