Tuberculosis ganglionar con compromiso genital: Reporte de Caso / Lymph node tuberculosis with genital involvement: Case Report

RESUMEN Se presenta el caso de un paciente varón de 44 años con antecedentes familiares de linfoma e hipertiroidismo. Él inició la enfermedad tres meses antes del ingreso hospitalario con dolor en la pierna derecha y abdominal, pérdida de peso y sudoración nocturna. Fue diagnosticado en su internamiento con ascitis en cavidad pélvica de etiología indeterminada, y múltiples adenomegalias poligástricas y en fosa iliaca derecha. A los seis meses, los síntomas persistieron y se agregó un nódulo en el pene, edema testicular izquierdo y secreción purulenta del ganglio inguinal derecho; se diagnosticó orquiepididimitis. Inicialmente, tuvo marcadores negativos para tuberculosis (TBC), sin embargó, se realizó biopsia del ganglio y el análisis con Xpert MTB/RIF, lo que resultó positivo. El paciente mejoró considerablemente con tratamiento anti TB y antibióticos para la secreción purulenta.

ABSTRACT The case of a 44-year-old male patient with a family history of lymphoma and hyperthyroidism is presented. His disease started three months prior to hospital admission with pain in the right leg and abdomen, weight loss, and night sweats. Upon admission, he was diagnosed with pelvic ascites of undetermined etiology and multiple polygastric and right iliac fossa lymph nodes. Six months later, his symptoms persisted, and a nodule appeared on his penis, along with left testicular edema and purulent discharge from the right inguinal lymph node; orchioepididymitis was diagnosed. Initially, tuberculosis (TB) markers were negative; however, a lymph node biopsy and analysis with Xpert MTB/RIF were performed, yielding a positive result. The patient showed significant improvement with anti-TB treatment and antibiotics for the purulent discharge.

Factors Associated with Late Diagnosis of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in a University Hospital in Brazil: Challenges to Achieving the 2030 Target.

INTRODUCTION: This study aimed to identify factors associated with late diagnosis and clinically monitor newly diagnosed HIV/AIDS patients. METHOD: Retrospective study, based on secondary data from a specialized unit at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the University of Sao Paulo. Data collection included sociodemographic, behavioral, clinical, and laboratory data of newly diagnosed HIV patients between 2015 and 2019. Data analysis was undertaken using inferential statistical tests. RESULTS: A total of 314 individuals were newly diagnosed with HIV/AIDS, 86.6% (272) had a late diagnosis and 53.8% (169) were diagnosed very late. Using the adjusted odds ratio, we observed that bisexual and MSM patients were less likely to have a late diagnosis compared to straight patients. Individuals who entered through the emergency department and Outpatient Clinic had a lower chance of having a very late diagnosis compared to those diagnosed in the ward/inpatient unit. Having a higher education and university education were protective factors against having a very late diagnosis of HIV infection compared to elementary school education only. In addition, male patients were more likely to have a very late diagnosis compared to female patients. CONCLUSIONS: This study evidenced a high prevalence of late and very late diagnoses. Therefore, attention should be directed towards factors related to late and very late presentation.

Increased cytokine levels induced by high phenylalanine concentrations in late diagnosis PKU patients compared to early diagnosis: Anti-inflammatory effect of L-carnitine.

Phenylketonuria (PKU) was the first genetic disease to have an effective therapy, which consists of phenylalanine intake restriction. However, there are patients who do not adhere to treatment and/or are not submitted to neonatal screening. PKU patients present L-carnitine (L-car) deficiency, compound that has demonstrated an antioxidant and anti-inflammatory role in metabolic diseases. This study evaluated the effect caused by exposure time to high Phe levels in PKU patients at early and late diagnosis, through pro- and anti-inflammatory cytokines, as well as the L-car effect in patients under treatment. It was observed that there was a decrease in phenylalanine levels in treated patients compared to patients at diagnosis, and an increase in L-car levels in the patients under treatment. Inverse correlation between Phe versus L-car and nitrate plus nitrite versus L-car in PKU patients was also showed. We found increased proinflammatory cytokines levels: interleukin (IL)-1ß, interferons (IFN)-gamma, IL-2, tumor necrosis factor (TNF)-alpha, IL-8 and IL-6 in the patients at late diagnosis compared to controls, and IL-8 in the patients at early diagnosis and treatment compared to controls. Increased IL-2, TNF-alpha, IL-6 levels in the patients at late diagnosis compared to early diagnosis were shown, and reduced IL-6 levels in the treated patients compared to patients at late diagnosis. Moreover, it verified a negative correlation between IFN-gamma and L-car in treated patients. Otherwise, it was observed that there were increased IL-4 levels in the patients at late diagnosis compared to early diagnosis, and reduction in treated patients compared to late diagnosed patients. In urine, there was an increase in 8-isoprostane levels in the patients at diagnosis compared to controls and a decrease in oxidized guanine species in the treated patients compared to the diagnosed patients. Our results demonstrate for the first time in literature that time exposure to high Phe concentrations generates a proinflammatory status, especially in PKU patients with late diagnosis. A pro-oxidant status was verified in not treated PKU patients. Our results demonstrate the importance of early diagnosis and prompt start of treatment, in addition to the importance of L-car supplementation, which can improve cellular defense against inflammation and oxidative damage in PKU patients.

El difícil camino al diagnóstico del paciente con atrofia muscular espinal / The difficult path to diagnosis of the patient with spinal muscular atrophy

Introducción. Con las nuevas terapias, el diagnóstico temprano de la atrofia muscular espinal (AME) es esencial. El objetivo de este estudio es analizar los distintos componentes que influyen en el retraso diagnóstico. Población y métodos. Se incluyeron pacientes con un diagnóstico molecular de AME tipo I, II y III. Se estudiaron varios parámetros, como la edad al momento de la aparición del primer signo, qué signo fue y el intervalo entre este y el diagnóstico confirmado. Neurólogos especialistas realizaron entrevistas que se complementaron con la revisión de historias clínicas cuando fue necesario. Resultados. Se entrevistaron 112 pacientes. AME I n = 40, AME II n = 48, AME III n = 24. La mediana de edad en meses al momento del reporte del primer signo fue AME I: 1,5 (R 0-7), AME II: 9 (R 2-20), AME III: 18 (R 8-180). Los primeros signos fueron reconocidos por los padres en el 75 % al 85 % de las veces en todos los subtipos. La mediana del tiempo transcurrido entre el primer signo y la primera consulta médica fue menor a un mes en los tres tipos. La mediana de tiempo transcurrido en meses entre el primer signo y el diagnóstico molecular confirmado fue en AME I: 2 (R 0-11), en AME II: 10 (3-46) y en AME III: 31,5 (R 4-288). Conclusiones. Existe un significativo retraso en el diagnóstico de la AME relacionado fundamentalmente a la falta de sospecha clínica. La demora es menor en AME I y mayor en AME III. Otros factores incluyen deficiencias en el sistema de salud.

