Delay In Definitive Diagnosis Research Articles

Identification of Risk Factors Associated with Tuberculosis in Southwest Iran: A Machine Learning Method.

Tuberculosis is a principal public health issue. Reducing and controlling tuberculosis did not result in the expected success despite implementing effective preventive and therapeutic programs, one of the reasons for which is the delay in definitive diagnosis. Therefore, creating a diagnostic aid system for tuberculosis screening can help in the early diagnosis of this disease. This research aims to use machine learning techniques to identify economic, social, and environmental factors affecting tuberculosis. This case-control study included 80 individuals with TB and 172 participants as controls. During January-October 2021, information was collected from thirty-six health centers in Ahvaz, southwest Iran. Five different machine learning approaches were used to identify factors associated with TB, including BMI, sex, age , marital status, education, employment status, size of the family, monthly income, cigarette smoking, hookah smoking, history of chronic illness, history of imprisonment, history of hospital admission, first-class family, second-class family, third-class family, friend, co-worker, neighbor, market, store, hospital, health center, workplace, restaurant, park, mosque, Basij base, Hairdressers and school. The data was analyzed using the statistical programming R software version 4.1.1. According to the calculated evaluation criteria, the accuracy level of 5 SVM, RF, LSSVM, KNN, and NB models is 0.99, 0.72, 0.97,0.99, and 0.95, respectively, and except for RF, the other models had the highest accuracy. Among the 39 investigated variables, 16 factors including First-class family (20.83%), friend (17.01%), health center (41.67%), hospital (24.74%), store (18.49%), market (14.32%), workplace (9.46%), history of hospital admission (51.82%), BMI (43.75%), sex (40.36%), age (22.83%), educational status (60.59%), employment status (43.58%), monthly income (63.80%), addiction (44.10%), history of imprisonment (38.19%) were of the highest importance on tuberculosis. The obtained results demonstrated that machine-learning techniques are effective in identifying economic, social, and environmental factors associated with tuberculosis. Identifying these different factors plays a significant role in preventing and performing appropriate and timely interventions to control this disease.

Prototype Salivary Assay for Quantification of Two Biomarkers for In Vitro Diagnosis of Endometriosis.

Endometriosis, a very common disease in women, is characterized by endometrial structures outside the uterine cavity. The lack of a reliable noninvasive diagnostic test and the often nonspecific symptoms of this pathology are responsible for the delay in definitive diagnosis of this disease. Recently, through a proteomics approach, our research group has identified two potential diagnostic markers for endometriosis in serum (Zn-alpha2-glycoprotein and complement C3 precursor). In this article, we describe the experimental conditions of a simple ELISA for rapid quantification of these two biomarkers in the saliva of patients with endometriosis. Finally, preliminary experiments on a small cohort of patients and controls have confirmed the potential diagnostic value of this assay.

Assessment of the Initial Diagnostic Accuracy of a Fragility Fracture of the Sacrum: A Study of 56 Patients.

Retrospective study. To investigate the clinical manifestations of a fragility fracture of the sacrum (FFS) and the factors that may contribute to a misdiagnosis. The number of patients diagnosed with FFS has increased because of extended life expectancy and osteoporosis. Patients with FFS may report nonspecific symptoms, such as back, buttock, groin, and/or leg pain, leading to a misdiagnosis and a delay in definitive diagnosis. Fifty-six patients (13 males and 43 females) with an average age of 80.2±9.2 years admitted to the hospital for FFS between 2006 and 2021 were analyzed retrospectively. The following patient data were collected using medical records: pain regions, a history of trauma, initial diagnoses, and rates of fracture detection using radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Forty-one patients presented with low back and/or buttock pain, nine presented with groin pain, and 17 presented with thigh or leg pain. There was no history of trauma in 18 patients (32%). At the initial visit, 27 patients (48%) were diagnosed with sacral or pelvic fragility fractures. In contrast, 29 patients (52%) were initially misdiagnosed with lumbar spine disease (23 patients), hip joint diseases (three patients), and buttock bruises (three patients). Fracture detection rates for FFS were 2% using radiography, 71% using CT, and 93% using MRI. FFS was diagnosed definitively using an MRI with a coronal short tau inversion recovery (STIR) sequence. Some patients with FFS have leg pain with no history of trauma and are initially misdiagnosed as having lumbar spine disease, hip joint disease, or simple bruises. When these clinical symptoms are reported, we recommend considering FFS as one of the differential diagnoses and performing lumbar or pelvic MRIs, particularly coronal STIR images, to rule out FFS.

