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1.
Wiad Lek ; 72(9 cz 1): 1607-1610, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31586971

RESUMO

OBJECTIVE: Introduction: The probability of development of axial spondyloarthritis (axSpA) is estimated to be above 90% among patients with chronic back pain, presence of HLA B27 antigen and positive family history of ankylosing spondylitis (AS), psoriasis, reactive arthritis, inflammatory bowel disease or uveitis. The nonradiographic axSpA and ankylosing spondylitis diseases' activity has a comparable impact on the patients' quality of life and from the practical point of view the approach to treatment of each of them is the same. The aim: The attempt to identify the reasons of diagnostic delays of AS among patients hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin and to suggest the ways of improving the accuracy of diagnostic track among other healthcare providers than rheumatologists. PATIENTS AND METHODS: Material and methods: We performed a retrospective analysis of the records of 82 patients' with the established diagnosis of AS, hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin in 2000-2019, and of 45 years of age and older. RESULTS: Results: From among 82 patients (28 women and 54 men) the diagnosis of AS after 45 years of age was established in 25 patients (10 women and 15 men) - group t, and in the other 57 patients (group n) the diagnosis was established before 45 years of age. On average the age at the time of diagnosis in the whole group (t+n) was 40,7±10,2 (18-76) years, the age at the beginning of inflammatory back pain (age of axial symptoms) was 30,9±8,5 (13-51) years and the diagnostic delay (period between first axial symptoms and diagnosis establishment) was 9,75±9,5 (0-46) years. We did not find any statistically significant associations between sex and age at the moment of diagnosis, age of the beginning of axial symptoms and the time of diagnostic delay. There was no significant difference of incidence of enthesitis, uveitis, arthritis, prevalence of family history of spondyloarthritis and CRP level between group t and n. Antigen HLA B27 was more frequently present in group t. CONCLUSION: Conclusions: Instead of the recognition progress and worldwide popularization of knowledge about axSpA, the diagnostic delays in this field are still estimated to last many years, the patients are looking for other specialists' help, and they can be not knowledgeable of the inflammatory back pain criteria. Currently, HLA B27 antigen and C-reactive protein are the two most commonly used biomarkers for diagnostic and disease activity monitoring purposes of axSpA and magnetic resonance is the only "imaging biomarker". The presence of extra-axial symptoms does not improve the diagnostic sensitivity.


Assuntos
Diagnóstico Tardio , Espondilartrite/diagnóstico , Adolescente , Adulto , Idoso , Biomarcadores/análise , Proteína C-Reativa/análise , Feminino , Antígeno HLA-B27/análise , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Adulto Jovem
2.
Wiad Lek ; 72(9 cz 1): 1687-1690, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31586984

RESUMO

Sjögren's syndrome is a systemic autoimmune disease characterized by exocrine glands damage, resulting in the development of dry eyes and dry mouth, as well as extraglandular manifestation. It usually starts between the ages of 30 and 50. Late-onset Sjögren's syndrome should be considered as a disease that appears after age 65, but the literature also reports of the age 50, 60, or even 70. The prevalence of late-onset Sjögren's syndrome is estimated about 20%. The course of late-onset Sjögren's syndrome may differ when compared with patients with a younger onset. Lack of sicca symptoms and marker antibodies may be associated with a delay in Sjögren's syndrome diagnosis. Particularly in the elderly, the occurrence of sicca symptoms may be considered as age-related and medication-related.


