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[PMID]:28457513
[Au] Autor:Bonsignore A; Orcioni GF; Barranco R; De Stefano F; Ravetti JL; Ventura F
[Ad] Endereço:University of Genova, Department of Legal and Forensic Medicine, Via De Toni 12, Genova 16132, Italy.
[Ti] Título:Fatal disseminated histoplasmosis presenting as FUO in an immunocompetent Italian host.
[So] Source:Leg Med (Tokyo);25:66-70, 2017 Mar.
[Is] ISSN:1873-4162
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Histoplasmosis is a relatively rare infectious disease endemic to certain geographic areas such as East Africa, eastern and central United States, western Mexico, Central and South America. Disseminated histoplasmosis has been reported mainly in immunocompromised hosts and in AIDS patients. In this paper we report on a fatal case of undiagnosed disseminated histoplasmosis presenting as fever of unknown origin (FUO) in a 43-year-old Italian woman who, although splenectomized 5years earlier due to a motor vehicle accident, was otherwise immunocompetent. This case report highlights the fact that, even in Europe, histoplasmosis is an emerging sporadic infection which needs be considered in the differential diagnosis of given clinical scenarios. The proposed case is of blatant forensic concern as it addresses the hypothesis of professional responsibility due to a missed diagnosis of histoplasmosis. A timely diagnosis, with appropriate therapies, could have prevented death. The role of the forensic pathologist is also crucial because the post-mortem diagnosis of histoplasmosis (never considered in the differential diagnosis during prior hospitalization) highlights the importance of a meticulous and thorough autopsy to elucidate the cause of death.
[Mh] Termos MeSH primário: Diagnóstico Tardio
Febre de Causa Desconhecida/diagnóstico
Histoplasmose/diagnóstico
Histoplasmose/patologia
Hospedeiro Imunocomprometido
[Mh] Termos MeSH secundário: Adulto
Autopsia
Evolução Fatal
Feminino
Seres Humanos
Itália
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:27770828
[Au] Autor:Álvarez-Lerma F; Marín-Corral J; Vila C; Masclans JR; González de Molina FJ; Martín Loeches I; Barbadillo S; Rodríguez A; H1N1 GETGAG/SEMICYUC Study Group
[Ad] Endereço:Service of Intensive Care Medicine, Hospital del Mar, Passeig Marítim 25-29, E-08003, Barcelona, Spain. FAlvarez@parcdesalutmar.cat.
[Ti] Título:Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome.
[So] Source:Crit Care;20(1):337, 2016 Oct 23.
[Is] ISSN:1466-609X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. METHODS: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis. RESULTS: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001). CONCLUSIONS: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.
[Mh] Termos MeSH primário: Influenza Humana/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Idoso
Distribuição de Qui-Quadrado
Estado Terminal/epidemiologia
Diagnóstico Tardio
Feminino
Mortalidade Hospitalar
Seres Humanos
Vírus da Influenza A Subtipo H1N1/patogenicidade
Unidades de Terapia Intensiva/organização & administração
Unidades de Terapia Intensiva/estatística & dados numéricos
Tempo de Internação
Modelos Logísticos
Masculino
Meia-Idade
Razão de Chances
Estudos Prospectivos
Fatores de Risco
Espanha/epidemiologia
Estatísticas não Paramétricas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:27777282
[Au] Autor:Meka AO; Chukwu JN; Nwafor CC; Oshi DC; Madichie NO; Ekeke N; Anyim MC; Alphonsus C; Mbah O; Uzoukwa GC; Njoku M; Ntana K; Ukwaja KN
[Ad] Endereço:Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
[Ti] Título:Diagnosis delay and duration of hospitalisation of patients with Buruli ulcer in Nigeria.
[So] Source:Trans R Soc Trop Med Hyg;110(9):502-509, 2016 09.
