BACKGROUND Studies investigating diagnostic delays and their effects on patients with alcoholic cirrhosis.AIM To investigate the current status and associated factors influencing diagnostic delays in 401 patients with...BACKGROUND Studies investigating diagnostic delays and their effects on patients with alcoholic cirrhosis.AIM To investigate the current status and associated factors influencing diagnostic delays in 401 patients with alcoholic cirrhosis.METHODS A cross-sectional analysis was conducted at a tertiary hospital in China from June 2020 to December 2023.Data were collected through telephone follow-ups and questionnaires.The Wilcoxon and Kruskal-Wallis H tests were used to compare diagnostic delays across various characteristics.Multivariate linear regression was employed to identify factors associated with diagnostic delays.RESULTS The median diagnostic delay was 5 months,with an interquartile range of 2-11 months.The proportions of patients with alcoholic cirrhosis who initially visited tertiary,secondary,and primary hospitals were 38.9%,37.91%,and 23.19%,respectively.Furthermore,the rates of patients undergoing liver computed tomography(CT)during their first visit at tertiary,secondary,and primary hospitals were 92.95%,13.82%,and 1.08%,respectively(P<0.001).Significant differences were observed in diagnostic delay-related characteristics,including residence,resident type,initial diagnosis,medical insurance,liver CT,and liver ultrasound during the first visit,age,years of education,family size,marital status,annual family income,years of drinking,daily alcohol consumption,and type of alcohol consumed(P<0.01).Furthermore,diagnostic delays were variably associated with daily alcohol consumption and other characteristics(i.e.residence,years of drinking,medical insurance,years of education,annual family income,liver CT and ultrasound during the first visit).Significant predictors of diagnostic delay identified on multivariate linear regression analysis included years of education,daily alcohol consumption,annual family income and blood ammonia levels(P<0.01).Patients with alcoholic cirrhosis experience varying degrees of diagnostic delays,necessitating interventions targeting potential contributing factors.CONCLUSION Our study indicates that patients with alcoholic cirrhosis may experience varying degrees of diagnostic delay.Interventions targeting potential factors contributing to diagnostic delay are necessary.展开更多
BACKGROUND Early diagnosis is key to prevent bowel damage in inflammatory bowel disease(IBD).Risk factor analyses linked with delayed diagnosis in European IBD patients are scarce and no data in German IBD patients ex...BACKGROUND Early diagnosis is key to prevent bowel damage in inflammatory bowel disease(IBD).Risk factor analyses linked with delayed diagnosis in European IBD patients are scarce and no data in German IBD patients exists.AIM To identify risk factors leading to prolonged diagnostic time in a German IBD cohort.METHODS Between 2012 and 2022,430 IBD patients from four Berlin hospitals were enrolled in a prospective study and asked to complete a 16-item questionnaire to determine features of the path leading to IBD diagnosis.Total diagnostic time was defined as the time from symptom onset to consulting a physician(patient waiting time)and from first consultation to IBD diagnosis(physician diagnostic time).Univariate and multivariate analyses were performed to identify risk factors for each time period.RESULTS The total diagnostic time was significantly longer in Crohn’s disease(CD)compared to ulcerative colitis(UC)patients(12.0 vs 4.0 mo;P<0.001),mainly due to increased physician diagnostic time(5.5 vs 1.0 mo;P<0.001).In a multivariate analysis,the predominant symptoms diarrhea(P=0.012)and skin lesions(P=0.028)as well as performed gastroscopy(P=0.042)were associated with longer physician diagnostic time in CD patients.In UC,fever was correlated(P=0.020)with shorter physician diagnostic time,while fatigue(P=0.011)and positive family history(P=0.046)were correlated with longer physician diagnostic time.CONCLUSION We demonstrated that CD patients compared to UC are at risk of long diagnostic delay.Future efforts should focus on shortening the diagnostic delay for a better outcome in these patients.展开更多
In this article,we comment on the article by Blüthner et al published recently.Inflammatory bowel disease(IBD),including ulcerative colitis and Crohn’s disease,is a chronic relapsing and remitting condition prim...In this article,we comment on the article by Blüthner et al published recently.Inflammatory bowel disease(IBD),including ulcerative colitis and Crohn’s disease,is a chronic relapsing and remitting condition primarily as a consequence of intestinal inflammation.It is important about adopting early and effective treatment to control clinical symptoms of IBD patients.Diagnostic delay can lead to adverse clinical outcomes and increase disease burden.Diagnostic delay is multifactorial.There are some factors related to diagnostic delay,such as patient factors and healthcare factors.We focus on the diagnostic tools for IBD,the outcomes and factors of diagnostic delay of IBD.展开更多
Inflammatory bowel diseases(IBDs),including Crohn's disease(CD)and ulcerative colitis,are chronic inflammatory conditions of the gastrointestinal tract that necessitate timely diagnosis to prevent complications an...Inflammatory bowel diseases(IBDs),including Crohn's disease(CD)and ulcerative colitis,are chronic inflammatory conditions of the gastrointestinal tract that necessitate timely diagnosis to prevent complications and improve patient outcomes.Despite advancements in medical knowledge and diagnostic techniques,significant diagnostic delays persist,particularly in CD.The study by Blüthner et al,published in the World Journal of Gastroenterology,elucidates the diagnostic delays experienced by German patients with IBD and identifies key risk factors contributing to these delays.展开更多
In this article,we comment on the article by Blüthner et al.The article provides a comprehensive analysis of the factors contributing to the late detection of Crohn’s disease and ulcerative colitis within a Germ...In this article,we comment on the article by Blüthner et al.The article provides a comprehensive analysis of the factors contributing to the late detection of Crohn’s disease and ulcerative colitis within a German cohort.It highlights the conse-quences on patient outcomes,particularly disease progression and the increased risk of developing complications.The study identifies specific predictors asso-ciated with both patient-related and physician-related delays,offering a detailed exploration of the initial approach.Additionally,the article delves into the distinct patterns observed in the German population,stressing the unique aspects of diagnostic delays that may differ from those reported in other regions.This detailed examination offers valuable insights into the specific challenges faced within the German healthcare system and underscores the necessity of targeted interventions to facilitate early diagnosis.The importance of improved screening tools,patient education,and better healthcare infrastructure is emphasized as crucial steps toward improving patient care in inflammatory bowel disease.展开更多
