Late Recognition Research Articles

New Treatments for Synovial Cell Sarcoma with Genetically Modified T-Cell?

Synovial cell sarcoma is rare but very aggressive tumour if not treated early, due to the painless nature of this tumour patients normally come in late and advances stage, can occur in bones, muscle cells, cartilages, ligaments and de-novo from pleuripotent stem cells from asnywhere in the body but most commonly arm, leg, or foot, and near joints such as the wrist or ankle and possibly from any joints in the body, even from soft tissues of lung and abdomen, the other name for this tumour is called malignant synovioma.The 5 year survival after the effective primary treatment is 30-75% and the survival rate is less than 5% if the tumour recurred within 1 year of primary treatment and that’s why new treatments are explored continuously. Due to late recognition and diagnosis of this rare tumour leads to many problems in treatment and in disease course. This tumour can occur at any age but is most common in growing periods like teen agers and adolescents. This tumour can spread to any organ in the body but most commonly distant metastases occur in lungs. Synovial sarcomas actually a misnomer as previously thought, now with advances in cell structure advances, These tumours can occur not only from synovial cells but from any cell of bone, muscle, tendon, ligaments and cartilage forming cells and supporting cells. These tumours occur with equal propensity in both men and women of younger age. If diagnosed early and treated early with surgery alone patients can be cured completely without any morbidity and mortality

Case Report: Cotard's Syndrome in Anti-N-methyl D-aspartate (NMDA) Receptor (Anti-NMDAR) Encephalitis

Cotard's syndrome is uncommon psychopathology among patients with psychotic illnesses. Limited cases had been reported regarding the occurrence of this syndrome in anti-NMDAR encephalitis which itself is a relatively new disease that often presents with florid psychotic symptoms. This poses difficulties in differentiating it from a primary psychiatric illness. Late recognition of anti-NMDAR encephalitis can lead to death as it can progress to autonomic instability in its natural course of illness. We report a patient who first presented with psychotic symptoms with initial negative findings from baseline investigations. Further investigation revealed anti NMDAR antibodies in the cerebrospinal fluid. Prompt treatment was initiated and despite early poor response to the first-line treatment with the development of allergic reaction, our patient recovered completely after 1 month of hospitalization. This case report aims to highlight the importance of early detection of anti-NMDAR encephalitis and the possibility of uncommon psychopathology such as Cotard's syndrome occurring in this disease.

Leveraging EHR Data to Evaluate the Association of Late Recognition of Deterioration With Outcomes.

Emergency transfers (ETs), deterioration events with late recognition requiring ICU interventions within 1 hour of transfer, are associated with adverse outcomes. We leveraged electronic health record (EHR) data to assess the association between ETs and outcomes. We also evaluated the association between intervention timing (urgency) and outcomes. We conducted a propensity-score-matched study of hospitalized children requiring ICU transfer between 2015 and 2019 at a single institution. The primary exposure was ET, automatically classified using Epic Clarity Data stored in our enterprise data warehouse endotracheal tube in lines/drains/airway flowsheet, vasopressor in medication administration record, and/or ≥60 ml/kg intravenous fluids in intake/output flowsheets recorded within 1 hour of transfer. Urgent intervention was defined as interventions within 12 hours of transfer. Of 2037 index transfers, 129 (6.3%) met ET criteria. In the propensity-score-matched cohort (127 ET, 374 matched controls), ET was associated with higher in-hospital mortality (13% vs 6.1%; odds ratio, 2.47; 95% confidence interval [95% CI], 1.24-4.9, P = .01), longer ICU length of stay (subdistribution hazard ratio of ICU discharge 0.74; 95% CI, 0.61-0.91, P < .01), and longer posttransfer length of stay (SHR of hospital discharge 0.71; 95% CI, 0.56-0.90, P < .01). Increased intervention urgency was associated with increased mortality risk: 4.1% no intervention, 6.4% urgent intervention, and 10% emergent intervention. An EHR measure of deterioration with late recognition is associated with increased mortality and length of stay. Mortality risk increased with intervention urgency. Leveraging EHR automation facilitates generalizability, multicenter collaboratives, and metric consistency.

