Delay in Diagnosis of Pulmonary Tuberculosis is Associated with Increased Risk of Transmission in Pastoralist Setting, Ethiopia

Abstract Background To comprehend the effect of delayed care on risk of tuberculosis (TB) transmission in a TB prevalent but low case detection area, this study examined the association of diagnosis delay with patient infectiousness (cavitation and smear positivity) and determined the threshold delay that optimizes infectiousness. It also assessed transmission drivers in Somali region of Ethiopia, an area with ample pastoralist population. Methods A cross-sectional study was conducted using 434 new pulmonary TB patients, aged ≥15 years, who were recruited prospectively in five major facilities between December 2017 and October 2018. Data were collected on delays in diagnosis, socio-demographics, clinical and epidemiological information using interview, record-review, anthropometry, sputum microscopy and chest radiography techniques. Log-binomial regression models were used to reveal predictors of cavitation and smear positivity at p<0.05 using Stata/SE®14. C-statistics was applied to determine predictive ability and threshold delay that classifies infectiousness. Results Median age of participants was 30 years. Majorities were male (62.9%), nearly half (46.5%) were pastoralist and 2.3% TB/HIV co-infected. Median delay from debut of illness to diagnosis was 49 days (IQR=37). Among all cases, 45.6% [95%CI: 40.9-50.4] had pulmonary cavity and 42.0% [95%CI: 37.3˗46.9] were smear positive. On multivariable analysis, cavitation was higher in patients delayed over a month [P<0.001], ≤35 years [APR (95%CI) =1.3(1.01-1.6)], with 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 higher in patients delayed >49 days [p=0.02], ≤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)]. Delay discriminates cavitation [AUC (95%CI) =0.67(0.62-0.72)] at 43 days optimal cutoff and 74.6% sensitivity. Conclusion This study highlights that delay in diagnosis of pulmonary TB remains high and is associated with increased risk of cavitation and smear positivity in pastoral setting in Ethiopia. In pastoral settings, this may call upon a socio-cultural tailored TB prevention and control strategies.

Download Full-text

Consumption of ultra-processed foods is associated with abdominal obesity in rotating shift workers

10.21203/rs.3.rs-1074710/v1 ◽

2021 ◽

Author(s):

Luiz Antônio Alves de Menezes Júnior ◽

Virgínia Capistrano Fajardo ◽

Jonathas Assis de Oliveira ◽

George Luiz Lins Machado-Coelho ◽

Fausto Aloísio Pedrosa Pimenta ◽

...

Keyword(s):

Abdominal Obesity ◽

Multivariable Analysis ◽

Saturated Fat ◽

Cross Sectional Study ◽

Processed Foods ◽

Cross Sectional ◽

Shift Workers ◽

Logistic Regression Models ◽

Body Adiposity ◽

Increased Risk

Abstract Background and aims: Higher intake of ultra-processed foods might be associated with an increased risk of obesity. Our objective was to evaluate the consumption of ultra-processed foods and their association with nutrient intake and excess body adiposity in shift workers.Design: Cross-sectional study conducted in 2016 with 238 male rotating shift workers. Dietary data is obtained by the 24-hour recall and classified according to processing by the NOVA classification system. Body adiposity indicators assessed were waist circumference and body mass index. Logistic regression models were built and adjusted for sociodemographic, lifestyle, and dietary variables.Results: Ultra-processed foods represented on average 22.3% of the total caloric value of the individuals' food consumption, with a maximum value of 66.9%. Participants with the highest tercile of ultra-processed foods consumed more carbohydrate (57%), protein (35%), total fat (96%), saturated fat (79%), cholesterol (68%), and sodium (44%) intake compared to the first tercile (p < 0.001). The most frequencies of ultra-processed foods consumed were bread (81.0%), followed by cookies (45.9%), sweetened beverages (45.7%), processed meats (46.8%), and margarine (46.8%). In multivariable analysis, the highest consumption of ultra-processed foods had 183% higher odds of abdominal obesity (OR = 2.83, 95%CI 1.29-6.22), compared with the lowest consumption. Conclusion: Ultra-processed foods are important contributors to the energy intake of these workers, and higher consumption of ultra-processed foods was associated with abdominal obesity.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Gender and time delays in diagnosis of pulmonary tuberculosis: a cross-sectional study from China