Assuntos
Síndrome de Sjogren/diagnóstico , Adulto , Idade de Início , Idoso , Diagnóstico Tardio , Humanos , Pessoa de Meia-Idade , Síndrome de Sjogren/fisiopatologia
3.
Cent Eur J Public Health ; 27(3): 229-234, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31580559

RESUMO

OBJECTIVE: Late presentation of the patients with human immunodeficiency virus (HIV) infection is associated with less favourable treatment responses, more accelerated clinical progression, and a higher mortality risk. Although HIV prevalence is low in Turkey, it is steadily increasing and the information about late presentation among HIV-positives is limited. We aimed to analyze the status of late presentation among HIV-positive patients in Turkey. METHODS: All newly diagnosed HIV/AIDS patients from 2003 to 2016 were enrolled in this study by five dedicated centres in Istanbul, Turkey. Demographic data, CD4+ counts, and HIV RNA were collected from medical records and were transferred to a HIV database system. Late pre- sentation was defined as presentation for care with a CD4 count < 350 cells/mm3 or presentation with an AIDS-defining event, regardless of the CD4 cell count. A medical literature search was done for the analysis of late presentation in Turkey. RESULTS: The cohort included 1,673 patients (1,440 males, median age 35 years). Among them, 847 (50.6%) had an early diagnosis, with a CD count of more than 350 cells/mm3. The remaining 826 were late presenters. Among late presenters, 427 (25.5% of all, 51.7% of late presenters) presented with advanced HIV disease. Late presenters were more elderly and less educated. The gender seemed comparable between groups. Late presentation was more likely among married patients. Early presenters were more likely among homosexuals, those diagnosed in screening studies, and in lower HIV-RNA viral load category. There has been a decreasing trend among late presenters in 2011-2016 when compared to 2003-2011 period. CONCLUSION: Current data suggest that half of HIV-infected patients present late in Turkey. In our cohort, those presented late were more elderly, less educated, married and had heterosexual intercourse. On admission, late presenters had more HIV-related diseases and were more likely in higher HIV-RNA category. In the cohort, men having sex with men were less likely late presenters. Efforts to reduce the proportion of late presentation are essential for almost every country. The countries should identify the risk factors of late presentation and should improve early diagnosis and presentation for HIV care.


Assuntos
Diagnóstico Tardio , Infecções por HIV , Adulto , Idoso , Contagem de Linfócito CD4/métodos , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Heterossexualidade/estatística & dados numéricos , Humanos , Masculino , Fatores de Risco , Turquia
4.
Am Surg ; 85(10): 1179-1183, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657320

RESUMO

Delayed presentation of acute appendicitis is associated with increased complications. We hypothesized that the outcomes of appendectomy in delayed presentations of acute appendicitis (>72 hours of pain) were dependent on radiologic findings rather than late presentation. We reviewed records from 2009 to 2015 and analyzed delayed presentations of acute appendicitis. We divided patients into three groups based on specific CT findings: uncomplicated appendicitis (UA), phlegmon or abscess (PA), and other perforated appendicitis (PERF, signs of perforation without abscess or phlegmon). One hundred thirty-eight patients were included in this study (58 in the UA, 67 in the PA, and 13 in the PERF groups). Overall, 78 (57%) patients underwent early appendectomy (EA) and 60 (43%) underwent initial conservative management. The incidence of adverse events was lower in EA than that in initial conservative management (17% vs 42%, P = 0.005). EA in the UA group was associated with shorter hospitalization (3.2 vs 5.6 days, P < 0.001) and less adverse events (6% vs 29%, P < 0.05). Severe adverse events (two colectomies and one fecal fistula) were observed in the PA group. In conclusion, in these late presentations of appendicitis, complicated appendicitis was common. EA was safe in selected patients, however, and associated with decreased adverse events.


Assuntos
Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Diagnóstico Tardio/efeitos adversos , Perfuração Espontânea/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Doença Aguda , Adulto , Apendicectomia/estatística & dados numéricos , Apendicite/complicações , Tratamento Conservador/efeitos adversos , Tratamento Conservador/estatística & dados numéricos , Diagnóstico Tardio/estatística & dados numéricos , Diagnóstico Precoce , Feminino , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Análise de Regressão , Perfuração Espontânea/complicações , Perfuração Espontânea/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(40): e17454, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577773

