Therapeutic Delay Research Articles

Modified Split-Scan Computed Tomography (CT) Diagnostics of Severely Injured Patients: First Results from a Level I Trauma Center Using a Dedicated Head-and-Neck CT-Angiogram for the Detection of Cervical Artery Dissections.

Introduction: Traumatic cervical artery dissections are associated with high mortality and morbidity in severely injured patients. After finding even higher incidences than reported before, we decided to incorporate a dedicated head-and-neck computed tomography angiogram (CT-A) in our imaging routine for patients who have been obviously severely injured or, according to trauma mechanism, are suspected to be severely injured. Materials and Methods: A total of 134 consecutive trauma patients with an ISS ≥ 16 admitted to our level I trauma center during an 18 month period were included. All underwent standardized whole-body CT in a 256-detector row scanner with a dedicated head-and-neck CT-A realized as single-bolus split-scan routine. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded and analyzed in patients with carotid artery dissection (CAD) and vertebral artery dissection (VAD). Results: Of the 134 patients included, 7 patients had at least one cervical artery dissection (CeAD; 5.2%; 95% CI 1.5–9.0%). Six patients (85.7%) had carotid artery dissections, with one patient having a CAD of both sides and one patient having a CAD and contralateral VAD combined. Two patients (28.6%) showed a VAD. Overall mortality was 14.3%, neurologic morbidity was 28.6%. None of the patients showed any attributable neurologic symptoms on admission. The new scanning protocol led to further 5 patients with suspected CeAD during the study period, all ruled out by additional magnetic resonance imaging with angiogram (MRI/MR-A). Conclusion: A lack of specific neurologic symptoms on admission urges the need for a dedicated imaging pathway for severely injured patients, reliable for the detection of cervical artery dissections. Although our modified CT protocol with mandatory dedicated CT-A led to false positives requiring additional magnetic resonance imaging, it likely helped reduce possible therapeutic delays.

Clearance of therapy-induced senescent tumor cells by the senolytic ABT-263 via interference with BCL-XL -BAX interaction.

Tumor cells undergo senescence in response to both conventional and targeted cancer therapies. The induction of senescence in response to cancer therapy can contribute to unfavorable patient outcomes, potentially including disease relapse. This possibiliy is supported by our findings that tumor cells induced into senescence by doxorubicin or etoposide can give rise to viable tumors invivo. We further demonstrate sensitivity of these senescent tumor cells to the senolytic ABT-263 (navitoclax), therefore providing a "two-hit" approach to eliminate senescent tumor cells that persist after exposure to chemotherapy or radiation. The sequential combination of therapy-induced senescence and ABT-263 could shift the response to therapy toward apoptosis by interfering with the interaction between BCL-XL and BAX. The administration of ABT-263 after either etoposide or doxorubicin also resulted in marked, prolonged tumor suppression in tumor-bearing animals. These findings support the premise that senolytic therapy following conventional cancer therapy may improve therapeutic outcomes and delay disease recurrence.

Therapeutic Anticoagulation Delays Death in COVID-19 Patients: Cross-Sectional Analysis of a Prospective Cohort.

A hypercoagulable state has been described in coronavirus disease 2019 (COVID-19) patients. Others have reported a survival advantage with prophylactic anticoagulation (pAC) and therapeutic anticoagulation (tAC), but these retrospective analyses have important limitations such as confounding by indication. We studied the impact of tAC and pAC compared with no anticoagulation (AC) on time to death in COVID-19. We performed a cross-sectional analysis of 127 deceased COVID-19 patients and compared time to death in those who received tAC ( n = 67), pAC ( n = 47), and no AC ( n = 13). Median time to death was longer with higher doses of AC (11 days for tAC, 8 days for pAC, and 4 days for no AC, p < 0.001). In multivariate analysis, AC was associated with longer time to death, both at prophylactic (hazard ratio [HR] = 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p < 0.001) and therapeutic doses (HR = 0.15; 95% CI: 0.07 to 0.32; p < 0.001) compared with no AC. Bleeding rates were similar among tAC and remaining patients (19 vs. 18%; p = 0.877). In deceased COVID-19 patients, AC was associated with a delay in death in a dose-dependent manner. Randomized trials are required to prospectively investigate the benefit and safety of higher doses of AC in this population.

