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 What is the knowledge of tubercular patients about risk factors contributing to development of their disease

2006 ◽  
Vol 134 (Suppl. 2) ◽  
pp. 122-127 ◽  
Author(s):  
Miroslav Ilic
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Main Risk Factor ◽  
Active Pulmonary Tuberculosis ◽  
Anonymous Questionnaire ◽  
Number Of Patients ◽  
Significant Difference ◽  
Level Of Knowledge ◽  
Basic Characteristics

INTRODUCTION. Present knowledge of population on basic characteristics of tuberculosis is a significant issue of prevention of tuberculosis. OBJECTIVE. The objective of our study was to determine the level of knowledge on risk factors of tuberculosis among tubercular patients. METHOD. A total of 115 new patients with the active pulmonary tuberculosis were interviewed by means of anonymous questionnaire, who has been treated at the Institute of Pulmonary Diseases, Sremska Kamenica during six-month period (October 2003-March 2004). RESULTS. The patients fulfilled the questionnaire; 37.6 % had no or finished only elementary school, and 58.6 % considered genetics the main risk factor of tuberculosis. Every second patient believed that he could not catch tuberculosis if he suffered from diabetes mellitus or any kind of tumor. 8.7 % of patients who suffered from diabetes mellitus had been informed by their physicians that could catch tuberculosis one day. Every third patient did not possess sewage system and nearly 20% lived in moist flats. Around 85% had no regular salaries or these were significantly under the average Serbian income per capita in this period (12820 dinars-CSD). Leading risk factors that can contribute to development of tuberculosis were as follows: irregular nutrition (91.4 %), smoking (74.2 %), alcohol consumption (65.5%) and associated diseases (diabetes mellitus, tumors). Only 15% of them believed that all these risk factors (smoking, alcohol, irregular diet) could participate together in development of tuberculosis, and not as individual factors. Analyzing the patients? knowledge on risk factors of tuberculosis, in relation to their educational level and alcohol and cigarettes consumption, there was no significant difference (p<0.05). Nevertheless, analyzing the quality of life in patients? houses, in relation to salary and bad habits (alcohol, cigarettes) as risk factors of tuberculosis, significant statistical difference was found (p>0.05). CONCLUSION. Intensive and permanent education of population is necessary primarily considering the knowledge on tuberculosis that would be the basis of reducing the number of patients and leading to possible eradication of this disease.

scholarly journals Senile hypopituitarism: Characteristics of its diagnosis and treatment

2013 ◽  
Vol 1 (1) ◽  
pp. 13-17
Author(s):  
Xian-Ling Wang ◽  
Ying-Qian Wang
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Dose Reduction ◽  
Rapid Development ◽  
Hormone Replacement ◽  
Clinical Manifestations ◽  
Clinical Syndrome ◽  
Diagnosis And Treatment ◽  
Delay In Diagnosis ◽  
Adenohypophyseal Hormones

Abstract Hypopituitarism is a clinical syndrome caused by reduced production of adenohypophyseal hormones. The clinical manifestations of senile hypopituitarism are more complicated and a delay in diagnosis and treatment may lead to rapid development of pituitary crisis. Therefore, clinicians should be alerted to senile hypopituitarism. For patients with hyponatremia, hypoglycemia and unexplained coma, an evaluation of pituitary function should be performed. Hormone replacement therapy for patients with confirmed hypopituitarism should be standardized and unauthorized dose reduction or withdrawal is not allowed.

scholarly journals A study of serum thyroid stimulating hormone levels, and its correlation with clinical features and delayed diagnosis of hypothyroidism in central India

2019 ◽  
Vol 7 (1) ◽  
pp. 176
Author(s):  
Dharmendra Jhavar ◽  
Umesh Kumar Chandra ◽  
Shivshankar Badole ◽  
Anurag Rahekar ◽  
Sumit Vishwakarma
Keyword(s):  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Central India ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
P Value ◽  
Overt Hypothyroidism ◽  
Delay In Diagnosis ◽  
High Level ◽  
High Index Of Suspicion