RESUMO

To examine the current situation of patient delay and to identify factors associated with patient delay among women with breast cancer in China.A total of 283 women, aged 23 to 83 years old and with histologically confirmed breast cancer, were investigated in this cross-sectional study. The women were recruited from seven selected hospitals in Sichuan Province, China. Face-to-face interviews using a structured questionnaire were performed.Among the 283 participants, the range of patient delay was 0.2 to 900 days with a median patient delay of 50 days. A total of 35.8% of patients waited ≥90 days to access medical treatment after symptom onset. Binary logistic regression analysis showed that the main predictors of patient delay were knowledge of breast cancer symptoms (OR = 0.716, 95%CI:0.637-0.804, P = .000), external health locus of control (OR = 1.173, 95%CI:1.087-1.266, P = .000), breast self-examination/physical examination (OR = 0.065, 95%CI: 0.007-0.590, P = .015), perceived health competence (OR = 0.873, 95%CI:0.808-0.944, P = .000), family support (OR = 0.911,95%CI:0.847-0.981, P = .013), pain stimulation (OR = 0.191, 95%CI:0.046-0.792, P = .023) and age (OR = 1.028, 95%CI:1.000-1.058, P = .049).These factors explained 41.0% of the variance.Information on the current situation and predictors of patient delay in Chinese women with breast cancer might provide meaning insights into the early diagnosis of breast cancer. The results of this study may help health professionals develop specific clinical practice strategies to reduce patient delay of initial treatment as a way to improve outcomes for women with breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico , Diagnóstico Tardio , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , China , Estudos Transversais , Feminino , Humanos , Controle Interno-Externo , Modelos Logísticos , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
6.
Medicine (Baltimore) ; 98(39): e17303, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574857

RESUMO

Treatment with nitisinone (NTBC) has brought about a drastic improvement in the treatment and prognosis of hereditary tyrosinemia type I (HT1). We conducted a retrospective observational multicentric study in Spanish HT1 patients treated with NTBC to assess clinical and biochemical long-term evolution.We evaluated 52 patients, 7 adults and 45 children, treated with NTBC considering: age at diagnosis, diagnosis by clinical symptoms, or by newborn screening (NBS); phenotype (acute/subacute/chronic), mutational analysis; symptoms at diagnosis and clinical course; biochemical markers; doses of NTBC; treatment adherence; anthropometric evolution; and neurocognitive outcome.The average follow-up period was 6.1 ±â€Š4.9 and 10.6 ±â€Š5.4 years in patients with early and late diagnosis respectively. All patients received NTBC from diagnosis with an average dose of 0.82 mg/kg/d. All NBS-patients (n = 8) were asymptomatic at diagnosis except 1 case with acute liver failure, and all remain free of liver and renal disease in follow-up. Liver and renal affectation was markedly more frequent at diagnosis in patients with late diagnosis (P < .001 and .03, respectively), with ulterior positive hepatic and renal course in 86.4% and 93.2% of no-NBS patients, although 1 patient with good metabolic control developed hepatocarcinoma.Despite a satisfactory global nutritional evolution, 46.1% of patients showed overweight/obesity. Interestingly lower body mass index was observed in patients with good dietary adherence (20.40 ±â€Š4.43 vs 24.30 ±â€Š6.10; P = .08) and those with good pharmacological adherence (21.19 ±â€Š4.68 vs 28.58 ±â€Š213.79).intellectual quotient was ≥85 in all NBS- and 68.75% of late diagnosis cases evaluated, 15% of which need pedagogical support, and 6.8% (3/44) showed school failure.Among the 12 variants identified in fumarylacetoacetate hydrolase gene, 1 of them novel (H63D), the most prevalent in Spanish population is c.554-1 G>T.After NTBC treatment a reduction in tyrosine and alpha-fetoprotein levels was observed in all the study groups, significant for alpha-fetoprotein in no NBS-group (P = .03), especially in subacute/chronic forms (P = .018).This series confirms that NTBC treatment had clearly improved the prognosis and quality of life of HT1 patients, but it also shows frequent cognitive dysfunctions and learning difficulties in medium-term follow-up, and, in a novel way, a high percentage of overweight/obesity.