Incidence of malignancy in patients with common variable immunodeficiency according to therapeutic delay: an Italian retrospective, monocentric cohort study

BackgroundCommon variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency and has a broad spectrum of clinical manifestations. Among non-infectious complications, an increased incidence of malignancies may have a special relevance for survival, but little is known about treatment efficacy on malignant complications.MethodsThis was a monocenter retrospective study on CVID patients, designed to provide preliminary data for the investigation of the possible link between therapeutic delay and tumor incidence.ResultsA total of 67 CVID subjects were included. The median diagnostic delay was 7.5 years (range: 0–63 years), and the median therapeutic delay was 8.5 years (range: 0–67 years). Malignancies were diagnosed in 18 (27%) patients. Eight out of 18 (44%) patients with a malignancy had lymphoma. Patients who developed a malignancy showed a longer therapeutic delay in comparison to patients with no malignancy, although no statistical significance was achieved (11 years vs 8 years, respectively, p = 0.424). We observed a lower frequency of malignancy in CVID patients with reduced therapeutic delay compared with patients with therapeutic delay ≥ 10 years. With a therapeutic delay of > 1 year, 74% had no tumor, and 25% had a tumor; with a therapeutic delay of > 10 years, 65% had no tumor and 35% had a malignancy. Among patients who had no malignancy, 64% had a therapeutic delay of < 10 years, and 36% had a therapeutic delay of ≥ 10 years. Among patients with malignancy, 47% of subjects had a therapeutic delay < 10 years, and 53% a therapeutic delay ≥ 10 years.ConclusionsThe observation of clinical characteristics of our patients with CVID may suggest that an early institution of IgG replacement therapy could be of benefit for the prevention of malignant complications.Name of the registry: Comitato Etico Regionale delle Marche. Trial registration number: 1505. Date of registration: 27/10/2016, Retrospectively registered URL of trial registry record: http://www.ospedaliriuniti.marche.it/portale/archivio13_cerm-ancona_0_446_1.html. The trial was not registered before the first participant was enrolled

Evidence for a 'window of opportunity' in hidradenitis suppurativa treated with adalimumab: a retrospective, real-life multicentre cohort study.

The anti-tumour necrosis factor (TNF)-α adalimumab is the only licenced biologic for moderate-to-severe hidradenitis suppurativa (HS). No predictors of response have been identified so far. To identify clinical parameters predicting response to adalimumab and confirm its efficacy/safety. The data of 389 patients with HS treated with adalimumab in 21 Italian centres were reviewed. Sex, age at onset/diagnosis/baseline, body mass index, smoking, phenotype, previous treatments, concomitant antibiotics and 'therapeutic delay', defined as the time from HS onset to adalimumab initiation, were assessed. Response to adalimumab and its impact on quality of life (QoL) were evaluated using the Hidradenitis Suppurativa Clinical Response (HiSCR) and the Dermatology Life Quality Index (DLQI) or the Visual Analogue Scale for pain (VAS pain), respectively. Logistic regression analysis was performed. The therapeutic delay correlated to lack of response to adalimumab at week 16 [odds ratio (OR) 1·92 for therapeutic delay > 10 years; 95% confidence interval (CI) 1·28-2·89; P = 0·0016). HiSCR was achieved in 43·7% and 53·9% patients at week 16 and 52, respectively. Significant reductions in both DLQI and VAS pain were found between week 16 vs. baseline (P < 0·0001 for both) and week 52 vs. baseline (P < 0·0001 for both). Previous immunosuppressants inversely correlated to HiSCR at week 52 (OR = 1·74, 95% CI 1·04-2·91, P = 0·0342). Inverse correlation between therapeutic delay and clinical response was found, supporting early adalimumab use and providing evidence for a 'window of opportunity' in HS treatment. Adalimumab efficacy and safety were confirmed, along with patients' QoL improvement. Immunosuppressants could negatively influence the response to adalimumab inducing a switch to non-TNF-α-driven pathways.

