Mean Time Of Diagnosis Research Articles

Clinical Characteristics of Ocular Mucous Membrane Pemphigoid: A Systematic Review and Meta-Analysis

ABSTRACT Purpose To synthesize the evidence and generate a combined weighted measure on the frequency of ocular manifestations of mucous membrane pemphigoid (OMMP). Methods Systematic literature review and meta-analysis, searching PubMed, Embase, VHL, and Google Scholar. Articles reporting patients with mucous membrane pemphigoid and ocular involvement were included. At least, two reviewers independently and in parallel participated in all the following phases; preliminary screening, full-text review, risk of bias assessment by validated tools, and data extraction. Qualitative analysis and meta-analysis were conducted. This study was previously registered in PROSPERO (CRD42023451844). Results Thirty-five studies met the inclusion criteria, comprising 1,439 patients and 1,040 eyes summarized in qualitative analysis. Twenty-eight studies were included in the meta-analysis. Ages included ranged from 60.4 to 75 years. Women were reported with more frequency. The mean time for diagnosis was 55.1 months, usually with bilateral ocular disease in 90% (95% CI 78%; 96%). Trichiasis and entropion were the most frequent manifestations in up to 92%, followed by symblepharon and punctate keratitis. Ankyloblepharon, persistent epithelial defects, and visual impairment were less frequent complications. Direct immunofluorescence positivity in conjunctival biopsies was 54% (95% CI 43%; 64%). Extraocular involvement was highly frequent, being oral and skin involvement the most frequently reported. Conclusions Our systematic review and meta-analysis evidenced that patients around 60 years of age are the most affected population with a female preponderance, usually with bilateral ocular involvement. Trichiasis and entropion were the most frequent findings; although visual impairment and persistent epithelial defects were less reported, they should not be overlooked in suspected OMMP.

Diagnostic Delays in Cutaneous Coccidioidomycosis: a Report from Central California.

Cutaneous Coccidioidomycosis (CC) infection can present with a wide variety of clinical presentations and is well known as a 'great imitator'. We performed a retrospective analysis of patients with CC in a large referral center in Central Valley, California, from 2010 to 2022 using the ICD9 and ICD10 codes for coccidioidomycosis and CC. We identified forty patients with CC during the study period. The mean age of the study population was 43 years (with standard deviation of 14.08). Among these, 60% were men and 40% women. The appearance of the lesions varied from ulcers, plaques, nodules, blisters, cellulitis, and abscesses. The most common site of CC lesions was in the lower extremities (42.5%), followed by upper extremities (30%), chest and abdomen, head and neck (25% each). Only 22.5% of the 40 cases were diagnosed as CC and 15% were diagnosed as erythema nodosum. Rest were diagnosed initially as bacterial cellulitis in 37.5%, tinea in 7.5% and others in 12.5%. There was resolution of the cutaneous lesions in all patients with antifungal treatment. The mean time of diagnosis from onset of symptoms on an average was 12 weeks (8-16weeks) in our study with 75% cases initially misdiagnosed. Comprehensive knowledge about the manifestations and evaluation of CC among primary care providers and emergency room physicians is essential to prevent delays in diagnosis and treatment.

Walk-In Hospital Admission of Patients with Subarachnoid Hemorrhage: Clinical Presentation and Outcome

