Analysis of influencing factors for underdiagnosis of high-grade squamous intraepithelial lesion of the uterine cervix and cervical cancer by colposcopy / 肿瘤研究与临床

Objective:To investigate the influencing factors for underdiagnosis of high-grade squamous intraepithelial lesion (HSIL) of the uterine cervix and cervical cancer by colposcopy.Methods:The clinical data of 957 patients who underwent colposcopy and were diagnosed as HSIL or cervical cancer by histopathology at the Second Hospital of Shanxi Medical University from January 2017 to June 2022 were retrospectively analyzed, and logistic regression was used to analyze the influencing factors for underdiagnosis of HSIL and cervical cancer by colposcopy.Results:The results of univariate analysis showed that the underdiagnosis of HSIL and cervical cancer by colposcopy was related to whether or not menopause was present, whether or not there was coitus bleeding, whether or not there was irregular bleeding, liquid-based thin-layer cytology test (TCT) results, the morphology of the uterine cervix, the results of acetowhitening test, the results of iodine test, whether or not there was cuffed crypt (gland) openings, whether or not there was mosaicism, whether or not there was punctate vessels, whether or not the transformed zone was completely visible, the type of transformed zone, and whether or not the lesions involved the glands (all P < 0.05), but the underdiagnosis didn't related to whether or not there was human papillomavirus (HPV) infection, whether or not there was high-risk HPV multiple infections and the results of endocervical curettage (all P > 0.05). The results of multivariate logistic regression analysis showed that irregular bleeding ( OR = 4.279, 95% CI 2.170-8.441, P < 0.001), atypical squamous cells of uncertain significance (ASC-US) by TCT ( OR = 0.415, 95% CI 0.226-0.761, P = 0.004), atypical squamous cells, cannot exclud high-grade squamous intraepithelial lesion (ASC-H)/HSIL by TCT ( OR = 0.389, 95% CI 0.206-0.735, P = 0.004), thick acetowhite epithelium by acetowhitening test ( OR = 0.015, 95% CI 0.004-0.055, P < 0.001), and punctate vessels ( OR = 0.327, 95% CI 0.173-0.616, P = 0.001) were independent influencing factors for underdiagnosis of HSIL and cervical cancer by colposcopy. Conclusions:A history of irregular bleeding is a risk factor for underdiagnosis of HSIL of the uterine cervix and cervical cancer by colposcopy, while TCT results of ASC-US, ASC-H/HSIL and colposcopic visualization of thick acetowhite epithelium and punctate vessels could reduce the risk of underdiagnosis

Leptospirose em uma cidade do sul do Brasil / Leptospirosis in a municipality of southern Brazil

Introdução: Leptospirose é uma zoonose transmitida principalmente por roedores e está relacionada com a situação socioambiental de uma população. A transmissão ocorre especialmente pela eliminação de urina do roedor, por exemplo, nas enchentes que aumentam o risco de contaminação. O artigo analisa a presença de leptospirose na cidade de Pelotas/RS, visando identificar fatores de risco para realizar de forma mais adequada o diagnóstico precoce e evitar possíveis consequências da doença. Objetivos: O estudo tem por objetivo analisar o perfil das pessoas que contraíram leptospirose e seu desfecho no município de Pelotas/RS no período de 2007 a 2017. Métodos: Estudo transversal em que foram analisados dados de prevalência de Leptospirose em Pelotas/RS, comparando zona de residência, sexo, raça, escolaridade, faixa etária e evolução da doença. Resultados: Foi possível observar que a prevalência da doença foi maior em indivíduos com baixa escolaridade, do sexo masculino, brancos e residentes de zona urbana. Metade dos casos evoluiu para a cura, e 2,34% evoluíram para óbito devido ao agravo da doença. Contudo, 53,9% não tiveram a evolução notificada, tendo seus resultados registrados como em branco/ignorado. Conclusão: A leptospirose é uma patologia potencialmente fatal, e ainda subdiagnosticada, e consequentemente subnotificada, tendo grande prevalência em locais com as características de Pelotas/RS. É de fundamental importância que haja uma reestruturação do registro da notificação compulsória com uma abrangência maior sobre dados epidemiológicos para haver um melhor planejamento de meios de prevenção, alcançando uma redução da incidência e melhorando o desfecho desses pacientes.