Epidemiology and Infection ◽

10.1017/s0950268819000049 ◽

2019 ◽

Vol 147 ◽

Author(s):

H. G. Chen ◽

T. W. Wang ◽

Q. X. Cheng

Keyword(s):

Gender Differences ◽

Pulmonary Tuberculosis ◽

Rural Areas ◽

Diagnostic Delay ◽

Cross Sectional Study ◽

Diagnosis Delay ◽

Sectional Study ◽

Short Delay ◽

Cross Sectional ◽

Increased Risk

AbstractGender inequality has severe consequences on public health in terms of delay in diagnosis of pulmonary tuberculosis (PTB). In order to explore gender-related differences in diagnosis delay, a cross-sectional study of 10 686 patients diagnosed with PTB in Yulin from 1 January 2009 to 31 December 2014 was conducted. Diagnosis delay was categorised into ‘short delay’ and ‘long delay’ by four commonly used cut-off points of 14, 30, 60 and 90 days. Logistic regression analysis was used to analyse gender differences in diagnostic delay. Stratified analyses by smear results, age, urban/rural were performed to examine whether the effect persisted across the strata. The median delay was 31 days (interquartile range 13–65). Diagnostic delay in females at cut-off points of 14, 30, 60 and 90 days had odds ratios (OR) of 0.99 (95% CI 0.91–1.09), 1.09 (95% CI 1.01–1.18), 1.15 (95% CI 1.05–1.26) and 1.18 (95% CI 1.06–1.31), respectively, compared with males. Stratified analysis showed that females were associated with increased risk of longer delay among those aged 30–60 years, smear positive and living in the rural areas (P < 0.05). The female-to-male OR increased along with increased delay time. Further inquiry into the underlying reasons for gender differences should be urgently addressed to improve the current situation.

Download Full-text

Factors Associated with Inadequate Intravenous Colistin Dosages: Post Hoc Analysis of a Multicenter, Cross-Sectional Study

Antibiotics ◽

10.3390/antibiotics10121554 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1554

Author(s):

Daniele Roberto Giacobbe ◽

Michele Mirabella ◽

Matteo Rinaldi ◽

Angela Raffaella Losito ◽

Francesca Raffaelli ◽

...

Keyword(s):

Random Effect ◽

Multivariable Analysis ◽

Cross Sectional Study ◽

Primary Objective ◽

Sectional Study ◽

Cross Sectional ◽

Post Hoc Analysis ◽

Factors Associated ◽

Increased Risk ◽

Post Hoc

Colistin is a last-resort agent for the treatment of infections due to Gram-negative bacteria with difficult-to-treat resistance. The primary objective of this post hoc analysis of a cross-sectional study conducted in 22 Italian hospitals was to assess factors associated with inadequate intravenous colistin dosage. Overall, 187 patients receiving intravenous colistin were included in the analyses. Inadequate colistin dosages were administered in 27% of cases (50/187). In multivariable analysis, AKI (dummy variable with KDIGO stage 0 as a reference, odds ratio (OR) 3.98 with 95% confidence interval (CI) 1.48–10.74 for stage 1, OR 4.44 with 95% CI 1.17–16.93 for stage 2, OR 9.41 with 95% CI 1.59–55.70 for stage 3; overall p = 0.001) retained an independent association with inadequate colistin dosage, whereas the presence of a central venous catheter was associated with adequate colistin dosage (OR: 0.34 for inadequate dosage, 95% CI: 0.16–0.72, p = 0.004). These results were confirmed in an additional multivariable model with the center as a random effect. The association between AKI and inadequate dosage may reflect the perception of an increased risk of nephrotoxicity in patients with impaired renal function, which nonetheless should not be accompanied by dosage reductions beyond those recommended and could represent the target of dedicated antimicrobial stewardship efforts.

Download Full-text

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.