Harnessing the Data Universe to Understand and Reduce Clinical Deterioration in Children.

Harnessing the Data Universe to Understand and Reduce Clinical Deterioration in Children.

Purple Urine Bag Syndrome as the Primary Presenting Feature of a Urinary Tract Infection

Purple urine bag syndrome (PUBS) is a curious condition that manifests with purple discoloration of a urinary catheter bag as a result of a urinary tract infection (UTI). This syndrome is produced through a reaction between urinary by-products and the components of a plastic urinary catheter bag. Predisposing factors include old age, long-term catheterization, chronic constipation, and limited mobility. We describe a case of a UTI in a 90-year-old woman in which the initial presentation was PUBS. Here, late recognition of PUBS led to delayed treatment of the associated UTI. Despite being a simple spot diagnosis, knowledge about this uncommon syndrome is lacking amongst clinicians and this may have implications on patient outcomes.

Meeting abstracts from the 15th international conference on neonatal and childhood pulmonary vascular disease

Meeting abstracts from the 15th international conference on neonatal and childhood pulmonary vascular disease

Detection of HIV Virologic Failure and Switch to Second-Line Therapy: A Systematic Review and Meta-analysis of Data From Sub-Saharan Africa.

BackgroundThe late recognition of virologic failure (VF) places persons with HIV in Sub-Saharan Africa at risk for HIV transmission, disease progression, and death. We conducted a systematic review and meta-analysis to determine if the recognition and response to VF in the region has improved.MethodsWe searched for studies reporting CD4 count at confirmed VF or at switch to second-line antiretroviral therapy (ART). Using a random-effects metaregression model, we analyzed temporal trends in CD4 count at VF—or at second-line ART switch—over time. We also explored temporal trends in delay between VF and switch to second-line ART.ResultsWe identified 26 studies enrolling patients with VF and 10 enrolling patients at second-line ART switch. For studies that enrolled patients at VF, pooled mean CD4 cell count at failure was 187 cells/mm3 (95% CI, 111 to 263). There was no significant change in CD4 count at confirmed failure over time (+4 cells/year; 95% CI, –7 to 15). Among studies that enrolled patients at second-line switch, the pooled mean CD4 count was 108 cells/mm3 (95% CI, 63 to 154). CD4 count at switch increased slightly over time (+10 CD4 cells/year; 95% CI, 2 to 19). During the same period, the mean delay between confirmation of VF and switch was 530 days, with no significant decline over time (–14 days/year; 95% CI, –58 to 52).ConclusionsVF in Africa remains an event recognized late in HIV infection, a problem compounded by ongoing delays between VF and second-line switch.

Spinal Cord Atrophy Predicts Progressive Disease in Relapsing Multiple Sclerosis.

ObjectiveA major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progression and conversion to secondary progressive disease (SPMS).MethodsFrom a single‐center observational study, all RRMS (n = 360) and SPMS (n = 47) patients and 80 matched controls were evaluated. RRMS patient subsets who converted to SPMS (n = 54) or silently progressed (n = 159), respectively, during the 12‐year observation period were compared to clinically matched RRMS patients remaining RRMS (n = 54) or stable (n = 147), respectively. From brain MRI, we assessed the value of brain and spinal cord measures to predict silent progression and SPMS conversion.ResultsPatients who developed SPMS showed faster cord atrophy rates (−2.19%/yr) at least 4 years before conversion compared to their RRMS matches (−0.88%/yr, p < 0.001). Spinal cord atrophy rates decelerated after conversion (−1.63%/yr, p = 0.010) towards those of SPMS patients from study entry (−1.04%). Each 1% faster spinal cord atrophy rate was associated with 69% (p < 0.0001) and 53% (p < 0.0001) shorter time to silent progression and SPMS conversion, respectively.InterpretationSilent progression and conversion to secondary progressive disease are predominantly related to cervical cord atrophy. This atrophy is often present from the earliest disease stages and predicts the speed of silent progression and conversion to Progressive MS. Diagnosis of SPMS is rather a late recognition of this neurodegenerative process than a distinct disease phase. ANN NEUROL 2022;91:268–281