Neurosurgeons occasionally encounter cases of subarachnoid hemorrhage (SAH) in admitted walk-in patients, termed "walk-in SAH." However, their clinical characteristics have not been fully understood. We thus, aimed to investigate several characteristics of patients with walk-in SAH and compare them with those of patients with good grade SAH who arrived at the hospital by ambulance. Between January 2011 and January 2018, consecutive patients with World Federation of Neurosurgical Society (WFNS) grade I and II aneurysmal SAH were enrolled. They were dichotomized into walk-in and ambulance groups, and their demographic and disease-related characteristics were compared. Furthermore, predictors associated with unfavorable outcomes were investigated in patients with walk-in SAH. Of 171 patients with World Federation of Neurosurgical Society grade I and II SAH, 68 (39.8%) were categorized as walk-in SAH. The mean time for diagnosis in patients with walk-in SAH was significantly longer than that in patients who arrived by ambulance (P < 0.01). Multivariate analysis demonstrated that a lower rate of hypertension, high grades on the Barrow Neurological Institute scale, and Early Brain Edema Score were significantly associated with walk-in SAH (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.21-0.91, P= 0.03; OR 0.32, 95% CI 0.13-0.76, P= 0.007; OR 0.11, 95% CI 0.02-0.51, P < 0.0001, respectively). Additionally, severe angiographic vasospasm was a significant predictor of unfavorable outcomes in walk-in SAH (OR 37.7, 95% CI 1.10-1290.90, P= 0.04). Patients with walk-in SAH exhibit radiological characteristics associated with a more favorable outcome among patients with good grade SAH. Therefore, these patients may have a positive prognosis.

#5296 CYTOMEGALOVIRUS INFECTION AFTER COVID-19 IN KIDNEY TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE

Abstract Background and Aims Kidney transplant recipients (KTR) have adverse COVID-19 outcomes due to the immunosuppressed status and multiple comorbidities. Cytomegalovirus (CMV) is one of the most frequent opportunistic infections after kidney transplantation. However, data concerning its reactivation after COVID-19 is scarce. Herein, we present a single-center cohort of KRT presenting with CMV infection after COVID-19 and its clinical outcomes. Method Single-center cross-sectional study including 22 KTR with CMV viraemia detected by quantitative polymerase chain reaction up to 6 months after COVID-19, between 2020 and 2022. Demographic and clinical data were collected from the electronic records. Results A total of 22 KTR (13 male) were included with a mean age of 55.5±15.5 years and a median Charlson score of 4 (IQR 3-6). Median time after transplantation was 65 months (IQR 12.5-174.5; 3 KTR with &amp;lt;6 months) and only one patient had been submitted to living-donor transplantation. Eight patients received induction therapy with antithymocyte globulin (ATG). At transplantation time, CMV serologic status had been: 50% D+/R+, 13.6% D+/R- and 4.5% D-/R+. CMV infection prior to COVID-19 had been documented in 6 patients. Concerning COVID-19, severe or critical disease had been reported in 8 patients. Specific therapy had been used in 4 patients: 2 with remdesivir/baricitinib, one with remdesivir and one with molnupiravir. Moreover, immunosuppressive therapy had been adjusted in 11 patients, namely by withdrawing the antimetabolite and increasing steroids (7 patients). Median maximum steroid dose (expressed as equivalents of prednisone dose) had been 40 mg (IQR 20-40) and mean cumulative steroid dose had been 416±317 mg. CMV disease was documented in 8 patients (4 with gastrointestinal involvement) and the mean time of diagnosis after COVID-19 was 10±6 weeks. Maintenance immunosuppression included tacrolimus, antimetabolite and steroid in 12 patients; 6 patients had supratherapeutic levels of tacrolimus at CMV infection diagnosis. Median initial viraemia was 770 copies/mL (IQR 288-4106). Valganciclovir was used in 14 patients (one was already taking it as prophylaxis), ganciclovir in 4 patients and CMV enriched human intravenous immunoglobulin was used in one patient. Nine patients required hospitalization and 2 were transferred to an intensive care unit; one of these 2 patients died. Induction therapy with ATG, CMV serologic status at transplantation time, previous CMV infection, COVID-19 severity or supratherapeutic immunosuppressive drug levels were not associated with CMV infection severity or hospitalization. However, higher maximum steroid dose during COVID-19 was associated with CMV disease (p = 0.038), higher viraemia at diagnosis (p = 0.032) and hospitalization (p = 0.018). Conclusion CMV infection is a common and clinically relevant complication in KTR. Altered immunologic status after COVID-19 may predispose to this infection. In addition, immunosuppressive therapy adjustments, namely the increase in steroid dosing may be very relevant to favor reactivation of CMV. Larger studies are warranted, but careful monitoring could help identifying risk patients earlier and prophylaxis may be considered when increased corticosteroids are prescribed.