Assuntos
Cicloexanonas/uso terapêutico , Diagnóstico Tardio , Nitrobenzoatos/uso terapêutico , Obesidade , Qualidade de Vida , Tirosinemias , Adulto , Criança , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/prevenção & controle , Inibidores Enzimáticos/uso terapêutico , Feminino , Seguimentos , Humanos , Recém-Nascido , Nefropatias/diagnóstico , Nefropatias/etiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Triagem Neonatal/métodos , Obesidade/diagnóstico , Obesidade/etiologia , Prognóstico , Estudos Retrospectivos , Espanha , Tempo para o Tratamento , Tirosinemias/complicações , Tirosinemias/diagnóstico , Tirosinemias/tratamento farmacológico , Tirosinemias/psicologia
12.
Artigo em Chinês | MEDLINE | ID: mdl-31495126

RESUMO

A farm worker in Baodi District of Tianjin was diagnosed with Tsutsugamushi disease due to fever and intermittent cough for more than 3 months.The patient's diagnosis and treatment process was complicated, and the diagnosis was delayed in the early stage of the disease because the clinician neglected the occupational history and lacked knowledge about the prevention and control of tsutsugamushi disease. As an important part of the epidemiological history, occupational history is crucial for the diagnosis of occupational related diseases. Clinical thinking runs through the whole process of clinical diagnosis and disease treatment, and correct clinical thinking can effectively reduce the occurrence of misdiagnosis.Clinicians should ask and record career history in detail to improve the quality of health care.


Assuntos
Diagnóstico Tardio , Exposição Ocupacional , Tifo por Ácaros/diagnóstico , Humanos , Anamnese , Competência Profissional
13.
Psychiatr Danub ; 31(Suppl 3): 390-394, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488758

RESUMO

BACKGROUND: Cannabinoid Hyperemesis Syndrome (CHS) is characterized by cyclic vomiting and compulsive need to take hot showers in the context of chronic cannabis use. Physicians' lack of knowledge of CHS often results in a diagnostic delay of several years. The purpose of this article is to describe CHS in order to enable physicians, and more particularly psychiatrists, to diagnose it as quickly as possible and thus avoid unnecessary additional invasive examinations. SUBJECTS AND METHODS: Bibliographic search for scientific articles published between 2004 and 2019 in the Cochrane, Medline, PubMed, and Psycinfo databases. Key words used were "hyperemesis", "cannabis", "cannabinoid". RESULTS: CHS is associated with chronic cannabis use and typically manifests as incoercible cyclical vomiting, diffuse abdominal pain, and relief of symptoms by taking hot showers. Patients suffering from CHS generally visit emergency departments very regularly and undergo numerous additional examinations, both invasive and unnecessary. Since no organic cause can explain these symptoms, these patients are referred to the psychiatry department. The only curative treatment is the complete cessation of cannabis use. CONCLUSION: CHS is an under-diagnosed pathology because it is little known to physicians. This syndrome has unique clinical characteristics. Early recognition of CHS avoids repeated visits to the emergency room and unnecessary follow-up examinations.


Assuntos
Canabinoides/efeitos adversos , Abuso de Maconha/complicações , Vômito/complicações , Diagnóstico Tardio , Humanos , Síndrome
14.
Medicine (Baltimore) ; 98(37): e17103, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517841