Background:Tanzania is among the 30 countries with the highest tuberculosis(TB)burdens.Because TB has a long infectious period,early diagnosis is not only important for reducing transmission,but also for improving tre...Background:Tanzania is among the 30 countries with the highest tuberculosis(TB)burdens.Because TB has a long infectious period,early diagnosis is not only important for reducing transmission,but also for improving treatment outcomes.We assessed diagnostic delay and associated factors among infectious TB patients.Methods:We interviewed new smear-positive adult pulmonary TB patients enrolled in an ongoing TB cohort study in Dar es Salaam,Tanzania,between November 2013 and June 2015.TB patients were interviewed to collect information on socio-demographics,socio-economic status,health-seeking behaviour,and residential geocodes.We categorized diagnostic delay into≤3 or>3 weeks.We used logistic regression models to identify risk factors for diagnostic delay,presented as crude(OR)and adjusted Odds Ratios(aOR).We also assessed association between geographical distance(incremental increase of 500 meters between household and the nearest pharmacy)with binary outcomes.Results:We analysed 513 patients with a median age of 34 years(interquartile range 27-41);353(69%)were men.Overall,444(87%)reported seeking care from health care providers prior to TB diagnosis,of whom 211(48%)sought care>2 times.Only six(1%)visited traditional healers before TB diagnosis.Diagnostic delay was positively associated with absence of chest pain(aOR=7.97,95%confidence intervals[CI]:3.15-20.19;P<0.001),and presence of hemoptysis(aOR=25.37,95%CI:11.15-57.74;P<0.001)and negatively associated with use of medication prior to TB diagnosis(aOR=0.31,95%CI:0.14-0.71;P=0.01).Age,sex,HIV status,education level,household income,and visiting health care facilities(HCFs)were not associated with diagnostic delay.Patients living far from pharmacies were less likely to visit a HCF(incremental increase of distance versus visit to any facility:OR=0.51,95%CI:0.28-0.96;P=0.037).Conclusions:TB diagnostic delay was common in Dar es Salaam,and was more likely among patients without prior use of medication and presenting with hemoptysis.Geographical distance to HCFs may have an impact on health-seeking behaviour.Increasing community awareness of TB signs and symptoms could further reduce diagnostic delays and interrupt TB transmission.展开更多
Research Background: Cervical cancer is the second most common cancer in women and the third leading cause of female cancer death in Bangladesh. Delay in initiation of treatment in advanced stage cervical cancer patie...Research Background: Cervical cancer is the second most common cancer in women and the third leading cause of female cancer death in Bangladesh. Delay in initiation of treatment in advanced stage cervical cancer patients is an important modifiable risk factor for cancer-related mortality. Identifying elements associated with delay of diagnosis will help reduce barriers to timely treatment of cervical cancer. Research Objectives: The objective of this study was to analyze the factors leading to delay in diagnosis and treatment of women with advanced stage cervical cancer. Methods: A cross-sectional observational study analyzed the factors associated with delay in initiation of treatment for 138 patients with advanced-stage cervical cancer from November 2019 to October 2020 at the National Institute of Cancer Research and Hospital (NICRH) in Dhaka, Bangladesh. Advanced-stage cervical cancer patients between the ages of 30 to 70 years were included in this study. Face-to-face interviews with the participants used a predesigned data collection sheet. In this study, three components of delay were identified: primary delay due to patient factors, healthcare provider delay, and healthcare-system infrastructure delay. Factors associated with delay were the independent variables and durations of delay were the outcome variables. Descriptive statistics were expressed as mean + standard deviation, median, percentage, and frequency. Results: One hundred and thirty-eight patients with advanced stage cervical cancer were included in the study. The mean age of the patients was 48.74 (±9.57) years. Thirty-four percent of patients were illiterate. More than half (57.25%) of the patients were from lower middle-class families. Delays were categorized as patient-related, healthcare provider delay, and healthcare-system infrastructure related. Patient-related factors included low monthly income, residence in a rural area, embarrassment, fear, lack of knowledge regarding cervical cancer, delay in contacting a spouse, family member or friend prior to the first medical encounter. These elements predicted a primary delay of more than 60 days (P value Conclusion: Three broad categories of delay in diagnosis and treatment of cervical cancer: patient-related factors, healthcare provider-related factors, and healthcare-system infrastructure factors were analyzed. Illiteracy, lack of awareness regarding cervical cancer, lack of health-seeking behavior, and poor income status were associated with patient-related primary delay. Nonperformance of speculum examination in the initial consultation, misdiagnosis, inappropriate management, and delay in referral to the cancer treatment center by primary healthcare providers were the contributing factors for healthcare provider delay. Lack of availability and accessibility of health services and limitation of radiotherapy resources led to healthcare-system infrastructure delays. All three categories of delay must be addressed through the education of communities, the gynecologic training of community healthcare providers, the improvement of medical infrastructure, and the increase of medical resources.展开更多