Oncogeriatrics (part 5.) The role of comorbidities in older patients with cancer

Comorbidity is defined as the presence of one or more additional conditions co-occurring with primary indices. Comor­bidity is common in older cancer patients. Its prevalence, however, is difficult to determine and varies by cancer site. There is no single reason for which comorbidity and cancer coexist, but chronic diseases and cancer are both common in older age and share many risk factors. There is no consensus on how should comorbidity be measured. Even though many comorbidity indices have been developed so far, no unified, widely used instrument exists. Patients with comorbidities have worse outcomes compared to those with no such conditions. They may experience diagnostic and therapeutic delay and be disqualified from radical treatment more often. Moreover, they are more likely to suffer from treatment-related complications and have worse overall survival. It seems important to assess the comorbidity status as a part of individualised oncologic treatment planning. However, as data regarding its significance are insufficient and in many cases conflicting, patients with comorbidity should not be routinely considered as not fit enough for a radical treatment. Therefore, to adequately address all of the concerns that have been raised, a broader participation of older, comorbid patients in clinical trials is needed.

Practical approach to vasculitides in adults: an overview of clinical conditions that can mimic vasculitides closely

Primary systemic vasculitides are rare diseases affecting blood vessel walls. The type and patterns of distribution of the organs affected usually reflect the size of the vessels predominantly involved, and the patterns of clinical manifestations are generally useful to reach a specific diagnosis. However, presenting symptoms may lack adequate specificity for a prompt diagnosis, leading to a diagnostic (and therapeutic) delay, often causing irreversible damage to the affected organs. Due to their rarity and variable clinical presentation, the diagnosis of primary vasculitides could be challenging for physicians. Vasculitis mimickers, i.e. the clinical conditions that could be likely mistaken for vasculitides, need to be carefully ruled out, especially before starting the immunosuppressive therapy. We present here a practical approach to the diagnosis of primary systemic vasculitides involving large, medium and small size vessels, and reviewed most of the conditions that could mimic primary systemic vasculitides.

Does Waiting Time from Diagnosis to Treatment Affect Outcome in Locally Advanced Rectal Cancer? Real World Data Analysis

Introduction: Rectal cancer is a common and lethal disease, with approximately 44,180 new cases of diagnosed annually in the United States and a five-year survival of 67% [1, 2]. The interval from diagnosis to chemoradiation treatment, or waiting time (WT), is considered to be an important quality indicator for cancer care and has been demonstrated to be associated with oncologic outcomes in various cancers [3, 4]. The current recommendation for pre-treatment staging evaluation includes rigid proctoscopy, PET CT, transrectal ultrasound (TRUS) and often rectal MRI. These diagnostic procedures may significantly postpone the start of treatment. We aim to examine the effect of WT on overall survival (OS) and disease free survival (DFS) of rectal cancer patients. Methods: Retrospective analysis was performed in a detailed database of patients with resectable primary rectal cancer who underwent chemoradiation between January 2000 and January 2019. Univariate and multivariate cox proportional hazard regressions were conducted in order to evaluate the effect of WT on oncological outcomes. Results: 387 patients were enrolled in our database; of them 297 patients were eligible by the inclusion criteria. Median WT was 6.3 weeks (IQR 4.3-8.7). Multivariate analysis showed adjusted Hazard Ratio (HR) for OS increases by 1.07 for each additional week of therapeutic delay in all age groups (p=0.025). Furthermore, focusing on the majority of patients in the age group 45 - 70 years, adjusted HR for OS increases by 1.12 for each additional week of therapeutic delay (p=0.011). Adjusted HR for DFS increases by 1.06 for each additional week of therapeutic delay in all age groups (p=0.045) and an increment by 1.09 for each additional week of therapeutic delay in age group 45-70 years (p=0.02). Conclusion: Prolonged WT leads to significant poorer overall survival in patients with primary rectal cancer who underwent chemoradiation and curative surgical treatment. This marks the importance of efficient diagnostic evaluation and clinical multidisciplinary decision making in a timeframe of 6 weeks in order to not jeopardize oncological outcomes.

