scholarly journals Delayed referral and treatment of paediatric cancer in Nigeria: Time to stop blaming the victim

2021 ◽  
Vol 48 (2) ◽  
pp. 82-87
Author(s):  
Adedayo O. Joseph ◽  
Adeseye M. Akinsete ◽  
Bolanle Adegboyega ◽  
Opeyemi M. Awofeso ◽  
Azeezat O. Ajose
Keyword(s):  
Delayed Diagnosis ◽  
Care Facility ◽  
Cancer Type ◽  
Delayed Presentation ◽  
Specialist Care ◽  
Time Duration ◽  
Duration Of Symptoms ◽  
Low Middle Income Countries ◽  
National Implementation ◽  
Delayed Referral

Background: Caregiver delay in presentation has been cited as a major contributor to poor prognosis of paediatric cancers in low-middle income countries like Nigeria. This study explored the time duration between onset of symptoms and presentation to healthcare facilities, diagnosis, and referral for specialist care. Methods: Data were compiled from caregivers of newly registered children at a teaching hospital in Nigeria. Sociodemographic and clinical history of the child were taken. Type of cancer, date of diagnosis, centre where the diagnosis was made, treatment start date, and duration of symptoms until treatment were elicited from consenting caregivers and documented. Results: Acute lymphoblastic leukaemia was the most prevalent cancer type among the patients. The mean time from first symptom to presentation was 15 weeks and from presentation at any health care facility to specialist referral and diagnosis was 38 and 39 weeks, respectively. Time from diagnosis to treatment was a mean of 8 weeks (range: 1 to 27 weeks) Conclusion: Delayed presentation has become a commonly cited factor for poor cancer outcomes in Nigeria and may often inaccurately assign blame to the patient/caregivers. The results of this study point to delayed detection, delayed diagnosis and delayed referral for specialist care, as more accurate contributors to late-stage presentation and consequently worse outcomes of paediatric cancers in Nigeria. Strengthening of community and primary level healthcare professionals’ understanding of paediatric cancers, establishment of simple detection algorithms and national implementation of efficient referral protocols will potentially reduce delays in specialist attention and improve outcomes.

scholarly journals Surgical management of bronchopulmonary carcinoids: A single center experience

2017 ◽  
Vol 06 (01) ◽  
pp. 006-010 ◽  
Author(s):  
Ashish Jakhetiya ◽  
Pankaj Kumar Garg ◽  
Rambha Pandey ◽  
Palaniappan Ramanathan ◽  
Sunil Kumar ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Histopathological Examination ◽  
Postoperative Mortality ◽  
North India ◽  
Biological Behavior ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Delayed Presentation ◽  
Duration Of Symptoms ◽  
Tertiary Teaching

Abstract Introduction: Bronchopulmonary carcinoids are uncommon tumors with relatively indolent biological behavior but a distinct malignant potential. Surgery is the mainstay of treatment. Our aim was to study preoperative characteristics, surgical approaches, and outcome in patients with bronchopulmonary carcinoid tumors. Patients and Methods: This retrospective study was done in the Department of Surgical Oncology of a Tertiary Teaching Hospital of North India. The case records of all the patients who underwent surgical treatment for lung neoplasms and were diagnosed to have bronchopulmonary carcinoids were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, postoperative complications, and outcome were retrieved from the case records. Results: Sixteen patients who underwent surgical treatment were found to have bronchopulmonary carcinoids on histopathological examination. The median age of the patients was 34 years (range 18–62 years). There were 11 men and five women. All patients were symptomatic, and the median duration of symptoms was 12 months (range 6–72 months) before presentation. Six patients had received antitubercular treatment before presentation, and one patient had been treated with chemotherapy due to misdiagnosis. Surgical procedures included six pneumonectomies (one with carinoplasty), four bilobectomies, three lobectomies, and three bronchoplastic procedures (two with lobectomy and one with bilobectomy). There was no postoperative mortality; three patients had morbidity in the form of lobar collapse, prolonged pleural collection, and surgical site infection. With a median follow-up time of 11 months (range 2–85 months), all the 16 patients are alive and disease-free. Conclusions: Delayed presentation and misdiagnosis of bronchial carcinoid are major concerns in North India. Adequate surgical resection can be performed without undue morbidity and is associated with good long-term results.

