scholarly journals Reliance on Self-Medication Increase Delays in Diagnosis and Management of GI Cancers: Results From Nepal

2020 ◽  
pp. 1258-1263
Author(s):  
Soniya Dulal ◽  
Bishnu Dutta Paudel ◽  
Lori Anne Wood ◽  
Prakash Neupane ◽  
Aarati Shah ◽  
...  
Keyword(s):  
Diagnosis And Treatment ◽  
Primary Care Visit ◽  
Use Of Self ◽  
Self Medication ◽  
Time Intervals ◽  
Gi Cancer ◽  
Significant Difference ◽  
Presentation Time ◽  
Baseline Factors ◽  
Gi Cancers

PURPOSE Patients with GI cancers in Nepal often present with advanced disease and poor outcomes. The purpose of the study was to determine the time to presentation, diagnosis, and treatment of GI cancer and the baseline factors that may be associated with delays. PATIENTS AND METHODS An institutional review board–approved study was performed in Kathmandu, Nepal, from July 2018 to June 2019. Patients with newly diagnosed GI cancers were asked to fill out a standardized questionnaire. Baseline factors such as residence, literacy, and use of self-medication were recorded. Patients were asked to report the time from first symptom to presentation, time from primary care visit to pathologic diagnosis, and time from diagnosis to surgery and/or treatment. Baseline factors were analyzed using 2-tailed t tests (Prism 8.0; GraphPad, La Jolla, CA) to determine whether any factors were associated with longer time delays in these 3 intervals. RESULTS The cohort comprised of 104 patients with a median age of 53.5 years (range, 22-77 years); 61.5% were men, 46.2% had upper GI cancers, and 83.7% presented with stage III or IV disease. The median time to presentation was 150 days, time to diagnosis was 220 days, and time to treatment was 50 days. There was no statistically significant difference in time intervals between upper and lower GI cancers. Use of self-medication (88.5%) was the only factor associated with longer time intervals to presentation, diagnosis, and treatment. CONCLUSION Patients in Nepal have long time intervals to presentation, diagnosis, and treatment of GI cancer. Self-medication led to longer delays. Reasons for self-medication and other potential barriers will be explored in future studies in the hopes of improving outcomes.

Delay in diagnosis and treatment of gastrointestinal cancer in Nepal.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18269-e18269
Author(s):  
Soniya Dulal ◽  
Bishnu D. Paudel ◽  
Aarati Shah ◽  
Bibek Acharya ◽  
Sandhya Chapagain Acharya ◽  
...  
Keyword(s):  
Rural Areas ◽  
Diagnostic Delay ◽  
Treatment Delay ◽  
Medical Consultation ◽  
Diagnosis And Treatment ◽  
Histopathological Diagnosis ◽  
Diagnosis Delay ◽  
Self Medication ◽  
Delay In Diagnosis ◽  
Gi Cancers

e18269 Background: Gastrointestinal (GI) cancers represent a major health challenge worldwide including Nepal where patients (pts) often present with advanced disease. The purpose of this study was to determine the time delay in diagnosis and treatment by evaluating time from first symptoms to diagnosis and treatment and to identify contributing factors from both pts and the health system in Nepal. Methods: An IRB approved cross sectional study was performed in pts with GI cancers. 50 newly diagnosed pts were enrolled and interviewed with a standardized questionnaire during the last 6 months of 2018. Diagnosis delay was defined as time from first symptoms to histopathological diagnosis. Treatment delay was defined as time from diagnosis to surgery and/or treatment by medical/ radiation oncologist. Results: The median age at diagnosis was 52.5 years. 52% had gastroesophageal cancer and 48% had colorectal cancer. 84% presented with Stage III/ IV disease. The median diagnosis delay was 217 days and the median treatment delay was 37 days. The median patient delay (time from first symptoms to first medical consultation) was 150 days. 64% were illiterate, 94% had a history of self medication prior to first medical consultation, 68% were from rural areas with limited healthcare facilities and 72% were unaware of causes of GI cancers. Reasons for diagnostic delay appear to be self diagnosis, self medication and lack of a prompt referral system. Reasons for treatment delay included financial constraint, prolonged wait times for procedures and treatment due to limited skilled manpower. Conclusions: Our data shows there is a significant delay in diagnosis and treatment especially in the time from first symptoms to first medical consultation. We found many preventable reasons for this that, if addressed appropriately, could have a significant impact on reducing the morbidity and mortality of GI cancers. There is an urgent need for intensive and comprehensive cancer education in Nepal and other developing countries.