Hypophosphatasia(HPP)is a rare metabolic bone disorder often misdiagnosed as fibromyalgia due to overlapping symptoms such as chronic pain,fatigue,and muscle weakness.This diagnostic error disproportionately affects w...Hypophosphatasia(HPP)is a rare metabolic bone disorder often misdiagnosed as fibromyalgia due to overlapping symptoms such as chronic pain,fatigue,and muscle weakness.This diagnostic error disproportionately affects women and can result in significant psychological distress due to repeated dismissal of symptoms.Despite low serum alkaline phosphatase(ALP)being a key biochemical clue to HPP,it is frequently overlooked in standard diagnostic evaluations.Consequen-tly,many patients endure years of ineffective treatment,invalidation,and worse-ning psychiatric outcomes.This editorial emphasizes the need for greater clinical vigilance in distinguishing HPP from fibromyalgia,particularly when features such as chronic pain,premature tooth loss,and persistently low ALP are present.Gender biases in pain diagnosis further compound this problem,leading to gr-eater misdiagnosis rates among women and contributing to the erosion of trust in medical care.The psychiatric consequences of diagnostic delays are substantial,with affected individuals experiencing elevated rates of depression,anxiety,and emotional distress.Greater recognition of low ALP as a meaningful diagnostic clue may enhance diagnostic accuracy,improve patient outcomes,and reduce the psychological toll of misdiagnosis.展开更多
Acute compartment syndrome(ACoS)involves a complex pathological process in which rising pressures within an enclosed muscle space ultimately result in anoxia and cell death.The most common etiologies include long bone...Acute compartment syndrome(ACoS)involves a complex pathological process in which rising pressures within an enclosed muscle space ultimately result in anoxia and cell death.The most common etiologies include long bone fractures,crush injuries,and burns.[1,2]While rare,ACoS can also occur in atraumatic settings following periods of prolonged limb compression,such as intoxication.[3]Atraumatic ACoS is easily overlooked,resulting in diagnostic delay and poor patient outcomes.Prompt recognition and surgical management is essential to prevent critical sequelae.展开更多
Transthyretin amyloidosis(ATTR),a rare systemic disorder characterized by misfolded transthyretin(TTR)protein aggregation,predominantly affects the heart and peripheral nervous system.Central nervous system(CNS)involv...Transthyretin amyloidosis(ATTR),a rare systemic disorder characterized by misfolded transthyretin(TTR)protein aggregation,predominantly affects the heart and peripheral nervous system.Central nervous system(CNS)involvement in ATTR,especially widespread leptomeningeal amyloidosis(LA),is exceedingly rare.Early diagnosis of CNS‐predominant ATTR is difficult due to nonspecific symptoms and low awareness.This study adopted a dual‐methodology:A single‐case analysis of a CNSpredominant hereditary ATTR(CNS‐ATTR)patient at a tertiary referral center and a systematic literature review following PRISMA guidelines.PubMed and Embase were systematically searched from the start to March 2025 using controlled vocabulary(MeSH/Emtree terms)and Boolean operators for reported CNS‐involved ATTR cases.A systematic review of 79 CNSATTR cases revealed universal leptomeningeal enhancement on magnetic resonance imaging(MRI)(77/79,97%)and cerebrospinal fluid(CSF)protein elevation(66/79,84%).The index case(p.Gly73Ala)showed diffuse leptomeningeal enhancement,grade 3 PYP uptake,and CSF protein 1.88 g/L.In summary,LA associated with ATTR is extremely scarce.A four‐tiered,protocolbased diagnostic algorithm is crucial for patients with unexplained leptomeningeal disorders.展开更多
Spinal subarachnoid hemorrhage(SSAH)is a relatively uncommon but significant cause of acute and progressive neurological impairment.It represents less than 1.5%of all instances of bleeding within the subarachnoid spac...Spinal subarachnoid hemorrhage(SSAH)is a relatively uncommon but significant cause of acute and progressive neurological impairment.It represents less than 1.5%of all instances of bleeding within the subarachnoid space.[1]The early stages of SSAH often present atypical clinical symptoms,making diagnosis challenging and potentially leading to treatment delays,which further result in irreversible neurological damage.Lower back pain is a common complaint in the emergency department(ED).[2]Common causes include overuse resulting in back strain.展开更多
BACKGROUND The implementation of a colorectal cancer(CRC)screening programme may increase the awareness of Primary Care Physicians,reduce the diagnostic delay in CRC detected outside the scope of the screening program...BACKGROUND The implementation of a colorectal cancer(CRC)screening programme may increase the awareness of Primary Care Physicians,reduce the diagnostic delay in CRC detected outside the scope of the screening programme and thus improve prognosis.AIM To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme.METHODS We performed a retrospective intervention study with a pre-post design.We identified 322 patients with incident and confirmed CRC in the pre-implantation cohort(June 2014–May 2015)and 285 in the post-implantation cohort(June 2017-May 2018)in the Cancer Registry detected outside the scope of a CRC screening programme.In each patient we calculated the different healthcare diagnostics delays:global,primary and secondary healthcare,referral and colonoscopyrelated delays.In addition,we collected the initial healthcare that evaluated the patient,the home location(urban/rural),and the CRC stage at diagnosis.We determined the two-year survival and we performed a multivariate proportional hazard regression analysis to determine the variables associated with survival.RESULTS We did not detect any differences in the patient or CRC baseline-related variables.A total of 20.1%of patients was detected with metastatic disease.There was a significant increase in direct referral to colonoscopy from primary healthcare(25.5%,35.8%;P=0.04)in the post-implantation cohort.Diagnostic delay was reduced by 24 d(106.64±148.84 days,82.84±109.31 d;P=0.02)due to the reduction in secondary healthcare delay(46.01±111.65 d;29.20±60.83 d;P=0.02).However,we did not find any differences in CRC stage at diagnosis or in two-year survival(70.3%;P=0.9).Variables independently associated with twoyear risk of death were age(Hazard Ratio-HR:1.06,95%CI:1.04-1.07),CRC stage(II HR:2.17,95%CI:1.07-4.40;III HR:3.07,95%CI:1.56-6.08;IV HR:19.22,95%CI:9.86-37.44;unknown HR:9.24,95%CI:4.27-19.99),initial healthcare consultation(secondary HR:2.93,95%CI:1.01-8.55;emergency department HR:2.06,95%CI:0.67-6.34),hospitalization during the diagnostic process(HR:1.67,95%CI:1.17-2.38)and urban residence(HR:1.44,95%CI:1.06-1.98).CONCLUSION Although implementation of a CRC screening programme can reduce diagnostic delays for CRC detected in symptomatic patients,this has no effect on CRC stage or survival.展开更多