scholarly journals Early Diagnosis of Lung Cancer in the United Arab Emirates: Challenges and Strategic Recommendations

2021 ◽  
Vol 11 (3) ◽  
pp. 671-678
Author(s):  
Humaid O. Al-Shamsi ◽  
Hassan Jaffar ◽  
Bassam Mahboub ◽  
Faraz Khan ◽  
Usama Albastaki ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Diagnosis ◽  
United Arab Emirates ◽  
National Level ◽  
Delayed Diagnosis ◽  
Suspected Case ◽  
Contributing Factors ◽  
Published Evidence ◽  
Cause Of Deaths ◽  
Delayed Referral

In the United Arab Emirates (UAE), lung cancer (LC) was the third leading cause of deaths due to cancer in 2017. Around 80% of the patients in the UAE are diagnosed at a late stage, rendering the treatment less effective in improving survival outcomes. Lack of awareness of disease symptomatology, deficient screening initiatives, misdiagnosis, and delayed referral to the specialist are contributing factors for delayed diagnosis. Effective screening at a primary care setting can be crucial for early diagnosis, referral to specialists, and enhancing patient outcomes. It is important to establish screening and referral guidelines through which each suspected case can be identified and provided timely intervention. Although the international screening and referral pathway framework are comprehensive, several regional barriers need to be addressed before they can be adapted at the national level. A group of LC experts from the UAE deliberated on issues like delayed diagnosis of LC and strategic recommendations for overcoming the challenges. The discussion was based on the review of the published evidence, international and regional guidelines for screening and early diagnosis of LC. Herein, we present a guideline, endorsed by the esteemed panel of experts, for aiding early diagnosis and optimizing the management of LC in the UAE.

scholarly journals The state of cancer in Meru, Kenya: a retrospective study

2019 ◽  
Vol 2 ◽  
pp. 167
Author(s):  
Francis Kobia ◽  
Jesse Gitaka ◽  
Francis Makokha ◽  
Moses Kamita ◽  
Joshua Kibera ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Stomach Cancer ◽  
Control Strategies ◽  
Cancer Control ◽  
Cancer Registries ◽  
The State ◽  
Cancer Type ◽  
African Countries ◽  
Low Middle Income Countries ◽  
Cancer Rates

Background: It is projected that by 2030, 70% of all cancer related deaths will occur in low-middle income countries. However, data on the state of cancer in most African countries is scanty. Cancer estimates for Kenya are based on the Nairobi and Eldoret cancer registries, leaving most parts of the country unrepresented. Lacking national coverage, these data do not accurately reflect Kenya’s cancer burden. The paucity of reliable data impedes formulation of effective cancer control strategies and cancer research prioritization. Here, we report the findings of a retrospective study of the cancer state in Meru County, Kenya. Methods: A retrospective analysis of patient files at Meru hospice was carried out. 2349 cancer cases seen at the Meru hospice between 2003 and 2018 were analyzed. Data abstracted from the records included patient age, gender and cancer type. The abstracted data was analyzed by descriptive statistics. Results: Our results indicate that cancer is almost evenly distributed across genders, with men accounting for 49% and women 51%. Stomach cancer rates are strikingly elevated and equal to those in countries with the highest stomach cancer rates globally – making it the commonest cancer in this region (14%). Among men, the most common cancers affect the prostate (18%), stomach (17%), esophagus (14%), head & neck (12%), liver (8%) and colorectum (5%). Among women, the commonest are cancers of the breast (22%), cervix (20%), stomach (11%), esophagus (8%), head & neck (6%) and liver (5%). Breast cancer occurs at a notably early age, with 20% of those affected aged below 40. Lung cancer rates are notably low in this region (1.3%) relative to world estimates. Conclusion: Cancer distribution in Meru is nearly even between sexes. Our analysis suggests that the Meru region is a stomach cancer hotspot and that it also experiences elevated esophageal cancer levels.

scholarly journals TP10.1.5The reorganisation of Emergency General Surgery services during the COVID-19 pandemic in the UK: Outcomes of delayed presentation, mortality and BAME patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Anthony Chan ◽  
Panos Stathakis ◽  
Paul Goldsmith ◽  
Stella Smith ◽  
Christian Macutkiewicz
Keyword(s):  
General Surgery ◽  
Lower Proportion ◽  
University Teaching ◽  
Perioperative Outcomes ◽  
Delayed Presentation ◽  
Global Public Health ◽  
Emergency General Surgery ◽  
Duration Of Symptoms ◽  
Co Morbidity ◽  
The Uk