Download Full-text

Relationship between Cardiovascular Calcium and Atrial Fibrillation

Journal of Clinical Medicine ◽

10.3390/jcm11020371 ◽

2022 ◽

Vol 11 (2) ◽

pp. 371

Author(s):

Sung Ho Lee ◽

Mi Yeon Lee ◽

Seung Yong Shin ◽

Wang-Soo Lee ◽

Sang-Wook Kim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

Multivariable Analysis ◽

Calcium Score ◽

Cross Sectional Study ◽

Health Examination ◽

Cross Sectional ◽

Increased Risk ◽

History Of ◽

Artery Disease

Coronary artery calcium score (CACS) is associated with increased risk of atrial fibrillation (AF). However, the relationship between the burden of CACS and extra-coronary calcium and the AF is unclear. This cross-sectional study retrospectively analyzed the data of 143,529 participants (74.9% men; mean age, 41.7 ± 8.6 years) who underwent health examination including non-contrast cardiac CT and electrocardiography, from 2010 to 2018 to evaluate the association between cardiac calcium and AF. AF was diagnosed in 679 participants. The prevalence of AF was significantly increased as the CACS increased (p < 0.01). Multivariable analysis adjusted for age, sex, body mass index, hypertension, diabetes, hyperlipidemia, smoking, alcohol, and history of coronary artery disease showed a significant association between a high CACS ≥1000 and AF (OR 2.26, 95% CI 1.07–4.77, p = 0.032). In a subgroup analysis of participants with a CACS ≥100, aortic valve and thoracic aorta calcium were significantly associated with AF (OR 3.49, 95% CI 1.57–7.77, p = 0.002 and OR 2.19, 95% CI 1.14–4.21, p = 0.01, respectively). High CACS was associated with AF, and extra-coronary atherosclerosis was associated with AF in participants with a moderate to very high CACS.

Download Full-text

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

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19085 ◽

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]

Download Full-text

SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study

Thorax ◽

10.1136/thoraxjnl-2020-215414 ◽

2020 ◽

Vol 75 (12) ◽

pp. 1089-1094 ◽

Cited By ~ 22

Author(s):

Adrian Shields ◽

Sian E Faustini ◽

Marisol Perez-Toledo ◽

Sian Jossi ◽

Erin Aldera ◽

...

Keyword(s):

Intensive Care ◽

Healthcare Workers ◽

Venous Blood ◽

Cross Sectional Study ◽

Nasopharyngeal Swab ◽

Sectional Study ◽

University Hospitals ◽

Cross Sectional ◽

General Internal ◽

Increased Risk

ObjectiveTo determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers.DesignA cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020.SettingUniversity Hospitals Birmingham NHS Foundation Trust (UHBFT), UK.Participants545 asymptomatic healthcare workers were recruited while at work. Participants were invited to participate via the UHBFT social media. Exclusion criteria included current symptoms consistent with COVID-19. No potential participants were excluded.InterventionParticipants volunteered a nasopharyngeal swab and a venous blood sample that were tested for SARS-CoV-2 RNA and anti-SARS-CoV-2 spike glycoprotein antibodies, respectively. Results were interpreted in the context of prior illnesses and the hospital departments in which participants worked.Main outcome measureProportion of participants demonstrating infection and positive SARS-CoV-2 serology.ResultsThe point prevalence of SARS-CoV-2 viral carriage was 2.4% (n=13/545). The overall seroprevalence of SARS-CoV-2 antibodies was 24.4% (n=126/516). Participants who reported prior symptomatic illness had higher seroprevalence (37.5% vs 17.1%, χ2=21.1034, p<0.0001) and quantitatively greater antibody responses than those who had remained asymptomatic. Seroprevalence was greatest among those working in housekeeping (34.5%), acute medicine (33.3%) and general internal medicine (30.3%), with lower rates observed in participants working in intensive care (14.8%). BAME (Black, Asian and minority ethnic) ethnicity was associated with a significantly increased risk of seropositivity (OR: 1.92, 95% CI 1.14 to 3.23, p=0.01). Working on the intensive care unit was associated with a significantly lower risk of seropositivity compared with working in other areas of the hospital (OR: 0.28, 95% CI 0.09 to 0.78, p=0.02).Conclusions and relevanceWe identify differences in the occupational risk of exposure to SARS-CoV-2 between hospital departments and confirm asymptomatic seroconversion occurs in healthcare workers. Further investigation of these observations is required to inform future infection control and occupational health practices.

Download Full-text