External Auditory Canal Cholesteatoma after Radiation Therapy for Nasopharyngeal Cancer: Case Series and Systematic Review

The authors performed a systematic review, in accordance with the PRISMA guidelines, across multiple databases, including all original studies published until November 2022, focusing on External auditory canal cholesteatoma (EACC) after radiation therapy (RT) for nasopharyngeal cancer (NC). Inclusion criteria were original articles reporting on secondary EACC after RT for NC. Articles were critically appraised to assess level of evidence using the Oxford Center for Evidence-Based Medicine criteria. Overall, 138 papers were identified and after duplicate removal (34 papers) and excluding papers not in English, 93 papers were assessed for eligibility; finally, only five papers were included and summarized with the three cases coming from our institution. These mainly involved the anterior and the inferior part of the EAC. The mean time of diagnosis after RT was the largest series of 6.5 years (with a range from 0.5 to 15.4 years). Patients undergoing RT for NC have 18 times a higher risk of developing EACC compared to the normal population. EACC is probably one of the most underreported side effects, because patients may present variable clinical findings, which could lead to misdiagnosis. Early diagnosis of RT related EACC is advised to enable conservative treatment.

A multi-feature deep learning system to enhance glaucoma severity diagnosis with high accuracy and fast speed

Glaucoma is the leading cause of irreversible blindness, and the early detection and timely treatment are essential for glaucoma management. However, due to the interindividual variability in the characteristics of glaucoma onset, a single feature is not yet sufficient for monitoring glaucoma progression in isolation. There is an urgent need to develop more comprehensive diagnostic methods with higher accuracy. In this study, we proposed a multi- feature deep learning (MFDL) system based on intraocular pressure (IOP), color fundus photograph (CFP) and visual field (VF) to classify the glaucoma into four severity levels. We designed a three-phase framework for glaucoma severity diagnosis from coarse to fine, which contains screening, detection and classification. We trained it on 6,131 samples from 3,324 patients and tested it on independent 240 samples from 185 patients. Our results show that MFDL achieved a higher accuracy of 0.842 (95 % CI, 0.795–0.888) than the direct four classification deep learning (DFC-DL, accuracy of 0.513 [0.449–0.576]), CFP-based single-feature deep learning (CFP-DL, accuracy of 0.483 [0.420–0.547]) and VF-based single-feature deep learning (VF-DL, accuracy of 0.725 [0.668–0.782]). Its performance was statistically significantly superior to that of 8 juniors. It also outperformed 3 seniors and 1 expert, and was comparable with 2 glaucoma experts (0.842 vs 0.854, p = 0.663; 0.842 vs 0.858, p = 0.580). With the assistance of MFDL, junior ophthalmologists achieved statistically significantly higher accuracy performance, with the increased accuracy ranged from 7.50 % to 17.9 %, and that of seniors and experts were 6.30 % to 7.50 % and 5.40 % to 7.50 %. The mean diagnosis time per patient of MFDL was 5.96 s. The proposed model can potentially assist ophthalmologists in efficient and accurate glaucoma diagnosis that could aid the clinical management of glaucoma.

Left ventricular dysfunction in a cohort of new onset idiopathic inflammatory myopathy without known heart disease