Introduction. News treatments, make early diagnosis of spinal muscular atrophy (SMA) critical. The objective of this study is to analyze the different factors that influence delay in diagnosis. Population and methods. Patients with a molecular diagnosis of types I, II, and III SMA were included. Several parameters were studied, such as age at onset of first sign, what sign it was, and the time from recognition of first sign to confirmed diagnosis. Neurologists specialized in SMA conducted interviews, supported by the review of medical records when deemed necessary. Results. A total of 112 patients were interviewed. SMA I n = 40, SMA II n = 48, SMA III n = 24. The median age in months at the time of reporting the first sign was SMA I: 1.5 (R: 0­7), SMA II: 9 (R: 2­20), SMA III: 18 (R: 8­180). In all subtypes, first signs were identified by parents from 75% to 85% of the times. The median time from first sign to first medical consultation was less than a month in all 3 types. The median time in months, from first sign to confirmed molecular diagnosis in SMA I was: 2 (R: 0­11), in SMA II: 10 (R: 3­46), in SMA III: 31.5 (R: 4­288). Conclusions. There is a significant delay in SMA diagnosis mainly related to the absence of clinical suspicion. The delay is shorter in SMA I and longer in SMA III. Other factors include deficiencies in the health care system.

Análisis del coste directo de la atención médica y quirúrgica del cáncer de mama. Estudio comparativo entre etapas temprana y tardía en tercer nivel de atención.

BACKGROUND: Management of breast cancer is increased by late diagnoses. OBJECTIVE: To analyse direct costs of breast cancer in early and advanced stage in a third level medical facility at Mexican Social Security Institute. METHOD: Observational study, direct costs of care in breast cancer in initial and advanced clinical stages are compared. Variables analysed were laboratory and diagnostic imaging studies, drugs, as well as hospitalization costs. The evaluated period included from the first care to the completion of the treatment. Costs were determined according to the table of Unit Costs by Level of Medical Care for the year 2019 of the Mexican Social Security Institute. Student's t test was used to determinate differences between groups, as well as descriptive statistics. RESULTS: The advanced stage compared to the initial stage, causes a greater number of laboratory-cabinet studies, surgeries, day/bed and interconsultations. The average cost of breast cancer care per patient is $99,280.36 (US$5,230.78) and $148,023.60 (US$7,789.92) for the initial and advanced stages, respectively (p = 0.024). CONCLUSIONS: Cost of medical attention in the initial stage is lower than that of the advanced stage.

ANTECEDENTES: Los diagnósticos tardíos elevan los costes de atención del cáncer de mama. OBJETIVO: Analizar los costes directos de la atención del cáncer de mama en etapa temprana y avanzada en el tercer nivel de atención en el Instituto Mexicano del Seguro Social (IMSS). MÉTODO: Estudio observacional que compara los costes directos de atención en cáncer de mama en estadios clínicos inicial y avanzado. Los datos analizados fueron estudios de laboratorio, gabinete, tratamiento y hospitalización. El tiempo evaluado incluyó desde la primera atención hasta la finalización del primer tratamiento. Se determinaron los costes de acuerdo con la tabla de Costes Unitarios por Nivel de Atención Médica para el año 2019 del IMSS. Se utilizó la prueba t de Student para diferencias entre grupos, así como estadística descriptiva. RESULTADOS: El estadio avanzado, comparado con el estadio inicial, ocasiona un número mayor de estudios de laboratorio-gabinete, cirugías, día/cama e interconsultas. El coste promedio de la atención del cáncer de mama por paciente es $99,280,36 (US$5,230.78) y $148,023.60 (US$7,789.92) para los estadios inicial y avanzado, respectivamente (p = 0.024). CONCLUSIONES: El coste de la atención médica del estadio inicial es menor que el del estadio avanzado.

The difficult path to diagnosis of the patient with spinal muscular atrophy. / El difícil camino al diagnóstico del paciente con atrofia muscular espinal.

Introduction. News treatments, make early diagnosis of spinal muscular atrophy (SMA) critical. The objective of this study is to analyze the different factors that influence delay in diagnosis. Population and methods. Patients with a molecular diagnosis of types I, II, and III SMA were included. Several parameters were studied, such as age at onset of first sign, what sign it was, and the time from recognition of first sign to confirmed diagnosis. Neurologists specialized in SMA conducted interviews, supported by the review of medical records when deemed necessary. Results. A total of 112 patients were interviewed. SMA I n = 40, SMA II n = 48, SMA III n = 24. The median age in months at the time of reporting the first sign was SMA I: 1.5 (R: 0-7), SMA II: 9 (R: 2-20), SMA III: 18 (R: 8-180). In all subtypes, first signs were identified by parents from 75% to 85% of the times. The median time from first sign to first medical consultation was less than a month in all 3 types. The median time in months, from first sign to confirmed molecular diagnosis in SMA I was: 2 (R: 0-11), in SMA II: 10 (R: 3-46), in SMA III: 31.5 (R: 4-288). Conclusions. There is a significant delay in SMA diagnosis mainly related to the absence of clinical suspicion. The delay is shorter in SMA I and longer in SMA III. Other factors include deficiencies in the health care system.

Introducción. Con las nuevas terapias, el diagnóstico temprano de la atrofia muscular espinal (AME) es esencial. El objetivo de este estudio es analizar los distintos componentes que influyen en el retraso diagnóstico. Población y métodos. Se incluyeron pacientes con un diagnóstico molecular de AME tipo I, II y III. Se estudiaron varios parámetros, como la edad al momento de la aparición del primer signo, qué signo fue y el intervalo entre este y el diagnóstico confirmado. Neurólogos especialistas realizaron entrevistas que se complementaron con la revisión de historias clínicas cuando fue necesario. Resultados. Se entrevistaron 112 pacientes. AME I n = 40, AME II n = 48, AME III n = 24. La mediana de edad en meses al momento del reporte del primer signo fue AME I: 1,5 (R 0-7), AME II: 9 (R 2-20), AME III: 18 (R 8-180). Los primeros signos fueron reconocidos por los padres en el 75 % al 85 % de las veces en todos los subtipos. La mediana del tiempo transcurrido entre el primer signo y la primera consulta médica fue menor a un mes en los tres tipos. La mediana de tiempo transcurrido en meses entre el primer signo y el diagnóstico molecular confirmado fue en AME I: 2 (R 0-11), en AME II: 10 (346) y en AME III: 31,5 (R 4-288). Conclusiones. Existe un significativo retraso en el diagnóstico de la AME relacionado fundamentalmente a la falta de sospecha clínica. La demora es menor en AME I y mayor en AME III. Otros factores incluyen deficiencias en el sistema de salud.