Tempestividade da perda por redução ao valor recuperável do goodwill em empresas brasileiras

ABSTRACT This article aimed to examine the timeliness of goodwill impairment perceived by the Brazilian capital market. Despite it being widely studied internationally, the timeliness of goodwill impairment has not yet been empirically investigated in Brazil, given that previous studies focus on the determinants of this loss, on its disclosure, or on manager behavior. This question is relevant primarily due to the context of standardization of the International Accounting Standards Board (IASB), which has discussed possibilities for altering the treatment of goodwill. It is also important for investors, since a lack of timeliness affects the utility of accounting information for these users. The study provides indications that the discretion of the impairment test is used opportunistically, altering the moment of recognition of a goodwill loss. This shows the need for a joint effort between monitoring agents and standard-setting bodies to guide the use of discretion, as well as changes in manager behavior. It also indicates that the current rule for recording impairment fails in providing timely information, as it provides a shielding effect against losses. The study used non-financial companies listed on the B3 S.A. - Brasil, Bolsa, Balcão that had goodwill recognized in the 2010-2020 period. The analysis considered two dependent variables, applying a logistic regression to explain the recognition or not of goodwill impairment and a tobit model to predict its value. To examine timeliness, the current and lagged annual returns on shares were used. The findings suggest that losses through goodwill impairment are not recognized in a timely manner and that managers delay recording them by at least one to two years, with stronger indications of late recognition in two years. In addition, the loss amount can be influenced by returns occurring up to three years before its recording.

CONVOLUTIONAL DEEP LEARNING NEURAL NETWORK FOR STROKE IMAGE RECOGNITION: REVIEW

Deep learning is one of the developing area of articial intelligence research. It includes machine learning methods based on articial neural networks. One method that has been widely used and researched in recent years is convolution neural networks (CNN). Convolutional neural networks have dierent research issues and medicine is one of the main ones. Today, the predominant global problem is acute cerebral blood ow disorder - stroke. The most important diagnostic tests for stroke are computerized tomography (CT) imaging and magnetic resonance imaging (MRI). However, late recognition and diagnosis by a specialist can aect the lives of many patients. For such cases, the role and help of the convolutional neural networks is extraordinary. In-depth clustering neural networks apply non-linear transformations and abstractions of highlevel models in large databases. Year after year, advances in the eld of deep learning architecture, namely crate neural networks for the recognition of stroke, are making a signicant contribution to the development of medicine. The given article aords a review of the achievements of deep learning neural networks in the recognition of stroke from brain images. The next review chronologically presents the main neural network block diagram and open databases providing MRI and CT images. In addition, a comparative analysis of the use of convolutional neural networks in the detection of stroke is presented, as well as the achieved indicators of the methodologies used.

Impossibilidade da comunicação:

Aristóteles é estimado como a fonte mais importante para os estudos de comunicação na Antiguidade grega. Isso vem de uma tradição filosófica racionalista que, por muito tempo, dificultou o reconhecimento da sofística como um movimento produtor de teorias filosóficas autênticas. O objetivo deste artigo é apresentar a ontologia do sofista Górgias de Leontinos como uma possível contribuição da filosofia antiga para os estudos de comunicação. Nossa conclusão é que o resgate da sofística estimula uma concepção de comunicação que leva a temas importantes para a sociedade grega assim como para a sociedade contemporânea, mobilizando as noções de verdade, discurso e realidade.