Frequency and clinicoeconomic impact of delays to definitive diagnosis of obstructive hypertrophic cardiomyopathy in the United States

AimsThe diagnostic history in the years leading up to the definitive diagnosis of patients with obstructive hypertrophic cardiomyopathy (HCM) has not been studied.MethodsPatients with a delay in the definitive diagnosis of obstructive HCM from January 2009 to March 2019 were identified in the US IBM MarketScan Commercial and Medicare Supplemental Databases if they had an alternative diagnosis indicating a misdiagnosis during the 24 months before the definitive obstructive HCM diagnosis. Resource use and costs associated with the delay were estimated during the same period.ResultsOf 3,888 eligible patients with obstructive HCM, 59.5% had a delay in definitive diagnosis. Patients received a mean of 4.0 misdiagnoses before the definitive obstructive HCM diagnosis, most of which were other cardiovascular conditions. Consequently, 15.7% of patients may have received inappropriate treatment. Approximately 78.4% of patients visited a cardiologist (mean 4.7 visits) before the definitive obstructive HCM diagnosis. Additionally, 26.8% and 32.1% of patients had an inpatient and emergency room visit, respectively. Annualized healthcare costs associated with the delay were $4,379 per patient.LimitationsThe current study used administrative claims data for a commercially insured population. Therefore, the results may not be generalizable to other populations (e.g. those insured by Medicare or Medicaid and the uninsured). Like other database studies, the current study may have suffered from miscoding or undercoding, which may have caused misclassification of patients. Owing to insufficient data, the study could not evaluate all potential consequences of a delay in definitive diagnosis.ConclusionsMost patients with obstructive HCM had a delay of ≤ 2 years before receiving the definitive diagnosis. The diagnostic journey involved multiple potential misdiagnoses, predominantly cardiovascular, as well as a substantial clinical and economic burden on patients and the healthcare system.

Epidemic status of malaria and progress of malaria elimination in Henan Province, 2018

To understand the epidemic status of malaria and progress of malaria elimination in Henan Province in 2018, so as to provide the scientific evidence for formulating the control strategy of malaria. All data pertaining to the epidemic status of malaria and malaria case were captured from Henan Province in 2018, and the epidemic status of malaria and the diagnosis and treatment of malaria cases were analyzed using a descriptive epidemiological method. A total of 174 malaria cases were reported in Henan Province in 2018, with a male-to-female ratio of 33.8∶1. The cases were predominantly found at 30- and 40- years, and farmer was the highest-risk population. All cases were imported for overseas countries and 96.55% (168/174) were from Africa. The cases were reported across 17 cities of the province, and 63.22% (110 cases) were detected in 4 cities of Zhengzhou, Luoyang, Xuchang and Puyang. Both the median duration from onset to initial admission and the median time from the initial admission to definitive diagnosis were 1 d. There were 6 cases (3.45%) with more than 7 days to visit a doctor, and there were 13 cases (7.47%) with definitive diagnosis of over 7 days (delay in definitive diagnosis). All malaria cases were reported within 24 h, and 98.28% (171/174) completed case investigations within 3 d. All 18 cities had achieved malaria elimination by December 2018. All malaria cases reported in Henan Province in 2018 are imported from overseas countries. Intensifying malaria surveillance among returnees from Africa and Southeast Asia and timely identification and treatment of imported malaria cases are required to prevent the development of secondary malaria cases, so as to ensure the achievement of malaria elimination in Henan Province on schedule.

Temporal changes in slipped upper femoral epiphysis at a regional level: a declining incidence and literature review.