[Is] ISSN:1878-3503
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Delayed diagnosis of Buruli ulcer can worsen clinical presentation of the disease, prolong duration of management, and impose avoidable additional costs on patients and health providers. We investigated the profile, delays in diagnosis, duration of hospitalisation, and associated factors among patients with Buruli ulcer in Nigeria. METHODS: This was a prospective cohort study of patients with Buruli ulcer who were identified from a community-based survey. Data on the patients' clinical profile, delays in diagnosis and duration of hospitalisation were prospectively collected. RESULTS: Of 145 patients notified, 125 (86.2%) were confirmed by one or more laboratory tests (81.4% by PCR). The median age of the patients was 20 years, 88 (60.7%) were >15years old and 85 (58.6%) were females. In addition, 137 (94.5%) were new cases, 119 (82.1%) presented with ulcers and 110 (75.9%) had lower limb lesions. The mean time delay to diagnosis was 50.6 (±101.9) weeks. The mean duration of hospitalisation was 108 (±60) days. Determinants of time delay to diagnosis were higher disease category (p=0.001) and laboratory confirmation of disease (p=0.02). Determinants of longer hospitalisation were; multiple lesions (p=0.035), and having functional limitation at diagnosis and undertaking surgery (p=0.003). CONCLUSIONS: Patients with Buruli ulcer have very long time delays to diagnosis and long hospitalisation during treatment. This calls for early case-finding and improved access to Buruli ulcer services in Nigeria.
[Mh] Termos MeSH primário: Úlcera de Buruli/diagnóstico
Diagnóstico Tardio
Acesso aos Serviços de Saúde/normas
Hospitalização/estatística & dados numéricos
Tempo de Internação/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Úlcera de Buruli/economia
Úlcera de Buruli/microbiologia
Úlcera de Buruli/terapia
Criança
Diagnóstico Tardio/efeitos adversos
Diagnóstico Tardio/economia
Feminino
Custos de Cuidados de Saúde
Gastos em Saúde
Conhecimentos, Atitudes e Prática em Saúde
Hospitalização/economia
Seres Humanos
Tempo de Internação/economia
Masculino
Mycobacterium ulcerans/isolamento & purificação
Nigéria/epidemiologia
Reação em Cadeia da Polimerase/economia
Estudos Prospectivos
População Rural
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161030
[St] Status:MEDLINE


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[PMID]:29480882
[Au] Autor:Yang JH; Shin JY; Roh SG; Chang SC; Lee NH
[Ad] Endereço:Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University.
[Ti] Título:Delayed diagnosis of xanthogranulomatous pyelonephritis in a quadriplegic patient with uncontrolled cutaneous fistula: A case report.
[So] Source:Medicine (Baltimore);97(2):e9659, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation that is characterized by urinary tract obstruction and invasion of the renal parenchyma. Although rare, XGP can lead to fatal complications, including perinephric inflammation, psoas abscess, and cutaneous fistula. PATIENT CONCERNS: A quadriplegic patient initially presented to the hospital with a chronic open wound and cutaneous fistula. DIAGNOSES: Abdominal computed tomography revealed a renal obstructing stone and enlarged right kidney with a perinephric fluid collection that communicated with the cutaneous fistula. INTERVENTIONS: The patient underwent a right nephrectomy at the department of urology. OUTCOMES: Two months after surgery, the patient was clinically well with no discharging fistula. LESSONS: The XGP accompanied by complications requires an immediate evaluation and early diagnosis. In this case, the diagnosis was delayed because the state of quadriplegia rendered no symptoms of XGP.
[Mh] Termos MeSH primário: Fístula Cutânea/complicações
Pielonefrite Xantogranulomatosa/complicações
Pielonefrite Xantogranulomatosa/diagnóstico
Quadriplegia/complicações
[Mh] Termos MeSH secundário: Fístula Cutânea/diagnóstico
Diagnóstico Tardio
Seres Humanos
Rim/diagnóstico por imagem
Rim/cirurgia
Masculino
Meia-Idade
Nefrectomia
Pielonefrite Xantogranulomatosa/cirurgia
Quadriplegia/diagnóstico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009659


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[PMID]:29195536
[Au] Autor:Baenziger NL
[Ti] Título:Mountains, Melting Pot, and Microcosm: Health Care Delay and Dengue/Zika Interplay on Hawaii Island.
[So] Source:Creat Nurs;22(4):233-242, 2016 Nov 01.
[Is] ISSN:1078-4535
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Human history in the Hawaiian Islands offers a sobering study in the population dynamics of infectious disease. The indigenous population numbering an estimated half million people prior to Western contact in 1778 was reduced to less than 24,000 by 1920. Much of the decline occurred in the earliest decades after contact with Western diseases including measles, chicken pox, polio, tuberculosis, and venereal disease. A recent outbreak on the Island of Hawaii (also called the Big Island) of imported dengue fever, an illness endemic in 100 countries affecting an estimated 100-400 million people worldwide, provides insights into the problems and prospects for health care policy in managing mosquito-borne disease in a multicultural setting of geographic isolation and health care provider shortage. This incident represents in microcosm a practice run, applicable in many contexts, for an initial localized appearance of Zika virus infection, with important lessons for effective health care management in a rapidly moving and fluid arena.