Time delay barriers in diagnosis and treatment of gastrointestinal cancer in Nepal.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19085-e19085
Author(s):  
Soniya Dulal ◽  
Bishnu D. Paudel ◽  
Prakash C. Neupane ◽  
Bibek Acharya ◽  
Sandhya Chapagain Acharya ◽  
...  
Keyword(s):  
Rural Areas ◽  
Safety Net ◽  
Cross Sectional Study ◽  
Medical Consultation ◽  
Diagnosis And Treatment ◽  
Diagnosis Delay ◽  
Self Medication ◽  
Cross Sectional ◽  
Delay In Diagnosis ◽  
Gi Cancers

e19085 Background: Gastrointestinal (GI) cancers represent a major health challenge worldwide including in Nepal where patients (pts) often present with advanced disease and outcomes are poor. The purpose of this study was to quantify and to determine the causes of delay in diagnosis and treatment of GI cancer pts in Nepal. Methods: An IRB-approved cross sectional study was performed in pts with GI cancers at safety net Bir Hospital, Kathmandu, Nepal. All diagnosed consenting pts, both in- and out-pts, were enrolled. Pts were interviewed with a standardized questionnaire from July 2018 to June 2019. The caregivers were allowed to answer on behalf of illiterate pts. Diagnosis delay was defined as days from first symptoms to pathological diagnosis. Patient delay was defined as days from first symptoms to first medical consultation. Treatment delay was defined as days from diagnosis to surgery and/or treatment by medical/radiation oncologist. Differences in median times to delay were compared with two-tailed t-tests (Prism 8.0) based on the identified potential causes of delays. Results: The median age at diagnosis was 53.5 (22-77) years and 62% were males; 46% were farmers, 29% were housewives, and the rest had various occupations. 73% were outpatient at diagnosis. 46% had gastroesophageal cancer (gastric – 38%; esophagus – 8%) and 54% had colorectal cancer (left sided colon - 23%, right sided colon -13%; rectum 18%). No patients with anal or small bowel cancer were identified. 84% presented with Stage III/ IV disease. 68% were illiterate, 89% had a history of self-medication prior to first medical consultation, 74% were from rural areas with limited healthcare facilities and 79% were unaware of causes of GI cancers. Only self-medication was associated with delays in diagnosis and patient delays (Table). Conclusions: Self-medication rather than seeking help from medical professionals led to significant delays in the diagnosis of GI cancers in Nepal. Reasons for these decisions will be explored in future studies and may be amenable to efforts such as lay navigation. [Table: see text]

A prospective randomized study to assess the efficacy of post-operative nasal medication after endonasal surgery

1995 ◽  
Vol 109 (7) ◽  
pp. 618-621 ◽  
Author(s):  
Paul D. R. Spraggs ◽  
Marcelle Macnamara ◽  
Theo Joseph
Keyword(s):  
Randomized Study ◽  
Correlation Coefficients ◽  
Control Group ◽  
Time Intervals ◽  
Treatment Groups ◽  
Ephedrine Hydrochloride ◽  
Patent Airway ◽  
Significant Difference ◽  
Blood Clots ◽  
Betamethasone Sodium Phosphate

AbstractPost-operative nasal medications are commonly used following routine septal or turbinate surgery but their efficacy in removing blood clots, improving the sensation of a patent airway and promoting healing are unknown. This prospective randomized trial of patients undergoing septal and/or turbinate surgery assessed the efficacy of three commonly used nasal medicines, 0.5 per cent ephedrine hydrochloride nasal drops, betamethasone sodium phosphate (Betnosol®) nose drops and alkaline nasal douches, in producing the sensation of a patent airway in the 14 days following surgery. Ninety-seven patients were randomized into the three treatment groups and a control group who received no nasal medication. Patients assessed their nasal patency by means of a visual analogue scale (VAS) and any complications of treatment were recorded. Statistical analysis of the 76 complete sets of results using the Mann-Whitney U-test showed that there was a significant difference in the distribution of all of the treatments for each of the time intervals (p<0.05). Glass rank biserial correlation coefficients were all small (rg<0.085) but the most significant differences were between ephedrine and the control group at two hours, two, seven and 10 days (0.02, 0.054, 0.057, 0.085 respectively), alkaline nasal douches being most significant at four and 14 days (0.06 and 0.0722 respectively).

