Delayed Diagnosis of Hidradenitis Suppurativa and Its Effect on Patients and Healthcare System

Background: Hidradenitis suppurativa (HS) is a neglected chronic inflammatory disease with long delay in diagnosis. Besides pain, purulent discharge, and destruction of skin architecture, HS patients experience metabolic, musculoskeletal, and psychological disorders. Objectives: To determine the delay in HS diagnosis and its consequences for patients and the healthcare system. Methods: This was a prospective, multicenter, epidemiologic, non-interventional cross-sectional trial carried out in Germany and based on self-reported questionnaires and medical examinations performed by dermatologists. In total, data of 394 adult HS patients were evaluated. Results: The average duration from manifestation of first symptoms until HS diagnosis was 10.0 ± 9.6 (mean ± SD) years. During this time, HS patients consulted on average more than 3 different physicians – most frequently general practitioners, dermatologists, surgeons, gynecologists – and faced more than 3 misdiagnoses. Diagnosis delay was longer in younger and non-smoking patients. In most cases, HS was correctly diagnosed by dermatologists. The longer the delay of diagnosis, the greater the disease severity at diagnosis. Delayed HS diagnosis was also associated with an increased number of surgically treated sites, concomitant diseases, and days of work missed. Conclusion: This study demonstrates an enormous delay in the diagnosis of HS, which results in more severe disease. It also shows for the first time that a delay in diagnosis of a chronic inflammatory disease leads to a higher number of concomitant systemic disorders. In addition to the impaired health status, delayed diagnosis of HS was associated with impairment of the professional life of affected people.

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Endometriosis-Associated Symptoms and Diagnostic Delay: An Online Survey

10.21203/rs.3.rs-126422/v1 ◽

2020 ◽

Author(s):

Maryam Moradi ◽

Azin Niazi ◽

Melissa Parker ◽

Anne Sneddon ◽

Violeta Lopez ◽

...

Keyword(s):

Online Survey ◽

Age Of Onset ◽

Diagnostic Delay ◽

Delayed Diagnosis ◽

Cross Sectional Study ◽

Diagnosis Delay ◽

Cross Sectional ◽

Delay In Diagnosis ◽

Associated Symptoms ◽

Surgical Treatments

Abstract Background: Endometriosis is found in women of all ethnic and social groups with a prevalence of around 10%. However, data on diagnostic-delay and associated symptoms are limited. The aim of this study was to determine the endometriosis-associated symptoms and diagnosis-delay through an online survey. Methods: A cross-sectional study was conducted in Australia using an online web-based survey. All data were entered and analyzed using STATA (version 14/1). A total of 903 responders completed an online survey from September 2013 to October 2015.Results: Total participants of 903, 71.10% Australians (were born in Australia) and 28.90% Non-Australian (were not born in Australia), with self-reported diagnosis of endometriosis was confirmed by surgery in 86.5% of participants completed the online survey. Delay in diagnosis was 8.1±6.2 years. There was no difference between age range (p = 0.35), mean age of onset of the first symptoms (p = 0.93), and delay in diagnosis (p = 0.11) in both groups. Most common endometriosis-related symptoms that all responders had experienced in their lifetime were period pain 98.11%, fatigue 94.01%, bloating 90.69%, ovulation pain 88.70%, pelvic pain 87.26%, pain during before/after sexual activity 82.72% and heavy bleeding 82.17% and delayed fertility 37.98%. Treatments used in affected women included: pain killers 96.01% (n=867), hormonal medication 84.71% and surgical treatments 84.49 %. Rate of miscarriage or stillbirth was 13.4% and hysterectomy because of endometriosis was 9.6%. Conclusions: Vast similarities in demographics and endometriosis-associated symptoms among the Australian and non-Australian women with endometriosis support the universality of the disease characteristics. Delay in diagnosis of endometriosis is a problem and the reasons for delayed diagnosis must be better understood to try to shorten this delay. Except for pain, endometriosis patients suffer from a variety of symptoms and treatment must take into account the most prominent symptoms.