Introduction: Leptospirosis is a zoonosis transmitted mainly by rodents and is related with the socioenvironmental conditions of a population. Transmission occurs especially through rodents' urine, for example, risk for contamination increases in floods. The article analyzes the presence of leptospirosis in the municipality of Pelotas, Brazil, in order to identify risk factors so as to perform a more appropriate early diagnosis and to prevent possible disease consequences. Objectives: The study aimed to assess the profile of people who contracted leptospirosis and its outcome in the municipality of Pelotas, Brazil, from 2007 to 2017. Methods: Cross-sectional study that analyzed data on the prevalence of leptospirosis in Pelotas, Brazil, comparing area of residence, sex, race, schooling, age, and disease outcome. Results: It was observed that the prevalence of the disease was higher in individuals with little education, male, white, and living in the urban area. Half of the cases evolved to cure, and 2.34% evolved to death due to disease worsening. However, 53.9% of the cases did not have their outcome informed, being reported as blank/unknown. Conclusion: Leptospirosis a potentially lethal disease and is still underdiagnosed, and consequently underreported, being highly prevalent in place with the characteristics of Pelotas, Brazil. It is extremely importance to promote a restructuring in disease notification reporting, with a greater coverage on epidemiological data, in order to improve the planning of prevention strategies, achieving a reduction in disease incidence and improving patient outcomes.

Evidencia de sobrediagnóstico en el TDAH en base a evaluación neuropsicológica: un estudio en escolares chilenos / Evidence of overdiagnosis in Attention Deficit Hyperactivity Disorder (ADHD) based on neuropsychological evaluation: a study in Chilean students

Resumen Objetivo: El Trastorno por Déficit de Atención con Hiperactividad/impulsividad (TDAH) es una de las dificultades de aprendizaje más comunes en las escuelas chilenas. Se caracteriza por un patrón de funcionamiento atípico en atención e inhibición, con fuerte compromiso de otras funciones ejecutivas. Uno de los desafíos que plantea este trastorno está referido al proceso de diagnosis, el cual no suele ser suficientemente preciso. Se pretende explorar las diferencias en la distribución de dos muestras de estudiantes con y sin TDAH diagnosticadas con una escala de observación conductual a través de la evaluación de las funciones ejecutivas de atención, inhibición y flexibilidad cognitiva. Método: En este estudio se evaluó a 132 escolares, 66 con TDAH y 66 sin TDAH, en las variables de atención, inhibición y flexibilidad cognitiva de un colegio de la ciudad de Concepción en Chile. Se contrastó el rendimiento cognitivo con los diagnósticos y se reagrupó a los estudiantes en los subtipos conocidos del trastorno. Resultados: La evaluación neuropsicológica mostró que en el grupo con TDAH había alumnos que no cumplían los criterios diagnósticos para estar incluidos en él. En el grupo sin TDAH se observó un fenómeno semejante. En ambos grupos la evaluación neuropsicológica de la atención y la inhibición resultaron útiles para diagnosticar con mayor certeza y para determinar el subtipo al que pertenecía cada estudiante con TDAH detectado. La flexibilidad cognitiva solo permitió diferenciar a los sujetos con y sin TDAH. Conclusiones: En ambos grupos estudiados fue posible encontrar sujetos mal diagnosticados; el sobrediagnóstico fue de 43,93 % en el grupo con TDAH, mientras que el infradiagnóstico fue de 42,42 % en el grupo sin TDAH.

Abstract Objective: Attention Deficit Hyperactivity/Impulsivity Disorder (ADHD) is one of the most common learning difficulties in Chilean schools. It is characterized by an atypical functioning pattern in attention and inhibition, strongly compromising other executive functions. One of the challenges posed by this disorder is the diagnosis process, which is often not sufficiently accurate. The intention is to study the distribution of two students samples, with and without ADHD, diagnosed by a behavioral observation scale through the evaluation of attention, inhibition, and cognitive flexibility executive functions. Method: This study evaluated 132 students, 66 with ADHD and 66 without ADHD, considering the attention, inhibition, and cognitive flexibility variables of a school in the city of Concepción in Chile. Cognitive performance was contrasted with the diagnoses, and students were regrouped in the disorder known subtypes. Results: The neuropsychological evaluation showed that in the ADHD group, there were students who did not meet the diagnostic criteria to be included in the group. A similar phenomenon was observed in the group without ADHD. In both the groups, the neuropsychological evaluation of attention and inhibition was useful in providing a more certain dignosis and in determining the subtype to which each student detected with ADHD belonged. Cognitive flexibility was only useful in differentiating betwen the subjects with and without ADHD. Conclusions: In both the groups studied, it was possible to find misdiagnosed subjects; the overdiagnosis was 43,93 % in the ADHD group, while the under-diagnosis was 42,42 % in the group without ADHD.

