Incidence Of Late Presentation Research Articles

Impact of the COVID-19 Pandemic on ST-elevation Myocardial Infarction from a Single-center Experience in Tokyo.

Objective The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on global healthcare systems. Some studies have reported the negative impact of COVID-19 on ST-elevation myocardial infarction (STEMI) patients; however, the impact in Japan remains unclear. This study investigated the impact of the COVID-19 pandemic on STEMI patients admitted to an academic tertiary-care center in Tokyo, Japan. Methods In this retrospective, observational, cohort study, we included 398 consecutive patients who were admitted to our institute from January 1, 2018, to March 10, 2021, and compared the incidence of hospitalization, clinical characteristics, time course, management, and outcomes before and after March 11, 2020, the date when the World Health Organization declared COVID-19 a pandemic. Results There was a 10.7% reduction in hospitalization of STEMI patients during the COVID-19 pandemic compared with that in the previous year (117 vs. 131 cases). During the COVID-19 pandemic, the incidence of late presentation was significantly higher (26.5% vs. 12.1%, p<0.001), and the onset-to-door [241 (IQR: 70-926) vs. 128 (IQR: 66-493) minutes, p=0.028] and door-to-balloon [72 (IQR: 61-128) vs. 60 (IQR: 43-90) min, p<0.001] times were significantly longer than in the previous year. Furthermore, the in-hospital mortality was higher, but the difference was not significant (9.4% vs. 5.0%, p=0.098). Conclusion The COVID-19 pandemic significantly impacted STEMI patients in Tokyo and resulted in a slight decrease in hospitalization, a significant increase in late presentation and treatment delays, and a slight but nonsignificant increase in mortality. In the COVID-19 era, the acute management system for STEMI in Japan must be reviewed.

COVID-19 pandemic is associated with mechanical complications in patients with ST-elevation myocardial infarction

ObjectiveAlthough there are regional reports that the COVID-19 pandemic is associated with a reduction in acute myocardial infarction presentations and primary percutaneous coronary intervention (PCI) procedures, little is known about...

Recurrent pleomorphic adenoma: is treatment considerably delayed thus affecting surgical morbidity?

Objective: To examine the incidence of late presentation of patients with recurrent pleomorphic adenoma (RPA) of the parotid gland.Methods: This is a retrospective analysis of patients treated in our center. We examined patients demographics, disease characteristics, treatment, and outcome and as well as the time period length from the first discovery of a recurrent mass until seeking treatment at our clinic and its effect on morbidity.Results: A total of 30 patients were included. 26% underwent initial enucleation in other institutions. In eight patients (26%), the recurrence of the mass was second or higher. The patients average time period length until seeking treatment was 2.48 years, with 33% of patients showing a time period length of over three years. Multifocal tumor, tumor diameter larger than 2 cm and facial nerve involvement were found in 15 (50%),16 (53.3%) and seven (25%) patients respectively. Patient's delay of presentation by ≥3 years was associated with a tumor size of ≥2 cm (Relative Risk [RR] = 2, p = .02). Patient's delay of presentation by ≥2 years was also associated with a trend towards a higher rate of post-operative facial nerve palsy (RR = 3.37, p = .07, CI = 0.88–12.85).Conclusion: Most patients with RPA were presented late, thus affecting disease extent and surgical morbidity.

An audit of vascular surgery experience at North Surgical Unit, Mayo Hospital Lahore

The prevalence of Peripheral vascular disease, Carotid artery stenosis and Aortic aneurysm in our society is higher than generally accepted because of higher incidence of established modifiable risk factors like Smoking, Diabetes, Hypertension and Hyperlipidaemia. We present a review of 246 patients with prospective collection of data who were referred for opinion to North Surgical Ward Mayo Hospital Lahore from March 2005 to February 2006. Surgical treatment was possible in 165 patients. Amongst remaining 81 patients 38 presented late and had amputations either in referring unit or with us and 43 were managed conservatively or under follow up. 24 prosthetic grafts were used, 8 in Aortic aneurysms, 4 in carotid endarterectomies and 11 in iliofemoral reconstructions with no peri-operative mortality or stroke. We had 2 grafts occlusion and amputations in critically ischaemic patients who had single vessel run off. Non invasive investigations were the first choice in Carotid and peripheral vascular disease. Conclusion: Our experience shows higher incidence of late presentation and under treatment of these high risk patients which need patient awareness and life style modification at community level. We advocate multidisciplinary approach and establishment of fully supported dedicated peripheral vascular and endovascular services at tertiary care level.