PurposeSlipped upper femoral epiphysis (SUFE) is one of the most common adolescent hip pathologies in children with potential for life-long morbidity secondary to avascular necrosis (AVN). The primary aim is to determine an up-to-date demographic of SUFE, as well as current trends in presentation and radiological characteristics. Secondary aims are to quantify prophylactic fixation and subsequent contralateral SUFE.MethodsBetween 01 January 2013 and 31 December 2015, all cases of SUFE were identified in Northern Ireland. Patient demographics, slip characteristics and outcomes are presented and the incidence rates were calculated using census data. Temporal changes in incidence, compared with a previous cohort, are demonstrated.ResultsA total of 56 patients (80 hips) were identified. Based on census data, SUFE incidence has declined from 7.14 to 4.69/100,000 population aged < 16 years. Male cases predominated by > 2:1 ratio, and tended to be older than female cases. Approximately 75% of patients were above the 75th centile for age-sex adjusted body weight. Knee pain as a presenting symptom led to a delay in diagnosis. Prophylactic fixation was performed in 25.9%, with contralateral slips occurring in 27.5%. AVN occurred in 7.4% and remained static.ConclusionThe incidence of SUFE has declined ~34% in our region. When SUFE occurs, knee pain often results in a delay in definitive diagnosis, and commands clinical vigilance to avoid delays in diagnosis. Patients in our region should be aware of a 1-in-4 contralateral slip rate. Overall, AVN rates remain static and are acceptable, despite the declining incidence of SUFE.Level of evidenceLevel III - Retrospective Cohort Study

Sinonasal Sarcoidosis: A Case Report

Sarcoidosis is a chronic granulomatous disease of unknown etiology which principally affects the lower respiratory tract &amp; lungs. Sarcoidosis in the head &amp; neck region is infrequent. Isolated sino nasal sarcoidosis without pulmonary involvement is rare.Case: An 18 years old male patient presented with the complaints of nasal blockage, purulent nasal discharge which was occasionally blood stained for 6 months, deformity of nose, swelling of face &amp; lips for 4 months &amp; watering of eyes for same duration. Endoscopy of nose revealed intra nasal mucosal thickening which was friable &amp; bleeds on touch. The diagnosis of sino nasal sarcoidosis was made by histopathological examination of nasal biopsy specimen.Conclusion: Sino nasal sarcoidosis is a disease of diagnostic challenge to the clinician as its mimicking clinical features may be misleading &amp; cause delay in definitive diagnosis. In the current case report, we presented a case of sino nasal sarcoidosis presenting as chronic rhino sinusitis.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.648-650

Gingival squamous cell carcinoma masquerading as periodontal pathology

Cancer of the oral cavity and pharynx are the most common type of head and neck cancer with annual global incidence estimated at approximately 480,000 cases. More than 90% of oral cancer cases occur in people older than 45 years. Lesions of gingiva account for approximately 10% of the oral squamous cell carcinomas and may clinically present mimicking as benign or inflammatory lesions, leading to delay in definitive diagnosis and treatment with unfavorable outcome. Present case is a 60 year old male patient who presented with chronic periodontal lesion since the past 6 months. However, a through history, clinical and histopathological examination revealed the lesion to be gingival squamous cell carcinoma and treatment was initiated.

Visual Diagnosis: An 11-Month-Old With Nausea, Vomiting, and an Abdominal Mass

Children with intussusception can present with a wide variety of symptoms, including vomiting, fever,lethargy, and abdominal pain. The classic triad of abdominal pain, hematochezia, and palpable abdominal mass is seen in a few patients.• Early diagnosis of intussusception depends on a high level of clinical suspicion in any child with non specific abdominal findings followed by appropriate radiographic or ultrasonographic evaluation and confirmation with a contrast enema.• Abdominal radiography, although an appropriate component of the initial workup for gastrointestinal symptoms, lacks the sensitivity to reliably exclude the presence of intussusception.• Because ultrasonography is a safe, sensitive, and specific test for the diagnosis of intussusceptions, it should be performed early whenever there is clinical suspicion of intussusception.• Contrast enema is the gold standard for diagnosis and first-line treatment of intussusception. There is an increasing trend for pneumatic reduction of intussusception compared with hydrostatic reduction.Intravenous placement, fluid resuscitation, and notification of the pediatric surgeon should be completed before contrast enema.