Abstract Background The COVID-19 pandemic is a global public health emergency. The reconfiguration of local healthcare systems to accommodate the increase in Critical Care capacity has put strain on ‘non-COVID’ specialities. This study characterises the utilisation of Emergency General Surgery (EGS) services at a busy UK university teaching hospital during the COVID-19 lockdown period to evaluate outcomes and to identify patient groups with worse outcomes. Method This retrospective study compares EGS admissions during the UK’s lockdown period (23rd March-28th May 2020) to the same period in 2019. Patient demographics were recorded together with details of their hospital stay and treatment outcomes. Results A total of 645 patients were included, comprising 223 in the COVID-19 and 422 in the non-COVID-19 periods. There was no difference in age, sex, co-morbidity or socioeconomical status. A lower proportion of Black, Asian and Minority Ethnic (BAME) patients were admitted during the COVID-19 period (20.6% vs 35.4%, p < 0.05). The duration of symptoms prior to presentation were longer, and admission Early Warning Scores and serum inflammatory markers were higher. More patients present with acute kidney injury (9.9% vs 4.7%, p = 0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p = 0.023). Conclusion We show that the UK reorganisation of EGS services has been successful in terms of outcomes and access to services despite a more unwell population. There was a lower proportion of BAME admissions suggesting additional barriers to access to healthcare under pandemic lockdown conditions.

scholarly journals In the transition from fibrinolysis to primary PCI, the HERO trials help refine STEMI ECG interpretation and Q wave analysis potentially alters future management

2018 ◽  
Vol 9 (1_suppl) ◽  
pp. 26-33
Author(s):  
Cheuk-Kit Wong ◽  
Harvey D White
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Symptom Onset ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Time Duration ◽  
Duration Of Symptoms ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Q Wave

Electrocardiogram sub-studies from the Hirulog Early Reperfusion/Occlusion 1 and 2 trials, which tested bivalirudin as an adjunctive anticoagulant to fibrinolysis in ST-elevation myocardial infarction, have contributed to the literature. The concept of using the presence of infarct lead Q waves to determine reperfusion benefit has subsequently been explored in multiple primary percutaneous coronary intervention studies. The angiographic findings before percutaneous coronary intervention combine with the baseline electrocardiogram to accurately diagnose ST-elevation myocardial infarction and evaluate its potential territory. This review discusses the relative merits of the presence of infarct lead Q waves versus time duration from symptom onset using observational data from cohorts of patients from multiple clinical trials. The presence of infarct lead Q waves at presentation has been repeatedly shown to be superior to time duration from symptom onset in determining prognosis, despite that continuous variable (time duration) statistically should be more powerful than dichotomous variable (Q wave). If quantitative or semi-quantitative measurement of Q waves correlates well with irreversible myocardial injury in vivo (a research goal of many cardiac magnetic resonance imaging studies), Q waves measurements by mirroring ST-elevation myocardial infarction evolution better than the current metric of time duration of symptoms will impact future ST-elevation myocardial infarction reperfusion management. Newer methodology will more quickly capture and transmit electrocardiogram information including infarct lead Q waves potentially before first medical contact, and help differentiate new evolving Q waves of the ongoing ST-elevation myocardial infarction from old changes. Q waves as the new metric in ST-elevation myocardial infarction reperfusion should be tested in upcoming trials.

Exploring the determinants of delayed diagnosis of breast cancer in the female population of Punjab (Pakistan)

2021 ◽  
Author(s):  
Samina Farooqi ◽  
Samina Kausar ◽  
Kalsoom Bibi ◽  
Zunaira Aziz ◽  
Tahira Rehmat
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Metastasis ◽  
Delayed Diagnosis ◽  
Care Facility ◽  
Breast Cancer Metastasis ◽  
Diagnosis Delay ◽  
Breast Cancer Patients ◽  
Related Factors ◽  
Female Population