Evaluating the time interval from diagnosis to fibrinolysis at centres in the drainage area of Tygerberg Hospital, Cape Town, South Africa

ST-segment elevation myocardial infarction (STEMI) is one of the main contributors to morbidity and mortality in South Africa (SA). Timeous intervention by means of percutaneous coronary intervention (PCI) or fibrinolysis can significantly improve the outcome of STEMI. To determine the median time interval between diagnosis and fibrinolysis in patients presenting to centres within the drainage area of Tygerberg Hospital, Cape Town, SA, and compare it with the European Society of Cardiology (ESC) recommendation of 10 minutes. A retrospective medical record review of patients presenting to the abovementioned centres between 1 March 2017 and 28 February 2018 was performed. The primary presenting centre, time between diagnosis and fibrinolysis and discharge medication were recorded, in addition to other relevant demographic information. A total of 492 patients were identified, of whom 447 were included in the study. Three hundred and eighteen patients received fibrinolysis, of whom 18 (5.7%) were treated within 10 minutes of diagnosis. The median time interval between diagnosis and fibrinolysis was 67 (interquartile range (IQR) 32.5 -122.5) minutes. Most patients received fibrinolysis &gt;10 minutes after diagnosis, which indicates suboptimal therapy when compared with the ESC guidelines. Future studies should investigate the factors prolonging this therapeutic delay.

Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda

SETTING: In 2005, in response to the increasing prevalence of rifampicin-resistant tuberculosis (RR-TB) and poor treatment outcomes, Rwanda initiated the programmatic management of RR-TB, including expanded access to systematic rifampicin drug susceptibility testing (DST) and standardised treatment.OBJECTIVE: To describe trends in diagnostic and treatment delays and estimate their effect on RR-TB mortality.DESIGN: Retrospective analysis of individual-level data including 748 (85.4%) of 876 patients diagnosed with RR-TB notified to the World Health Organization between 1 July 2005 and 31 December 2016 in Rwanda. Logistic regression was used to estimate the effect of diagnostic and therapeutic delays on RR-TB mortality.RESULTS: Between 2006 and 2016, the median diagnostic delay significantly decreased from 88 days to 1 day, and the therapeutic delay from 76 days to 3 days. Simultaneously, RR-TB mortality significantly decreased from 30.8% in 2006 to 6.9% in 2016. Total delay in starting multidrug-resistant TB (MDR-TB) treatment of more than 100 days was associated with more than two-fold higher odds for dying. When delays were long, empirical RR-TB treatment initiation was associated with a lower mortality.CONCLUSION: The reduction of diagnostic and treatment delays reduced RR-TB mortality. We anticipate that universal testing for RR-TB, short diagnostic and therapeutic delays and effective standardised MDR-TB treatment will further decrease RR-TB mortality in Rwanda.