Monitoramento clínico de casos recém diagnosticados de HIV/Aids assistidos em um hospital do interior paulista / Clinical monitoring of newly diagnosed HIV/AIDS cases assisted in an interior hospital in São Paulo

Introdução: O diagnóstico oportuno da infecção pelo HIV deve ser uma das prioridades para o controle da aids. Globalmente, as pessoas que vivem com o HIV têm acesso ao diagnóstico tardiamente e com doenças associadas, trazendo implicações para o tratamento e desfecho clínico desfavorável. Apesar dos esforços para o diagnóstico oportuno, os hospitais ainda recebem pacientes com a aids. Objetivo: Monitorar clinicamente pacientes recém diagnosticados com HIV/aids quanto ao diagnóstico oportuno e desfecho após um ano. Método: Estudo retrospectivo, com dados secundários de uma unidade especializada localizada em um hospital terciário no interior paulista. A coleta de dados incluiu dados sociodemográficos, comportamentais, clínicos e laboratoriais de recém diagnosticados com HIV coletados em prontuário eletrônico que chegaram para primeiro atendimento hospitalar entre 2015-2019. A análise dos dados utilizou os softwares estatísticos SPSS e STATA e abordou estatística descritiva e inferencial, a saber: teste do Qui-Quadrado, Exato de Fisher, T pareado, regressão logística multivariada e multinominal, com significância estatística de 5% (α ≤ 0,05). O estudo atendeu aos preceitos éticos da Resolução nº 466/2012. Resultados: 314 pessoas foram recém diagnosticadas com HIV/aids. 70,3% (208) tiveram diagnóstico tardio e 57,1% (169) muito tardio. Houve associação do diagnóstico muito tardio com as variáveis sexo e escolaridade e com: origem, entrada, ocorrência de doenças oportunistas, uso de TARV e óbito, essas com diagnóstico tardio e muito tardio, respectivamente. O seguimento clínico do dia zero e doze meses após apresentou melhora na contagem de CD4, carga viral e indivíduos indetectáveis. A regressão multinominal mostrou uma chance de ocorrência de óbito - 6,17 vezes maior em 2017 quanto em 2015 e chance de ocorrência de perda de seguimento 4,31 vezes maior no mesmo período. Quanto a chance de ocorrência de transferência para serviços secundários, em 2018 foi 7,13 vezes maior do que em 2015 e decréscimo em 2019. A modalidade de entrada pelo primeiro atendimento teve uma chance menor de ocorrência de óbito do que os pacientes originários de enfermaria (87,73%). Os pacientes cuja entrada se deu pelo ambulatório apresentaram uma chance menor de ocorrência de óbito (76,11%) e de transferência para serviço secundário (94,59%) em relação aos originários de enfermaria. Discussão: As evidências identificadas foram compatíveis com achados previamente descritos na literatura como a importância da educação no enfretamento a epidemia de HIV, alta eficiência da TARV e dificuldades das políticas públicas voltadas para o HIV (sejam essas para a prevenção e diagnóstico precoce ou tratamento) em alcançar as pessoas em situação de vulnerabilidade social, especialmente, homens. Conclusão: Evidenciou-se alta prevalência de diagnóstico tardio e muito tardio em pacientes recém diagnosticados para o HIV, que apresentam em grande proporção doenças oportunistas, principalmente, quando necessitam de internação hospitalar. Recomenda-se planos de ação voltados para o diagnóstico oportuno do HIV e ações para efetivação da política nacional de saúde do homem. Além de outras pesquisas a fim de preencher lacunas como referente ao impacto da pandemia de COVID -19 no diagnóstico e tratamento desses indivíduos

Introduction: Timely diagnosis of HIV infection should be a priority for AIDS control. Globally, people living with HIV have late access to diagnosis and associated illnesses, resulting in implications for treatment and unfavorable clinical outcomes. Despite efforts towards timely diagnosis, hospitals still receive patients with AIDS. Objective: To clinically monitor newly diagnosed HIV/AIDS patients for timely diagnosis and outcomes after one year. Method: Retrospective study with secondary data from a specialized unit located in a tertiary hospital in the interior of São Paulo. Data collection included sociodemographic, behavioral, clinical, and laboratory data from newly diagnosed HIV patients collected from electronic medical records who arrived for initial hospital care between 2015-2019. Data analysis used statistical software SPSS and STATA and included descriptive and inferential statistics, namely: Chi-Square test, Fisher's Exact test, paired t-test, multivariate and multinomial logistic regression, with statistical significance set at 5% (α ≤ 0.05). The study met the ethical precepts of Resolution no. 466/2012. Results: 314 people were newly diagnosed with HIV/AIDS. 70.3% (208) had late diagnosis and 57.1% (169) had very late diagnosis. Very late diagnosis was associated with sex and education variables, as well as origin, entry, occurrence of opportunistic diseases, use of ART, and death, all with late and very late diagnosis, respectively. Clinical follow-up at zero and twelve months showed improvement in CD4 count, viral load, and undetectable individuals. Multinomial regression showed a 6.17-fold higher chance of death in 2017 than in 2015 and a 4.31-fold higher chance of loss to follow-up in the same period. The chance of transfer to secondary services was 7.13 times higher in 2018 than in 2015, with a decrease in 2019. The entry modality for initial care had a lower chance of death than patients originating from the ward (87.73%). Patients whose entry was through the outpatient clinic had a lower chance of death (76.11%) and transfer to secondary service (94.59%) than those originating from the ward. Discussion: The evidence identified was consistent with previously described findings in the literature, such as the importance of education in dealing with the HIV epidemic, the high efficiency of ART, and the difficulties of public policies focused on HIV (whether for prevention and early diagnosis or treatment) in reaching people in situations of social vulnerability, especially men. Conclusion: A high prevalence of late and very late diagnosis was found in newly diagnosed HIV patients, who presented a high proportion of opportunistic diseases, especially when hospitalized. Action plans aimed at timely HIV diagnosis and actions to implement the national health policy for men are recommended. Further research is needed to fill gaps regarding the impact of the COVID-19 pandemic on the diagnosis and treatment of these individuals

Diagnóstico tardio do Vírus da Imunodeficiência Humana e da Síndrome da Imunodeficiência Adquirida em Idosos: protocolo scoping review / Late diagnosis of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome in the Elderly: scoping review protocol