Background: The clinical manifestations of hypothyroidism are variable, depending upon its cause, duration and severity. The spectrum extends from subclinical to overt hypothyroidism to myxedema coma. A high degree of suspicion is thus required in order to appreciate the clinical manifestation of the disorder to reach a diagnosis. Purpose of this study was to correlate serum TSH level with severity of clinical manifestations and evaluate possible cause of delay in the diagnosis.Methods: A cross section observational and descriptive study for the assessment of severity of primary hypothyroidism at presentation and evaluation of the causes of delay in diagnosis in 86 patients was done from December 2012 to November 2013 in the Department of Medicine, MGM Medical College, Indore, MP, India.Results: Illiterate patients had significantly (p value 0.002) higher TSH values at presentation. 34.8% of patients presented as severe hypothyroidism with TSH value >100 mIU/L. Delay of as much as 7 years was noted. Majority of patients had a delay of around 1 to 3 years in diagnosis. Only 4.6% patients were diagnosed without any delay due to high level of suspicion at presentation.Conclusions: Due to non-specific symptomatology of hypothyroidism diagnosis is often delayed. Therefore, high index of suspicion is required at the physician’s level and test of thyroid function is available at subsided cost therefore it should be offered to all such patients.

scholarly journals A Need for Standardization of the Diagnosis and Treatment of Pelvic Inflammatory Disease: Pilot Study in an Outpatient Clinic in Quito, Ecuador

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Francisco Cueva ◽  
Andrés Caicedo ◽  
Paula Hidalgo
Keyword(s):  
Pelvic Inflammatory Disease ◽  
Outpatient Clinic ◽  
Inflammatory Disease ◽  
Medical Records ◽  
Clinical Manifestations ◽  
Disease Diagnosis ◽  
Diagnosis And Treatment ◽  
Transvaginal Sonography ◽  
Microbiological Agents ◽  
Cervical Motion

Background. Pelvic inflammatory disease (PID) diagnosis is often challenging as well as its treatment. This study sought to characterize the diagnostic and therapeutic trend among physicians at the outpatient level, in Quito, Ecuador, where currently no nationwide screening or specific clinical guideline has been implemented on PID or its main microbiological agents. Methods. A retrospective analysis of medical records with pelvic inflammatory disease diagnosis in an outpatient clinic was performed. Electronic medical records from 2013 to 2018 with any pelvic inflammatory disease-related diagnoses were retrieved. Information with regard to age, sexually related risk factors, symptoms and physical exam findings, ancillary tests, method of diagnosis, and antibiotic regimens was extracted. Results. A total of 186 records were included. The most frequent clinical manifestations were vaginal discharge (47%) and pelvic pain (39%). In the physical examination, leucorrhea was the most frequent finding (47%), followed by lower abdominal tenderness (35%) and cervical motion tenderness in 51 patients (27%). A clinical diagnosis was established in 60% of patients, while 37% had a transvaginal sonography-guided diagnosis. Antibiotic treatment was prescribed with standard regimens in 3% of cases, while other regimens were used in 93% of patients. Additionally, an average of 1.9 drugs were prescribed per patient, with a range from 1 to 5, all in different combinations and dosages. Conclusions. No standardized methods of diagnosis or treatment were identifiable. These findings highlight the need for standardization of the diagnosis and treatment of PID attributed to chlamydial and gonococcal infections.

Risk Factors for Clinical Manifestations in Patients with Factor V Leiden and Prothrombin Gene Mutations.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4090-4090
Author(s):  
Maria Teresa De Sancho ◽  
Nickisha Berlus ◽  
Jacob H. Rand
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Gene Mutations ◽  
Factor V Leiden ◽  
Factor V ◽  
Female Hormones ◽  
Significant Difference ◽  
History Of