Clinical Presentation and Management of Eyes with Globe Perforation during Peribulbar and Retrobulbar Anesthesia: A Retrospective Case Series.

PurposeTo evaluate the clinical presentation, management, and outcome of eyes with an inadvertent globe perforation during peribulbar or retrobulbar block.MethodsThis retrospective study evaluated the eyes which had an accidental globe perforation during local ocular anesthesia from 2012 to 2020. The patients were divided into three groups: group 1, Clear media with no rhegmatogenous retinal detachment (RRD); group 2, significant vitreous hemorrhage (VH) precluding the retinal view without RRD; and group 3, RRD with/without VH.ResultsTwenty-five patients were included in the study. The mean axial length (AL) was 24.7 ± 2.7 mm (range, 20.9–31.2 mm). The most common presenting feature was VH (n = 14). The treatment included retinal laser barrage (n = 7) and vitrectomy (n = 17). Retinal breaks were identified in all the eyes (total breaks = 37). The mean presenting best-corrected visual acuity in groups 1, 2, and 3 were logarithm of the minimum angle of resolution 0.79 ± 0.73, 1.82 ± 0.78, and 2.13 ± 0.59 respectively. All the treated patients had an attached retina at the last follow-up. The mean final best-corrected visual acuity for each group was logarithm of the minimum angle of resolution 0.59 ± 0.79, 0.48 ± 0.26, and 1.25 ± 0.64, respectively (p = 0.006). The development of RRD was associated with a larger AL (p = 0.015); while the development of significant VH associated with the superior location of the perforation (p = 0.015), late recognition of the perforation (p = 0.004), and multiple perforations (p = 0.015).ConclusionsEarly recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer AL, superior, and multiple perforations are at higher risk of developing complications like RRD and VH. Complications like RRD, macular injury, and vascular occlusion are risk factors for poor prognosis.

Hepatocellular Carcinoma in Non-cirrhotic Liver Arises with a More Advanced Tumoral Appearance: A Single-Center Cohort Study.

A small proportion of all hepatocellular carcinomas (HCCs) arise in a non-cirrhotic liver (NCL). However, our knowledge about the HCCs developing in a NCL is scarce. This study was undertaken to investigate the characteristics and survival course of this patient group. We retrospectively analyzed the database of patients with HCC at a tertiary center during a 10-year period (2009-2019). All demographic, clinical, laboratory, and tumoral features with survival outcomes were compared between the HCC-CL and HCC-NCL groups. Out of 384 HCC cases, 11.2% (n = 43) had no cirrhosis. The dominant etiology in the HCC-NCL group was hepatitis B virus (n = 26, 60.5%), followed by non-alcoholic fatty liver disease (n = 10, 23.2%), and hepatitis C virus (n = 7, 16.3%). The maximum tumor diameter was approximately 2 times larger in the HCC-NCL group (HCC-NCL: 90 mm vs. HCC-CL: 46.5 mm, P < .001). The proportion of patients with vascular (HCC-NCL: 27.9% vs. HCC-CL: 8.6%, P < .001) and extrahepatic invasion (HCC-NCL: 14% vs. HCC-CL: 3%, P = .001) were prominently higher in the HCC-NCL group. Patients with HCC-NCL were less often detected in early-curable stages (BCLC 0-A) than those in the HCC-CL group (HCC-NCL: 16.3% vs. HCC-CL: 34.9%, P = .004). The overall survival was not different between the 2 groups (HCC-NCL: 19.4 ± 9.8 months vs. HCC-CL: 17.5 ± 2.3 months, P = .581). HCC in NCL is diagnosed at more advanced tumoral stages with larger tumor size and more often with vascular and extrahepatic spread. Despite the preserved liver functions, the overall survival is not prolonged in HCCs without cirrhosis, due to the late recognition.