Progressive chorioretinal involvement in a patient with light-chain (AL) amyloidosis: a case report

BackgroundTo report an unusual case of light-chain (AL) amyloidosis with progressive bilateral chorioretinal abnormalities documented with short-wavelength autofluorescence, SD-OCT, fluorescein and indocyanine green angiography.Case presentationCase report of a forty-three-year-old male patient with kappa AL amyloidosis. The patient presented with rapidly progressing pigmented and hyperautofluorescent drusenoid deposits in both eyes, associated with central serous retinal detachments, a pachychoroid and choriocapillaris enlargement. The general assessment revealed a renal failure symptomatic of a nephrotic syndrome, associated with proteinuria composed mainly of free kappa light chains. A kidney biopsy confirmed the diagnosis of kappa AL amyloidosis. Chemotherapy was quickly started. During remission, the extension of drusenoid deposits on the fundus was stopped and a disappearance of the subretinal fluid on SD-OCT was observed.ConclusionsAL amyloidosis is an insidious and potentially fatal condition. This case is one of the first to document the rapid progression of fundus alterations and their stabilization after disease remission. Identifying these specific fundus abnormalities is essential to avoid diagnosis wandering and therapeutic delay.

CYSTIC TUBERCULOSIS OF TALUS IN A CHILD: A CASE REPORT

Tuberculosis of the talus is an unusual presentation of musculoskeletal tuberculosis. It is a rare manifestation of extra-pulmonary tuberculosis (EPTB) and accounts for around 0.1 to 0.3% of total EPTB. Its indolent nature often leads to missed or delayed diagnosis. Thus, prompt diagnosis is of utmost importance as diagnostic and therapeutic delay can worsen the prognosis. We are reporting a case of an 8-year-old boy with tuberculosis of the isolated right Talus with discharging sinus. The X-ray showed a cystic form of tuberculosis. He was treated with first-line antitubercular drugs. The child responded to the chemotherapy and by the end of the12-month course, he was asymptomatic. Thus, early diagnosis and therapy are crucial for good results.

Comorbidity in head and neck cancer: Is it associated with therapeutic delay, post-treatment mortality and survival in a population-based study?

This study aims to investigate the relationship between comorbidities and therapeutic delay, post-treatment mortality, overall and relative survival in patients diagnosed with squamous cell carcinoma of the head and neck (HNSCC). 9245 patients with a single HNSCC diagnosed between 2009 and 2014 were identified in the Belgian Cancer Registry. The Charlson Comorbidity Index (CCI) was calculated for 8812 patients (95.3%), distinguishing patients having none (0), mild (1-2), moderate (3-4) or severe comorbidity (>4). The relationship between CCI and therapeutic delay was evaluated using the Spearman correlation. Post-treatment mortality was modelled with logistic regression, using death within 30days as the event. The association between comorbidity and survival was assessed using Cox proportional hazard models. Among 8812 patients with a known CCI, 39.2% had at least one comorbidity. Therapeutic delay increased from 31 to 36days when the CCI worsened from 0 to 4 (rho=0.087). After case-mix adjustment, higher baseline comorbidity was associated with increased post-surgery mortality (mild, OR 3.52 [95% CI 1.91-6.49]; severe, OR 18.71 [95% CI 6.85-51.12]) and post-radiotherapy mortality (mild, OR 2.23 [95% CI 1.56-3.19]; severe, OR 9.33 [95% CI 4.83-18.01]) and with reduced overall survival (mild, HR 1.39, [95% CI 1.31-1.48]; severe, HR 2.41 [95% CI 2.00-2.90]). That was also the case for relative survival in unadjusted analyses (mild, EHR 1.77 [95% CI 1.64-1.92]; severe, EHR=4.15 [95% CI 3.43-5.02]). Comorbidity is significantly related to therapeutic delay, post-treatment mortality, 5-year overall and relative survival in HNSCC patients. Therapeutic decision support tools should optimally integrate comorbidity.