Abstract Factor V Leiden (FVL) and prothrombin G20210A gene mutations are the most prevalent hereditary thrombophilias (HT). Carriers of these HT are at greater risk for developing thromboembolic events (TEE) and/or pregnancy complications (PC) compared to non-carriers, but not all carriers develop clinical manifestations. We retrospectively analyzed the risk factors (RF) for clinical manifestations of all subjects who tested positive for FVL and/or PG20210A gene mutations in our hematology clinic between January 2000 and July 2006. Symptomatic carriers (cases) and asymptomatic carriers (controls) were compared. Cases were defined as having had a TEE (venous and/or arterial) or a PC (pregnancy loss (PL), preeclampsia, abruption placenta and intrauterine growth restriction). Data analyzed included secondary RF for thrombosis, use of female hormones (FH), family history of thrombosis (FHT), and the presence of other thrombophilias. During the study period, 197 subjects were fully evaluable; 9 were excluded due to insufficient data. The clinical characteristics are shown in Table 1. Of the 85 venous thromboses (VT), 59 (69%) had DVT and/or PE, 10 (12%) had superficial thrombophlebitis, 9 (11%) intra-abdominal thrombosis, 2 (2%) cerebral VT, 2 (2%) had retinal VT and 3 (4%) had &gt; 1 site of VT. Of the 25 arterial thromboses (AT), 11 (44%) were CVA, 7 (28%) had TIA, 6 (24%) had other AT, and 1 (4%) had an MI. Of the 52 cases with PL, 27 (52%) were early recurrent 1st trimester PL, 8 (15%) were 2nd or 3rd trimester PL, 4 (8%) had infertility and 13 (25%) had both PL and infertility. Of the 5 PC, 3 were abruption placenta, 1 preeclampsia and 1 had &gt; 1 PC. The most common RF was the presence of &gt; 1 secondary RF (Table 2). There was no significant difference between cases and controls regarding the use of FH, FHT, and presence of other thrombophilias. Fertility medications were used by 12 (10%) of cases vs. 1 (2%) of controls. Antiphospholipid (aPL) antibody-positivity was the most prevalent concurrent thrombophilic factor and occurred in 18 of cases (12%) vs. 2 (4%) of controls. Cases and controls were similar regarding gender, age, family history of thrombosis, and presence of other thrombophilias. In summary, fertility medications and aPL antibodies appear to be significant risk factors for clinical manifestations in cases. Larger multicenter studies are warranted to identify additional RF in carriers of these HT. Clinical Characteristics Cases (n=145) Controls (n=52) *85 heterozygous, 6 homozygous, **29 heterozygous, 2 homozygous, ***37 heterozygous, 2 homozygous, ****100% heterozygous Mean Age, yr [+/−SD] 44+/−13 42+/−13 Gender, female 115 (79%) 42 (81%) FVL 91 (63%)* 31 (60%)** PG20210A 39 (27%)*** 18 (35%)**** FVL + PG20210A 15 (10%) 3 (6%) VT 85 (59%) --- AT 25 (17%) --- PC and infertility (female carriers, n=115) 57 (50%) --- Risk Factors Cases (n=145) Controls (n=52) p value Includes obesity, postoperative period, pregnancy, puerperium, long airplane flight, smoking, hypertension, hypercholesterolemia, and immobilization; **oral contraceptives, hormone replacement therapy, selective estrogen receptor modulators, progesterone OC, fertility medications Secondary RF* 74 (51%) 15 (29%) 0.265 NS Use of female hormones**, n=115 59 (51%) 21 (50%) 0.478 NS Family history of thrombosis 73 (50%) 34 (65%) 0.252 NS Other thrombophilias 60 (41%) 21 (40%) 0.232 NS

Hereditary Thrombophilic Risk Factors and Venous Thromboembolism in Istanbul, Turkey: The Role in Different Clinical Manifestations of Venous Thromboembolism

2008 ◽  
Vol 14 (2) ◽  
pp. 168-173 ◽  
Author(s):  
Gulfer Okumus ◽  
Esen Kiyan ◽  
Orhan Arseven ◽  
Levent Tabak ◽  
Reyhan Diz-Kucukkaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Clinical Manifestations ◽  
Factor V Leiden ◽  
Protein S ◽  
Prothrombin G20210a ◽  
Factor V ◽  
Vein Thrombosis ◽  
Significant Difference ◽  
Deep Vein