As pessoas idosas, diagnosticadas tardiamente, tem maior risco de desenvolver AIDS. Com a contagem de CD4 inferior a 200 células/ml3, elas apresentam em média mais chances de morrer no primeiro ano após o diagnóstico. O objetivo desta revisão de escopo é mapear evidências relativas aos fatores associados e de risco do diagnóstico tardio de HIV/AIDS em pessoas idosas, mas especificamente, esta revisão quer dar resposta às seguintes questões: Quais são os fatores associados do diagnóstico tardio de HIV/AIDS em pessoas idosas? Quais são os fatores de riscos do diagnóstico tardio de HIV/AIDS em pessoas idosas? Que contexto o diagnóstico tardio de HIV/AIDS em pessoas idosas foi realizado? Esta revisão será orientada pela metodologia do Joanna Briggs Institute, que assentará na estratégia de definição dos participantes, conceito e contexto. Os resultados serão apresentados pelo resumo lógico e descritivo, apresentados, como um mapa de dados extraídos dos artigos e alinhado com o objetivo e as perguntas da revisão de escopo. Espera-se que esta revisão de escopo contribua para a análise compreensiva das práticas de cuidados à saúde das pessoas idosas.

Elderly people, diagnosed late, have a higher risk of developing AIDS. With a CD4 count of less than 200 cells / ml3, they are on average more likely to die in the first year after diagnosis. The purpose of this scope review is to map evidence regarding the associated risk factors of late diagnosis of HIV / AIDS in older people, but specifically, this review aims to address the following questions: What are the associated factors of late diagnosis of HIV / AIDS in elderly people? What are the risk factors for late diagnosis of HIV / AIDS in elderly people? In what context was the late diagnosis of HIV / AIDS in elderly people given? This review will be guided by the methodology of the Joanna Briggs Institute, which will be based on participant definition strategy, concept and context. Results will be presented by the logical and descriptive summary, presented as a map of data extracted from the articles and aligned with the objective and scope review questions. This scope review is expected to contribute to a comprehensive analysis of the health care practices of elderly people.

Las personas mayores, diagnosticadas tardíamente, tienen un mayor riesgo de desarrollar SIDA. Con un recuento de CD4 de menos de 200 células/ml3, tienen en promedio más probabilidades de morir en el primer año después del diagnóstico. El objetivo de esta revisión de alcance es mapear las evidencias relacionadas con los factores asociados y de riesgo del diagnóstico tardío del VIH/SIDA en personas mayores, pero específicamente esta revisión tiene como objetivo responder a las siguientes preguntas: ¿Cuáles son los factores asociados con el diagnóstico tardío del VIH/SIDA en las personas mayores? ¿Cuáles son los factores de riesgo para el diagnóstico tardío del VIH/SIDA en las personas mayores? ¿Cuál es el contexto del diagnóstico tardío del VIH/SIDA en las personas mayores? Esta revisión se guiará por la metodología del Joanna Briggs Institute, que se basará en la estrategia de definición, concepto y contexto de los participantes. Los resultados se presentarán mediante un resumen lógico y descriptivo, presentado como un mapa de los datos extraídos de los artículos y alineados con el objetivo y las preguntas de la revisión del alcance. Se espera que esta revisión del alcance contribuya al análisis exhaustivo de las prácticas de atención de la salud de los ancianos.

Prevalence and factors associated with late diagnosis of the HIV infection in a municipality of São Paulo / Prevalencia y factores asociados al diagnóstico tardío de la infección ocasionada por el VIH en un municipio de São Pauloo / Prevalência e fatores associados ao diagnóstico tardio da infecção pelo hiv em um município paulista

ABSTRACT Objective: to identify the prevalence and factors associated with late diagnosis of the infection by the Human Immunodeficiency Virus (HIV), in a municipality of São Paulo. Method: an epidemiological, analytical and retrospective study that analyzed the HIV and AIDS cases notified by the health services in the period from 2015 to 2017 using data from the notifications of the Information System for Notifiable Diseases (SINAN Net) corresponding to the users recently diagnosed with HIV/AIDS infection in the municipality of Ribeirão Preto/SP, Brazil. Data collection was in May 2018. The chi-square test was performed, as well as binary logistic regression, where the dependent variable was the AIDS criterion at the moment of notifying infection by HIV. A p-value<0.05 was considered for the association between the variables studied in relation to late diagnosis. Results: of the 829 (100%) new HIV cases, 290 (35.0%) were diagnosed in the condition of AIDS. Most of the population was male and aged between 15 and 34 years old. Oral candidiasis and weight loss greater than 10% were the main symptoms associated with AIDS. It was observed that people with lower schooling levels and older were more prone to late diagnoses. Conclusion: it is necessary to devise strategies that favor timely diagnosis in the municipality under study, particularly among the individuals aged over 45 years old and with lower schooling levels.

RESUMEN Objetivo: identificar la prevalencia y los factores asociados al diagnóstico tardío de la infección ocasionada por el Virus de Inmunodeficiencia Humana (HIV) en un municipio del interior de Brasil. Método: estudio epidemiológico, analítico y retrospectivo que analizó los casos de VIH y SIDA notificados por los servicios de salud entre 2015 y 2017 por medio de los datos de las notificaciones del Sistema de Información de Problemas de Salud pasibles de Notificación (SINAN Net) referentes a los usuarios recién diagnosticados con la infección ocasionada por el VIH/SIDA en el municipio de Ribeirão Preto/SP, Brasil. La recolección de datos fue en mayo de 2018. Se realizaron tanto una prueba de chi-cuadrado como un análisis de regresión logística binaria, en la cual la variable dependiente fue el criterio de SIDA al momento de notificar la infección ocasionada por el HIV. Se consideró un valor de p<0,05 para la asociación entre las variables estudiadas en relación con el diagnóstico tardío. Resultados: entre los 829 (100%) casos nuevos de HIV, 290 (35,0%) fueron diagnosticados en la condición de SIDA. La mayoría de la población era del sexo masculino y pertenecía al grupo etario de 15 a 34 años. Candidiasis oral y pérdida de peso superior al 10% fueron los principales síntomas asociados al SIDA. Se observó que las personas con niveles de educación más bajos y de mayor edad fueron más propensas a ser diagnosticadas tardíamente. Conclusión: es necesario elaborar estrategias que favorezcan el diagnóstico oportuno en el municipio estudiado, particularmente entre las personas de más de 45 años de edad y con niveles de educación más bajos.