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Delay in diagnosis of pulmonary tuberculosis increases the risk of pulmonary cavitation in pastoralist setting of Ethiopia

BMC Pulmonary Medicine ◽

10.1186/s12890-019-0971-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Fentabil Getnet ◽

Meaza Demissie ◽

Alemayehu Worku ◽

Tesfaye Gobena ◽

Rea Tschopp ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Severe Disease ◽

Cross Sectional Study ◽

Adverse Outcomes ◽

Diagnosis Delay ◽

Discriminative Ability ◽

Cross Sectional ◽

Delay In Diagnosis ◽

Factors Associated ◽

Record Review

Abstract Background Delay in diagnosis and treatment of pulmonary tuberculosis (PTB) leads to severe disease, adverse outcomes and increased transmission. Assessing the extent of delay and its effect on disease progression in TB affected settings has clinical and programmatic importance. Hence, the aim of this study was to investigate the possible effect of delay on infectiousness (cavitation and smear positivity) of patients at diagnosis in Somali pastoralist area, Ethiopia. Methods A cross-sectional study was conducted between December 2017 and October 2018, and 434 newly coming and confirmed PTB patients aged ≥15 years were recruited in five facilities. Data were collected using interview, record-review, anthropometry, Acid-fast bacilli and chest radiography techniques. Log-binomial regression models were used to reveal the association of delay and other factors associated with cavitation and smear positivity, and ROC Curve was used to determine discriminative ability and threshold delays. Results Median age of patients was 30 years. Of all, 62.9% were males, and 46.5% were pastoralists. Median diagnosis delay was 49 days (IQR = 33–70). Cavitation was significantly associated with diagnosis delay [P < 0.001]; 22.2% among patients diagnosed within 30 days of illness and 51.7% if delay was over 30 days. The threshold delay that optimizes cavitation was 43 days [AUC (95% CI) = 0.67(0.62–0.72)]. Smear positivity was significantly increased in patients delayed over 49 days [p = 0.02]. Other factors associated with cavitation were age ≤ 35 years [APR (95% CI) =1.3(1.01–1.6)], chronic diseases [APR (95% CI) = 1.8(1.2–2.6)] and low MUAC*female [APR (95% CI) = 1.8(1.2–2.8)]. Smear positivity was also associated with age ≤ 35 years [APR (95% CI) =1.4(1.1–1.8)], low BMI [APR (95% CI) =1.3(1.01–1.7)] and low MUAC [APR (95% CI) =1.5(1.2–1.9)]. Conclusion This study highlights delay in diagnosis of pulmonary TB remained high and increased infectiousness of patients in pastoral settings of Ethiopia. Hence, delay should be targeted to improve patient outcomes and reduce transmission in such settings.

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Intermammary Hidradenitis Suppurativa: Considerations on a Unique Presentation

Skin Appendage Disorders ◽

10.1159/000514363 ◽

2021 ◽

pp. 1-4

Author(s):

Ana Luísa João ◽

Nélia Cunha ◽

Joana Cabete

Keyword(s):

Surgical Approach ◽

Inflammatory Disease ◽

Pilonidal Sinus ◽

Hidradenitis Suppurativa ◽

Chronic Inflammatory Disease ◽

Pilonidal Sinus Disease ◽

Sinus Disease ◽

Case Presentation ◽

Overweight Women

Introduction: Hidradenitis suppurativa (HS) is a potentially disabling chronic inflammatory disease. The intermammary location, not clearly specified in the usual phenotypic classifications, entails significant functional and cosmetic compromise. Case Presentation: Eleven cases of predominantly intermammary disease with multiple fistulization and disfiguring scarring were observed at our Department between January 2016 and March 2020. They were young (mean age = 22 years) obese or overweight women, in which the medical-surgical approach has led to variable results. Discussion/Conclusion: Intermammary HS possibly represents a unique phenotypic presentation, likely to be fistulizing and severe. We believe that anatomo-functional considerations, which can be paralleled to pilonidal sinus disease, contribute to its pathophysiology and striking appearance, and further emphasize the importance of multidisciplinary endeavor to reduce the morbidity associated with this seemingly overlooked location.

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Pelvic inflammatory disease

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0043 ◽

2020 ◽

pp. 536-549

Author(s):

Gillian Dean ◽

Jonathan Ross

Keyword(s):

Ectopic Pregnancy ◽

Pelvic Inflammatory Disease ◽

Inflammatory Disease ◽

Severe Disease ◽

Lower Abdominal Pain ◽

Asymptomatic Infection ◽

Public Understanding ◽

Transmitted Infection ◽

Delay In Diagnosis ◽

Sexually Transmitted

Pelvic inflammatory disease is a sexually transmitted infection of the female upper genital tract. Rates of pelvic inflammatory disease have fallen in many countries over the last 10 years, at least in part due to increased screening for chlamydial infection. The clinical spectrum ranges from asymptomatic infection through to severe disease requiring hospitalization. Due to the non-specific nature of the condition, diagnosis can be challenging. All sexually active women presenting with acute lower abdominal pain should have a pregnancy test to rule out ectopic pregnancy. Treatment must be initiated as soon as the diagnosis is suspected and include antibiotics covering a broad spectrum of pathogens. Delay in diagnosis increases the risk of adverse sequelae including ectopic pregnancy and infertility. It is recommended that current and recent sexual partners receive empirical treatment, regardless of symptoms or microbiological results, and refrain from sexual contact until completion of therapy. Through better public understanding of the symptoms of pelvic inflammatory disease, women seeking earlier medical attention may reduce the risk of reproductive damage.