ABSTRACT Objective: To explore the factors contributing to late diagnosis of breast cancer in female population of Punjab, Pakistan. Methodology: Descriptive qualitative study with phenomenological approach was used. The study was carried out in University of Health Sciences, Lahore in collaboration with breast cancer clinics/departments of the Jinnah Hospital, Lahore, Sir Ganga Ram Hospital Lahore and Mayo Hospital Lahore. 15 Females diagnosed more than 4 months after appearance of symptoms of breast cancer were recruited using purposive sampling until saturation of data. Data collected through in depth semi structured face to face interviews was tape-recorded, transcribed and then analysed using thematic analysis framework method. Results: Personal/psychological factors, Sociocultural and Health care system related factors were identified as main themes emerged from data. Lack of knowledge, religious believes, use of Alternative medicine, socioeconomic status cultural myths and poorly facilitated health care facility were the most influential determinants of delay among breast cancer patients. Conclusion: Diagnosis delay is very significant health problem in women with breast cancer linked with multiple determinants. However, educating women for recognition of symptoms and reinforcement to pursue for earlier medical consultation will be helpful in reducing breast cancer diagnosis delay in the country. Key terms: Breast Cancer, Metastasis, Delayed Diagnosis, Prognosis, Advance Stage.

Stillbirth as the primary manifestation of disseminated tuberculosis in a young immunocompetent mother with multiple perforations of the ileum

2021 ◽  
Vol 14 (2) ◽  
pp. e239386
Author(s):  
Deepak Rajput ◽  
Amit Gupta ◽  
Ravi Roshan ◽  
Arvind Kumar
Keyword(s):  
Weight Loss ◽  
Pregnancy Loss ◽  
Clinical Presentation ◽  
Delayed Presentation ◽  
Female Reproductive System ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Mother And Child ◽  
In Pregnancy

Tuberculosis (TB), a significant cause of morbidity and mortality worldwide, is particularly relevant in low/middle-income countries like India, where the disease is endemic. The female reproductive system is very vulnerable to this infection with, the clinical presentation being utterly silent in most patients. Symptoms of TB in pregnancy may initially be attributed to the gravidity itself besides temporary concealment of associated weight loss by the normally occurring weight gain during the pregnancy. Untreated TB may cause pregnancy loss by either placental damage or direct harm to both the mother and child. We report a case of latent disseminated TB in a young immunocompetent female that was revealed in the postpartum state (after full-term stillbirth delivery at home) as 20 ileal perforations secondary to intestinal TB. Due to ongoing sepsis and delayed presentation to the hospital, the patient could not be salvaged despite the best possible efforts.

Pediatric Intussusception and Interventional Radiology in a Developing Country: Experience and Challenges of Ultrasound Saline Reduction Complementary to Primary Surgery

2015 ◽  
Vol 100 (9-10) ◽  
pp. 1301-1307
Author(s):  
Sebastian O. Ekenze ◽  
Kelvin E. Chukwubuike ◽  
Uchechukwu O. Ezomike ◽  
Phillip C. Okere ◽  
Augustine C. Onuh
Keyword(s):  
Operative Treatment ◽  
Average Duration ◽  
Oral Intake ◽  
Right Hemicolectomy ◽  
Delayed Presentation ◽  
Reduction Procedure ◽  
Duration Of Symptoms ◽  
Hydrostatic Reduction ◽  
Primary Surgery ◽  
Nigeria Teaching Hospital

Nonoperative reduction is considered a safe and effective treatment procedure for pediatric intussusception. However, the procedures are yet to be adopted in some developing countries. This study evaluates our experience with ultrasound saline reduction of pediatric intussusception in southeast Nigeria. Retrospective analysis of 58 children managed for intussusception from June 2009 to May 2013 at the University of Nigeria teaching hospital, Enugu. The median age at presentation was 7 months (IQR = 5 to 9 months), and the average duration of symptoms before diagnosis was 3.9 days (range, 1 to 14 days). Thirteen (22.4%) had saline hydrostatic reduction initially (11 succeeded, 2 failed), and a total of 47 cases had operative treatment (including the 2 with failed saline reduction). Operative procedures were right hemicolectomy in 24 cases, manual reduction 18, ileal resection 3, and colonic resection 2. Eighteen (38.3%) cases developed postoperative complications, and there were 2 postoperative deaths from unremitting septicemia. Comparison of the cases that had saline reduction with cases that underwent operative treatment showed a difference in the average time to diagnosis, need for preintervention transfusion, onset of oral intake, and average duration of admission. Challenges in the saline reduction procedure were delayed presentation, insufficient facilities and trained personnel. Ultrasound saline reduction procedure for pediatric intussusception is feasible in our setting. Despite the delay in presentation in most of our cases, this procedure may still be applied initially to patients who do not have clinical or radiologic contraindications.