RESUMO Objetivo: identificar a prevalência e os fatores associados ao diagnóstico tardio da infecção pelo vírus da imunodeficiência humana (HIV), em um município do interior paulista. Método: estudo epidemiológico, analítico e retrospectivo que analisou os casos de HIV e AIDS notificados pelos serviços de saúde no período de 2015 a 2017 por meio dos dados das notificações do Sistema de Informação de Agravos de Notificação (Sinan Net) dos usuários recém-diagnosticados para a infecção pelo HIV/AIDS no município de Ribeirão Preto/SP, Brasil. A coleta de dados ocorreu em maio de 2018. Foi realizado o teste qui-quadrado e regressão logística binária, no qual a variável dependente foi o critério de AIDS no momento da notificação da infecção pelo HIV. Foi considerado o valor de p<0,05 para a associação entre as variáveis estudadas com relação ao diagnóstico tardio. Resultados: dentre os 829 (100%) casos novos de HIV, 290 (35,0%) foram diagnosticados na condição de AIDS. A maioria da população pertencia ao sexo masculino e na faixa etária dos 15 aos 34 anos. A candidose oral e a perda de peso acima de 10% foram os principais sintomas associados à AIDS. Observou-se que pessoas com menor escolaridade e com o aumento da idade eram mais propensas a serem diagnosticadas tardiamente. Conclusão: estratégias que favoreçam o diagnóstico oportuno no município estudado são necessárias, particularmente entre os indivíduos com idade acima de 45 anos e com menor escolaridade.

Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study.

BACKGROUND: In 2007-2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013-2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Still, late HIV diagnosis is a major concern in Mexico due to its association with the development of AIDS development and mortality. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013-2017 National HIV program. METHODS: Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. RESULTS: The study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45 to 43% (P < 0.001) between 2008 and 2012 and 2013-2017 (i.e. before and after the implementation of the 2013-2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013 and 2017 (odds ratio [OR] = 0.96 [95% Confidence interval [CI] [0.93, 0.98]) or in health facilities specialized in HIV care (OR = 0.64 [95% CI 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis. CONCLUSIONS: The results of this study indicate that the 2013-2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico. We identified several predictors of late diagnosis which could help establishing health policies. The main determinants for late diagnosis were being male, older than 29 years old, and being diagnosed in a Hospital or National Institute.

Sequelae of late diagnosis and treatment of developmental dysplasia of the hip: case report and surgical technique description. / [Secuela de diagnóstico tardío y tratamiento en displasia del desarrollo de la cadera: reporte de caso y descripción de técnica quirúrgica.]

Developmental hip dysplasia (DHD) is a common entity that affects 4 out of every 1000 live births and is a recognized cause of secondary hip osteoarthritis despite routine perinatal controls. In most patients, the early diagnosis of the pathology allows an evolution without sequelae. However, in the basis that patients diagnosed late and with multiple surgeries are patients with open physis, ossification nuclei present and previous surgeries in the approach area, the late diagnosis represents a real challenge for the orthopedist. We report below the case of a patient treated in our center since birth, who evolved with complications associated with late diagnosis and surgical interventions, describing rescue surgery performed at 12 years of age and finally highlighting the importance of routine perinatals and early diagnosis of DHD.

La displasia del desarrollo de la cadera (DDC) es una entidad frecuente que afecta a 4 de cada 1000 nacidos vivos y es una causa reconocida de artrosis de cadera secundaria a pesar de los controles perinatales de rutina. En la mayoría de los pacientes, el diagnóstico precoz de la patología permite una evolución sin secuelas. Sin embargo, el diagnóstico tardío con múltiples intervenciones representa un verdadero reto para el ortopedista, ya que se trata de pacientes con fisis abierta, nucleos de osificación presentes y cirugías previas en la zona de abordaje. Se reporta a continuación el caso de una paciente tratada en nuestro centro desde su nacimiento, que evolucionó con complicaciones asociadas al diagnóstico tardío y a las intervenciones quirúrgicas, describiendo la cirugía de salvataje realizada a los 12 años de edad y destacando finalmente la importancia de los controles perinatales de rutina y el diagnóstico precoz de la DDC.

Undiagnosed Phenylketonuria Can Exist Everywhere: Results From an International Survey.

Many countries do not have a newborn screening (NBS) program, and immigrants from such countries are at risk for late diagnosis of phenylketonuria (PKU). In this international survey, 52 of 259 patients (20%) with late diagnosed PKU were immigrants, and 145 of the 259 (55%) were born before NBS or in a location without NBS.

Características clínico-epidemiológicas de mujeres con Virus de Inmunodeficiencia Humana. Boyeros. 1986-2016 / Clinical and epidemiological characteristics of women with Human Immunodeficiency Virus. Boyeros. 1986-2016

Introducción: En los últimos años las mujeres constituyen uno de los grupos más vulnerables y afectados por el VIH. Objetivo: Determinar características clínico-epidemiológicas de mujeres con VIH, residentes en el municipio Boyeros. Material y métodos: investigación descriptiva, retrospectiva de pacientes femeninas con VIH, diagnosticadas y residentes en el municipio Boyeros, desde 1986 hasta el 31 de diciembre del 2016. Se incluyeron solo las pacientes mayores de 14 años, vivas, diagnosticadas y residentes en el municipio. La muestra estuvo constituida por 99 casos. La fuente de información se obtuvo de las historias clínicas de la Consulta Municipal especializada para la atención a pacientes con VIH/sida del municipio Boyeros. Resultados: Las tasas de incidencia muestran tendencia ascendente. El 49,5 por ciento se diagnostican con edades entre 15 y 29 años. Predominan las mujeres blancas en 40 por ciento, con nivel de escolaridad secundaria básica (43 por ciento). Un 19 por ciento se hizo el diagnostico como gestante y más de 50 por ciento no declararon vínculo laboral estable. El diagnóstico tardío se presentó en 43 por ciento y a edades mayores. El último conteo de T-CD4 fue mayor de 350 células/mm3 en más de 50 por ciento. El 92,9 por ciento de los casos tienen indicado TARV. Conclusiones: La población femenina con VIH del municipio Boyeros es predominantemente joven, con nivel de escolaridad básica y sin vínculo laboral. Se mantienen casos de diagnóstico tardío y las cifras de T-CD4 muestran valores adecuados en la mayoría de los casos(AU)

Introduction: Women are one of the most vulnerable groups affected by HIV during the last years. Objective: To determine the clinical and epidemiological characteristics of women with HIV in Boyeros municipality. Material and Methods: A descriptive retrospective research was conducted in female HIV patients in Boyeros municipality from 1986 to December 31, 2016. Only alive women older than 14 years living in the aforementioned municipality who were previously diagnosed with HIV were included in the study. The sample was composed of 99 cases. The information was obtained from the clinical records of the Municipal Consultation where specialized care is given to patients with HIV/AIDS. Results: The incidence rates of HIV infection in women showed a rising trend. Also, 49,5 percent of women infected with HIV were between 15 and 29 years of age. There was a prevalence of whites (40 percent) as well as women with secondary levels of education (43 percent). The diagnosis was also made in pregnant women, representing the 19 percent. More than 50 percent of them declared not to have steady jobs. Late diagnosis was identified in 43 percent of women in older ages. The latest T-CD4 count was higher than 350 cells/mm3 in more than 50 percent of them. ART was indicated in 92,9 percent of the cases. Conclusions: The female population infected with HIV in Boyeros municipality is mainly young; a lot of them have basic educational levels and do not have an employment contract. Late diagnosis of HIV infection continues to be identified. T-CD4 cell counts show adequate values in most of the cases(AU)

Sociodemographic factors related with emergency colorectal cancer surgery at a referral center in Mexico.