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FACTORS AFFECTING DELAY IN DIAGNOSIS OF COLORECTAL CANCER: A CROSS-SECTIONAL STUDY; FROM TERTIARY CARE HOSPITAL OF KARACHI PAKISTAN

10.22541/au.161894113.38241511/v1 ◽

2021 ◽

Author(s):

Rubab Nafees Ahmed ◽

Lajpat Rai ◽

Khursheed Ahmed Samo ◽

Summaya Saeed ◽

Ammara Salam ◽

...

Keyword(s):

Colorectal Cancer ◽

Control Program ◽

Cross Sectional Study ◽

Diagnosis Delay ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Delay In Diagnosis ◽

Presenting Symptoms ◽

Keywords Colorectal Cancer

Background: CRC incidence is increasing in our region. There is no specific CRC control program or national cancer registry in Pakistan. Previously no data has been published on presentation and diagnosis delay of CRC in our region. This study is conducted to determine the factor affecting delay in presentation and diagnosis and to provide baseline information to launch a CRC control program. Primary objective is to determine factor causing delay in diagnosis of CRC. Secondary objective is to evaluate relationship between tumor site and stage of CRC with presenting symptoms and symptom duration. Methods: This project is a prospective cross-sectional study on 113 biopsy-proven CRC patients admitted to the surgical ward of civil hospital Karachi. Results: A total number of participants was 113. Presentation delay was observed in 83.2% of patients. The main reasons for a reported delay in the presentation were lack of patients’ knowledge that these symptoms may be cancer (60.4%), the wrong diagnosis by the primary physician (34.6%), or the patient didn’t want to visit the doctor (0.04%). Most tumors (95%) originated from the sigmoid and rectum. 38.9% and 44.2% of the patients diagnosed at Stage 4 and 3 respectively. Conclusions: This study revealed that CRC patients in Pakistan are facing delays in presentation and diagnosis. This is the reason behind diagnosis at the advanced stage with a poor prognosis. Based on this study findings CRC control program should be introduced to detect CRC at an early stage. Keywords: Colorectal cancer, Colon, Rectum, Cancer, Presentation delay, Diagnosis delay.

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Treatment of psoriasis in general practice

South African General Practitioner ◽

10.36303/sagp.2020.2.0017 ◽

2020 ◽

pp. 82-84

Author(s):

T Jacobs ◽

CM Kgokolo

Keyword(s):

Cardiovascular Disease ◽

General Practice ◽

Inflammatory Disease ◽

Systemic Therapy ◽

Topical Treatment ◽

Severe Disease ◽

Treatment Options ◽

Chronic Inflammatory Disease ◽

Biological Agents ◽

Moderate Disease

Psoriasis is a prevalent chronic inflammatory disease. Beyond skin and joint manifestations, psoriasis has numerous associated comorbidities, including metabolic and cardiovascular disease. There are many treatment options available, from topical treatment for mild psoriasis, phototherapy for moderate disease, to systemic therapy or biological agents for severe disease. This article aims to focus on the treatment for the majority of patients where topical agents alone are generally appropriate.

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Management of Esophageal Perforation: 28-Year Experience in a Major Referral Center

The American Surgeon ◽

10.1177/000313481808400520 ◽

2018 ◽

Vol 84 (5) ◽

pp. 684-689 ◽

Cited By ~ 3

Author(s):

Ana Puertavicente ◽

Pablo Priego JimÉNez ◽

María Ángeles Cornejo López ◽

Francisca GarcÍA-Moreno Nisa ◽

Gloria RodrÍGuez Velasco ◽

...