Stroke represents the 2<sup>nd</sup> cause of mortality and 1<sup>st</sup> cause of physical disability in the adult population. In Senegal, it represents 30% of hospitalization and 2/3 of the ...Stroke represents the 2<sup>nd</sup> cause of mortality and 1<sup>st</sup> cause of physical disability in the adult population. In Senegal, it represents 30% of hospitalization and 2/3 of the mortality in the department of neurology in the capital city, Dakar. <b>Objective: </b>To specify the types of stroke and to evaluate diagnostic delays in Senegal’s regional hospitals. <b>Materials and Methods: </b>This was a retrospective, cross-sectional, descriptive, multicentric study for 4 years (from 2014 to 2017) including any patient presenting a clinical suspicion with a CT scan confirmation of stroke in one of the 9 regional hospitals in Senegal with a recruitment period of 6 months per hospital. CT scans were performed with a 16 slices machine in 6 hospitals, 4 slices in 2 hospitals and 2 slices in 1 hospital. We studied the types and location of strokes, the associated signs and the time from stroke onset to admission and the time from admission to CT scan.<b> Results: </b>655 patients were retained including 322 men and 333 women for an M/F ratio of 0.96. The average age was 63 years (range: 7 years, 112 years). High blood pressure was noted in 59.2% of patients and diabetes in 10.7% of patients. Strokes were ischemic in 76% of cases involving the middle cerebral artery in 73% of cases and hemorrhagic in 24%, of which 80.7% were deep localized. A mass effect was noted in 7.5% of cases, an engagement in 6.9% of cases and ventricular hemorrhage in 2.7% of cases. The delay between the onset of the deficit and admission was less than 6 hours in 10.6% of patients. The time between the onset of stroke and admission to hospital was specified in 416 patients (63.5%) of the study population, it was less than 6 hours in 10.6% of patients, between 6 hours and 24 hours for 29.3% and more than 24 hours for 60.1%. Between admission and the CT scan, the time was precise in 459 patients (70%), it was less than 6 hours in 37.9%, between 6 hours and 24 hours in 43.6 % and more than 24 hours in 18.5%. <b>Conclusion: </b>CT is central to the diagnosis of stroke in rural areas. However, there is a significant delay in diagnosis and management.展开更多
The diagnosis of inflammatory bowel disease(IBD)is complicated by its nonspecific clinical presentation and the limited accuracy of existing biomarker tests,frequently resulting in significant delays from the time of ...The diagnosis of inflammatory bowel disease(IBD)is complicated by its nonspecific clinical presentation and the limited accuracy of existing biomarker tests,frequently resulting in significant delays from the time of symptom onset to the achievement of a definitive diagnosis.Thus,improving the early identification of IBD remains a crucial focus for gastroenterologists.Blüthner et al innovatively utilized medical data from German IBD patients to investigate risk factors contri-buting to these diagnostic delays.However,certain methodological limitations in the study have impacted data extraction and interpretation,underscoring the need for more comprehensive analyses to validate these findings.展开更多
Retroperitoneal soft tissue sarcomas in the retroperitoneal/intra-abdominal regions represent 10% - 15% of all cases of soft tissue sarcoma. Liposarcomas, which are the most common histological type, account for 20% -...Retroperitoneal soft tissue sarcomas in the retroperitoneal/intra-abdominal regions represent 10% - 15% of all cases of soft tissue sarcoma. Liposarcomas, which are the most common histological type, account for 20% - 45% of retroperitoneal/intra-abdominal sarcoma cases, and 20% of liposarcomas cases are primary retroperitoneal liposarcomas. Surgical resection in case of malignancy remains the treatment of choice for liposarcomas, according to the guidelines of most major international companies. Our goal was to improve the management of retroperitoneal liposarcoma. This was a 65-year-old patient, with no medical or surgical history, who was referred to us for abdominal swelling, in whom clinical and paraclinical examination found retroperitoneal liposarcoma stage IV, and the surgical treatment consisted in making a tumor reduction. Conclusion: Retro-peritoneal liposarcoma is an undervalued malignant tumor, and the diagnosis is often late.展开更多
Background: Since introducing stereotactic core biopsy (SCB) on breast lesions in Denmark, no national follow-up of the procedure has been executed. Purpose: To evaluate performance of SCB in Danish mammography screen...Background: Since introducing stereotactic core biopsy (SCB) on breast lesions in Denmark, no national follow-up of the procedure has been executed. Purpose: To evaluate performance of SCB in Danish mammography screening. 3 areas were selected for evaluation: diagnostic value of SCB, performance of the Danish 7-tier mamma-radiological classifications system, DKBI-RADS, and diagnostic delay for SCB-diagnosis. Materials & Methods: Danish retrospective national cohort study including 2195 screening patients undergoing SCB. Study period: 01.01.2010 to 30.09.2012. Patients were identified from The Danish National Patient Register. Pathology-data were obtained from the Danish Pathology Database. Radiological-data according to DKBI-RADS were recorded. Diagnostic delay from clinical mammography until diagnosis was registered. Results: 173 SCBs indicated cancer;all operated with 3 cases finalized as benign. 1296 cases were determined benign with diagnostic surgery in 81 cases of which 31 were concluded pre-malignant/malignant. Correlation between DKBI-RADS and pathology diagnosis: 329 of 485 DKBI-RADS3, 227 of 450 DKBI-RADS4 were benign. 4 of 16 DKBI-RADS5 were benign. The diagnostic value of pre-malignant/malignant SCB related to results from surgery showed 94.4% sensitivity and a positive predictive value of 93.9%. Median diagnostic-time of single-biopsy was 13 days. Conclusion: The performance of SCB in Denmark is comparable to international studies regarding the diagnostic value of malignant SCB. The study indicates that DKBI-RADS classifications are not used consistently regarding micro-calcifications selected in screening-mammographies. Diagnostic delay is acceptable, subject to EUSOMA specifications, regarding single-biopsy.展开更多
Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure.Bone involvement in melioidosis is generally low,and the major risk factor is the dela...Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure.Bone involvement in melioidosis is generally low,and the major risk factor is the delay in diagnosing the primary site infection.We present a case of septic arthritis with primary lung melioidosis,whose diagnosis of pulmonary melioidosis was delayed for 5 weeks leading to a septicaemia and septic arthritis.This case highlights the importance of improved clinical awareness among health practitioners and a low threshold for radiological screening of high-risk patients,even in non-endemic areas.It also highlights the fact that having adjunctive open arthrotomy in managing joint infection in melioidosis improves the clinical response to treatment.展开更多
基金Supported by National Key Research and Development Program of China,No.2019YFE0190800.