Agustín habla sobre Alipio y Nebridio

In conf. VI, the younger Augustine – as described by his older self – is well on his way to conversion, even though he is not yet aware of this himself. His spell as a Manichaean had not given him what he had hoped to find, and he feared that the Catholics would prove equally disappointing. Confronted with this situation, he decided to consult his friends. After an evocation of the influence of Ambrose (conf. VI,1,1–6,10), to which he proved susceptible, and before dealing with the problems to which the resulting choice gave rise (conf. VI, 11,18–16,26): to continue to work or not, to marry or not, Augustine describes his encounters with Alypius and Nebridius in conf. VI, 7,11–10,17. In this section, which is very carefully composed with regard not only to form (structure), but also, and primarily, to content (argument), he summons up the impasse in which he finds himself, and describes it with the aid of two images: that of illness, and that of danger at sea. The argument that he develops is that of a crisis: when a person is ill, it sometimes happens that the patient’s condition must first deteriorate before it improves, just as someone in danger at sea must sometimes face even greater peril before he is able to escape. This is what Augustine describes in conf. VI, 7,11–10,17, and this ensures that conf. VI is not a book in which he comes to a standstill, but one in which a therapeutic delay is created that gives him the strength and courage to accept humility instead of pride, and to persevere on his journey towards conversion, described in conf. VIII. This article analyses and interprets the strategy that Augustine employs to achieve this.

ACUTE PANCREATITIS AND PREGNANCY : A RARE AND SEVERE ASSOCIATION

Introduction Acute pancreatitis associated with pregnancy is a serious condition, surgical discovery or even necropsy and difficult diagnosis. We report a case of acute pancreatitis occurring in a pregnant woman. Observation This is a 29-year-old woman, nulliparous with no previous pathological history, presented to obstetric emergencies for hepatic colic. The patient had no transit disorder or gastrointestinal bleeding. Clinically, the patient was feverish, blood pressure was 16/9 mmHg and her hemodynamic status was stable. Obstetrical examination was normal, correlated with gestational age. The biological assessment performed showed anemia. The viral serology performed was negative. Liver status, renal status and coagulation status were normal. The diagnosis was acute pancreatitis and pre-eclampsia in pregnancy. Discussion Acute pancreatitis rarely occurs during pregnancy. It is associated with high maternal and fetal mortality. It occurs in most cases in the 3rd trimester of pregnancy [1]. In the 2nd and 3rd trimesters, supersaturation of bile in relation to increased cholesterol excretion and stagnation of supersaturated bile in the gallbladder induces formation of cholesterol crystals and gallstones [2]. In the 3rd trimester, the gravid uterus compresses the common bile duct and can lead to acute pancreatitis. Acute pancreatitis during pregnancy may be associated with pre-eclampsia that increases fetal mortality [3]. Conclusion Acute pancreatitis during pregnancy is a rare association, difficult to diagnose and has a terrible prognosis for both the mother and the fetus. The diagnostic and therapeutic delay will be fatal to the mother-child couple.

Case report: horse or zebra, ascites or pseudo-ascites? Care for pictural details!

BackgroundPseudo-ascites is a very rare condition in children and remains a challenging diagnosis. Targeted imaging may be helpful, but a high index of clinical suspicion is often necessary to guide the investigations, as pseudo-ascites may efficiently mimic true ascites. To date, still many cases of pseudo-ascites suffer diagnostic and therapeutic delay, and some are only diagnosed during surgical exploration. We report the case of a patient with a late laparoscopic diagnosis of pseudo-ascites. We retrospectively review our patient’s imaging findings and suggest new characteristic features which may help differentiate pseudo-ascites from true ascites.Case presentationA 7-month-old infant was referred for a progressive abdominal distention. Physical examination and initial ultra-sonographic findings evoked free ascites. An extensive diagnostic workup was then performed and was negative for hepatic, renal, cardiac, intestinal, pancreatic, inflammatory or infectious diseases, malignancy and congenital metabolic disorders. Pseudo-ascites was evoked and dedicated ultra-sonographic and magnetic resonance studies were repeated but could not confirm this diagnosis. Symptomatic diuretic treatment with spironolactone and furosemide was then started. A temporary and limited effect was noted but, with time, repeated paracenteses were necessary as the abdominal distention progressed causing discomfort and breathing difficulty. Last, because the patient’s quality of life deteriorated, a peritoneal-venous shunting was proposed; as the operation started with a diagnostic laparoscopy, a benign giant cystic mesenteric lymphangioma was identified and totally excised. The resolution of symptoms was immediate and the patient remained symptom-free throughout the subsequent observation period that lasted more than 1 year.ConclusionsIncreased awareness about pseudo-ascites is necessary, as the diagnosis is often overlooked, and treatment delayed. Targeted imaging may be helpful, as some specific, although not pathognomonic, features exist which may aid in the diagnosis.