RESUMO

BACKGROUND: To assess whether the ultrasound (US) is a reliable approach in detecting lower-limb deep-vein thrombosis (DVT) in patients without symptoms of DVT. METHODS: The research team performed a systematic search in PubMed, Ovid, Cochrane, and Web of Science without language or date restrictions. Full-text reports on prospective diagnostic studies involve the detection of lower-limb proximal and distal DVT in patients without symptoms of DVT using US and venography. A meta-analysis was performed using Meta-DiSc (version 1.4), providing the pooled sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios of the detection accuracy of US. There were 4 different classes of subgroup analysis-the class of patients stratified by location of US exam (proximal, distal, whole leg), the class stratified by technique (color/doppler, compression, both modalities), the class stratified by kind of surgery (orthopedic, otherwise hospitalized) and the class stratified by era of publishing (1980s, 1990s, 2000s). The study quality and the risk of bias were evaluated using QUADAS-2, with heterogeneity was assessed and quantified by the Q score and I statistics, respectively. RESULTS: The meta-analysis included 26 articles containing 41 individual studies with a total of 3951 patients without symptoms of DVT. Using venography as the gold standard, US for proximal DVT had a pooled sensitivity of 59% (95% confidence interval (CI) = 51%-66%) and a pooled specificity of 98% (95% CI = 97%-98%), US for distal DVT had a poor sensitivity of 43% (95% CI = 38%-48%) and a pooled specificity of 95% (95% CI = 94%-96%), US for whole-leg DVT had a pooled sensitivity of 59% (95% CI = 54%-64%) and a pooled specificity of 95% (95% CI = 94%-96%), US for post-major orthopedic surgery patients had a pooled sensitivity of 52% (95% CI = 49%-55%), and US for other types of patients had a pooled sensitivity of 58% (95% CI = 43%-72%). Pure compression technique for DVT had a poor sensitivity of 43% (95% CI = 39%-48%), pure color/doppler technique for DVT had a pooled sensitivity of 58% (95% CI = 53%-63%), compression and color/doppler technique for DVT had a pooled sensitivity of 61% (95% CI = 48%-74%). CONCLUSION: US could be a useful tool for diagnosing DVT, but it has a lower positive rate and a higher false negative rate. The rate of missed diagnosis of lower-limb DVT by US amounts to 50% or so in the patients without symptoms of DVT. The negative results do not preclude the possibility of DVT and if appropriate heightened surveillance and continued monitoring or try a more accurate inspection method is warranted. The whole leg evaluation and color/doppler technique should be the preferred approach.


Assuntos
Diagnóstico Tardio , Extremidade Inferior/irrigação sanguínea , Ultrassonografia/normas , Trombose Venosa/diagnóstico , Humanos , Extremidade Inferior/fisiopatologia , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos , Trombose Venosa/epidemiologia
15.
J Spec Oper Med ; 19(3): 14-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539427

RESUMO

Presumptive antirelapse therapy (PART) with primaquine for Plasmodium vivax malaria postdeployment is an important component of the US military Force Health Protection plan. While primaquine is well tolerated in the majority of cases, we present a unique case of an active duty Army Ranger without glucose-6-phosphatase dehydrogenase or cytochrome b5 reductase (b5R) deficiencies who developed symptomatic methemoglobinemia while taking PART following a deployment to Afghanistan.


Assuntos
Metemoglobinemia/induzido quimicamente , Metemoglobinemia/diagnóstico , Militares , Primaquina/toxicidade , Campanha Afegã de 2001- , Diagnóstico Tardio , Humanos
16.
Pol Merkur Lekarski ; 47(279): 85-90, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31557135

RESUMO

Breast cancer is the most common malignant tumor in women. The results of breast cancer treatment to a large extent depend on the time of the primary diagnosis of the disease. AIM: The aim of this study was to determine the most common causes of the delay and the delay time in the diagnosis of breast cancer in Polish women. MATERIALS AND METHODS: The study was performed using a diagnostic survey and analysis of medical documentation from the Subcarpathian Regional Oncology Center, Poland. A total of 231 patients with diagnosed breast cancer were recruited to the study. RESULTS: Delays in diagnosing of breast cancer were found in 83.1% of all the patients. The average time from the first symptom observation by a woman to the first medical consultation was on average 61.7 days. The most common cause of the delay in medical consultation in the examined group was a fear of diagnosing cancer (31.2%). CONCLUSIONS: The examined women require permanent health education in the field of breast cancer and the importance of early diagnosis of the disease for the effectiveness of treatment and prognosis.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/diagnóstico por imagem , Diagnóstico Tardio , Feminino , Humanos , Polônia , Prognóstico , Inquéritos e Questionários
17.
Rev. méd. Urug ; 35(3): 181-192, set. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1023542