PTSD in mental health outpatient settings: highly prevalent and under-recognized

Objectives: To estimate the current prevalence of posttraumatic stress disorder (PTSD) and the diagnosis rate of this disorder ascertained by psychiatrists in training. Methods: We interviewed 200 adults under treatment in a university mental health outpatient clinic. The PTSD diagnoses obtained using the Structured Clinical Interview for DSM-IV (SCID-IV) were compared with the patients' medical records. Results: Forty-one patients (20.5%) were diagnosed with current PTSD, but only one of them (2.4%) had previously received this diagnosis. This study confirms that although PTSD is highly prevalent among mental health outpatients, it is remarkably underdiagnosed in teaching hospitals. Conclusions: These findings suggest that psychiatrists in training may be failing to investigate traumatic events and their consequences and strongly indicate that trauma-related issues should be given more prominence in psychiatry curricula and psychiatrist training.

Actinomycosis, a lurking threat: a report of 11 cases and literature review

Abstract Actinomycosis remains characteristically uncommon, but is still an important cause of morbidity. Its clinical presentation is usually indolent and chronic as slow growing masses that can evolve into fistulae, and for that reason are frequently underdiagnosed. Actinomyces spp is often disregarded clinically and is classified as a colonizing microorganism. In this review of literature, we concomitantly present 11 cases of actinomycosis with different localizations, diagnosed at a tertiary hospital between 2009 and 2016. We outline the findings of at least one factor of immunosuppression in > 90% of the reported cases.

Preoperative ultrasonography of thyroid cancers:is it overdiagnosis or underdiagnosis? / 中华超声影像学杂志

Objective To investigate the accuracy and missed diagnosis rate of preoperative ultrasound in the diagnosis of thyroid carcinoma . Methods With the method of natural language recognition ,816 solitary thyroid nodules which received thyroidectomy were enrolled for the analysis of preoperative ultrasound examination and post-operative pathology results . The accuracy and the rate of missed diagnosis of ultrasonography for the diagnosis of thyroid carcinoma and lymph node metastasis were evaluated with the pathological results as the gold standard . Results There were 783 ( 96 .0％ ) malignant thyroid tumors ,6 ( 0 .7％ ) follicular tumor with uncertain malignant potential ,and 27 ( 3 .3％ ) benign thyroid tumors . Ultrasonography yielded an accuracy of 96 .1％ in the differential diagnosis between benign and malignant thyroid nodules and an accuracy of 94 .5％ in the quantification of nodule numbers . 5 .5％ of solitary nodules reported by ultrasound were proved to be 2 or more malignant nodules after the surgery . Regarding the diagnosis of central lymph node ,the preoperative ultrasound yielded an accuracy of 73 .0％and a misdiagnosis rate of 38 .7％ . For the lateral neck lymph node ,the accuracy was 88 .3％ ,and the misdiagnosis rate was 3 .4％ . Conclusions Natural language recognition method can assist clinical research . Ultrasonography is valuable in the diagnosis of thyroid carcinomas and neck lymph nodes . However , ultrasonography has a certain rate of misdiagnosis for the quantification of nodule numbers ,and for the diagnosis of lymph nodes in central and lateral necks .