scholarly journals Sutureless hemorrhoidectomy vs open hemorrhoidectomy: a prospective study in a regional hospital of Western Nepal

2015 ◽  
Vol 3 (2) ◽  
pp. 121-123
Author(s):  
P Ghimire ◽  
NV Gurung ◽  
PK Upadhaya ◽  
S Shrestha ◽  
A Gurung ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Demographic Data ◽  
Operating Time ◽  
Operation Time ◽  
Regional Hospital ◽  
Time Duration ◽  
Duration Of Symptoms ◽  
Sutureless Technique ◽  
Open Hemorrhoidectomy ◽  
Early Return

Background: The aim of this study is to compare sutureless Hemorroidectomy with Conventional Open Hemorrhoidectomy in terms of safety and clinical efficacy.Method: A prospective analytical study of 60 operated patients (a nonrandomized cohort) was carried out by following up from admission to 1 month period after hospital discharge in between July, 2013 to February, 2014 in Western Regional Hospital, Pokhara, Nepal. Demographic data, clinical data, mean operation time, duration of hospital stay, number of parenteral analgesic injections and post-operative complications between the two groups were recorded and analyzed.Result: There were no statistically significant differences between the two groups in terms of age, gender, duration of symptoms, grade of the hemorrhoid(s), or number of hemorrhoids resected. The mean operating time for LigaSure sutureless hemorrhoidectomy was significantly shorter than that for the Open hemorrhoidectomy (P < 0.001). Patients treated with the LigaSure technique had less blood loss, a better pain score (P < 0.001), less parenteral analgesic requirement (P < 0.001), shorter hospital stay (P < 0.001), and early return to work (P < 0.01). Conclusion: Sutureless Technique is safe and effective as compared to Conventional Open Hemorrhoidectomy for grade III and IV hemorrhoids.Nepal Journal of Medical Sciences Vol.3(2) 2014: 121-123

scholarly journals Patient and primary care delays in the diagnostic pathway of gynaecological cancers: a systematic review of influencing factors

2019 ◽  
Vol 69 (679) ◽  
pp. e106-e111 ◽  
Author(s):  
Pauline Williams ◽  
Peter Murchie ◽  
Christine Bond
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
Gynaecological Cancer ◽  
Current Evidence ◽  
Cochrane Library ◽  
Cancer Type ◽  
Patient Demographics ◽  
Diagnostic Pathway

BackgroundGynaecological cancers are the second most common female cancer type, with survival rates in the UK lower than in many comparable countries. A potentially important factor in the UK’s poorer cancer outcomes is diagnostic delay; gynaecological cancers are the cancer type most likely to be affected by less timely diagnosis.AimTo examine current evidence for factors that contribute to patient and primary care delays in the diagnostic pathway of gynaecological cancer.Design and settingA systematic review of the available literature.MethodPRISMA guidelines were followed. MEDLINE and Embase databases and the Cochrane Library were searched using three terms: primary care; gynaecological cancer; and delay. Citation lists of all identified articles were searched. Two authors independently screened the titles, abstracts, and full texts of publications. Data extraction was performed by one author and quality assured by a second reviewer in a 20% sample of selected articles. Synthesis was narrative.ResultsA total of 1253 references was identified, of which 37 met the inclusion criteria. Factors associated with delayed diagnosis were categorised as either patient factors (patient demographics, symptoms or knowledge, and presentation to the GP) or primary care factors (doctor factors: patient demographics, symptoms or knowledge, and referral process); and system factors (such as limited access to investigations).ConclusionDelayed diagnosis in the patient and primary care intervals of the diagnostic journey of gynaecological cancer is complex and multifactorial. This review identifies areas of future research that could lead to interventions to enable prompter diagnosis of gynaecological cancers.

Sign in / Sign up

Export Citation Format

Share Document