BACKGROUND: Diagnosis of colorectal cancer (CRC) after emergency presentation is associated with a worse prognosis. AIM: The aim of the study was to determine the sociodemographic factors related with emergency CRC surgery at our institution. METHODS: From January 2009 to December 2017, patients that underwent CRC surgery at our institution were included in the study. Univariate and multivariate logistic regression were used to determine the effect of the potential risk factors on the rate of emergency surgery. RESULTS: A total of 247 patients underwent CRC surgery at our institution. The rate of emergency surgery was 7.7%. On univariate analysis, patients without a family history of cancer (odds ratio [OR]: 4.95), living in a rural area (OR: 3.7), and late clinical cancer stage (OR: 5.06) were associated with emergent surgery. Mid-income status was a protective factor for emergency surgery (OR: 0.14, p = 0.003). On multivariate analysis, late clinical cancer stage (OR: 4.41, 95% CI 1.21-16.05, p = 0.024) and mid-income economic status (OR: 0.41, 95% CI 0.04-0.55, p = 0.004) were identified as independent risk factors for emergency surgery. CONCLUSION: Social, economic, and demographic factors were identified as predictors for emergent CRC surgery.

ANTECEDENTES: El diagnóstico de cáncer colorrectal (CCR) en el contexto de urgencia está asociado a un mal pronóstico. OBJETIVO: Determinar los factores sociodemográficos asociados a cirugía de urgencia en el CCR en nuestra institución. MÉTODO: De enero de 2009 a diciembre de 2017 se incluyeron los pacientes operados de CCR y se realizaron análisis univariado y multivariado para determinar los potenciales factores de riesgo. RESULTADOS: Se incluyeron en el estudio 247 pacientes operados de CCR. El 7.7% de las cirugías fueron de urgencia. En el análisis univariado, los pacientes sin antecedentes familiares de cáncer (odds ratio [OR]: 4.95), los habitantes de zonas rurales (OR: 3.7) y aquellos en etapas avanzadas del cáncer (OR: 5.06) se asociaron a cirugía de urgencia. Los pacientes con nivel socioeconómico medio tuvieron menos probabilidad de que su cirugía fuera de urgencia (OR: 0.14; p = 0.003). En el análisis multivariado, debutar con una etapa clínica avanzada (OR: 4.41; intervalo de confianza del 95% [IC95%]: 1.21-16.05; p = 0.024) y tener un nivel socioeconómico medio (OR: 0.41; IC95%: 0.04-0.55; p = 0.004) fueron factores independientes para cirugía de urgencia por CCR. CONCLUSIONES: Los factores sociales, económicos y demográficos se encontraron relacionados con la necesidad de cirugía de urgencia por CCR.

Determinants of delay from cancer diagnosis to treatment initiation in a cohort of brazilian women with breast cancer.

This objective this study was to identify the time interval between breast cancer (BC) diagnosis and treatment initiation and delay-associated factors. This is a prospective cohort study that followed breast cancer patients, enrolled and treated at the cancer center in Rio de Janeiro (RJ) - Brazil, from October 02, 2014 to April 30, 2015. Participants were interviewed at the first consultation. Treatment-related information was collected six months after recruitment. The median and interquartile range (IQR) were calculated. The interval between breast cancer diagnosis and treatment initiation of more than 60 days was considered the delay, according to the maximum term determined by Brazilian law. The association between independent variables and the outcome was performed using the crude odds ratios (OR). Variables presenting p < .20 in the univariate analysis were included in the multiple logistic regression model by the stepwise forward method, and those with p < .05 were retained in the final model. A total of 470 patients were included in the study. The median time was of 127 days (IQR: 85- 174). Delay was observed in 89.1% of the cases. After adjustment, the variables associated with delay were age ≥ 60 years (OR: 2.48; 95% CI 1.22-5.06), initial clinical staging (<2B) (OR: 2.01; 95% CI 1.05-3.86) and residence outside the city of Rio de Janeiro (OR: 2.75; 95% CI 1.38-5.51). Delays in starting treatment were associated with sociodemographic and clinical factors. Improving patient quality of care and restructuring the health service can minimise delays.

Clinical, biochemical and molecular findings of 24 Brazilian patients with glutaric acidemia type 1: 4 novel mutations in the GCDH gene.

Glutaric aciduria type 1 (GA-1) is a rare but treatable inherited disease caused by deficiency of glutaryl-CoA dehydrogenase activity due to GCDH gene mutations. In this study, we report 24 symptomatic GA-1 Brazilian patients, and present their clinical, biochemical, and molecular findings. Patients were diagnosed by high levels of glutaric and/or 3-hydroxyglutaric and glutarylcarnitine. Diagnosis was confirmed by genetic analysis. Most patients had the early-onset severe form of the disease and the main features were neurological deterioration, seizures and dystonia, usually following an episode of metabolic decompensation. Despite the early symptomatology, diagnosis took a long time for most patients. We identified 13 variants in the GCDH gene, four of them were novel: c.91 + 5G > A, c.167T > G, c.257C > T, and c.10A > T. The most common mutation was c.1204C > T (p.R402W). Surprisingly, the second most frequent mutation was the new mutation c.91 + 5G > A (IVS1 ds G-A + 5). Our results allowed a complete characterization of the GA-1 Brazilian patients. Besides, they expand the mutational spectrum of GA-1, with the description of four new mutations. This work reinforces the importance of awareness of GA-1 among doctors in order to allow early diagnosis and treatment in countries like Brazil where the disease has not been included in newborn screening programs.