RESUMO

Introducción: el diagnóstico precoz del virus de la inmunodeficiencia humana y el acceso a un tratamiento antirretroviral temprano y continuado son estrategias clave para evitar el fallecimiento por sida. En Uruguay, desde el año 2005, luego de un ascenso continuo, se observa una estabilización de la mortalidad por sida, no presentando el descenso previsto. Se realizó un estudio con el objetivo de caracterizar el perfil clínico-epidemiológico de la población fallecida por sida en 2014 en Uruguay y valorar la distribución de las muertes en la cascada de continuo de atención. Método: retrospectivo y observacional, en base a información de registros en certificados de defunción e historias clínicas de personas de edad igual o mayor a 18 años fallecidas por sida durante el año 2014. Resultados: de los 175 fallecidos, se accedió a 124 registros, correspondiendo a 105 las muertes por sida; 77% del subsector público y 68% varones. Se caracterizó por ser una población de adultos jóvenes (43,7±11,6 años) y con condiciones de vulnerabilidad (alguna vez consumo de drogas 47,1%; situación de calle y privación de libertad 15,4%; 37,5% beneficiarios de planes sociales). El 71,4% presentó diagnóstico tardío y el 37,1% falleció en el primer año del diagnóstico. El 60% falleció sin haber logrado contacto o continuidad en la atención (11,4% previnculación, 48,6% sin retención en cuidados). Conclusiones: la elevada proporción de pacientes fallecidos sin haber establecido vinculación y seguimiento en el sistema de salud, en una población con rasgos de vulnerabilidad social, evidencia la necesidad de adoptar estrategias integrales probadas para mejorar el acceso y la continuidad de la atención.


Introduction: early diagnosis of HIV and early and continuos antirretroviral treatment constitute key strategies to avoid dying of aids. After a steady increase, HIV-related mortality has remained stable since 2005, although the expected reduction has not occurred. A study was conducted in order to characterize the clinical and epidemiological profile of the population that died of AIDS in Uruguay in 2014 and to assess the distribution of deaths in the continuum of care cascade. Method: retrospective and observational study, based on information kept in files containing death certificates and medical histories of people who were 18 years old or older and died of AIDS in 2014. Results: we had access to 124 records of the 175 deaths, finding that 105 corresponded to HIV-related deaths, 77% of them came from the public subsector and 68% of them being men. Most of them were young adults (43.7±11.6 years old) and lived in vulnerable conditions (47.1% had used drugs; 15.4% were homeless or in prison; 37.5% benefited from social plans). In 71.4% of cases diagnosis was late and 37.1% died within the first year of diagnosis. 60% died without having consulted the health system or continued treatment (11.4% failed to seek health assistance, 48.6% interrupted treatment). Conclusions: the increased proportion of patients who died without having sought health assistance or follow up in the health system within a population of social vulnerability evidences the need to adopt comprehensive strategies that have been proved successful to increase access and continuation of treament.


Introdução: o diagnóstico precoce da infecção por VIH e o acesso rápido e continuo ao tratamento antirretroviral são estratégias chaves para evitar a morte por AIDS. Desde 2005, depois de um crescimento continuo, observa-se no Uruguai, a estabilização da mortalidade por AIDS não apresentando o descenso previsto. Este estudo foi realizado com o objetivo de identificar o perfil clínico-epidemiológico da população falecida por AIDS em 2014 no país e avaliar a distribuição das mortes na cascada do continuo da atenção. Método: estudo retrospectivo e observacional, analisando a informação dos atestados de óbitos e prontuário de paciente de pessoas com 18 ou mais anos de idade falecidas por AIDS durante 2014. Resultados: foram identificadas 175 mortes; 124 registros foram analisados, dos quais 105 eram mortes por AIDS, sendo 77% do subsetor público e 68% do sexo masculino. Era uma população de adultos jovens (43.7±11.6 anos) em condições de vulnerabilidade (consumo de drogas eventual 47.1%, morador de rua e privação de liberdade 15.4%; 37.5% beneficiários de planos sociais). 71.4% foi diagnosticado tardiamente e 37.1% faleceu no primeiro ano após o diagnóstico. 60% faleceu sem haver tido e/ou sem continuidade da atenção de saúde (11.4% pré vinculação, 48.6% sem retenção nos cuidados). Conclusões: a elevada proporção de pacientes falecidos sem ter estabelecido um vínculo e seguimento no sistema de saúde, em uma população com características de vulnerabilidade social, mostra a necessidade de adotar estratégias integrais provadas para melhorar o aceso e a continuidade da atenção.


