Late Diagnosis Of Patients Research Articles

Burden of schistosomiasis‐related mortality in Brazil: epidemiological patterns and spatial–temporal distribution, 2003–2018

To characterise the epidemiological patterns and the spatial-temporal distribution of schistosomiasis-related mortality in Brazil from 2003 to 2018. A national population-based ecological study that used official data from the Mortality Information System. The data included all deaths recorded in Brazil from 2003 to 2018 in which schistosomiasis was mentioned in the death certificate as an underlying or associated cause of death (multiple causes). The municipalities of residence were used as units of geographic analysis, and standardised and smoothed mortality rates (per 100000 inhabitants) were calculated using the local empirical Bayes method. Spatial autocorrelation was evaluated using global and local Moran indexes. To analyse the spatial dependence, the Getis-Ord G and Gi* statistics were used. During the study period, 18421113 deaths were recorded in Brazil. Schistosomiasis was mentioned in 11487 deaths (proportional mortality: 0.06%); for 8141 deaths (70.87%), it was listed as the underlying cause, and for 3346 deaths (29.13%), it was listed as an associated cause. The mean mortality rate was 0.38 deaths/100000 inhabitants. Individuals≥70years of age (RR: 115.34, 95% CI: 68.56-194.03) and residents in the Northeast region (RR: 10.81, 95% CI: 5.95-19.66) presented higher risks related to schistosomiasis. Municipalities with high mortality rates were identified in all regions, and high-risk clusters were found in municipalities located in the Northeast and Southeast regions of the country. Schistosomiasis remains an important cause of death in persistently endemic areas in Brazil, particularly in those with a high prevalence of the disease and a marked parasite load.

The high incidence of late presenters for HIV/AIDS infection in the Lodz province, Poland in the years 2009–2016: we are still far from the UNAIDS 90% target

ABSTRACTThe present study retrospectively analyses the prevalence of late diagnosis in patients with newly-diagnosed HIV infection in Lodz, Poland from January 2009 to December 2016, and assesses the predictive factors associated with late presenters. Late presentation is defined as a diagnosis of HIV with a CD4 count<350 cells/μL, or the occurrence of an AIDS- defining event, regardless of the CD4 cell count. Two hundred and fifty-nine (62.86%) patients were late presenters, 178 of whom (68.72%) were advanced late presenters (CD4 cell count below 200 cells/μL). Multivariate factors associated with late HIV presentation included referral from physician for HIV testing (OR: 3.95, 95% CI 2.42–6.46), older age (OR: 1.81, 95% CI: 1.38–2.38) and route of HIV transmission. Heterosexual patients (OR 1.98, 95% CI: 1.01–3.90), active drug users (OR: 3.49, 95% CI: 1.63–7.48) and patients who did not report the route of transmission (OR: 4.29, 95%: CI 1.45–12.62) were more likely to present late than MSM subjects. In conclusion, the majority of HIV-infected patients are still diagnosed late. There is a need for expanded testing not only in MSM group, in which HIV prevalence is the highest, but also in intravenous drug users, or among subjects who are heterosexual or from a higher age group.

Clinical characteristics and outcomes for patients with an initial emergency presentation of malignancy: A 15 month audit of patient level data

AimTo investigate the demographics, diagnoses and outcomes for new adult cancer patients with an initial presentation via the A&E or acute oncology teams. BackgroundPatients with initial emergency presentation of malignancy have been documented to have poorer treatment outcomes and shorter survival. Patient level data on this subject is relatively limited with regard to the demographics, diagnoses and the clinical factors that may underlie late presentations. MethodsA 15 month audit of the patients presenting with a new diagnosis of malignancy was performed in 2011–2012. Data on demographics, diagnosis and outcome were assembled and analysed. The clinical data on emergency presentations were compared to reference information on the incidence and median age at presentation for each malignancy within the standard population. ResultsDuring the study a total of 178 new cancer patients presented via the A and E service. The most frequent diagnoses were lung cancer with 21% of cases and CNS and colorectal cancer each with 9% of cases. There was a higher incidence of emergency new presentations of lung cancer, CNS tumours, ovarian, pancreatic and testicular cancer than in the standard population, whilst breast cancer, bladder cancer and prostate cancer patients were under-represented.The median age at diagnosis was 74 and for a number of malignancies including CNS tumours, breast cancer, colorectal cancer and head and neck cancer the emergency cases presented at significantly greater ages than in the standard population. Overall 27% of patients were unfit or unsuitable for a diagnostic biopsy, this group had only a 3 month median survival compared to 14 months for those suitable for biopsy and treatment. ConclusionDespite a wide range of initiatives, the emergency and late diagnosis of patients with metastatic cancer remains a significant challenge with many patients too advanced and unwell at presentation for active treatment. These patients tend to be older and have malignancies that present with either non-specific symptoms or symptoms requiring acute assessment. Improving the pathways for these patients will be challenging and require additional planning on improving awareness and access for these potentially hard to reach patients.