Abstract Impaired myocardial function is linked to inflammatory mechanisms. Indeed, many systemic inflammatory diseases are associated to risk of developing heart disease. Idiopathic inflammatory myopathy (IIM; here Dermato- or polymyositis) are rare systemic inflammatory diseases, characterised by immune infiltration in muscle, presence of autoantibodies and cytokines in circulation leading to weakness and disability. IIM can involve extra-muscular tissues, e.g. heart, and is associ-ated with elevated risk for cardiovascular disease. Heart function in IIM is little investigated and has mostly been studied in patients at a chronic IIM stage or with a concomitant heart disease. To our knowledge, heart function has not been characterized at the early stage in IIM when the risk of inflammatory associated cardiomyopathy may be high. Our hypothesis is that patients at early-stage IIM may present with subclinical myocardial dysfunction that can be detected by echocardiography. We used echocardiography (echo) following clinical standards to investigate heart function in a cohort of 18 patients (61% females; age 46±12 years) with recent onset IIM (mean diagnosis time 5 month). Patients were recruited from the rheumatology clinic at Karolinska University Hospital, Stockholm, and had given written consent. None had previous heart disease. Echo parameters were compared to normal reference limits as established by the American Society for Echocardiography. Heart failure association (HFA)-PEFF score (≥2 p) was used to define left ventricular diastolic dysfunction (LVDD). Ejection fraction (EF) was generally preserved in the cohort with no patient displaying EF&amp;lt;55% (Table 1). Yet, 4 patients (22%) displayed reduced global strain (LVGLS; &amp;gt;−20%) suggesting presence of impaired myocardial contraction. In contrast, diastolic dysfunction was seen in several patients as indicated by one or more diastolic parameters outside normal rage (table 1). Moreover, when calculating HAVA-PEFF score 9 patients (50%) fulfilled criteria for LVDD. None of the patients displayed hypertension (&amp;gt;140/90 mmHg), or left ventricular hypertrophy. In a cohort of patients with recent onset IIM without known heart disease, we have found that diastolic dysfunction is prevalent with 50% of the patients fulfilling criteria for LVDD according to the HFA-PEFF score. This gives a high likelihood of fulfilling criteria for the diagnosis heart failure with preserved EF (HFpEF). We conclude that clinical echocardiography is important in the initial work up of IIM to screen for LVDD as the risk of heart failure is likely to be high. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Swedish Heart Lung Foundation

Characteristics of Achalasia Subtypes: Result of a Study in a Tertiary Hospital.

Background:With the appearance of enhancing high-resolution manometry (HRM), realizing the difference of achalasia symptoms between classified groups by HRM is an outcome of interest in areas with remote access to this device.Methods:All patients newly diagnosed with achalasia from January 2019 to March 2020 were enrolled in the study. All the patients were diagnosed via HRM after undergoing endoscopy to rule out pseudo-achalasia, and grouped based on the Chicago classification criteria and answered a questionnaire assessing relevant symptoms.Results:We included 62 patients recently diagnosed with achalasia with a mean age of 53.66 in males (n=30), and 45.4 in females (n=32). Mean time of diagnosis was 24 months. Thirty-seven percent were in type I, 50% in type II, and 13% in type III. Dysphagia and weight loss were higher in type III, while all other relevant symptoms were higher in type II, none of which, however, was statistically significant. Weight loss was reversely associated with duration of symptoms (Spearman correlation= -0.3, P=0.01), and this reverse association was more prominent in females (Spearman correlation= -0.47, P=0.009), type III (Spearman correlation= -0.74, P=0.03), and in the first clinical stages (Spearman correlation= -0.55, P=0.04) in sub analysis.Conclusion:Type II is the most common type of achalasia in this study. Unlike HRM classification, clinical manifestations alone cannot be used to group patients into different types. However, significant weight loss of the newly diagnosed subjects can become an indicator of on-time diagnosis of the patients.

EPIDEMIOLOGICAL PROFILE AND EVOLUTION OF ANKLE MUSCULOSKELETAL TUMORS.