Late presentation in adolescent idiopathic scoliosis

Children and young teenagers with adolescent idiopathic scoliosis (AIS) not infrequently present with Cobb angles in excess of 40° at the first clinic visit. This study aimed to establish the incidence of this group of patients, identify the possible factors that may account for the late presentation, and make appropriate recommendations where applicable. This is an institutional review board-approved study. The index posteroanterior spinal radiographs of all 1176 AIS patients who presented to our institution between January 2007 and December 2011 were independently reviewed by two authors (J.Z.J.L. and K.B.L.L.). Patients with curves 40° or greater were included. An interviewer-administered survey was conducted by phone interview to obtain demographic information and identify possible factors for late presentation. The incidence of late presenters was found to be 5.5% (65/1176). The response rate was 73.8% (48/65). Twenty-four (50.0%) respondents acknowledged delaying seeking help after initial suspicion of scoliosis. The reasons cited most were that they were 'too busy' and 'did not know it was scoliosis'. Thirteen (27.1%) respondents attempted 'alternative' treatment before their first specialist appointment, of which 'Chinese Sinseh massage' was the most popular. Thirty-two (66.7%) respondents were not aware of AIS before their diagnosis. In conclusion, the incidence of late presentation in AIS is 5.5% in this series and significantly higher than the published figure of 0.1%. A time delay in seeking help because of a poor understanding of the condition and the failure to appreciate the importance of early specialist review may have contributed toward this relatively high incidence. Patient education and emphasis on timely specialist review can enhance and complement school screening to reduce the incidence of late presentation.

P3 The national lung cancer awareness campaign: Evidence of a measurable impact in stage shift and eligibility for radical therapy

RationaleLung cancer survival in North East London is consistently lower than expected. The incidence of late presentation with advanced, inoperable disease is significantly higher; our patients are also more likely...

Malignant diseases at Nnewi: the continuing scourge of late presentation

Background: Late presentation to hospital by patients with malignant diseases has remained a chronic problem. This work aims at studying the number of patients with malignant diseases that presented late to our centers as against those that presented early, to find out reasons for late presentation and to suggest ways of decreasing the incidence of late presentation. Patients and Methods: General surgical patients with malignant diseases seen between September 11, 2003 and September 10 2010 were recruited. Each lesion was clinically staged and a histological diagnosis obtained. At presentation, any lesion still within the primary site of origin and/or the regional lymph node was considered ‘early’. If the lesion had gone beyond the regional lymph node, it was considered ‘late’. Results: A total of 822 patients with confirmed malignant lesions were seen. Their ages ranged from 21 to 85 years. There were 364 males and 458 females. Majority of the patients did not acquire secondary education. Only 234 (28.5%) presented early. The remaining 588 patients (71.5%) presented late. Conclusions: Majority of the patients with malignant diseases in our community present late to hospital. Poverty and illiteracy on the part of the patients, as well as deceit of patients by quacks contribute significantly to these late presentations. Missed diagnosis by some doctors is also contributory. To decrease these late presentations, efforts should be directed at improving the general literacy level and the financial capability of the community as well as the diagnostic acumen of doctors.

Congenital diaphragmatic hernia "occulta".

Congenital diaphragmatic hernia usually presents with cyanotic attacks, dyspnoea and dextrocardia, a typical triad which is almost considered pathognomonic. The case records of 10 patients (out of a total of 20) of congenital diaphragmatic hernia presenting beyond the neonatal period were reviewed retrospectively. Age and symptoms at presentation and signs elicited were paid special attention. All the patients underwent operative repair of hernia under general anaesthesia. Given below is an explanation for such a high incidence of late presentation in our series. This nomenclature (Congenital Diaphragmatic Hernia "Occulta") will help clinicians in remembering this entity if and when such patients present to the clinicians.

The early management of congenital dislocation of the hip

The unstable hip at birth continues to evade detection, although determined efforts with screening can reduce the incidence of late presentation to a gratifyingly low level.‘.’ Failure to monitor abnormal or suspicious hips at the neonatal stage leads to disappointing results since acetabular and femoral head deformities progressively worsen. thus preventing a precise and durable reduction. The detection of the displaced or unstable hip at birth depends upon a thorough examination of the infant by an experienced examiner. If the assessment is hurried or the baby is squalling the value of this vital check is lost; it is equally important that the examiner, who need not be a medical practitioner, is well-versed in the technique.