The Clinical Application of Circulating Tumor Cells and DNAs as Prognostic and Predictive Biomarkers in Gastrointestinal Cancer

2021 ◽  
Vol 21 ◽  
Author(s):  
Sara Memarpour ◽  
Ghazaleh Khalili-Tanha ◽  
Awa Alizadeh Ghannad ◽  
Masoud Sharifian Razavi ◽  
Mona Joudi ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Tumor Biology ◽  
Predictive Biomarkers ◽  
Invasive Approach ◽  
New Approach ◽  
Non Invasive ◽  
Gi Cancer ◽  
Gi Cancers ◽  
Tumor Dna

: Gastrointestinal (GI) cancer is one of the most common cancers globally. Genetic and epigenetic mechanisms are involved in its pathogenesis. The conventional methods for diagnosis and screening for GI cancers are often invasive and have other limitations. In the era of personalized medicine, a novel non-invasive approach called liquid biopsy has been introduced for the detection and management of GI cancers, which focuses on the analysis of circulating tumor cells (CTCs) and circulating cell-free tumor DNA (ctDNA). Several studies have shown that this new approach allows for an improved understanding of GI tumor biology and will lead to an improvement in clinical management. The aim of the current review is to explore the clinical applications of CTCs and ctDNA in patients with GI cancer.

Risk factors for the delayed diagnosis of extrapulmonary TB

2021 ◽  
Vol 25 (3) ◽  
pp. 191-198
Author(s):  
M. K. Lee ◽  
C. Moon ◽  
M. J. Lee ◽  
Y. G. Kwak ◽  
E. Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Outpatient Clinic ◽  
Diagnostic Testing ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Delay In Diagnosis ◽  
Microbiological Characteristics ◽  
Significant Difference ◽  
Basic Characteristics

BACKGROUND: Extrapulmonary TB (EPTB) is more difficult to diagnose than pulmonary TB. The delayed management of EPTB can lead to complications and increase the socio-economic burden.METHODS: Patients newly diagnosed with EPTB were retrospectively enrolled from 11 general hospitals in South Korea from January 2017 to December 2018. The basic characteristics of patients were described. Univariable and multivariable analyses were performed between early and delayed diagnosis groups to identify risk factors for delayed diagnosis and treatment in EPTB.RESULTS: In total, 594 patients were enrolled. Lymph node TB (28.3%) was the predominant form, followed by abdominal (18.4%) and disseminated TB (14.5%). Concurrent lung involvement was 17.8%. The positivity of diagnostic tests showed no significant difference between the two groups. Acute clinical manifestations in disseminated, pericardial and meningeal TB, and immunosuppression were associated with early diagnosis. Delayed diagnosis was associated with outpatient clinic visits, delayed sample acquisition and diagnostic departments other than infection or pulmonology.CONCLUSION: The delay in diagnosis and treatment of EPTB was not related to differences in microbiological characteristics of Mycobacterium tuberculosis itself; rather, it was due to the indolent clinical manifestations that cause referral to non-TB-specialised departments in the outpatient clinic and delay the suspicion of TB and diagnostic testing.

scholarly journals Prevalence of self-medication in Brazil and associated factors

2016 ◽  
Vol 50 (suppl 2) ◽  
Author(s):  
Paulo Sérgio Dourado Arrais ◽  
Maria Eneida Porto Fernandes ◽  
Tatiane da Silva Dal Pizzol ◽  
Luiz Roberto Ramos ◽  
Sotero Serrate Mengue ◽  
...  
Keyword(s):  
Associated Factors ◽  
Population Based ◽  
Use Of Self ◽  
Self Medication ◽  
Cross Sectional ◽  
Population Based Study ◽  
The North ◽  
Using Data ◽  
Prevalence Ratios ◽  
Use Of Health Services