Single Plaque Lepromatous Leprosy Presenting as Granuloma Annulare

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, primarily affecting the peripheral nerves and skin. The clinical presentation of leprosy is highly variable, depending on the immune status of the individual. Based on the Ridley–Jopling classification, the clinical spectrum ranges from tuberculoid to lepromatous leprosy (LL). In all its stages, it can mimic various other conditions. Early and accurate diagnosis of leprosy is crucial because late recognition may give rise to permanent deformity resulting from the disease. Here, we report a case of LL clinically presenting as granuloma annulare in a 75-year-old man, which was diagnosed and confirmed by histopathology.

Knowledge of neonatal danger signs and associated factors among mothers attending pediatric immunization clinics in Gidan District Health Centers, North Wollo, Ethiopia

BackgroundThe majority of neonatal deaths in developing countries occurred at home due to late recognition of the signs of serious illness by parents or caregivers. In Ethiopia, besides the attempts made to scale-up the maternal and child health services, maternal knowledge of neonatal danger signs is low. Therefore, this study aimed to assess the knowledge of neonatal danger signs and associated factors among mothers attending pediatric immunization clinics in Gidan district health centers, North Wollo, Ethiopia. MethodAn institution-based cross-sectional study was conducted from September 1–30, 2020, among 399 mothers attending pediatric immunization clinics in Gidan district health centers. The data were collected using a pretested, structured, and interviewer-administered questionnaire. Epidata version 4.4.2.0 was used for data entry, and Statistical Package for Social Sciences version 22 was used for analysis. Descriptive statistics, bivariate and multivariate logistic regression were computed. Finally, an adjusted odds ratio along with 95% CI was calculated, and variables that had a P-value <0.05 were declared statistically significant. ResultThe level of good maternal knowledge of neonatal danger signs in the study area was 48.1% (95% CI, 43.6%–52.9%). Maternal education level (AOR: 3.58, 95% CI, 1.22–10.55), parity (AOR: 2.10, 95% CI 1.18–3.71), having postnatal care follow-up (AOR: 2.05, 95% CI, 1.21–3.49), receiving health education about neonatal danger signs (AOR: 4.87, 95% CI, 2.73–8.68), and previous experience of neonatal danger signs (AOR: 2.35, 95% CI, 1.33–4.15) were significantly associated variables with the maternal knowledge of neonatal danger signs. ConclusionThis study revealed that maternal knowledge of neonatal danger signs was low. Maternal educational level, parity, postnatal care follow-up, health education about neonatal danger signs, and previous experience of neonatal danger signs were significantly associated variables. Therefore, maternal knowledge of neonatal danger signs needs to be enhanced through improving postnatal care services utilization and providing adequate health education about newborn health problems.

Using quality improvement to standardise and enhance the use of the national early warning score (NEWS) in an old age psychiatry inpatient setting

AimsWithin an inpatient old-age psychiatry setting, there is an increased risk of acute physical deterioration secondary to age, comorbidities and reduced physiological reserve. Numerous recent clinical incidents highlighted late recognition of physical deterioration within this population. We assessed the use of the NEWS, a system for scoring physiological measurements, in an old-age psychiatry ward and subsequently attempted to improve performance of obtaining physical health observations in this cohort of patients.MethodRetrospective pre- and post- quality improvement study in a twenty bed Old Age Psychiatry Ward in East Lothian Community Hospital, Haddington, Scotland. Data were collected from 12th October – 16th November, 2020 (pre- period) and from 16th November 2020 to 15th February, 2021 (post- period). The primary process measure was ensuring all patients had at least one full set of physical observations at least once a week, or more frequent as deemed clinically appropriate. Secondary measures included ensuring NEWS scores were accurately calculated and improved documentation. This was tracked using a run chart. Improvement activities focused on increased awareness, effective training, key stakeholder buy-in and reviewing trust policy.ResultThe percentage of NEWS documented for all patients at least once a week improved from a mean of 28.7% (31/108) in the 6 weeks prior to intervention, to a mean of 71.4% (125/175) in the following 13 weeks. The minimum required physical observations required to accurately calculate a NEWS improved from 51.6% (16/31) pre-intervention to 95.2% (119/125) post-intervention and NEWS being calculated correctly increased from 80.6% (25/31) to 96% (120/125). Documentation of a reason why physical observations were not taken increased from 2.5% (2/77) to 62% (31/50) pre- and post- intervention respectively.ConclusionThis quality improvement project highlighted that recording of physical observations and use of NEWS was inadequate in this setting, increasing the risk of a delay in identification of acute physical deterioration and thus increase morbidity and mortality. Introducing simple measures and standardising the NEWS assessment process, along with senior nursing and medical oversight, greatly enhanced acquiring and recording of physical observations and NEWS scores. This quality improvement project has shown that practical solutions and staff education can increase efficacy and are hoping further input can consolidate the gains achieved and lead to continued improvements.