Waiting times for diagnosis and surgery in a large obstetric-gynecological hospital in Italy

Abstract Issue Diagnostic testing and surgical waiting times are related to quality of healthcare services. An extension of waiting times, indeed, could lead to a diagnostic or therapeutic delay, with potential consequences on patient health outcomes. Several policies have been implemented in different European countries in order to improve these indicators. Our study aims to analyse the waiting times of the largest obstetric and gynaecological hospital of Northern Italy, in order to identify potential issues in women’s health services. Description of the problem Data of “Sant’Anna Hospital” (Turin, Italy) about the waiting times in the period 2016-2017 for outpatient and surgical services addressed to women were collected. Specifically, number of health care procedures and mean waiting times (MWT) for “Obstetric-Gynaecological Echography” (OGE), “First Endocrinological Visit” (FEV), “First Gynaecological Visit” (FGV), “Surgical Intervention for Breast Cancer” (SIBC) and “Surgical Intervention for Uterus Cancer” (SIUC) were retrieved. Results were compared with the benchmark identified by the regional law. Results A total of 21,735 OGEs were performed, with a MWT of 3 days in 2016 and 5 days in 2017, below the benchmark (11 days). The total number of FEVs was 1,234, with a MWT of 19 and 23 days in 2016 and 2017 respectively, again below the benchmark (30 days). The FGVs were 21,096 with a MWT of 9 (2016) and 24 (2017) days (benchmark 30 days). The number of SIBCs (N = 89) performed within 30 days (benchmark) were 87 (98% of SIBCs), while SIUCs (N = 90) were 84 (93%). Lessons The waiting times of the “Sant’Anna hospital” were, for all the performances considered, shorter than the regional benchmarks. This is an indicator of the quickness of diagnosis and treatment and, indirectly, of the quality of care. An international comparison among the main European hospitals should be encouraged in a perspective of continuous improvement of health care provided to European citizens. Key messages Diagnostic testing and surgical waiting times are useful to assess the quickness and quality of health care provided in European hospitals. “Sant’Anna hospital”, leader for women’s health care, provides care with waiting times shorter than benchmarks. It would be interesting to compare its results with other large European hospitals.

Identifying factors associated with treatment delay in leptospirosis: A retrospective study of patients admitted to hospital in Reunion (Indian Ocean) between 2014 and 2015

BackgroundLeptospirosis is a life-threatening zoonotic disease for which delayed treatment onset has been associated to poor prognosis. The purpose of the study was to identify the determinants of therapeutic delay in hospitalized leptospirosis cases. Patients and methodsWe carried out a retrospective multicenter study in the 4 public hospitals of Reunion Island, South Western Indian Ocean. Medical records of confirmed leptospirosis cases occurring in 2014–2015 were reviewed for socio-economic, demographic, geographic and medical data. The primary outcome measure was the therapeutic delay, defined as the time elapsed between the onset of symptoms and initiation of antibiotics. ResultsOf the 117 patients included, 107 were men, with an average age of 44.9±15years. The median therapeutic delay was 4 days (interquartile: 2–5 days) and this delay was not found to be associated with severity. The following were found to be at increased risk of having a longer therapeutic delay: cases occurring outside the epidemic period, or rainy season (OR 2.8 [1.08–7.3], P=0.04) and cases with first medical evaluation in primary health care (OR 4.63 [1.43–14.93]; P=0.01) instead of emergency unit. No socio-economic or geographic characteristics were found to be linked to a longer therapeutic delay. ConclusionAlthough delayed treatment was not associated to disease severity, our results indicate that leptospirosis awareness is needed all year in the subtropical area of Reunion Island and particularly in primary care.