ABSTRACT OBJECTIVE To analyze the prevalence and associated factors regarding the use of medicines by self-medication in Brazil. METHODS This cross-sectional population-based study was conducted using data from the PNAUM (National Survey on Access, Use and Promotion of Rational Use of Medicines), collected between September 2013 and February 2014 by interviews at the homes of the respondents. All people who reported using any medicines not prescribed by a doctor or dentist were classified as self-medication practitioners. Crude and adjusted prevalence ratios (Poisson regression) and their respective 95% confidence intervals were calculated in order to investigate the factors associated with the use of self-medication by medicines. The independent variables were: sociodemographic characteristics, health conditions and access to and use of health services. In addition, the most commonly consumed medicines by self-medication were individually identified. RESULTS The self-medication prevalence in Brazil was 16.1% (95%CI 15.0–17.5), with it being highest in the Northeast region (23.8%; 95%CI 21.6–26.2). Following the adjusted analysis, self-medication was observed to be associated with females, inhabitants from the North, Northeast and Midwest regions and individuals that have had one, or two or more chronic diseases. Analgesics and muscle relaxants were the therapeutic groups most used for self-medication, with dipyrone being the most consumed medicines. In general, most of the medicines used for self-medication were classified as non-prescriptive (65.5%). CONCLUSIONS Self-medication is common practice in Brazil and mainly involves the use of non-prescription medicines; therefore, the users of such should be made aware of the possible risks.

scholarly journals Experimental Pulpitis Treated By Double-Pinhole Drainage

2019 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Dental Pulp ◽  
Control Group ◽  
Pulp Chamber ◽  
Control Groups ◽  
Time Intervals ◽  
Irrigation Methods ◽  
Significant Difference ◽  
And Control ◽  
Experimental Group ◽  
Labial Surface

Objective: To search for a dental pulp preservative method in experimental pulpitis. Methods: 20 rabbits with experimental pulpitis were selected for this study; Teeth were randomly assigned to 2 groups (experimental and control groups) based on the final irrigation methods. In experimental group (double-pinhole drainage), the two pinholes were drilled in middle 1/3 dental cervix of buccal labial surface of tooth; the pinholes were inserted into infant transfusion needles then the two syringes were contacted with them, one for suck, another for irrigation. In control group, pinhole was sealed. Rabbits were executed in 1, 3, 5, 7 day. The inflammation in pulp chamber was assessed after 1, 3, 5, and 7 days. Results: At the 1, 5 day time intervals, control group reported more inflammation than experimental group (P < .05). There was no significant difference between two groups at the other time intervals (P > .05), and in all groups the inflammation decreased over time. Conclusion: Dental pulp can be preserved by double-pinhole drainage efficiently.

scholarly journals 10% povidone-iodine versus 2% chlorhexidine gluconate for Periurethral cleansing before catheterization among hospitalized patients: A randomized controlled trial

2019 ◽  
Author(s):  
elham vahabi ◽  
somayeh ghafari ◽  
somayeh haghighat
Keyword(s):  
Randomized Controlled Trial ◽  
Povidone Iodine ◽  
Controlled Trial ◽  
Chlorhexidine Gluconate ◽  
Hospitalized Patients ◽  
Time Intervals ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Tract Infections ◽  
Urine Specimens

Abstract Background There are evidences that periurethral cleaning by antiseptics before catheterization decreases the risk of urinary tract infections. The purpose of this study was to Comparing 10% povidone-iodine and chlorhexidine gluconate (CHG) effectiveness in periurethral cleaning before catheterization on bacteriuria and pyuria in hospitalized patients. Methods A randomized controlled trial was used, and subjects were randomly allocated to either the 10% povidone -iodine group or the 2% chlorhexidine gluconate group. Urine specimens for culture and Analyse were collected 3 times for each subject within 5 days. Results Overall, 216 urine samples were collected in 72 subjects .There were no significant difference in results of bacteriuria of two groups immediately, 72 hrs. and 5 days after catheterization (p>0.05). There was no significant difference between two groups regarding positive pyuria immediately after sampling (p>0.05). Although its amount was significantly higher 72 hrs and 5days after catheterization in 10% povidone-iodine group than 2% chlorhexidine gluconate (p<0.05). In order to evaluate average of micro-organism in different time intervals between two groups Mann– Whitney test was used. This test showed that there was no significant difference of number of time intervals (p>0.05). Conclusions The results of this study showed that using 2% chlorhexidine gluconate reduced the amount of bacteriuria in catheterazied patients compared to 10% povidone-iodine. However this difference was not significant. Therefore doing more studies with more number of samples in this field is suggested. Trial registration: Retrospectively registered. IRCT20170712035044N2 Key words: 10% povidone-iodine- 2% chlorhexidine gluconate - Bacteriuria- Periurethral cleansing