Analysis of Diagnostic Differences between Colposcopy Beginner and Pathologic Report in Cervical Disease / 实用妇产科杂志

Objective:To evaluate the consistency of colposcopy diagnosis performed by a single examiner with pathologic diagnosis and to analyze the factors related with colposcopy over-and under diagnosis.Methods:A retrospective study was performed.The initial 200 cases diagnosed by a single colposcopy beginner at Peking University first Hospital out-patient clinic from March 2015 to October 2015 were included in this study.The consistency rate and bias rate of colposcopy diagnosis versus pathologic diagnosis as well as the causes of such differences were analyzed.Results:Of 174 cases with pathologic diagnosis,the consistency rate was 59.2％.The underdiagnosis rate and overdiagnosis rate were 18.4％ and 22.4％ separately.Of HSIL underdiagnosis group,the rate of TCT NILM was 78.6％ which was higher than 18.1％ in HSIL consistency group,P ＜ 0.05.Re-evaluation of the colposcopy pictures revealed that acetowhite epithelium were present in all 14 cased of HSIL underdiagnosis group.The rate of post-menopausal women was higher in HSIL underdiagnosis group than in HSIL consistency group(21.4％ vs 0％),P ＜0.05.The medium numbers of biopsy were higher in HSIL consistency group when compared with HSIL underdiagnosis group,P ＜0.05.The medium numbers of biopsy was higher in overdiagnosis group when compared with consistency group,P ＜ 0.05.Conclusions:Underdiagnosis of colposcopy was related with TCT-overdependent,insufficient understanding of acetowhite epithelium and post-menopausal women.Increasing biopsy numbers may improve the consistency rate of colposcopy and pathologic diagnosis.However,the increasing numbers of biopsy often results from overdiagnosis.

Inflammatory Bowel Disease, a Rare or Under Diagnosed Disease in Nigeria.

Six Nigerians, consisting of 5 females and 1 male with confirmed inflammatory bowel disease (IBD) were recruited from a tertiary institution and two private hospitals in Lagos into this study from January 2001 to January 2014. Their ages at the time of first visit ranged from 27 to 65 years. They all had repeated bouts of bloody mucoid stools and abdominal pain plus or minus tenesmus requiring admission and fluid replacement. One of the cases even showed a total reversal of barium enema findings after the follow up treatment of oral sulphasalazine and prednisolone given. The four females and the male have remained relatively symptom free up to the time of their last visit in the follow up clinic, while one of the females was lost to follow up. This is a prospective case series that highlights the need for a high index of suspicion to make a diagnosis of inflammatory bowel disease in an environment where the reported incidence is low. Its diagnosis requires a team approach between the gastroenterological surgeon, radiologist, gastroenterologist Physician and a sub-specialized pathologist.

Aspectos estomatológicos en el síndrome del X frágil: Revisión de la literatura y presentación de un caso clínico / Stomatological aspects in fragile X syndrome cases: Literature review and clinical case presentation

El síndrome del X frágil (SXF) es una anomalía genética causada por la replicación excesiva en la secuencia del nucleótido CGG que ocasiona anomalías físicas y psicológicas importantes, las cuales repercuten en el desarrollo intelectual del niño, además de que es la segunda causa genética más importante de retraso mental después del síndrome de Down; en ocasiones, y debido a la transición epidemiológica los trastornos de déficit de atención así como la hiperactividad, son confusos en el diagnóstico clínico y puede ser que el SXF sea subdiagnosticado. En la práctica estomatológica los trastornos del comportamiento son de suma importancia, ya que la piedra angular en el manejo de la conducta es la comunicación. Este trabajo está destinado a estimular al clínico para que busque más en los pacientes con retraso mental, trastorno por déficit de atención (TDA) e hiperactividad para encontrar el SXF, ya que el subdiagnóstico complica el tratamiento, el cual es específico y el consejo genético es importante en estos pacientes.

Fragile X syndrome (FXS) is a genetic anomaly caused by excessive replication in the CGG nucleotide sequence which elicits severe physiological and physical anomalies which impair the child's intellectual development. Moreover, FXS constitutes, after Down's syndrome, the second most frequent genetic cause for mental retardation. Due to epidemiological transition, attention deficit disorders as well as hyperactivity are confused in the clinical diagnosis; this might lead to a situation where FXS might be under-diagnosed. In the realm of stomatological practice, behavior disorders are most important since communication can be considered the cornerstone of behavior management. The present study purports the aim of encouraging the clinician to look further into patients afflicted with mental retardation, TDA and hyperactivity to find FXS since under-diagnosis impairs treatment, is specific and genetic counseling for these patients is of the utmost importance.