Keyword(s):

Esophageal Perforation ◽

Severe Disease ◽

Treatment Options ◽

Delayed Diagnosis ◽

Mortality Rates ◽

Endoscopic Management ◽

High Morbidity ◽

Septic Complications ◽

Delay In Diagnosis ◽

Individualized Approach

Esophageal perforation constitutes a surgical emergency. Despite its gravity, no single strategy has been described as sufficient to deal with most situations to date. The aim of this study was to assess the etiology, management, and outcome of esophageal perforation over a 28-year period, to characterize optimal treatment options in this severe disease. A retrospective clinical review of all patients treated for esophageal perforation at Ramón y Cajal Hospital between January 1987 and December 2015 was performed (n = 57). Iatrogenic injury was the most frequent cause of esophageal perforation (n = 32). Abdominal esophagus was the main location (23 patients; 40.4%). Eight patients (14%) were managed with antibiotics and parenteral nutrition. In seven patients (12.3%), an endoscopic stent was implanted. Surgical therapy was performed in 38 patients (66.7%). Morbidity and 90-day mortality rates were 61.4 and 28 per cent, respectively. Five patients were reoperated (8.8%). Median hospital stay was 23.5 days. The mortality rate was higher among patients with spontaneous and tumoral perforation (54.5 and 100%; P = 0.009), delayed diagnosis (>24 hours; P = 0.0001), and abdominal/thoracic location (37.5%; P = 0.05). No statistical differences were found between surgical and conservative/endoscopic management (31% vs 20%; P = 0.205) although hospital staying was longer in surgical group (36.30 days vs 15.63 days; P = 0.029). Esophageal perforation was associated with high morbidity and mortality rates. Global outcomes depend on etiology, site of perforation, and delay in diagnosis. An individualized approach for each patient should be chosen to prevent septic complications of this potentially fatal disease.

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POS1016 ANKYLOSING SPONDYLITIS IN WEST AFRICAN PATIENTS: A SERIES OF 37 CASES REPORTED IN TOGO

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4199 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 776.1-776

Author(s):

P. Houzou ◽

V. E. S. Koffi-Tessio ◽

S. Oniankitan ◽

K. Kakpovi ◽

E. Fianyo ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Delayed Diagnosis ◽

Symptomatic Treatment ◽

Sub Saharan Africa ◽

Lumbar Pain ◽

Diagnosis Delay ◽

Hla B27 ◽

Delay In Diagnosis ◽

Male Predominance ◽

Sub Saharan

Background:Spondyloarthritis (SpA) is generally uncommon in sub-Saharan Africa, in part because of the rarity of HLA-B27 in this region.Objectives:The aim of our study was to determine the epidemiological, semiological, paraclinical and therapeutic aspects of ankylosing spondylitis in rheumatology in Togo.Methods:This was a retrospective multicenter descriptive study on the files of patients suffering from ankylosing spondylitis seen in an outpatient setting or hospitalized in one of the four Rheumatology departments of Togo in the period from January 1, 2000 to December 31, 2019. The diagnosis was essentially radio-clinical based on the modified New York criteria.Results:In 20 years, and out of a population of 35,304 rheumatic patients, we have collected 37 cases of ankylosing spondylitis, meaning a hospital frequency of 0.10% and an annual frequency of 1.85 cases. There was clearly a male predominance with an M / F ratio of 4.28. The onset of the disease was on average of 29.62 ± 10.27 years and the diagnosis delay on average of 9.45 ± 9.20 years. The clinic was dominated by spinal pain in the form of chronic inflammatory cervical-dorsal-lumbar pain (41.2%) or lumbar pain (29.4%). Common joint injuries were those of the knees (57.69%), ankles (26.9%) and shoulders (23.1%). The most frequent extra-articular manifestations were ocular with conjunctivitis (62.5%) and uveitis (37.5%). Due to the delayed diagnosis, significant spinal deformities including hypercyphosis, straightness and ankylosis were found; the radiography of the spine objectified syndesmophytes (50.0%) with ankyloses and the bamboo column (23.5%) and that of the pelvis objectified sacroiliitis at stage 3 (54.6%) and at stage 4 (27.3%). The HLA B27 antigen was positive in 10.8% of cases. NSAIDs and sulfasalazine were the most commonly used drugs in management, respectively in 94.3% of symptomatic treatment and 92.6% of background therapy.Conclusion:Ankylosing spondylitis is relatively rare in Togo, affecting more men and young adults. There are no clinical or paraclinical particularity. The delay in diagnosis reflects the importance of the radiological signs. Treatment is mainly done by NSAIDs and DMRADs in particular sulfasalazine, due to their accessibility.References:[1]Dean LE, Jones GT, MacDonald AG, Downham C, Sturrock RD, Macfarlane GJ. Global Prevalence of Ankylosing Spondylitis. Rheumatology (Oxford). 2014;53:650-7.[2]Zabsonre TWJ, Sawadogo SA, Kabore F, Ilboudo A, Sougue C, Zongo E, et al. Ankylosing Spondylitis in Sub-Saharan Africa: A Series of 48 Cases Reported in Burkina Faso (West Africa). Open J Rheumatol Autoimmune Dis. 2018;8:87-92.[3]Mijiyawa M. Ankylosing Spondylitis in Togolese Patients. Med Trop. 1993;53:185-9.Disclosure of Interests:None declared.