[Mh] Termos MeSH primário: Diagnóstico Tardio/psicologia
Dengue/tratamento farmacológico
Surtos de Doenças/prevenção & controle
Grupos Étnicos/psicologia
Aceitação pelo Paciente de Cuidados de Saúde/psicologia
Infecção pelo Zika virus/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Dengue/diagnóstico
Feminino
Geografia
Hawaii/epidemiologia
Seres Humanos
Masculino
Meia-Idade
Infecção pelo Zika virus/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171203
[St] Status:MEDLINE
[do] DOI:10.1891/1078-4535.22.4.233


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[PMID]:29228004
[Au] Autor:Richardus RA; van der Zwet K; van Hooij A; Wilson L; Oskam L; Faber R; van den Eeden SJF; Pahan D; Alam K; Richardus JH; Geluk A
[Ad] Endereço:Department of Infectious Diseases Leiden University Medical Center, Leiden, The Netherlands.
[Ti] Título:Longitudinal assessment of anti-PGL-I serology in contacts of leprosy patients in Bangladesh.
[So] Source:PLoS Negl Trop Dis;11(12):e0006083, 2017 12.
[Is] ISSN:1935-2735
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite elimination efforts, the number of Mycobacterium leprae (M. leprae) infected individuals who develop leprosy, is still substantial. Solid evidence exists that individuals living in close proximity to patients are at increased risk to develop leprosy. Early diagnosis of leprosy in endemic areas requires field-friendly tests that identify individuals at risk of developing the disease before clinical manifestation. Such assays will simultaneously contribute to reduction of current diagnostic delay as well as transmission. Antibody (Ab) levels directed against the M.leprae-specific phenolic glycolipid I (PGL-I) represents a surrogate marker for bacterial load. However, it is insufficiently defined whether anti-PGL-I antibodies can be utilized as prognostic biomarkers for disease in contacts. Particularly, in Bangladesh, where paucibacillary (PB) patients form the majority of leprosy cases, anti-PGL-I serology is an inadequate method for leprosy screening in contacts as a directive for prophylactic treatment. METHODS: Between 2002 and 2009, fingerstick blood from leprosy patients' contacts without clinical signs of disease from a field-trial in Bangladesh was collected on filter paper at three time points covering six years of follow-up per person. Analysis of anti-PGL-I Ab levels for 25 contacts who developed leprosy during follow-up and 199 contacts who were not diagnosed with leprosy, was performed by ELISA after elution of bloodspots from filter paper. RESULTS: Anti-PGL-I Ab levels at intake did not significantly differ between contacts who developed leprosy during the study and those who remained free of disease. Moreover, anti-PGL-I serology was not prognostic in this population as no significant correlation was identified between anti-PGL-I Ab levels at intake and the onset of leprosy. CONCLUSION: In this highly endemic population in Bangladesh, no association was observed between anti-PGL-I Ab levels and onset of disease, urging the need for an extended, more specific biomarker signature for early detection of leprosy in this area. TRIAL REGISTRATION: ClinicalTrials.gov ISRCTN61223447.
[Mh] Termos MeSH primário: Anticorpos Antibacterianos/sangue
Antígenos de Bactérias/imunologia
Glicolipídeos/imunologia
Hanseníase/diagnóstico
Mycobacterium leprae/imunologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Bangladesh/epidemiologia
Biomarcadores/sangue
Criança
Pré-Escolar
Estudos de Coortes
Diagnóstico Tardio/prevenção & controle
Feminino
Seres Humanos
Imunoglobulina G/sangue
Imunoglobulina M/sangue
Lactente
Hanseníase/imunologia
Hanseníase/transmissão
Estudos Longitudinais
Masculino
Mycobacterium leprae/isolamento & purificação
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antibodies, Bacterial); 0 (Antigens, Bacterial); 0 (Biomarkers); 0 (Glycolipids); 0 (Immunoglobulin G); 0 (Immunoglobulin M); 0 (phenolic glycolipid I, Mycobacterium leprae)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pntd.0006083


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[PMID]:29381936
[Au] Autor:Ye S; Dai T; Leng B; Tang L; Jin L; Cao L
[Ad] Endereço:Department of Neurology, Tianjin Huanhu Hospital.
[Ti] Título:Genotype and clinical course in 2 Chinese Han siblings with Wilson disease presenting with isolated disabling premature osteoarthritis: A case report.