Prognostic Factors and Therapy Assessment of IgA Nephropathy: Report from a Single Unit in Iran

Background: Immunoglobulin A (IgA) nephropathy is the most common cause of primary glomerulonephritis with slow progression to end-stage renal disease (ESRD) in up to 40% of patients. Methods: A retrospective cohort study of patients with biopsy-proven IgA nephropathy was performed in our center from 1998 to 2009. We tried to determine the clinical and pathological factors which affect patients progressing to ESRD. We also compared the impact of renin–angiotensin system (RAS) blockers therapy alone or in combination with prednisone on baseline proteinuria and glomerular filtration rate (GFR) after 6 months of treatment in patients with proteinuria>1 g/d and GFR>30 mL/min. Results: There were 70 IgA nephropathy patients of whom 46 were men. The average age of patients at biopsy was 39 ± 12.1 years. During the median 23.5 (6–130) months of follow-up, 10 patients progressed to ESRD and no patient died. Five-year renal survival following biopsy was 88%. By multivariate analysis, age more than 50 years (p = 0.003) and baseline serum creatinine level (p = 0.012) were independent predictors of progressing to ESRD and poor prognosis. Although there was no significant difference in proteinuria reduction after 6 months of treatment, kidney function was less preserved in RAS inhibitors therapy alone than in the combination treatment with prednisone. Conclusion: We showed that late diagnosis of patients with IgA nephropathy might be associated with poor outcome. Our results also suggest that addition of prednisone to RAS blockers may lead to better preservation of kidney function.

Do we adequately diagnose early gastric cancer in Turkey

Late diagnosis of patients with advanced gastric cancer is due to late admission of patients or overlooked early gastric cancers in early endoscopies. We retrospectively evaluated gastroscopic results in our clinic over 9 years and assessed outcomes of all patients diagnosed and treated for gastric cancers, including early gastric cancers. We retrospectively evaluated all gastroscopic reports in our hospital between January 2000 and January 2009, dividing these patients into two time periods: 2000-2004 and 2005-2009. For all patients with early gastric cancers, we assessed age, gender, macroscopic tumor type, location in the stomach, type of surgery, histopathological verification of the tumor, lymph node involvement and general patient condition. Of the 37,768 patients who underwent gastroscopy, 3.53% (536 patients) during 2000-2004 and 4.3% (973 patients) during 2005-2009 were diagnosed with gastric cancer. During these two time periods, 21 (3.91%) and 61 (6.26%), respectively, of the patients who underwent radical surgical intervention were diagnosed with histopathologically proven early gastric cancers. The rate of early gastric cancers among patients with gastric cancer was lower in Turkey than in western countries and Japan. As in other western countries, screening endoscopy is not feasible in Turkey. The use of chromoendoscopy and magnified endoscopy, particularly in patients with alarm symptoms and in risk groups, may increase the rate of early diagnosis.