Obesity-Hypoventilation Syndrome - A Neglected Problem?

Abstract Obesity-hypoventilation syndrome (OHS) is the most severe complication of obesity, being burdened by numerous cardiovascular complications and an increase in the mortality rate. Late recognition of this syndrome is common. Approaching the patient with suspicion or confirmed with OHS requires a multidisciplinary team. Positive pressure treatment remains the first line therapy, with the highest efficiency. Weight loss should be recommended in all patients. Apparently, bariatric surgery is superior to lifestyle changes. Early detection and prompt treatment are of paramount importance to minimize adverse effects, which has necessitated consideration of this article.

Thiamine responsive pulmonary hypertension: case series

Pulmonary hypertension (PH) is most commonly related either to a cardiac or a pulmonary cause. But less commonly various hematological, hepatic, genetic causes are also associated. Infantile PH due to vitamin deficiencies is very rare though few cases with thiamine deficiencies causing PH have been reported lately. Lack of awareness and late recognition of thiamine deficiency may result in high mortality. A high index of suspicion is required for early diagnosis and management to decrease the severity and morbidity and thereby preventing long term implications on neurological development. Here, we described three cases of infants admitted to Kamineni academy of medical sciences diagnosed with PH who responded dramatically to thiamine supplements. The lack of rapid diagnostic capacity and the severe outcome of thiamine deficiency justify the use of a therapeutic thiamine challenge in cases with high clinical suspicion. Increased awareness about thiamine deficiency and low threshold for thiamine use should guide clinicians in their practice.

Could routine pregnancy self-testing facilitate earlier recognition of unintended pregnancy? A feasibility study among South African women

IntroductionWe explored whether routine pregnancy self-testing is feasible and acceptable to women at risk of late recognition of pregnancy as a strategy to facilitate early entry into either antenatal or...

Contribution de la psychomotricité à l’évaluation et la compréhension des souffrances identitaires à l’adolescence

Prescriptions of psychomotor assessments and care of adolescents and young adults suffering from psychological distress remain very insufficient. Several factors could explain this: societal representations of the person and care; lack of knowledge of the profession and its role; the late recognition of the adolescent's developmental specificities; conceptual difficulties. Adolescence corresponds to a developmental leap and a sensitive period presenting many health issues, particularly in mental health. Prevention, evaluation and care actions for adolescents are therefore fundamental, as recommended by the WHO. Adolescence is a biopsychosocial process, requiring a multidisciplinary approach. A theoretical conceptualization centered on concerns related to the psycho-corporal integration seems essential. The Psychomotor Modeling of Body Représentations - M-PRECOR - is the result of qualitative and inductive research in psychomotricity. It takes place within the complexity paradigm and calls upon different disciplinary fields to define the concept of psychomotor identity as a dynamic construction anchored in body representations. This psychomotor conceptualization can then contribute to the evaluation of the identity sufferings. Its revised version is presented here. This could lead to the creation of a more systematized psychomotor semiology in the field of adolescent and young adult psychopathology, by means of ongoing comparative research works.