[So] Source:Medicine (Baltimore);96(47):e8641, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Premature osteoarthritis (POA) is a rare condition in Wilson disease (WD). Particularly, when POA is the only complaint of a WD patient for a long time, there would be misdiagnosis or missed diagnosis and then treatment delay. PATIENT CONCERNS AND DIAGNOSIS: Two Chinese Han siblings were diagnosed as WD by corneal K-F rings, laboratory test, and mutation analysis. They presented with isolated POA during the first 2 decades or more of their disease course, and were of missed diagnosis during that long time. The older affected sib became disabled due to his severe osteoarthritis when he was as young as 38 years old. Two compound heterozygous pathogenic variants c.2790_2792del and c.2621C>T were revealed in the ATP7B gene through targeted next-generation sequencing (NGS). LESSONS: Adolescent-onset POA could be the only complaint of WD individual for at least 2 decades. Long delay in the treatment of WD's POA could lead to disability in early adulthood. Detailed physical examination, special biochemical test, and genotyping through targeted NGS should greatly reduce diagnosis delay in atypical WD patients with isolated POA phenotype.
[Mh] Termos MeSH primário: ATPases Transportadoras de Cobre/genética
Erros de Diagnóstico
Degeneração Hepatolenticular
Osteoartrite
Irmãos
Tempo para o Tratamento
[Mh] Termos MeSH secundário: Adulto
Idade de Início
China
Diagnóstico Tardio/efeitos adversos
Diagnóstico Tardio/prevenção & controle
Erros de Diagnóstico/efeitos adversos
Erros de Diagnóstico/prevenção & controle
Avaliação da Deficiência
Progressão da Doença
Degeneração Hepatolenticular/complicações
Degeneração Hepatolenticular/genética
Degeneração Hepatolenticular/fisiopatologia
Seres Humanos
Masculino
Anamnese
Mutação
Osteoartrite/diagnóstico
Osteoartrite/etiologia
Osteoartrite/fisiopatologia
Osteoartrite/prevenção & controle
Índice de Gravidade de Doença
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
EC 3.6.3.54 (ATP7B protein, human); EC 3.6.3.54 (Copper-transporting ATPases)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008641


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[PMID]:29201310
[Au] Autor:El-Sobky TA; Haleem JF; Sakr HM; Aly AS
[Ad] Endereço:Division of Pediatric Orthopedics, Department of Orthopedic Surgery, Ain-Shams University Faculty of Medicine, Cairo, Egypt.
[Ti] Título:A Neglected Markedly Displaced Medial Epicondyle Fracture with Simultaneous Ulnar Nerve Palsy in an Adolescent.
[So] Source:Clin Orthop Surg;9(4):542-546, 2017 Dec.
[Is] ISSN:2005-4408
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:Humeral medial epicondyle fractures constitute around 15% of pediatric elbow fractures. Up to 60% occur in association with elbow dislocations. Knowledge of potential imaging pitfalls when examining acute elbow fractures in children contributes significantly to accurate diagnosis. Nevertheless, management of missed pediatric medial epicondyle fractures has rarely been reported. We present an 11-year-old boy with a neglected and severely displaced medial epicondyle fracture with concurrent ulnar nerve palsy. We performed neural decompression, fragment excision, and muscular and capsuloligamentous reconstruction of the medial elbow. This study demonstrates that the surgical outcome of a late presenting fracture can be satisfactory in terms of function and neural recovery. It also underscores the importance of careful interpretation of elbow imaging including normal anatomic variants.
[Mh] Termos MeSH primário: Articulação do Cotovelo/cirurgia
Fraturas do Úmero/complicações
Fraturas do Úmero/cirurgia
Neuropatias Ulnares/complicações
Neuropatias Ulnares/cirurgia
[Mh] Termos MeSH secundário: Criança
Diagnóstico Tardio
Erros de Diagnóstico
Articulação do Cotovelo/lesões
Epífises
Seres Humanos
Fraturas do Úmero/diagnóstico por imagem
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE
[do] DOI:10.4055/cios.2017.9.4.542


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Younes, Riad Naim
Texto completo SciELO Brasil
[PMID]:29236913
[Au] Autor:Abrao FC; Abreu IRLB; Rocha RO; Munhoz FD; Rodrigues JHG; Younes RN
[Ad] Endereço:Departamento de Cirurgia Toracica, Faculdade de Medicina Santa Marcelina, Sao Paulo, SP, BR.
[Ti] Título:Impact of the delay to start treatment in patients with lung cancer treated in a densely populated area of Brazil.