文摘BACKGROUND Studies investigating diagnostic delays and their effects on patients with alcoholic cirrhosis.AIM To investigate the current status and associated factors influencing diagnostic delays in 401 patients with alcoholic cirrhosis.METHODS A cross-sectional analysis was conducted at a tertiary hospital in China from June 2020 to December 2023.Data were collected through telephone follow-ups and questionnaires.The Wilcoxon and Kruskal-Wallis H tests were used to compare diagnostic delays across various characteristics.Multivariate linear regression was employed to identify factors associated with diagnostic delays.RESULTS The median diagnostic delay was 5 months,with an interquartile range of 2-11 months.The proportions of patients with alcoholic cirrhosis who initially visited tertiary,secondary,and primary hospitals were 38.9%,37.91%,and 23.19%,respectively.Furthermore,the rates of patients undergoing liver computed tomography(CT)during their first visit at tertiary,secondary,and primary hospitals were 92.95%,13.82%,and 1.08%,respectively(P<0.001).Significant differences were observed in diagnostic delay-related characteristics,including residence,resident type,initial diagnosis,medical insurance,liver CT,and liver ultrasound during the first visit,age,years of education,family size,marital status,annual family income,years of drinking,daily alcohol consumption,and type of alcohol consumed(P<0.01).Furthermore,diagnostic delays were variably associated with daily alcohol consumption and other characteristics(i.e.residence,years of drinking,medical insurance,years of education,annual family income,liver CT and ultrasound during the first visit).Significant predictors of diagnostic delay identified on multivariate linear regression analysis included years of education,daily alcohol consumption,annual family income and blood ammonia levels(P<0.01).Patients with alcoholic cirrhosis experience varying degrees of diagnostic delays,necessitating interventions targeting potential contributing factors.CONCLUSION Our study indicates that patients with alcoholic cirrhosis may experience varying degrees of diagnostic delay.Interventions targeting potential factors contributing to diagnostic delay are necessary.
文摘BACKGROUND Early diagnosis is key to prevent bowel damage in inflammatory bowel disease(IBD).Risk factor analyses linked with delayed diagnosis in European IBD patients are scarce and no data in German IBD patients exists.AIM To identify risk factors leading to prolonged diagnostic time in a German IBD cohort.METHODS Between 2012 and 2022,430 IBD patients from four Berlin hospitals were enrolled in a prospective study and asked to complete a 16-item questionnaire to determine features of the path leading to IBD diagnosis.Total diagnostic time was defined as the time from symptom onset to consulting a physician(patient waiting time)and from first consultation to IBD diagnosis(physician diagnostic time).Univariate and multivariate analyses were performed to identify risk factors for each time period.RESULTS The total diagnostic time was significantly longer in Crohn’s disease(CD)compared to ulcerative colitis(UC)patients(12.0 vs 4.0 mo;P<0.001),mainly due to increased physician diagnostic time(5.5 vs 1.0 mo;P<0.001).In a multivariate analysis,the predominant symptoms diarrhea(P=0.012)and skin lesions(P=0.028)as well as performed gastroscopy(P=0.042)were associated with longer physician diagnostic time in CD patients.In UC,fever was correlated(P=0.020)with shorter physician diagnostic time,while fatigue(P=0.011)and positive family history(P=0.046)were correlated with longer physician diagnostic time.CONCLUSION We demonstrated that CD patients compared to UC are at risk of long diagnostic delay.Future efforts should focus on shortening the diagnostic delay for a better outcome in these patients.
文摘In this article,we comment on the article by Blüthner et al published recently.Inflammatory bowel disease(IBD),including ulcerative colitis and Crohn’s disease,is a chronic relapsing and remitting condition primarily as a consequence of intestinal inflammation.It is important about adopting early and effective treatment to control clinical symptoms of IBD patients.Diagnostic delay can lead to adverse clinical outcomes and increase disease burden.Diagnostic delay is multifactorial.There are some factors related to diagnostic delay,such as patient factors and healthcare factors.We focus on the diagnostic tools for IBD,the outcomes and factors of diagnostic delay of IBD.
文摘Inflammatory bowel diseases(IBDs),including Crohn's disease(CD)and ulcerative colitis,are chronic inflammatory conditions of the gastrointestinal tract that necessitate timely diagnosis to prevent complications and improve patient outcomes.Despite advancements in medical knowledge and diagnostic techniques,significant diagnostic delays persist,particularly in CD.The study by Blüthner et al,published in the World Journal of Gastroenterology,elucidates the diagnostic delays experienced by German patients with IBD and identifies key risk factors contributing to these delays.