Targeting the initial investigation and management in cases of acute pulmonary embolism.

It was noted by consultants in our hospital that the early investigation of suspected pulmonary embolism (PE) lacked structure. This was causing delays in definitive diagnosis and early management. The resulting unnecessary use of investigation was also wasting resources. In particular, the inappropriate use of serum d-dimer tests was causing concern. The National Institute of Clinical Excellence (NICE) guidelines recommend use of the 2-level Well's score to target investigation in suspected PE. A baseline audit against the NICE guideline revealed that Well's scores were rarely used (only calculated in 12% of cases) and confirmed the suspicion that early investigation was poorly targeted.This project intervened using educational talks promoting the use of Well's scores in cases of suspected PE. Well's score proformas were placed in the emergency department and emergency assessment unit for reference. Their availability was advertised.This significantly increased the use of Well's scores (46% vs 11%, p<0.001). Fewer patients underwent unnecessary d-dimer measurements in cases of likely PE (65% vs 86%). Initial investigation was more targeted in cases where a Well's score had been calculated than in cases without a Well's score. For example, significantly fewer unnecessary d-dimer tests were performed in these cases (45% vs 100%, p<0.05).The cost of unnecessary investigation in suspected PE is not only significant financially but also in the resulting delay in definitive diagnosis and management for the patient. The simple intervention used here was effective in addressing this problem.

Bronchial Carcinoid Tumours in Children — A Review

Bronchial carcinoids (BCs) are rare, well-differentiated malignant neuroendocrine tumours that account for 2–5 % of all lung neoplasms in adults. In paediatric patients, carcinoids represent the most frequent primary lung cancer. Although BCs in childhood often have an endobronchial location causing airway obstruction, they are frequently misdiagnosed as benign conditions, resulting in a delay in definitive diagnosis and treatment. Surgery represents the treatment of choice for BCs, and lung-sparing resections (sleeve or bronchoplastic procedures) are recommended in central carcinoid tumours; pneumonectomy should be avoided, particularly in childhood. If promptly diagnosed and radically treated, BCs in children have an excellent prognosis. Relapses can occur many years after a radical resection, highlighting the necessity for long-term follow-up.

Standard cisplatin and etoposide (PE)-based chemotherapy in young adult patients with pineal germinomas.

e12547 Background: Pineal germ cell tumors are very rare, accounting for less than 1% of all intracranial tumors. The peak incidence occurs in the second decade of life. The mainstay of therapy is radiation, especially for germinomas that are very radiosensitive. Leptomeningeal dissemination and histology seem to confer a higher risk for recurrence after radiation. These tumors are also very sensitive to chemotherapy. Attempts to decrease the dose and field of radiation or even to avoid radiotherapy at all have been published. However, the experience with the adult population is very limited. We review retrospectively our experience in adult patients with PGCT that received cisplatin and etoposide-based (PE) chemotherapy in two Brazilian instituition in the last five years. Methods: Consecutive review of patient charts of the last five years of two Brazilian instituitions (Instituto do Cancer de São Paulo and Hospital A. C. Camargo). Results: In the last 5 years we identified 6 young adult patients bearing a PGCT that received PE-based chemotherapy. Median age 21 years (range 17 – 31); all male; all had germinomatous histology; all presented with intracranial hypertension. All patients recieved 45 Gy radiotherapy to the main tumor volume and three recieved 36 Gy spinal irradiation. Four patients received chemotherapy upfront and two patients at relapse after radiotherapy. The main reason for adding chemotherapy to the primary therapy was leptomeningeal involvement in three patients and delay in definitive diagnosis in another one (this patient was erroneously diagnosed initially as a menigioma). Chemotherapy regimens were PEB (cisplatin, etoposide and bleomycin) in four patients and PE in two. Five patients received 4 cycles and one received 3 cycles. Survival data is as follows: of the six patients, five are alive and free of relapse at 9+, 15+, 32+, 52+, 60+ months. One patient died of recurrent systemic disease. Conclusions: Standard PE-based chemotherapy seems to be highly effective when combined to low-dose craniospinal radiotherapy in pineal germinomas in young adult patients. It could be considered as a backbone for future protocols aiming to decrease dose and/or field of radiotherapy in these tumors. No significant financial relationships to disclose.