The aim of this study was to investigate the hereditary thrombophilic risk factors in patients with venous thromboembolism (VTE) and whether these risk factors play a different role in patients with isolated pulmonary embolism (PE) as compared with patients with deep vein thrombosis (DVT) and patients with PE + DVT. The protein C (PC), protein S, antithrombin activities, homocysteine levels, and factor V Leiden (FVL) G1691A and prothrombin G20210A mutations were evaluated in 191 patients with VTE and 191 controls. The prevalence of FVL and PC deficiency were higher in patients ( P = .003 and P = .02, respectively). There was no significant difference for the other risk factors. The combination of thrombophilic risk factors was significantly higher in patients with DVT + PE as compared with patients with isolated PE or DVT ( P = .04). In conclusion, the most important hereditary risk factors for VTE in this study were the FVL mutation and PC deficiency.

Malignant melanoma. A clinical and surgical review. Part II: Diagnosis and treatment

1989 ◽  
Vol 79 (9) ◽  
pp. 421-431 ◽  
Author(s):  
ML Zivot ◽  
IO Kanat
Keyword(s):  
Risk Factors ◽  
Malignant Melanoma ◽  
Lower Extremity ◽  
Cause Of Death ◽  
Clinical Features ◽  
Delayed Diagnosis ◽  
Growth Patterns ◽  
Diagnosis And Treatment ◽  
Clinical Staging ◽  
Disease Entity

Malignant melanoma, the leading cause of death from disease of the skin, often is found on the lower extremity. A thorough understanding of the disease entity is essential, because misdiagnosis or delayed diagnosis can be fatal. In Part I of this two-part clinical and surgical review of malignant melanoma, the authors discussed etiology, risk factors, signs, symptoms, clinical features, and growth patterns. Part II places special emphasis on diagnosing malignant melanoma and differentiating it from other lesions of the lower extremity. Clinical staging of the tumor and the corresponding surgical criteria are presented from a podiatric medical standpoint.

scholarly journals Potential Markers of Arterial and/or Venous Thromboses and their Complications in Primary Antiphospholipid Syndrome

2007 ◽  
Vol 26 (4) ◽  
pp. 259-268
Author(s):  
Mirjana Bećarević ◽  
Nada Majkić-Singh
Keyword(s):  
Risk Factors ◽  
Antiphospholipid Syndrome ◽  
Clinical Manifestations ◽  
Primary Antiphospholipid Syndrome ◽  
Number Of Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Recurrent Abortions ◽  
Venous Thromboses

Potential Markers of Arterial and/or Venous Thromboses and their Complications in Primary Antiphospholipid SyndromeAntiphospholipid syndrome is characterized by venous or arterial thromboses and/or recurrent abortions accompanied by antiphospholipid antibodies and it can be primary (PAPS) or secondary (SAPS) to another disease. Arterial thromboses are less common than venous and most frequently they manifest as ischemia or infarction. Venous thromboses are usually multiple and bilateral and the most common complication of venous thromboses are pulmonary emboli. Considering that laboratory diagnosis of PAPS is currently based on persistently positive aCL, aβ2gpl and/or LA tests, and that neither one of those tests can discriminate between PAPS patients with arterial or venous thromboses or their complications, the aim of this study was to investigate the diagnostical significance of the determination of apo(a), oxLDL, anti-oxLDL antibodies, antianxA5 antibodies, hsCRP, C3 and C4 complement components and HPT for discrimination between PAPS patients with diverse clinical manifestations. Considering that elevated oxLDL and anti-oxLDL antibodies concentrations were found in PAPS patients, and also in subgroups of PAPS patients with MI or PE, it can be concluded that those parameters represent additional risk factors which together with other factors may lead to thromboses and their complications in PAPS. Regarding the fact that C3 and C4 concentrations were decreased in PAPS patients and that a positive correlation was found between hsCRP and C3 concentrations, this finding could indicate potential roles of these parameters as markers of atherosclerosis, which represents the leading cause of morbidity and mortality. HPT and apo(a) concentrations are not independent risk factors for MI in PAPS because lower levels were found in those patients in comparison to MI survivors without PAPS. No significant correlation of anti-anxA5 antibodies and the presence of arterial or venous thromboses or their complications was found, but increased concentrations of the IgG isotype of those antibodies could be a marker for recurrent abortions in PAPS, although this finding should be further investigated on a larger number of patients with this clinical finding. Determination of hsCRP in PAPS patients could not be an adequate parameter which would provide discrimination between patients with increased risk for development and/or recurrence of venous and/or arterial thromboses, nor for their complications, because no statistically significant difference in concentrations of this parameter was found among PAPS, IM, PE and SLE patients who were included in this study.