[So] Source:Clinics (Sao Paulo);72(11):675-680, 2017 Nov.
[Is] ISSN:1980-5322
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The aim of this study is to evaluate the access of patients with lung cancer in a densely populated area of São Paulo to the Brazilian Public Health System, focusing on the time spent from symptom onset or initial diagnosis until the beginning of treatment. METHODS: We retrospectively reviewed 509 patients with malignant lung neoplasms who were admitted to a single reference oncology center of the public health system between July 2008 and December 2014. Patients were considered eligible for this study if they were older than 18 years and had not undergone any previous oncology treatment when they were admitted to the institution. The following data were collected from all patients: age, gender, smoking status, tumor staging, time from the when the first symptoms were experienced by the patient to when the patient was diagnosed with cancer, time from the first appointment to cancer diagnosis, and time from when the patient was diagnosed with cancer to the initiation of treatment. RESULTS: The median time from symptom onset to diagnosis was three months. From the first appointment to diagnosis, the median time interval was one month; however, 79% of patients were diagnosed in up to two months. The median time from diagnosis to the start of treatment was one month, but most patients (82.5%) started treatment in up to two months. CONCLUSION: In our highly populated region with preferential access to the public health system, patients are required to wait a relatively long time to effectively begin treatment for lung cancer. This type of study is important to alert medical societies and government health agencies.
[Mh] Termos MeSH primário: Acesso aos Serviços de Saúde/estatística & dados numéricos
Neoplasias Pulmonares/terapia
Tempo para o Tratamento/estatística & dados numéricos
[Mh] Termos MeSH secundário: Brasil
Diagnóstico Tardio
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Neoplasias Pulmonares/diagnóstico
Neoplasias Pulmonares/mortalidade
Masculino
Meia-Idade
Estadiamento de Neoplasias
Setor Público
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29190267
[Au] Autor:Dailey AF; Hoots BE; Hall HI; Song R; Hayes D; Fulton P; Prejean J; Hernandez AL; Koenig LJ; Valleroy LA
[Ad] Endereço:Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.
[Ti] Título:Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays - United States.
[So] Source:MMWR Morb Mortal Wkly Rep;66(47):1300-1306, 2017 Dec 01.
[Is] ISSN:1545-861X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Persons unaware of their human immunodeficiency virus (HIV) infection account for approximately 40% of ongoing transmissions in the United States. Persons are unaware of their infection because of delayed HIV diagnoses that represent substantial missed opportunities to improve health outcomes and prevent HIV transmission. METHODS: Data from CDC's National HIV Surveillance System were used to estimate, among persons with HIV infection diagnosed in 2015, the median interval (and range) from infection to diagnosis (diagnosis delay), based on the first CD4 test after HIV diagnosis and a CD4 depletion model indicating disease progression and, among persons living with HIV in 2015, the percentage with undiagnosed infection. Data from CDC's National HIV Behavioral Surveillance were analyzed to determine the percentage of persons at increased risk for HIV infection who had tested in the past 12 months and who had missed opportunities for testing. RESULTS: An estimated 15% of persons living with HIV in 2015 were unaware of their infection. Among the 39,720 persons with HIV infection diagnosed in 2015, the estimated median diagnosis delay was 3.0 years (interquartile range = 0.7-7.8 years); diagnosis delay varied by race/ethnicity (from 2.2 years among whites to 4.2 years among Asians) and transmission category (from 2.0 years among females who inject drugs to 4.9 years among heterosexual males). Among persons interviewed through National HIV Behavioral Surveillance, 71% of men who have sex with men, 58% of persons who inject drugs, and 41% of heterosexual persons at increased risk for HIV infection reported testing in the past 12 months. In each risk group, at least two thirds of persons who did not have an HIV test had seen a health care provider in the past year. CONCLUSIONS: Delayed HIV diagnoses continue to be substantial for some population groups and prevent early entry to care to improve health outcomes and reduce HIV transmission to others. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Health care providers and others providing HIV testing can reduce HIV-related adverse health outcomes and risk for HIV transmission by implementing routine and targeted HIV testing to decrease diagnosis delays.
[Mh] Termos MeSH primário: Diagnóstico Tardio/estatística & dados numéricos
Infecções por HIV/diagnóstico
Programas de Rastreamento/estatística & dados numéricos
Vigilância da População
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Infecções por HIV/epidemiologia
Seres Humanos
Masculino
Meia-Idade
Fatores de Risco
Estados Unidos/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180119
[Lr] Data última revisão:
180119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.15585/mmwr.mm6647e1



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