O diagnóstico tardio na perspectiva do itinerário terapêutico: grau 2 de incapacidade física na hanseníase / El diagnóstico tardío desde la perspectiva del itinerario terapéutico: grado 2 de discapacidad física en la enfermedad de Hansen / Late diagnosis under the perspective of therapeutic itineraries: level 2 physical disabilities in Hansen's disease

Destacam-se casos novos de hanseníase com grau de incapacidade física 2 (GIF 2) que demonstram a ineficiente detecção oportuna. O artigo é um relato de casos e propõe analisar o diagnóstico tardio sob a perspectiva do itinerário terapêutico (IT), com base em um estudo qualitativo. O cenário foram dois municípios da Região Metropolitana da Baixada Santista: Praia Grande e São Vicente. Realizou-se análise documental e entrevista em profundidade com quatro participantes. O material foi submetido à análise de conteúdo e definiram-se as categorias temáticas: cuidado em saúde; corpo na hanseníase; incapacidades na hanseníase; e diagnóstico tardio. Revelaram-se intrincados itinerários terapêuticos, marcados pela fragilidade do cuidado com erro e atraso no diagnóstico, que potencializaram os riscos individuais e coletivos e impactaram negativamente o cotidiano dos sujeitos. (AU)

Se subrayan casos nuevos de enfermedad de Hansen (lepra) con grado de discapacidad física 2 (GIF 2), que demuestran la ineficiente detección oportuna. El artículo es un relato de casos y propone analizar el diagnóstico tardío bajo la perspectiva del itinerario terapéutico (IT), con base en un estudio cualitativo. El escenario fueron dos municipios de la Región Metropolitana de la Baixada Santista: Praia Grande y São Vicente. Se realizó el análisis documental y entrevista en profundidad con cuatro participantes. El material se sometió a análisis de contenido y se definieron las categorías temáticas: cuidado de salud, cuerpo en la enfermedad de Hansen; discapacidades en la enfermedad de Hansen y diagnóstico tardío. Se revelaron intricados itinerarios terapéuticos, señalados por la fragilidad del cuidado, con error y atraso en el diagnóstico, que potencializaron los riesgos individuales y colectivos e impactaron negativamente el cotidiano de los sujetos. (AU)

There are remarkable numbers of new leprosy cases with 2 (GIF 2) degree of physical disability, demonstrating the inefficient timely detection. This article presents case reports, based on a qualitative study, regarding four patients with Hansen's disease and a GIF 2 level at the time of diagnosis, analyzing the late diagnosis from the perspective of therapeutic itineraries (TI). The cases came from two municipalities in the Metropolitan Region of Baixada Santista: Praia Grande and São Vicente. Three men and one woman participated, between 45 and 61 years old. The researcher performed documentary analysis and in-depth interviews. Resulting data was submitted to content analysis and four thematic categories were identified: health care; body in leprosy; disabilities in leprosy; late diagnosis. The results reveal intricate therapeutic itineraries with obstacles for reaching a diagnosis. Lack of information about Hansen's disease and professional inability to diagnose increased both individual and collective risks, in addition to the negative impact on the subjects' daily lives. Thus, a late diagnosis due to the frailty of care strongly concurs to keep Hansen's disease as a stigmatizing and disabling disease. (AU)

[Association between delayed diagnosis and breast cancer in advanced clinical stage at the time of consultation in four oncology centers in Medellin- Colombia, 2017. Cross-sectional study].

OBJECTIVE: To determine the association between delayed diagnosis and advanced clinical stage breast cancer, and to explore the factors that influence this delay. METHODS: Cross-sectional study of women over 18 years of age with breast cancer who attended 4 oncology centers in Medellín, Colombia, in 2017. The "Breast Cancer Delay Questionnaire" which includes sociodemographic and clinical variables as well as time intervals was used. Crude and adjusted odds ratio (OR) were estimated, using advanced clinical stage as outcome and delayed diagnosis as exposure. RESULTS: 42 patients were included. The median time interval between the identification of the problem and the diagnostic biopsy was 104.5 days; between the identification of the problem and the first medical visit, 20 days; and between the first visit and the diagnostic biopsy, 53 days. Of all the cases, 52.1 % were diagnosed at an advanced stage. An association was found between delayed diagnosis and advanced clinical stage (OR = 2.15 95 % CI 1.21-3.79). Age above 40 was found to be a protective factor against having an advanced-stage lesion (OR = 0.35; 95 % CI: 0.14-0.83). Delayed diagnosis was associated with affiliation to the government subsidized health system (OR = 9.67; 95 % CI 2.76- 33.9) and age over 40 years (OR = 2.75; 95 % CI1.16-6.53). CONCLUSIONS: Patient education is required in order to ensure adherence to early screening programs or timely consultation whenever a sign or symptom is identified, thus allowing diagnosis at an early stage of the disease. Moreover, prospective studies are needed in order to identify factors associated with delays in treatment after the diagnosis of breast cancer, and to assess interventions designed to reduce delays in the care of this form of cancer.

TITULO: ASOCIACIÓN ENTRE RETRASO EN EL DIAGNÓSTICO Y ESTADIO CLÍNICO AVANZADO DE CÁNCER DE MAMA AL MOMENTO DE LA CONSULTA EN CUATRO CENTROS ONCOLÓGICOS DE MEDELLÍN, COLOMBIA, 2017. ESTUDIO DE CORTE TRANSVERSAL. OBJETIVO: Establecer la asociación entre el retraso en el diagnóstico de cáncer de mama con un estadio clínico avanzado y explorar factores que influyen en dicho retraso. METODOS: Estudio de corte transversal con mujeres mayores de 18 años con cáncer de mama que consultaron en cuatro centros oncológicos de Medellín, Colombia, en 2017. Se usó el Breast Cancer Delay Questionnaire que incluye variables sociodemográficas, clínicas y de tiempos de atención. Se estimó el odds ratio (OR) crudo y ajustado por medio de una regresión logística con el estadio clínico avanzado como desenlace y el retraso diagnóstico como exposición. RESULTADOS: Se incluyeron 242 pacientes. La mediana del tiempo entre identificar el problema y la biopsia diagnóstica fue 104,5 días; entre identificar el problema y la primera consulta médica, 20 días, y de la primera consulta a la biopsia diagnóstica fue de 53 días. El 52,1 % se diagnosticó en estadio avanzado. Hubo asociación del retraso diagnóstico con estadio clínico avanzado (OR = 2,15; IC 95 %: 1,21-3,79). Se encontró que la edad mayor a 40 años es un factor protector contra una lesión avanzada (OR = 0,35; IC 95 %: 0,14-0,83). El retraso diagnóstico se asoció con estar afiliada al régimen subsidiado por el Estado (OR = 9,67; IC 95 %: 2,76-33,9) y tener edad mayor a 40 años (OR = 2,75; IC 95 %: 1,16-6,53). CONCLUSIONES: Se requieren intervenciones educativas en las pacientes para adherir a los programas de tamización temprana o la consulta oportuna al identificar un signo o síntoma, para lograr un diagnóstico en estadios tempranos de la enfermedad. Además, se requieren estudios prospectivos para determinar los factores relacionados con la demora en recibir el tratamiento una vez diagnosticado el cáncer de seno y evaluar las intervenciones destinadas a disminuir las dilaciones en la atención de este cáncer.