文摘In this article,we comment on the article by Blüthner et al.The article provides a comprehensive analysis of the factors contributing to the late detection of Crohn’s disease and ulcerative colitis within a German cohort.It highlights the conse-quences on patient outcomes,particularly disease progression and the increased risk of developing complications.The study identifies specific predictors asso-ciated with both patient-related and physician-related delays,offering a detailed exploration of the initial approach.Additionally,the article delves into the distinct patterns observed in the German population,stressing the unique aspects of diagnostic delays that may differ from those reported in other regions.This detailed examination offers valuable insights into the specific challenges faced within the German healthcare system and underscores the necessity of targeted interventions to facilitate early diagnosis.The importance of improved screening tools,patient education,and better healthcare infrastructure is emphasized as crucial steps toward improving patient care in inflammatory bowel disease.
基金This work was supported by funding from the Rudolf Geigy Foundation(Basel,Switzerland).KS is a beneficiary of the Swiss Excellence Scholarship(ESKAS)The funder was not involved in study design,data collection,interpretation of data or in writing the manuscript.
文摘Background:Tanzania is among the 30 countries with the highest tuberculosis(TB)burdens.Because TB has a long infectious period,early diagnosis is not only important for reducing transmission,but also for improving treatment outcomes.We assessed diagnostic delay and associated factors among infectious TB patients.Methods:We interviewed new smear-positive adult pulmonary TB patients enrolled in an ongoing TB cohort study in Dar es Salaam,Tanzania,between November 2013 and June 2015.TB patients were interviewed to collect information on socio-demographics,socio-economic status,health-seeking behaviour,and residential geocodes.We categorized diagnostic delay into≤3 or>3 weeks.We used logistic regression models to identify risk factors for diagnostic delay,presented as crude(OR)and adjusted Odds Ratios(aOR).We also assessed association between geographical distance(incremental increase of 500 meters between household and the nearest pharmacy)with binary outcomes.Results:We analysed 513 patients with a median age of 34 years(interquartile range 27-41);353(69%)were men.Overall,444(87%)reported seeking care from health care providers prior to TB diagnosis,of whom 211(48%)sought care>2 times.Only six(1%)visited traditional healers before TB diagnosis.Diagnostic delay was positively associated with absence of chest pain(aOR=7.97,95%confidence intervals[CI]:3.15-20.19;P<0.001),and presence of hemoptysis(aOR=25.37,95%CI:11.15-57.74;P<0.001)and negatively associated with use of medication prior to TB diagnosis(aOR=0.31,95%CI:0.14-0.71;P=0.01).Age,sex,HIV status,education level,household income,and visiting health care facilities(HCFs)were not associated with diagnostic delay.Patients living far from pharmacies were less likely to visit a HCF(incremental increase of distance versus visit to any facility:OR=0.51,95%CI:0.28-0.96;P=0.037).Conclusions:TB diagnostic delay was common in Dar es Salaam,and was more likely among patients without prior use of medication and presenting with hemoptysis.Geographical distance to HCFs may have an impact on health-seeking behaviour.Increasing community awareness of TB signs and symptoms could further reduce diagnostic delays and interrupt TB transmission.
文摘Research Background: Cervical cancer is the second most common cancer in women and the third leading cause of female cancer death in Bangladesh. Delay in initiation of treatment in advanced stage cervical cancer patients is an important modifiable risk factor for cancer-related mortality. Identifying elements associated with delay of diagnosis will help reduce barriers to timely treatment of cervical cancer. Research Objectives: The objective of this study was to analyze the factors leading to delay in diagnosis and treatment of women with advanced stage cervical cancer. Methods: A cross-sectional observational study analyzed the factors associated with delay in initiation of treatment for 138 patients with advanced-stage cervical cancer from November 2019 to October 2020 at the National Institute of Cancer Research and Hospital (NICRH) in Dhaka, Bangladesh. Advanced-stage cervical cancer patients between the ages of 30 to 70 years were included in this study. Face-to-face interviews with the participants used a predesigned data collection sheet. In this study, three components of delay were identified: primary delay due to patient factors, healthcare provider delay, and healthcare-system infrastructure delay. Factors associated with delay were the independent variables and durations of delay were the outcome variables. Descriptive statistics were expressed as mean + standard deviation, median, percentage, and frequency. Results: One hundred and thirty-eight patients with advanced stage cervical cancer were included in the study. The mean age of the patients was 48.74 (±9.57) years. Thirty-four percent of patients were illiterate. More than half (57.25%) of the patients were from lower middle-class families. Delays were categorized as patient-related, healthcare provider delay, and healthcare-system infrastructure related. Patient-related factors included low monthly income, residence in a rural area, embarrassment, fear, lack of knowledge regarding cervical cancer, delay in contacting a spouse, family member or friend prior to the first medical encounter. These elements predicted a primary delay of more than 60 days (P value Conclusion: Three broad categories of delay in diagnosis and treatment of cervical cancer: patient-related factors, healthcare provider-related factors, and healthcare-system infrastructure factors were analyzed. Illiteracy, lack of awareness regarding cervical cancer, lack of health-seeking behavior, and poor income status were associated with patient-related primary delay. Nonperformance of speculum examination in the initial consultation, misdiagnosis, inappropriate management, and delay in referral to the cancer treatment center by primary healthcare providers were the contributing factors for healthcare provider delay. Lack of availability and accessibility of health services and limitation of radiotherapy resources led to healthcare-system infrastructure delays. All three categories of delay must be addressed through the education of communities, the gynecologic training of community healthcare providers, the improvement of medical infrastructure, and the increase of medical resources.