Subperiosteal Osteoid Osteoma of the Neck of Talus

Juxta-articular, subperiosteal osteoid osteomas arising around the ankle are unusual. Tumors arising on the neck of the talus commonly produce symptoms mimicking monoarticular arthritis. Patients are usually treated for arthritis or ankle sprain, which often leads to a delay in definitive diagnosis. Here we present a case of osteoid osteoma of neck of talus which was presented as ankle pain. It puzzled us until MRI was done. Diagnostic dilemma and delay can be avoided by high index of suspicion. The patient was treated with open removal of the tumor. We also present brief review of literature about juxta-articular, subperiosteal osteoid osteoma which is uncommon from the typical osteoid osteoma occurring elsewhere in the body.

Supervivencia de pacientes diagnosticados de cáncer de próstata seguidos en atención primaria

Objective To study survival of patients with prostate cancer and its relationship with diagnostic delay. Design Retrospective cohort study. Setting Six rural primary care practices. Participants All patients diagnosed with prostate cancer and monitored in these practices between 1992 and 2005. Main measurements Patient age at definite diagnosis, dates of definite and suspected diagnosis, diagnostic method, treatment strategy, and date of death, if it occurred, were determined. Kaplan-Meier analysis was used to estimate survival probability; and Cox's regression, to examine prognostic factors. Results A total of 84 patients were identified. Mean (SD) age at diagnosis was 75.8 (8.6) years. Median delay until definite diagnosis was 31 days. The diagnosis was carried out through biopsy in 38 cases (45.2%). Eighteen patients were given possibly curative treatment (21.4%) and 66 patients (78.6%) received palliative treatment. Mean age of the deceased was 82.6 (9.1) years. Of 49 patients who died by the end of the study, 22 (44.9%) died from prostate cancer. Mean survival was 72.1 months (SE, 6.1). The probability of overall survival 10 years after diagnosis was 33.3%, and specific survival was 57.5%. There were no differences in survival due to delay in definite diagnosis. Conclusions Survival after diagnosis of prostate cancer can be considered high. There is no relationship between survival and delay in definite diagnosis in patients with prostate cancer.

Foreign body aspiration: Clinical, radiological findings and factors associated with its late removal

The study was carried out to assess the clinical and radiological findings and factors related to delay in definite diagnosis of foreign body aspiration and its removal. Medical charts of 280 bronchoscopic-proven foreign body (FB) inhalators were reviewed. To analyze factors related to late removal, the population studied was divided into two groups according to time elapsed between injury and care-seeking (up to 24h and longer than 24h) followed by FB removal. Most children (69.5%) were under three, most were males (63.1%) and in 47.5%, rigid bronchoscopy was performed 24h after the accident. Organic foreign bodies were found in 63.4% of cases, most frequently peanuts (20.5%). Mortality related to FB aspiration reached 0.7%. In comparison with endoscopic diagnosis, clinical and radiological abnormalities were found in 99.3 and 84.3% (95% CI, 79.5-88.4%) of studied patients, respectively. The number of health services sought until definite diagnosis was the only factor associated with late removal (OR=23.0, 95% CI, 10.7-49.3%, p<0.001). The population studied presented a long delay in FB removal, thus demanding actions enhancing parent, physician and health services awareness, aiming at an earlier referral for diagnostic and therapeutic bronchoscopy.