Characterizing ankle tumors, presenting the epidemiological profile of these lesions. Retrospective observational case series study to evaluate the results of clinical and/or surgical treatments of patients with ankle tumors whose first visit occurred from 1990 to 2020. The dependent variables were: benign bone tumor, malignant bone tumor, benign soft tissue tumor, malignant soft tissue tumor, and infection. The independent variables were: sex, age; presence of symptoms (pain/local volume increase/fracture), duration of symptoms until treatment, diagnosis, treatment, and recurrence. In total, 70 patients were included-58.5% were women, with a mean age at the time of diagnosis of 21.66 years. Among all cases, 76% were bone tumor, 14% were soft tissue tumor, and 10% were infection. The mean age at the time of diagnosis was 21.7 ± 2.29 years. The overall prevalence of pain was 77.1%. In total, 55.6% patients had a general local volume increase 13.4% had fractures. The mean time from symptoms to treatment was 17.4 ± 4.61 months and the mean diagnosis time was 10.13 ± 0.86 months. Of all cases, 73.44% underwent surgical treatment and 22.64% had recurrence. In this series, ankle tumors corresponded mainly to bone tumors. Benign tumors were the most prevalent type of tumor and the highest occurrence was among young people. Level of Evidence IV, Case Series.

Early Fault Diagnosis Method for Batch Process Based on Local Time Window Standardization and Trend Analysis.

The products of a batch process have high economic value. Meanwhile, a batch process involves complex chemicals and equipment. The variability of its operation leads to a high failure rate. Therefore, early fault diagnosis of batch processes is of great significance. Usually, the available information of the sensor data in batch processing is obscured by its noise. The multistage variation of data results in poor diagnostic performance. This paper constructed a standardized method to enlarge fault information as well as a batch fault diagnosis method based on trend analysis. First, an adaptive standardization based on the time window was created; second, utilizing quadratic fitting, we extracted a data trend under the window; third, a new trend recognition method based on the Euclidean distance calculation principle was composed. The method was verified in penicillin fermentation. We constructed two test datasets: one based on an existing batch, and one based on an unknown batch. The average diagnostic rate of each group was 100% and 87.5%; the mean diagnosis time was the same; 0.2083 h. Compared with traditional fault diagnosis methods, this algorithm has better fault diagnosis ability and feature extraction ability.

Alexithymia in ankylosing spondylitis.

Objectives This study aims to determine the effect of ankylosing spondylitis (AS) on alexithymia. Patients and methods In this study, a total of 55 AS patients (30 males, 25 females; mean age: 40±8 years; range, 21 to 57 years) who were under follow-up and 55 age- and sex-matched healthy volunteers (31 males, 24 females; mean age: 38.9±8.5 years; range, 21 to 53 years) were included between March 2016 and August 2016. Toronto Alexithymia Scale (TAS), and Beck Depression Inventory (BDI) were performed to assess both patient and control groups. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Ankylosing Spondylitis Quality of Life (ASQoL) were performed to assess AS patients. Results The mean diagnosis time in the patient group was 5.18±4.32 (range, 1 to 18) years. Compared to the control group, depression scores were higher in the patient group and the alexithymic characteristics were significantly higher in the patient group (p<0.05). There was a positive correlation between complaint duration and BASMI, BASFI, and ASQoL scores (p<0.01). In our study, alexithymia rate was significantly higher in women (p<0.05). Conclusion As in all inflammatory chronic diseases, depression and anxiety are commonly seen in AS patients. Alexithymia of these patients should be considered carefully.

Congenital Duodenal Atresia Diagnosis, Treatment, and Influence on Further Development of Patients

Background: Congenital duodenal atresia (CDA) is a common and surgically treated digestive tract anomaly that develops in the early stage of pregnancy. It often coexists with trisomy 21 and other inborn defects. Surgery is the only way of treatment. This study aimed to investigate the relationship of CDA with early diagnosis, course of pregnancy, coexisting congenital defects, and further development of children. Methods: The data were collected using the medical history and a self-designed survey which consisted of 22 questions about the perinatal interview, coexisting inborn defects, after birth symptoms, time and methods of diagnosis, as well as the treatment outcome. Results: The surveys were sent to 31 patients who were diagnosed and treated because of CDA in our clinic between 2004 and 2019. According to the collected data, 73.7% of the patients were diagnosed prenatally with the mean time of diagnosis at 28th weeks of gestation. Moreover, 37% of the patients were preborn, and almost half of the patients had low and very low body weight. More than 2/3 of children presented coexisting inborn abnormalities. Among after birth symptoms, the most common ones were abdominal distention and lack of meconium. The majority of children were operated within 24 hours after birth. Conclusions: Prenatal diagnosis of CDA results in an earlier time of primary operation. Newborns diagnosed antenatally present fewer symptoms after the operation, fewer reoperations, and a shorter time of oral feeding toleration. The coexistence of other congenital defects increases patients’ mortality. The important factors that deteriorate the postoperative course are prematurity and low body weight. In order to avoid long-term complications, it is of utmost importance to provide follow-up.