文摘Hypophosphatasia(HPP)is a rare metabolic bone disorder often misdiagnosed as fibromyalgia due to overlapping symptoms such as chronic pain,fatigue,and muscle weakness.This diagnostic error disproportionately affects women and can result in significant psychological distress due to repeated dismissal of symptoms.Despite low serum alkaline phosphatase(ALP)being a key biochemical clue to HPP,it is frequently overlooked in standard diagnostic evaluations.Consequen-tly,many patients endure years of ineffective treatment,invalidation,and worse-ning psychiatric outcomes.This editorial emphasizes the need for greater clinical vigilance in distinguishing HPP from fibromyalgia,particularly when features such as chronic pain,premature tooth loss,and persistently low ALP are present.Gender biases in pain diagnosis further compound this problem,leading to gr-eater misdiagnosis rates among women and contributing to the erosion of trust in medical care.The psychiatric consequences of diagnostic delays are substantial,with affected individuals experiencing elevated rates of depression,anxiety,and emotional distress.Greater recognition of low ALP as a meaningful diagnostic clue may enhance diagnostic accuracy,improve patient outcomes,and reduce the psychological toll of misdiagnosis.
文摘Acute compartment syndrome(ACoS)involves a complex pathological process in which rising pressures within an enclosed muscle space ultimately result in anoxia and cell death.The most common etiologies include long bone fractures,crush injuries,and burns.[1,2]While rare,ACoS can also occur in atraumatic settings following periods of prolonged limb compression,such as intoxication.[3]Atraumatic ACoS is easily overlooked,resulting in diagnostic delay and poor patient outcomes.Prompt recognition and surgical management is essential to prevent critical sequelae.
文摘Transthyretin amyloidosis(ATTR),a rare systemic disorder characterized by misfolded transthyretin(TTR)protein aggregation,predominantly affects the heart and peripheral nervous system.Central nervous system(CNS)involvement in ATTR,especially widespread leptomeningeal amyloidosis(LA),is exceedingly rare.Early diagnosis of CNS‐predominant ATTR is difficult due to nonspecific symptoms and low awareness.This study adopted a dual‐methodology:A single‐case analysis of a CNSpredominant hereditary ATTR(CNS‐ATTR)patient at a tertiary referral center and a systematic literature review following PRISMA guidelines.PubMed and Embase were systematically searched from the start to March 2025 using controlled vocabulary(MeSH/Emtree terms)and Boolean operators for reported CNS‐involved ATTR cases.A systematic review of 79 CNSATTR cases revealed universal leptomeningeal enhancement on magnetic resonance imaging(MRI)(77/79,97%)and cerebrospinal fluid(CSF)protein elevation(66/79,84%).The index case(p.Gly73Ala)showed diffuse leptomeningeal enhancement,grade 3 PYP uptake,and CSF protein 1.88 g/L.In summary,LA associated with ATTR is extremely scarce.A four‐tiered,protocolbased diagnostic algorithm is crucial for patients with unexplained leptomeningeal disorders.
基金National Natural Science Foundation of China(82472218)National Key Clinical Specialist Construction Project(Z155080000004)+4 种基金National Key Research and Development Program of China(2024YFC3044400)Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0506502)the Science and Technology of Shanghai Committee(23Y31900100)Shen Kang Hospital Development Center Project for Technical Standardization Management and Promotion(SHDC22023239)Key Supporting Discipline of Shanghai Healthcare System(2023ZDFC0102).
文摘Spinal subarachnoid hemorrhage(SSAH)is a relatively uncommon but significant cause of acute and progressive neurological impairment.It represents less than 1.5%of all instances of bleeding within the subarachnoid space.[1]The early stages of SSAH often present atypical clinical symptoms,making diagnosis challenging and potentially leading to treatment delays,which further result in irreversible neurological damage.Lower back pain is a common complaint in the emergency department(ED).[2]Common causes include overuse resulting in back strain.
基金by the Spain’s Carlos III Health Care Institute by means of project PI17/00837(Co-funded by European Regional Development Fund/European Social Fund"A way to make Europe"/"Investing in your future").
文摘BACKGROUND The implementation of a colorectal cancer(CRC)screening programme may increase the awareness of Primary Care Physicians,reduce the diagnostic delay in CRC detected outside the scope of the screening programme and thus improve prognosis.AIM To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme.METHODS We performed a retrospective intervention study with a pre-post design.We identified 322 patients with incident and confirmed CRC in the pre-implantation cohort(June 2014–May 2015)and 285 in the post-implantation cohort(June 2017-May 2018)in the Cancer Registry detected outside the scope of a CRC screening programme.In each patient we calculated the different healthcare diagnostics delays:global,primary and secondary healthcare,referral and colonoscopyrelated delays.In addition,we collected the initial healthcare that evaluated the patient,the home location(urban/rural),and the CRC stage at diagnosis.We determined the two-year survival and we performed a multivariate proportional hazard regression analysis to determine the variables associated with survival.RESULTS We did not detect any differences in the patient or CRC baseline-related variables.A total of 20.1%of patients was detected with metastatic disease.There was a significant increase in direct referral to colonoscopy from primary healthcare(25.5%,35.8%;P=0.04)in the post-implantation cohort.Diagnostic delay was reduced by 24 d(106.64±148.84 days,82.84±109.31 d;P=0.02)due to the reduction in secondary healthcare delay(46.01±111.65 d;29.20±60.83 d;P=0.02).However,we did not find any differences in CRC stage at diagnosis or in two-year survival(70.3%;P=0.9).Variables independently associated with twoyear risk of death were age(Hazard Ratio-HR:1.06,95%CI:1.04-1.07),CRC stage(II HR:2.17,95%CI:1.07-4.40;III HR:3.07,95%CI:1.56-6.08;IV HR:19.22,95%CI:9.86-37.44;unknown HR:9.24,95%CI:4.27-19.99),initial healthcare consultation(secondary HR:2.93,95%CI:1.01-8.55;emergency department HR:2.06,95%CI:0.67-6.34),hospitalization during the diagnostic process(HR:1.67,95%CI:1.17-2.38)and urban residence(HR:1.44,95%CI:1.06-1.98).CONCLUSION Although implementation of a CRC screening programme can reduce diagnostic delays for CRC detected in symptomatic patients,this has no effect on CRC stage or survival.