The effects of prebiopsy corticosteroid treatment on the diagnosis of mediastinal lymphoma

Background/Purpose: For children with probable mediastinal lymphoma and a high risk of cardiorespiratory morbidity, many centers recommend delaying the diagnostic biopsy for 24 to 48 hours while corticosteroids are administered to reduce tumor size and morbidity. This study was undertaken to determine the effect of preoperative steroid use on the accuracy of the pathological diagnosis and incidence of perioperative cardiorespiratory morbidity. Methods: From 1988 to 1998, 86 children were treated for mediastinal lymphoma. Twenty-three received steroid before biopsy (study group) because of clinical evidence of respiratory compromise, and the remaining 63 served as controls. Clinical parameters, steroid use, and detailed pathological findings obtained at initial and subsequent biopsies were reviewed. Steroid treatment was considered to have had an adverse effect on the pathological diagnosis if (1) a definitive diagnosis was delayed more that 1 month, (2) a definitive diagnosis could not be made, or (3) the extent of disease could not be staged with certainty. Results: Steroid treatment had an adverse effect on the pathological diagnosis in 5 of 23 (22%) children: 1 diagnostic delay, 3 failures of a definitive diagnosis, and 1 possible failure of staging. A definitive diagnosis was made in all control patients. Perioperative survival was 100% in both groups. At biopsy, only 3 children in the steroid treatment group and 2 children in the control group had moderate, nonfatal cardiorespiratory instability. Parameters of steroid use among children who had inaccurate pathological diagnoses or cardiorespiratory morbidity were not significantly different from those who did not. Conclusions: Steroid treatment before biopsy of mediastinal lymphoma may adversely affect the pathological accuracy or cause a delay in definitive diagnosis in a minority of cases. The dose and duration of steroid use was not related to outcome. Prebiopsy steroid appears to minimize the likelihood of cardiorespiratory morbidity in high-risk patients. J Pediatr Surg 35:973-976. Copyright © 2000 by W.B. Saunders Company.

Unifocal Langerhans' Cell Histiocytosis (Eosinophilic Granuloma) of the Petrous Apex

Eosinophilic granuloma is a localized form of histiocytosis X, or Langerhans' cell histiocytosis, a benign lesion of proliferating Langerhans' cells. It is the least severe of the histiocytosis syndromes, and is characterized by lytic lesions of one or more bones. Temporal bone lesions usually occur in association with multifocal disease; however, isolated lesions may occur in either the mastoid bone alone, or in the entire temporal bone, without disease elsewhere in the body. We present the first case (to our knowledge) of eosinophilic granuloma, or unifocal Langerhans' cell histiocytosis, limited to the petrous apex. The patient, an 8-year-old girl, presented with facial nerve paralysis. Because of delay in definitive diagnosis, the disease extended beyond its original boundaries and resulted in complete destruction of the temporal bone. We will also review Langerhans' cell histiocytosis, with attention to its involvement of the temporal bone.

Invasive necrotizing infection secondary to anorectal abscess.

During a six-year period, six patients were treated for invasive necrotizing infection secondary to anorectal abscess. The delay in definitive diagnosis and treatment ranged from three to 14 days. All patients had significant concomitant diseases. The number of operative procedures for each patient ranged from one to nine. Antibiotics, as well as nutritional supplementation by the parenteral or enteral route, were used on all patients. Each patient had three or more complications attributable to this infection. Hospital stay ranged from 30 to 76 days. All patients survived. Factors contributing to the development of this condition are delay in diagnosis, inadequate and inappropriate treatment, and concomitant disease. Factors associated with a satisfactory outcome are examination under general or conduction anesthesia by an experienced examiner, prompt and definitive operation therapy (including drainage and removal ov all necrotic tissue), antibiotics, frequent reexamination under general anesthesia, nutritional support, and close attention to concomitant disease.

Nuclear Medicine in Diseases of the Central Nervous System

Simple and safe enough to be used as a screening procedure in ambulatory as well as hospitalized patients, brain scanning detects, differentiates, and localizes a wide variety of lesions, often eliminating delay in definitive diagnosis and treatment. With modern high-speed scintillation cameras and new radiopharmaceuticals, its range has now been expanded to dynamic studies of such processes as movement of the C S F.