scholarly journals Fungal Keratitis: Recent Advances in Diagnosis and Treatment

2021 ◽  
Author(s):  
Suwarna Suman ◽  
Arushi Kumar ◽  
Indu Saxena ◽  
Manoj Kumar
Keyword(s):  
Fungal Infections ◽  
Delayed Diagnosis ◽  
Fungal Keratitis ◽  
Diagnosis And Treatment ◽  
Bacterial Keratitis ◽  
Common Cause ◽  
Delay In Diagnosis ◽  
Recent Advances ◽  
Ocular Morbidity ◽  
Major Factors

Fungal keratitis or fungal corneal ulcer is potentially blinding infection of cornea, is considered one of the major cause of ocular morbidity, particularly in developing countries. It is a common cause of infectious keratitis, especially in tropical and subtropical countries. Fungal keratitis is notoriously challenging to diagnosis and difficult to treat. Delay in diagnosis may result in irreversible sequelae of corneal fungal infections, which can be preventable. Fungal keratitis often have worse treatment outcomes than bacterial keratitis, Delayed diagnosis and scarcity of effective antifungal agents are the major factors for poor outcome. In the recent years considerable advancement in the diagnosis and treatment has been occurred. In this chapter, we will discuss the recent advances in diagnosis and management of fungal keratitis with a brief discussion on pathogenesis and future therapeutic models.

scholarly journals Analysis of the Phenotypic Variability as Well as Impact of Early Diagnosis and Treatment in Six Affected Families With ALDH7A1 Deficiency

2021 ◽  
Vol 12 ◽  
Author(s):  
Xianru Jiao ◽  
Pan Gong ◽  
Ye Wu ◽  
Yuehua Zhang ◽  
Zhixian Yang
Keyword(s):  
Early Diagnosis ◽  
Mutation Analysis ◽  
Phenotypic Variability ◽  
Delayed Diagnosis ◽  
Diagnosis And Treatment ◽  
Psychomotor Development ◽  
Seizure Type ◽  
Severe Phenotype ◽  
Significant Difference ◽  
The Impact

ObjectiveTo describe the clinical characteristics of 12 patients from six families with pyridoxine-dependent epilepsy (PDE) carrying ALDH7A1 mutations, and analyze the impact of early diagnosis and treatment, as well as possible genotype–phenotype relationship.MethodsClinical and genetics data of 12 patients were collected.ResultsFamily 1–3 presented with symptoms in the neonatal period, while family 4-6 presented during early infancy. In the same family, the age of onset was similar. The focal motor seizure appeared in all patients. The affected identical twins from family 4 were diagnosed with infantile spasms. Mutation analysis identified nine different ALDH7A1 mutations among six families. The neurodevelopment of siblings in family 1 was mild delay and normal separately due to the minor difference of delayed diagnosis time. Siblings in family 2 showed severely delayed and normal development respectively due to the significant difference of a delayed diagnosis for 4 years. In family 5, although the difference of the delayed diagnosis time is up to 7 years, the nearly normal psychomotor development in both patients might be due to infrequent seizures before the delayed diagnosis. A severe phenotype exhibited in family 3, 4, and 6. The survived affected patients presented with severe developmental delay or refractory seizures and their twins or older sisters presented a similar clinical history and died in the early days of life. Mutation analysis showed D511N and IVS11 + 1G &gt; A in family 3, V188A and exon1 deletion in family 4, and Y354C and exon 8–13 deletion in family 6.ConclusionPatients from the same family often have the same phenotype, including onset age and seizure type. Early treatment with pyridoxine and infrequent seizures showed positive relationship with prognosis. The deletion of exon 1 and exon 8–13 might be associated with the severe phenotype.

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