EP1.16-09 Delays in Care of Lung Cancer: A Moroccan Public Health Problem

For several years, lung cancer, which is responsible for one in five cancer deaths, has been considered the leading cause of cancer death. In Morocco, in 2018, 6488 new cases of lung cancer were reported for both sexes and all ages with 22,9% of all new cases of male cancer (Globocan) It”s a real public health problem The delay between the different therapeutic sequences has a real impact on survival, which makes it”s optimization a real public health issue. The aim of this work was to describe the care pathway for patients treated for lung cancer at the Mohamed VI Center, as well as the different treatment delays in our context. To do this, we conducted a monocentric, retrospective study in patients treated for lung cancer between January 2012 and November 2017 at the Mohamed VI Cancer treatment Center. To study this period and obtain significant results, we referred to the statistical rules and retained one month pey year, one year out of two, for a total of six months spread between January 2012 and November 2017 Using the oncology department’s database, we identified all patients with histologically confirmed lung cancer and a usable archived record that was summarized in a farm with pre-established responses coded as numerical variables. The key point of this study was the study of the time between the appearance of the first clinical signs and the initiation of the different therapeutic sequences discussed in a multidisciplinary meeting. During the study period, 125 cases of lung cancer were collected. The average age was 57,6 years The average consult time also called patient time was 3.92 months. As for the delays related to the health system there are: An average diagnostic time of 63,5 days A therapeutic delay of 67,9 days on average An average overall delay of 216,3 days The time to diagnosis was therefore close to that recommended by the littérature, while the consultation, treatment and overall time to diagnosis were longer which significantly affects the survival curve. In several countries, delays in care and access to care services, considered as indicators of system performance, have become a priority in public health policies. The establishment of more specialized oncology and radiation oncology centers should help to reduce them A subsequent reassessment of these delays, after correction, will male it possible to assess the evolution of the quality of the managementof this cancet at the Mohamed VI center.

Abdominal wall endometriosis: An 11-year retrospective observational cohort study.

ObjectiveThe objective of this study was to review the records of patients with excised abdominal wall endometriosis (AWE) to determine patient characteristics, diagnostic methods, presence of concurrent pelvic endometriosis and type of surgery.Study designMedical records from an 11-year period were searched to identify histologically confirmed AWE cases. Descriptive data were collected and analyzed. Two subgroups were differentiated: isolated AWE and pelvic endometriosis-associated AWE.ResultsThirty-five women with AWE were included. The most common symptom was cyclic abdominal or parietal pain (68.6%); 17.1% of the women had no symptoms. Twenty-nine women (82.8%) had a history of gynecological or obstetrical surgery, most commonly cesarean section (CS). The mean interval between prior surgery and appearance of symptoms was 5.3 years. Six women (17.1%) had no prior surgery; all six presented with umbilical nodules, nulliparity and confirmed mild to severe pelvic endometriosis. Among all patients, 34.3% had concurrent pelvic endometriosis, 40% presented with isolated AWE and 25.7% had no pelvic exploration. Women with concurrent pelvic endometriosis had significantly lower parity, smaller nodule size and a higher likelihood of umbilical location than those with isolated AWE (p < 0.05). A history of CS was more commonly found in women with isolated AWE. The overall recurrence rate over the study period was 11.4%, with a mean follow-up period of 5.2 years.ConclusionsAWE is an uncommon condition associated with long diagnostic and therapeutic delays. In patients with umbilical AWE and no surgical history, pelvic endometriosis is commonly present and should be highly suspected.