Association between delayed diagnosis and breast cancer in advanced clinical stage at the time of consultation in four oncology centers in Medellin- Colombia, 2017. Cross-sectional study / Asociación entre retraso en el diagnóstico y estadio clínico avanzado de cáncer de mama al momento de la consulta en cuatro centros oncológicos de medellín, colombia, 2017. estudio de corte transversal

RESUMEN Objetivo: establecer la asociación entre el retraso en el diagnóstico de cáncer de mama con un estadio clínico avanzado y explorar factores que influyen en dicho retraso. Materiales y métodos: estudio de corte transversal con mujeres mayores de 18 años con cáncer de mama que consultaron en cuatro centros oncológicos de Medellín, Colombia, en 2017. Se usó el Breast Cancer Delay Questionnaire que incluye variables sociodemográficas, clínicas y de tiempos de atención. Se estimó el odds ratio (OR) crudo y ajustado por medio de una regresión logística con el estadio clínico avanzado como desenlace y el retraso diagnóstico como exposición. Resultados: se incluyeron 242 pacientes. La mediana del tiempo entre identificar el problema y la biopsia diagnóstica fue 104,5 días; entre identificar el problema y la primera consulta médica, 20 días, y de la primera consulta a la biopsia diagnóstica fue de 53 días. El 52,1 % se diagnosticó en estadio avanzado. Hubo asociación del retraso diagnóstico con estadio clínico avanzado (OR = 2,15; IC 95 %: 1,21-3,79). Se encontró que la edad mayor a 40 años es un factor protector contra una lesión avanzada (OR = 0,35; IC 95 %: 0,14-0,83). El retraso diagnóstico se asoció con estar afiliada al régimen subsidiado por el Estado (OR = 9,67; IC 95 %: 2,76-33,9) y tener edad mayor a 40 años (OR = 2,75; IC 95 %: 1,16-6,53). Conclusión: se requieren intervenciones educativas en las pacientes para adherir a los programas de tamización temprana o la consulta oportuna al identificar un signo o síntoma, para lograr un diagnóstico en estadios tempranos de la enfermedad. Además, se requieren estudios prospectivos para determinar los factores relacionados con la demora en recibir el tratamiento una vez diagnosticado el cáncer de seno y evaluar las intervenciones destinadas a disminuir las dilaciones en la atención de este cáncer.

ABSTRACT Objective: To determine the association between delayed diagnosis and advanced clinical stage breast cancer, and to explore the factors that influence this delay. Materials and methods: Cross-sectional study of women over 18 years of age with breast cancer who attended 4 oncology centers in Medellín, Colombia, in 2017. The "Breast Cancer Delay Questionnaire" which includes sociodemographic and clinical variables as well as time intervals was used. Crude and adjusted odds ratio (OR) were estimated, using advanced clinical stage as outcome and delayed diagnosis as exposure. Results: 242 patients were included. The median time interval between the identification of the problem and the diagnostic biopsy was 104.5 days; between the identification of the problem and the first medical visit, 20 days; and between the first visit and the diagnostic biopsy, 53 days. Of all the cases, 52.1 % were diagnosed at an advanced stage. An association was found between delayed diagnosis and advanced clinical stage (OR = 2.15 95 % CI 1.21-3.79). Age above 40 was found to be a protective factor against having an advanced-stage lesion (OR = 0.35; 95 % CI: 0.14-0.83). Delayed diagnosis was associated with affiliation to the government subsidized health system (OR = 9.67; 95 % CI 2.76- 33.9) and age over 40 years (OR = 2.75; 95 % CI: 1.16-6.53). Conclusion: Patient education is required in order to ensure adherence to early screening programs or timely consultation whenever a sign or symptom is identified, thus allowing diagnosis at an early stage of the disease. Moreover, prospective studies are needed in order to identify factors associated with delays in treatment after the diagnosis of breast cancer, and to assess interventions designed to reduce delays in the care of this form of cancer.

Diagnóstico tardio de HIV na terceira idade: uma análise de reportagens veiculadas na mídia / Late HIV diagnosis in third age: an analysis of news articles in media

Esse artigo apresenta resultados de uma pesquisa qualitativa exploratória, que buscou analisar a visão das mídias em relação ao sexo na terceira idade. Foram utilizadas cinco reportagens sobre a forma que as mídias auxiliam como ferramenta informativa sobre HIV na terceira idade. Os motivos dos idosos serem vulneráveis às IST (infecções sexualmente transmissíveis) a partir de dados midiáticos são diagnóstico tardio da doença pelos profissionais de saúde, que ao terem acesso as demandas dos pacientes, a priori, atribuem qualquer outro diagnóstico ao idoso, não considerando a possibilidade de ser um quadro clínico de HIV positivo; preconceitos, estereótipos e discriminações sociais perante a atividade sexual na terceira idade, pela crença social de vida sexual inativa da pessoa idosa. Diante destas problemáticas, se faz necessário trabalhar nas políticas públicas questões sobre soropositividade das pessoas na terceira idade, intervenções através da criação de campanhas, cartilhas e outras sobre a importância do uso do preservativo, importância do olhar humanizado do profissional de saúde voltado para a população idosa, e olhar mais minucioso e sensível aos sinais e sintomas da doença para que o tratamento possa ser praticado na fase inicial da infecção.

This article shows exploratory qualitative research outcomes that analyze how social media touch upon the theme of the sexual relations among elderly people. It was utilized five news reports published on newspapers that talk about how social media works as an informative tool about HIV among elderly people. The reasons to elderly people are vulnerable to sexually transmitted diseases, according to social media datas, can be the late diagnosis; prejudice, stereotypes and, social discrimination in relation to the sexual relations among elderly people, as a result of social representation that affirms there is not sexual practices in old age. As as result of this problem, it is necessary to work on public policies on issues of seropositivity in the old age, as well as interventions through the creation of campaigns, booklets and others approaches on the importance of condom use. The importance of the humanized approach of work of health professionals focused on older population, and a more refined look at the signs and symptoms of the HIV disease, so that treatment can be practiced in the early stages of infection.