Assuntos
Síndrome de Imunodeficiência Adquirida , Síndrome de Imunodeficiência Adquirida/mortalidade , Diagnóstico Tardio
18.
Crit Care Resusc ; 21(3): 200-211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462207

RESUMO

OBJECTIVE: To provide a contemporary description of the demographics, characteristics and outcomes of critically ill Indigenous patients in Australia. DESIGN, SETTING AND PARTICIPANTS: Retrospective database review using the Australian and New Zealand Intensive Care Society Adult Patient Database for intensive care unit (ICU) admissions in 2017-18. Characteristics of critically ill Indigenous patients were compared with non-Indigenous patients. MAIN OUTCOME MEASURES: Primary outcome was hospital mortality. Secondary outcomes examined demographics and resource use. RESULTS: Per capita, Indigenous Australians were overrepresented in the intensive care. They were younger (51 v 66 years), more likely to be admitted from outer regional, rural and remote settings (59% v 15%), more likely to require emergency admission (81% v 59%), and had higher rates of mechanical ventilation (35% v 32%; P < 0.01 for all). Indigenous patients were over-represented in the diagnostic categories of sepsis (15% v 9%), trauma (7% v 5%), and respiratory illness (17% v 15%), and had higher rates of ICU re-admission (7% v 5%; P < 0.01 for all). There was no difference in either unadjusted (7.9% for each; P = 0.96) or adjusted (odds ratio, 1.1; 95% CI, 1.0-1.2) in-hospital mortality. CONCLUSION: Indigenous patients, especially young Indigenous patients, were disproportionately represented in Australian ICUs, particularly for sepsis. The high level of acute illness and high proportion of emergency admissions could be interpreted as representing delayed presentation, which, with a higher re-admission rate, suggest access barriers to health care may exist. Nevertheless, there was no mortality gap between Indigenous and non-Indigenous Australians during a hospital admission for critical illness.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Serviços de Saúde do Indígena/estatística & dados numéricos , Mortalidade Hospitalar/etnologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adulto , Distribuição por Idade , Austrália , Estado Terminal , Diagnóstico Tardio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estudos Retrospectivos , Adulto Jovem
19.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(4): 748-752, 2019 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-31420634

RESUMO

OBJECTIVE: To investigate the diagnostic delay of patients with oral squamous cell carcinoma by self-designed questionnaire to find out the significant influencing factors, so as to identify the influencing factors of the patient's delay and the risk of oral cancer. METHODS: A total of 514 patients with primary oral squamous cell carcinoma were enrolled at Peking University School and Hospital of Stomatology from January 2014 to April 2016, including 334 men and 180 women, with a male to female ratio of 1.85:1. The youngest participant was 21 years old, with a maximum of 89 years and a median age of 57.6 years. The position of the disease according to International Classification of Diseases-10 (ICD-10) was divided into lip, buccal, gingival, retromolar, palate, floor of the mouth, tongue, and oropharynx. The age group is divided into 10 years. The level of education was divided into illiteracy, primary education level and advanced education level. Body mass index (BMI) was divided into three levels by 18 kg/m2 and 25 kg/m2. Visual analog scale (VAS) method was to evaluate the patient's preoperative pain. At the same time, the patients were examined by detailed questionnaire to understand the delay factors and delay characteristics, and use SPSS 18.0 software, analysis of variance and chi-square test to explore correlation. RESULTS: Among all patients, the proportion of patients developed in the tongue was the highest (43.3%). Delay was defined by a span of three months or longer from the onset of symptoms until treatment. The delays to diagnosis according to location were as follows (in months and in descending order): lip (6.1 months), buccal (4.1 months), floor of the mouth (3.9 months), tongue (3.6 months), oropharyngeal (2.9 months), retromolar (2.7 months), palatine (2.4 months), and gingival (2.4 months). Different sites and delayed diagnosis were statistically significant (P=0.048). There were no statistically significant differences in gender, education, pain, smoking, drinking and VAS score. CONCLUSION: The study has found that tumor positions and delay have a significant correlation. The position of the tumor is an obvious factor associated with the findings. The lip is the most likely to delay the diagnosis of oral positions. For the lip of the lesion, more than three months' obvious mass is recommended for timely treatment, while at admission, physicians should take the appropriate diagnostic method as soon as possible.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Bucais , Adulto , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Tardio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/diagnóstico , Fumar , Língua , Adulto Jovem
20.
Parasit Vectors ; 12(1): 359, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340851