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Place & Person involved in delivery: Factors leading to delay in diagnosis of Anorectal Malformation in Newborns

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.1.4156 ◽

2021 ◽

Vol 38 (1) ◽

Author(s):

Shazia Perveen ◽

Sajid Ali ◽

Abdul Jabbar ◽

Batool Fatima

Keyword(s):

Anorectal Malformation ◽

Delayed Diagnosis ◽

Cross Sectional Study ◽

Categorical Variables ◽

Paediatric Surgery ◽

Chi Square ◽

Cross Sectional ◽

Delay In Diagnosis ◽

Creative Commons ◽

Medical Person

Objective: To determine the frequency of place of delivery and person detecting the anomaly among newborn babies presenting with delayed diagnosis of anorectal malformation (ARM). Methods: This is a Descriptive Cross-Sectional Study, conducted at Department of Paediatric Surgery, National Institute of Child Health (NICH) Karachi, from February 19, 2019 to August 18, 2019. All patients with ARM who were diagnosed beyond two hours of life (Delayed diagnosis) were included in the study. Chi square test was applied for comparison of categorical variables. Results: Total 110 patients were enrolled in this study. Nineteen (17.3%) patients were delivered at home, while 91 (82.7%) were delivered at the hospital. The first person detecting the anomaly was grandmother (n=25) or a non-medical person in 58 patients (52.7%), 52 were diagnosed by a medical personal either primarily in 31 cases (28.2%) or secondarily by a neonatologist in 21 cases (19.1%). Conclusion: It is concluded that Non-medical person detected ARM mainly despite the babies being delivered mostly at the hospital, indicating the need for meticulous neonatal examination. doi: https://doi.org/10.12669/pjms.38.1.4156 How to cite this:Perveen S, Ali S, Jabbar A, Fatima B. Place & Person involved in delivery: Factors leading to delay in diagnosis of Anorectal Malformation in Newborns. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4156 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Development and Validation of HSCAPS-1: A Clinical Decision Support Tool for Diagnosis of Hidradenitis Suppurativa over Cutaneous Abscess

Dermatology ◽

10.1159/000511077 ◽

2020 ◽

Vol 237 (5) ◽

pp. 719-726

Author(s):

Amit Garg ◽

Sarah Reddy ◽

Joslyn Kirby ◽

Andrew Strunk

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Hidradenitis Suppurativa ◽

Decision Support Tool ◽

Clinical Decision ◽

Diagnosis Delay ◽

Cross Sectional ◽

Support Tool ◽

Clinical Decision Support Tool ◽

Validation Set

Background: A clinical decision support tool may improve recognition of hidradenitis suppurativa (HS) and reduce diagnosis delay. Objective: To develop and initially validate a clinical decision support to predict diagnosis of HS and distinguish it from cutaneous abscess of the axilla, groin, perineum, and buttock. Methods: This was a retrospective, cross-sectional analysis between January 2012 and June 2017 (development set) and July 2017 and March 2019 (validation set). We used an electronic records sample of 56 million patients from the Explorys database to identify patients with an ambulatory visit associated with either HS or cutaneous of the axilla, groin, perineum, and buttock. The outcome was predicted probability of HS diagnosis. Results: Development set included 7,974 patients with mean age of 41.4 years, who were predominantly female (66%) and white (62%). Validation set included 1,560 patients with similar demographic composition. Factors which were stronger independent predictors of HS included female sex (OR 2.17 [95% CI 1.96–2.40]); African American race (1.28 [95% CI 1.15–1.44]); increasing BMI (OR 1.05 [95% CI 1.05–1.06)]; history of acne (OR 3.46 [95% CI 2.83–4.23]); Down syndrome (OR 5.35 [95% CI 2.03–14.12]); and prescription for at least 7 opioid medications in the past year (OR 1.05 [95% CI 0.83–1.33]). Up to age 45 years, increasing age was a stronger predictor of HS diagnosis. The simplified model showed good discrimination (c-statistic 0.746 [SE 0.013]) and moderate calibration (calibration intercept –0.260 [SE 0.055]; calibration slope 1.142 [SE 0.076]). Conclusion: This clinical decision support tool shows good performance in predicting diagnosis of HS and distinguishing it from cutaneous abscess that involves the axilla, groin, perineum, and buttock.

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