Comportamiento clínico-epidemiológico del asma bronquial en menores de 15 años / Bronchial Asthma Clinical and epidemiological pattern in children younger 15 years

El asma bronquial es la enfermedad crónica más frecuente de la infancia, cuya prevalencia estimada en Cuba es de 8,2 por ciento. La identificación y el control de los factores de riesgo constituyen un pilar importante en el manejo de esta entidad. Objetivos: caracterizar el comportamiento clínico-epidemiológico del asma bronquial en menores de 15 años del policlínico Ana Betancourt. Métodos: se realizó un estudio descriptivo de corte transversal, durante el período del mes de abril de 2010 a marzo de 2011. Inicialmente se aplicó el cuestionario ISSAC para identificar un posible subregistro de asma. Se empleó la clasificación Global Initiative for Asthma 2007, que permitió agrupar clínicamente a los menores en cuatro categorías. Finalmente se aplicó, a la totalidad de la muestra, un cuestionario para la identificación de los factores de riesgo. Resultados: se identificó una morbilidad oculta de 9,3 por ciento. Con asma leve intermitente: 30 pacientes; leve persistente: 21; moderado persistente: 28 y con asma severa: 14. La totalidad de los pacientes tenían antecedentes familiares de atopia y desencadenaban las crisis con los cambios climáticos. El 95,0 por ciento era sensible a inhalantes respiratorios y en el 64,0 por ciento de los hogares se detectó la presencia de fumadores. Conclusiones: el asma bronquial persiste como una enfermedad infradiagnosticada. En el orden epidemiológico, los antecedentes familiares de atopia y los cambios de tiempo, aventajaron a los restantes factores de riesgo asociados...

Bronchial Asthma is the most common chronic disease of childhood in Cuba whose estimated prevalence is 8.2 percent. The identification and control of its risk factors is an important pillar in the management of this entity. Objective: to characterize the clinical and epidemiological behavior of Asthma in children younger 15 years at Ana Betancourt polyclinic. Methods: a descriptive cross-sectional study was conducted from April 2010 to March 2011. Initially the ISSAC questionnaire was used to identify a possible asthma underreporting. 2007 Global Initiative for Asthma classification was used, which allowed clinically grouping minors into four categories. Finally, a questionnaire to identify risk factors was applied to the entire sample. Results: a hidden morbidity of 9.3 percent was identified. With mild intermittent asthma: 30 patients; mild persistent: 21; persistent moderate 28; and severe asthma: 14. All the patients had a family history of atopy, and crises were triggered by weather changes. 95.0 percent were sensitive to respiratory inhalants and 64.0 percent was detected to have smokers at home. Conclusions: bronchial Asthma persists as an underdiagnosed disease. Regarding the epidemiological aspect, family history of atopy and weather changes, outdid the other associated risk factors...

Assessment of X-ray Readers in TB Prevalence Surveys.

A prevalence study was carried out a rural community in Tiruvallur district in Tami Nadu to standardize the method of assessing an X-ray reader in tuberculosis (TB) prevalence surveys by means of different measures of agreement between the reader and a Standard Reader (SR). The exercise on assessing the X-ray readers was carried out on two occasions; one involving three trainee readers (R1, R2, and R3), and the other involving one trainee reader (R4). The extent of agreement was estimated using Kappa statistics (K), over-diagnosis, under-diagnosis, crude agreement and prevalence adjusted bias adjusted kappa (PABAK). The overall performance of readers R1, R2 and R3 was not satisfactory in terms of K (21, 34 and 14%) in the first assessment. The K, over-diagnosis and under-diagnosis were estimated to be 61, 28 and 4% for R1, 63, 18 and 4% for R2 and 58, 31 and 5% for R3 in the final assessment. This suggested that R2 performed well compared to the other two readers. The K was 68% for R4 in the first assessment. As the over-diagnosis was to the extent of 40%, the trainee reader underwent one more assessment. The K was 64% which was as good as before, but there was no improvement in the over-diagnosis (43.5%) in the second assessment. Based on the performance, only one reader (R2) was certified as qualified for X-ray reading in the first occasion while the reader (R4) assessed in the second occasion was not qualified. These findings were subject to the inherent variation in the SR’s readings against which the readers were assessed.