Validity of the modified sphygmomanometer test for the assessment of tip pinch strength in Parkinson's disease

BackgroundThe tip pinch is one of the most delicate and precise movement of the hand, and it is used to manipulate small objects, commonly observed in the activities of daily living of any individuals. Individuals with Parkinson Disease (PD) with impaired manual dexterity, manipulative skills, and hand weakness have an important barrier for activities of daily life. However, the dynamometer usually used for measuring the tip pinch have a high cost, so, validate a sphygmomanometer can make this assessment more accessible. ObjectiveTo investigate the validity of the modified sphygmomanometer test in the evaluation of tip pinch strength when compared to the gold standard. Methods50 individuals with idiopathic PD took part in the study. The muscle strength of tip pinch on the dominant and non-dominant side was measured by the modified sphygmomanometer test and the gold standard, the dynamometer. Concurrent validity was analyzed using Pearson's correlation coefficient. Results50 individuals diagnosed with idiopathic PD, mean age of 67 ± 8.0 years, 68% male, mean time of diagnosis in months of 84 ± 66 and Hoehn and Yahr mean of 2.5 ± 0.6. There was a significant correlation of moderate magnitude between the modified sphygmomanometer test and the dynamometer in dominant side (r = 0.44; p < 0.01) and non-dominant side (r = 0.48; p < 0.01). ConclusionThe modified sphygmomanometer test showed adequate validity for assessing the muscle strength of the tip pinch in individuals with PD.

OUTCOME INDICATORS OF MULTI-PROFESSIONAL DIABETES CARE IN A REFERENCE SERVICE

ABSTRACT Objective to identify outcome indicators of the multi-professional Diabetes Mellitus care of a reference outpatient service. Method a descriptive study of evaluative nature, according to the health evaluation framework, carried out by documentary analysis of 173 medical charts, from August to October 2018. The variables were analyzed in the Statistical Package for the Social Science (SPSS), version 22.0, by descriptive statistics, as well as the association of variables, with the Chi-square, Mann-Whitney, and Wilcoxon tests being used, considering p-values ≤ 0.05 as statistically significant. Results predominance of older adult women, with a mean diagnosis time of 11.9 years. The tracking of complications due to Diabetes Mellitus occurred in 90.2% of the users, with a prevalence of 68.2%, of which 34.7% were diagnosed in the service. Absenteeism was 21.4%. The systolic and diastolic arterial pressure and total cholesterol parameters were in line with the proposed goals, while glycated hemoglobin (A1c), fasting glycaemia, HDL-c, LDL-c, triglyceride fractions, and BMI did not reach the target range. There was a significant reduction in final A1c, comparing to initial A1c, as well as an increase in the proportions of users who reached the goals in glycemic control. Conclusion a significant improvement in glycemic control, despite the fact that the parameters did not fully meet the goals, ratifying the importance of an effective assistance model for successful care strategies of Diabetes Mellitus.