Oft unterschätzte Probleme in der Lipidologie: Verspätung in der Diagnose und Tachyphylaxie in der Therapie

Summary Frequently underestimated problems in lipidology: late diagnosis and tachyphylaxis in treatment ( We report the case of a 44-year-old patient with severe hypercholesterol- aemia, referred to our outpatient clinic . On the basis of the clinical findings we performed a molecular genetic analysis which confirmed the suggested point mutation at amino acid position 3,500 (R3,500Q) in the gene encoding apolipo- protein B-100. The diagnosis of familial defective apolipoprotein B-100 (FDB) was thus molecularly proven. Unfortunately, at the time of diagnosis, a hitherto unknown three-vessel coronary artery disease was already present. ( In addition, this case confronted us with the problem of a potential tachyphy- laxis phenomenon when using atorvastatin. Replacing atorvastatin by rosu- vastatin resulted in a marked and persistent subsequent reduction of the total and LDL-cholesterol concentrations lasting for 40 months at least. ( The frequent problems of late diagnosis in patients with familial forms of hypercholesterolaemia and an insufficient long-term treatment are discussed.

Diagnostic pitfalls in sporadic transthyretin familial amyloid polyneuropathy (TTR-FAP)

Transthyretin familial amyloid polyneuropathies (TTR-FAPs) are autosomal dominant neuropathies of fatal outcome within 10 years after inaugural symptoms. Late diagnosis in patients who present as nonfamilial cases delays adequate management and genetic counseling. Clinical data of the 90 patients who presented as nonfamilial cases of the 300 patients of our cohort of patients with TTR-FAP were reviewed. They were 21 women and 69 men with a mean age at onset of 61 (extremes: 38 to 78 years) and 17 different mutations of the TTR gene including Val30Met (38 cases), Ser77Tyr (16 cases), Ile107Val (15 cases), and Ser77Phe (5 cases). Initial manifestations included mainly limb paresthesias (49 patients) or pain (17 patients). Walking difficulty and weakness (five patients) and cardiac or gastrointestinal manifestations (five patients), were less common at onset. Mean interval to diagnosis was 4 years (range 1 to 10 years); 18 cases were mistaken for chronic inflammatory demyelinating polyneuropathy, which was the most common diagnostic error. At referral a length-dependent sensory loss affected the lower limbs in 2, all four limbs in 20, and four limbs and anterior trunk in 77 patients. All sensations were affected in 60 patients (67%), while small fiber dysfunction predominated in the others. Severe dysautonomia affected 80 patients (90%), with postural hypotension in 52, gastrointestinal dysfunction in 50, impotence in 58 of 69 men, and sphincter disturbance in 31. Twelve patients required a cardiac pacemaker. Nerve biopsy was diagnostic in 54 of 65 patients and salivary gland biopsy in 20 of 30. Decreased nerve conduction velocity, increased CSF protein, negative biopsy findings, and false immunolabeling of amyloid deposits were the main causes of diagnostic errors. We conclude that DNA testing, which is the most reliable test for TTR-FAP, should be performed in patients with a progressive length-dependent small fiber polyneuropathy of unknown origin, especially when associated with autonomic dysfunction.

Early detection of breast cancer in relation to patient and physician characteristics

Higher participation rates of women in regular examination for early cancer detection (Krebsfrüherkennungsuntersuchung, KFU) are expected to improve the effectiveness of breast cancer screening. In the Federal Republic of Germany the law guaranties yearly examination. The detection of early stages is also intended to make breast conserving therapy possible. In our project "Patient- and physician-related problems of early breast cancer detection" we believed that early detection of breast cancer depends not solely on the participation of women entitled to make use of regular examination. We assumed that it depends also on the diagnostic reliability of the examinating physicians. Therefore, we became interested in the factors that cause early or late diagnosis in patients with malignant and good breast lesions. In order to identify these factors, we asked patients and the examinating physicians for case reports. Our qualitative investigations included 50 patients in the area of Munich and Ulm. We found out that, though most patients participated regularly in the early cancer detection examination, participation had no influence on early or late detection of the disease. The majority of patients included in the study, belonged to the group of women with a high participation rate according to the statistics. In general, examination for early cancer detection failed to recognize breast cancer in symptomless women. Not until the patient presented symptoms breast cancer was diagnosed. Early and late diagnoses followed this pattern. Only the patient with early breast cancer and primary surgery by a gynaecologist retained her breast. The surgeons removed the breast. They did not even consider partial resection.(ABSTRACT TRUNCATED AT 250 WORDS)