RESUMO

BACKGROUND: An outbreak of leishmaniasis caused by Leishmania infantum was declared in the southwest of the Madrid region (Spain) in June 2009. This provided a unique opportunity to compare the management of visceral leishmaniasis (VL) in immunocompetent adults (IC-VL), patients with HIV (HIV-VL) and patients receiving immunosuppressants (IS-VL). METHODS: A cohort of adults with VL, all admitted to the Hospital Universitario de Fuenlabrada between June 2009 and June 2018, were monitored in this observational study, recording their personal, epidemiological, analytical, diagnostic, treatment and outcome variables. RESULTS: The study population was made up of 111 patients with VL (10% HIV-VL, 14% IS-VL, 76% IC-VL). Seventy-one percent of the patients were male; the mean age was 45 years (55 years for the IS-VL patients, P = 0.017). Fifty-four percent of the IC-VL patients were of sub-Saharan origin (P = 0.001). Fever was experienced by 98% of the IC-VL patients vs 73% of the LV-HIV patients (P = 0.003). Plasma ferritin was > 1000 ng/ml in 77% of the IC-VL patients vs 17% of the LV-HIV patients (P = 0.007). Forty-two percent of patients fulfilled the criteria for haemophagocytic lymphohistiocytosis. RDT (rK39-ICT) serological analysis returned sensitivity and specificity values of 45% and 99%, respectively, and ELISA/iIFAT returned 96% and 89%, respectively, with no differences in this respect between patient groups. Fourteen (13.0%) patients with VL experienced treatment failure, eight of whom were in the IC-VL group. Treatment with < 21 mg/kg (total) liposomal amphotericin B (LAB) was associated with treatment failure in the IC-VL patients [P = 0.002 (OR: 14.7; 95% CI: 2.6-83.3)]. CONCLUSIONS: IS-VL was more common than HIV-VL; the lack of experience in dealing with IS-VL is a challenge that needs to be met. The clinical features of the patients in all groups were similar, although the HIV-VL patients experienced less fever and had lower plasma ferritin concentrations. RDT (rK39-ICT) analysis returned a good specificity value but a much poorer sensitivity value than reported in other scenarios. The patients with HIV-VL, IS-VL and IC-VL returned similar serological results. Current guidelines for treatment seem appropriate, but the doses of LAB required to treat patients with HIV-VL and IS-VL are poorly defined.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Infecções por HIV/parasitologia , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/epidemiologia , Adulto , Idoso , Antígenos de Protozoários/imunologia , Coinfecção/tratamento farmacológico , Coinfecção/epidemiologia , Coinfecção/parasitologia , Coinfecção/virologia , Diagnóstico Tardio , Surtos de Doenças/prevenção & controle , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Imunocompetência , Imunossupressores/uso terapêutico , Leishmania infantum , Leishmaniose Visceral/tratamento farmacológico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Minorias Sexuais e de Gênero , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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