Características sociodemográficas, clínicas e cuidados com a saúde de pessoas com diabetes mellitus hospitalizadas

O objetivo deste estudo foi identificar característica sociodemográficas e clínicas relacionadas a cuidados com a saúde de pessoas com diabetes mellitus. Estudo de caráter quantitativo, do tipo observacional descritivorealizado com pessoas com diabetes mellitus, hospitalizadas em unidades de clínica cirúrgica e clínica médica, em um hospital escola do sul do Brasil. Coleta de dados por consulta de enfermagem à beira do leito e em prontuários, realizada entre agosto e dezembro de 2017. Os dados foram submetidos à estatística descritiva. Participaram da pesquisa 37 pessoas, a maioria, 33 (89,2%) com diabetes tipo 2, a média de idade de 60 anos e tempo médio de diagnóstico de 9,6 anos; 27 (72,9%) tiveram episódios de hiperglicemia na internação; seis (16,2%) eram insulinodependentes; 26 (70,2%) eram hipertensos. Em suma, o perfil evidenciado por este estudo converge para perfis regionais e globais de pessoas com diabetes e, especificamente, em situação de hospitalização. Destacaram-se as características relacionadas à faixa etária maior de 40 anos mais acometida pela doença, com baixa escolaridade e com comorbidades associadas, especialmente as doenças cardiovasculares e a obesidade. O conhecimento deste perfil é potencial para um cuidado de enfermagem contextualizado, sobretudo para estratégias de educação em saúde.

Epidemiological situation of leprosy in a province in China: a long time to diagnosis and a high rate of deformity

BackgroundThis epidemiological study aimed to analyse both the distribution and characteristics of leprosy in an endemic province in Northwest China.MethodsThe medical records of leprosy patients in the province of Shaanxi, China, from 1998 to 2018 were collected from the Chinese Leprosy Management Information System (LEPMIS). Epidemiological variables were analysed in this study.ResultsA total of 477 new cases were diagnosed between 1998 and 2018 in this region. The average annual detection rate was 0.070/100,000 population, and the average annual prevalence was 0.305/100,000 population. The mean age of the newly diagnosed patients was 46.7 years, and the ratio of males to females was 2.5:1. There were 399 cases (83.6%) of multibacillary (MB) leprosy. One hundred forty-eight patients (31.0%) had grade 2 disability. The mean diagnosis time for new cases was 62.0 months.ConclusionThis epidemiological study showed that the characteristics of newly diagnosed leprosy cases in our province were a long time to diagnosis and a high rate of deformity, indicating the need for actions focusing on early diagnosis and treatment and strengthening the detection of leprosy in low-prevalence areas.

Dental Implant Survival after Postoperative Infection.

Early postoperative infection can lead to dental implant failure. This study aimed to evaluate the frequency of failed and survived implants after acute postoperative infection and the related factors. This cross-sectional cohort evaluated early infection after dental implant surgery. The study variables included the site of implant placement, age and gender of patients, bone augmentation, postoperative antibiotic therapy, smoking, and time of infection occurrence or diagnosis. Failed and survived implants were the outcome of the study. The patients were studied in 2 groups of survived implants (group 1) and failed implants (group 2). Thirty-four (3.46%) out of 980 patients developed a postoperative infection following implant placement, which included 25 males and 9 females. Ten implants (29.4%) survived (group 1), and 24 implants (70.6%) failed (group 2). There were significant differences between the 2 groups regarding the number of smoker patients, fresh socket or delayed implant placement, patients who received bone graft, and the meantime of diagnosis (P < 0.05). Regarding the covariates, the Kaplan-Meier analysis showed that the risk of implant failure in patients who did not receive postoperative antibiotic therapy increased by 1.1 times (hazard ratio) when infection occurred four days after surgery. In patients who received postoperative antibiotics, the risk of failure increased when infection occurred after 6days in smokers and after 9days in non-smokers. Considering the study results, it seems that smoking, early infection, fresh socket placement, and placement of implants along with bone substitutes may increase the failure rate after acute infection in dental implant placement.