文摘Stroke represents the 2<sup>nd</sup> cause of mortality and 1<sup>st</sup> cause of physical disability in the adult population. In Senegal, it represents 30% of hospitalization and 2/3 of the mortality in the department of neurology in the capital city, Dakar. <b>Objective: </b>To specify the types of stroke and to evaluate diagnostic delays in Senegal’s regional hospitals. <b>Materials and Methods: </b>This was a retrospective, cross-sectional, descriptive, multicentric study for 4 years (from 2014 to 2017) including any patient presenting a clinical suspicion with a CT scan confirmation of stroke in one of the 9 regional hospitals in Senegal with a recruitment period of 6 months per hospital. CT scans were performed with a 16 slices machine in 6 hospitals, 4 slices in 2 hospitals and 2 slices in 1 hospital. We studied the types and location of strokes, the associated signs and the time from stroke onset to admission and the time from admission to CT scan.<b> Results: </b>655 patients were retained including 322 men and 333 women for an M/F ratio of 0.96. The average age was 63 years (range: 7 years, 112 years). High blood pressure was noted in 59.2% of patients and diabetes in 10.7% of patients. Strokes were ischemic in 76% of cases involving the middle cerebral artery in 73% of cases and hemorrhagic in 24%, of which 80.7% were deep localized. A mass effect was noted in 7.5% of cases, an engagement in 6.9% of cases and ventricular hemorrhage in 2.7% of cases. The delay between the onset of the deficit and admission was less than 6 hours in 10.6% of patients. The time between the onset of stroke and admission to hospital was specified in 416 patients (63.5%) of the study population, it was less than 6 hours in 10.6% of patients, between 6 hours and 24 hours for 29.3% and more than 24 hours for 60.1%. Between admission and the CT scan, the time was precise in 459 patients (70%), it was less than 6 hours in 37.9%, between 6 hours and 24 hours in 43.6 % and more than 24 hours in 18.5%. <b>Conclusion: </b>CT is central to the diagnosis of stroke in rural areas. However, there is a significant delay in diagnosis and management.
文摘The diagnosis of inflammatory bowel disease(IBD)is complicated by its nonspecific clinical presentation and the limited accuracy of existing biomarker tests,frequently resulting in significant delays from the time of symptom onset to the achievement of a definitive diagnosis.Thus,improving the early identification of IBD remains a crucial focus for gastroenterologists.Blüthner et al innovatively utilized medical data from German IBD patients to investigate risk factors contri-buting to these diagnostic delays.However,certain methodological limitations in the study have impacted data extraction and interpretation,underscoring the need for more comprehensive analyses to validate these findings.
文摘Retroperitoneal soft tissue sarcomas in the retroperitoneal/intra-abdominal regions represent 10% - 15% of all cases of soft tissue sarcoma. Liposarcomas, which are the most common histological type, account for 20% - 45% of retroperitoneal/intra-abdominal sarcoma cases, and 20% of liposarcomas cases are primary retroperitoneal liposarcomas. Surgical resection in case of malignancy remains the treatment of choice for liposarcomas, according to the guidelines of most major international companies. Our goal was to improve the management of retroperitoneal liposarcoma. This was a 65-year-old patient, with no medical or surgical history, who was referred to us for abdominal swelling, in whom clinical and paraclinical examination found retroperitoneal liposarcoma stage IV, and the surgical treatment consisted in making a tumor reduction. Conclusion: Retro-peritoneal liposarcoma is an undervalued malignant tumor, and the diagnosis is often late.
基金Region of Southern DenmarkDepartment of Breast Surgery, Lillebaelt Hospital, Vejle Research Council Lillebaelt Hospital
文摘Background: Since introducing stereotactic core biopsy (SCB) on breast lesions in Denmark, no national follow-up of the procedure has been executed. Purpose: To evaluate performance of SCB in Danish mammography screening. 3 areas were selected for evaluation: diagnostic value of SCB, performance of the Danish 7-tier mamma-radiological classifications system, DKBI-RADS, and diagnostic delay for SCB-diagnosis. Materials & Methods: Danish retrospective national cohort study including 2195 screening patients undergoing SCB. Study period: 01.01.2010 to 30.09.2012. Patients were identified from The Danish National Patient Register. Pathology-data were obtained from the Danish Pathology Database. Radiological-data according to DKBI-RADS were recorded. Diagnostic delay from clinical mammography until diagnosis was registered. Results: 173 SCBs indicated cancer;all operated with 3 cases finalized as benign. 1296 cases were determined benign with diagnostic surgery in 81 cases of which 31 were concluded pre-malignant/malignant. Correlation between DKBI-RADS and pathology diagnosis: 329 of 485 DKBI-RADS3, 227 of 450 DKBI-RADS4 were benign. 4 of 16 DKBI-RADS5 were benign. The diagnostic value of pre-malignant/malignant SCB related to results from surgery showed 94.4% sensitivity and a positive predictive value of 93.9%. Median diagnostic-time of single-biopsy was 13 days. Conclusion: The performance of SCB in Denmark is comparable to international studies regarding the diagnostic value of malignant SCB. The study indicates that DKBI-RADS classifications are not used consistently regarding micro-calcifications selected in screening-mammographies. Diagnostic delay is acceptable, subject to EUSOMA specifications, regarding single-biopsy.
文摘Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure.Bone involvement in melioidosis is generally low,and the major risk factor is the delay in diagnosing the primary site infection.We present a case of septic arthritis with primary lung melioidosis,whose diagnosis of pulmonary melioidosis was delayed for 5 weeks leading to a septicaemia and septic arthritis.This case highlights the importance of improved clinical awareness among health practitioners and a low threshold for radiological screening of high-risk patients,even in non-endemic areas.It also highlights the fact that having adjunctive open arthrotomy in managing joint infection in melioidosis improves the clinical response to treatment.