The Evaluation of the Awareness, Attitude and Practice of the Elderly Toward Self-Medication: A Cross-Sectional Study

Drug Research ◽  
2018 ◽  
Vol 68 (08) ◽  
pp. 475-480
Author(s):  
Mohammad Heidari ◽  
Mansureh Borujeni ◽  
Mansour Ghafourifard ◽  
Rahim Sheikhi
Keyword(s):  
Rural Areas ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Average Score ◽  
Self Medication ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Age Related ◽  
Significant Difference ◽  
Urban And Rural Areas

Abstract Introduction The prevalence of various diseases in the elderly has increased the use of drugs, which is coupled with age-related physiological changes and places the elderly at risk for multiple side effects. The present study aimed to determine awareness, attitudes and practices of elderly towards self-medication. Materials and Methods The sample included 300 participants over 60 years under any of the health centers in urban and rural areas of Abadeh city, who were selected based on stratified random sampling method. In order to collect data, the questionnaire including demographic information, awareness, attitude and performance of the elderly and the checklist of drug intractable consumption. Results Based on the results, 76% of the elderly reported drug consumption. Regarding lifestyle, the average score of the elderly’s awareness for the elderly who lived with and without families were 78.6±14.2 and 69.2±13.6, respectively. In other words, a significant difference was observed between these two groups. In addition, there was a significant between the elderly’s performance score with and without family members about the self-medication (p=0.001). Conclusion Considering the increase in self-medication among the elderly, adherence to prescription criteria for drug among this age group is recommended. Finally, designing and implementing various educational programs in health education center is necessary for the elderly and their families for the purpose of improving awareness and practice.

Molecular Regulatory Roles of Long Non-coding RNA HOTTIP: An Overview in Gastrointestinal Cancer

2021 ◽  
Vol 21 ◽  
Author(s):  
Ummi Zulaiqha Hamid ◽  
Maw Shin Sim ◽  
Rhanye Mac Guad ◽  
Vetriselvan Subramaniyan ◽  
Mahendran Sekar ◽  
...  
Keyword(s):  
Cancer Progression ◽  
Molecular Mechanisms ◽  
Diagnostic Value ◽  
Migration And Invasion ◽  
Cellular Functions ◽  
Poor Overall Survival ◽  
Gi Cancer ◽  
Non Coding Rna ◽  
Gi Cancers ◽  
Cancer Phenotypes

: Gastrointestinal (GI) cancers presented an alarmingly high number of new cancer cases worldwide and highly characterised with poor prognosis. The poor overall survival is mainly due to late detection and emerging challenges in treatment, particularly chemoresistance. Thus, the identification of novel molecular targets in GI cancer is highly regarded as the main focus. Recently, long non-coding RNAs (lncRNAs) have been discovered as a potential novel molecular target for combating cancer, as it is highly associated with carcinogenesis and has a great impact on cancer progression. Amongst lncRNAs, HOTIIP has demonstrated a prominent oncogenic regulation in cancer progression, particularly in GI cancers, including oesophageal cancer, gastric cancer, hepatocellular carcinoma, pancreatic cancer and colorectal cancer. This review aimed to present a focused update on the regulatory roles of HOTTIP in GI cancer progression and chemoresistance, as well as deciphering the associated molecular mechanisms underlying their impact on cancer phenotypes and chemoresistance and the key molecules involved. It has been reported that it regulates the expression of various genes and proteins in GI cancers that impacts on the cellular functions, including proliferation, adhesion, migration and invasion, apoptosis, chemosensitivity and tumour differentiation. Furthermore, HOTTIP was also discovered to have a higher diagnostic value as compared to existing diagnostic biomarkers. In overall, HOTTIP has presented itself as a novel therapeutic target and potential diagnostic biomarker in the development of GI cancer treatment.

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