Delay in diagnosis of tuberculosis and related factors from a district in Kerala, India

BackgroundEarly diagnosis and treatment of tuberculosis is of vital importance both to cure patients and to reduce transmission for effective control of tuberculosis, It is important to know whether tuberculosis is diagnosed in time and also what causes delay if any. ObjectivesThe study was conducted with the objective of knowing the time taken to diagnose tuberculosis from the onset of symptoms and to identify the causes for delay if any. MethodsA study was conducted in the District of Malapppuram Kerala, South India among newly diagnosed smear positive tuberculosis patients. 489 patients were interviewed soon after diagnosis and their socio-demographic characteristics and details from onset of symptoms to diagnosis were collected using a structured format. ResultsThe mean time taken by the patient for consultation after onset was 36 days and the mean time for diagnosis was 42 days and total time until diagnosis was 78 days. 72.8% patients consult within 6 weeks of onset and 74.7% are diagnosed within 6 weeks of consultation. The delay for diagnosis was more with private institutions. Diagnosis took less time when government facilities are consulted and when cough was a prominent symptom. Socio demographic factors are seen not affecting the time. ConclusionsThere is delay in diagnosing tuberculosis especially with private health providers and more efforts are required to reduce the same.

Clinical Relevance and Characteristics of Nontuberculous Mycobacterial Pleuritis.

Nontuberculous mycobacteria (NTM) disease is of increasing public health concern; however, data regarding pleural effusion in NTM disease patients are limited. The purpose of this study was to investigate the clinical relevance and characteristics of NTM pleuritis. Patients with pleural effusion and NTM disease diagnosed between April 2012 and November 2017 were enrolled and their medical records were retrospectively reviewed. Clinical characteristics and treatment outcomes were analyzed. A total of seven among 100 patients with NTM disease had NTM pleuritis (7%). Flow cytometry of T and B lymphocytes revealed varying degrees of cellular immunodeficiency in five cases (71.4%). NTM pleuritis with pneumothorax occurred in five patients (71.4%) and bronchopleural fistula (BPF) was also found in four of them. All seven patients had delayed diagnosis and the mean time of diagnosis was 7 months (1-24 months). Four patients successfully completed treatment, while three patients (42.8%) succumbed to progressing NTM disease. Low CD4-positive T-cell counts were common in NTM pleuritis patients. Delayed diagnosis and treatment resulted in increased incidence of NTM pleurisy and poor prognosis. Moreover, BPF is perhaps a characteristic feature of Mycobacterium avium complex-associated pleuritis.

The immediate effect of vocal technique associated with virtual reality game in people with Parkinsons disease

Abstract Introduction People with Parkinson’s Disease (PD) have difficult motor hearing calibration, which affects the monitoring of vocal production. Therefore, employing visual stimulus associated with vocal therapy may benefit the voice of this population. For this purpose, some techniques favour the competence of the glottis, such as pushing, which consists of movements of the arms with a simultaneous effort to phonation and, associated with virtual reality games, provide playful therapeutic intervention through the simulation of experiences that can foster glottal adjustments and generate changes in the voice. Objectives To determine the immediate effect of the technique of pushing with plosive sounds associated with the use of a virtual reality game in the voice of people with Parkinson's disease. Methodology The participants were 17 men and 14 women, mean age of 62.61 (± 11.24) years, meantime of diagnosis 6.93 years, distributed in stages I (32.5%), II (22.59%), III (45.16%) of Hoehn and Yahr. scale. The vocal evaluation pre and post pushing technique with plosive sounds associated with virtual reality game consisted of analysing vocal, acoustic parameters from the record of the issuance of the vowel /ε/. The parameters extracted were Jitter, Shimmer, corresponding to signs of disturbance of the sound source and Glottal-to Noise Excitation (GNE), corresponding to the energy of the glottis on the noise. The satisfaction questionnaire on the implementation of this technique associated with virtual reality was used. Results The values of disturbance of the sound wave decreased, and the glottal energy on the noise increased, respectively, Jitter (p = 0.0075); Shimmer (p = 0.0048); GNE (p = 0.0008). Regarding the satisfaction questionnaire, 74.20% of them felt very satisfied and 25.80%, satisfied. Conclusion The vocal technique associated with virtual reality game improved the acoustic parameters of the participants' voice and the majority felt great satisfaction with the intervention.