The effect of late diagnosis on survival and risk of vascular complications in Takayasu's arteritis patients

Aim. To assess the effect of late diagnosis on survival and risk of vascular complications in Takayasu's arteritis (TA) patients. Methods. 183 patients with TA who were treated at the Sverdlovsk Regional Clinical Hospital No. 1 during the period from 01.01.1979 to 31.04.2018 were examined. There were 139 women and 44 men included, median age at the time of diagnosis being 35 [24; 44] years in females and 34 [26.5; 42] years in males and a median interval from the first symptoms onset to the diagnosis of 3 [1; 7] and 4 [1.5; 8] years respectively. The diagnosis of TA met the ACR criteria (1990).Results. During the follow-up period, 31 deaths were observed (18 in males and 13 in females). The median age of death for women was 36 [32-44] years, for men - 50 [40-57] years. Cardiovascular complications were recorded in 72 patients (27 men and 45 women). Vascular complications and namely acute cerebrovascular accident observed in 31 (43%) patients, including ischemic stroke in 24 (35%), transient ischemic attack in 3 (3%) and hemorrhagic stroke in 4 (6%) were the most frequent. Arterial thromboses were registered in 32 (44%) cases. In 162 (88.5%) patients, the diagnosis was established more than six months after the appearance of the first symptoms.At the primary physician visit in 71 (39%) patients, the initial diagnosis was erroneous. The most common symptoms they had were regarded as a manifestation of arterial hypertension (in 18% cases). 4 years or more interval from the onset of TA symptoms to diagnosis was associated with a significant cardiovascular events odds increase (OR=1.8; 95% CI: 1.07-3.34) and premature death by the 5th year of follow-up (OR=2.9; 95% CI: 1,27-6,55).Conclusion. In the retrospective TA cohort setting, late diagnosis verification and delayed treatment initiation were associated with an increased risk of premature death and severe vascular complications, described earlier in other samplings. Timely diagnosis and as early as possible appropriate treatment administration can prevent the disease progression and disabling complications occurrence.

To Assess the Knowledge Regarding Glaucoma among General Population

Background: The level of knowledge of glaucoma and their possible determinants in a group of people diagnosed with glaucoma and in a population based group without glaucoma. Studies performed on the prevalence of glaucoma have reported a high proportion of undiagnosed patients. Late diagnosis is related to increased risk of glaucoma associated with visual impairment and disability. Lack of awareness and non-availability of appropriate screening procedures are among the major reasons for non-diagnosis or late diagnosis of glaucoma. The present study has been undertaken to evaluate the level of awareness about glaucoma among the general population. Objective: 1. To assess the knowledge regarding glaucoma among general population. 2. To find an association between the level of knowledge with selected socio demographic variables. Materials and Methods: The study was conducted in selected hospital. Descriptive research approach was used in this study. Hundred people in the general population were selected for the study. Structured knowledge questionnaire was used to collect the data. Results: The show that 1 (1%) had poor level of knowledge, 27(27%) were having an average level of knowledge. Fifty seven percent (57%) had a good level of knowledge, fifth teen present 15 (15%) had very good knowledge. None exhibited excellent level of knowledge. The minimum score was 3 and the maximum score was 12, with the mean score for the test being 7.61 ±1.814 and mean percentage of knowledge was 50.73%.

Primary immunodeficiencies with predominant impairment of antibody synthesis

The urgency of the problem of primary immunodeficiencies (PID) lies in the late diagnosis of this pathology due to the low awareness of doctors of various specialties, the formation of chronic diseases in patients, and high mortality in this group of patients. Currently, the concept of PID includes both traditional concepts - defects leading to the development of quantitative and / or functional insufficiency, and new concepts - uncontrolled activation of the proliferation of immunocompetent cells and the formation of autoimmune, auto-inflammatory and allergic diseases. The article discusses the diagnostic criteria for PID and the main directions in the treatment of this contingent of patients

A case report of metanephric adenofibroma in a toddler

Oncological diseases are one of the most important problems of our time facing both adults and children. In children, benign tumors are more common. There are no specific signs or symptoms in the early stages of oncological diseases, which often leads to late diagnosis. Here we report a case of a rare benign tumor – metanephric adenofibroma of the kidney, found in a toddler. The patient underwent ureteronephrectomy. The diagnosis was confirmed by immunohistochemistry of the kidney tissue. The patient’s parents gave their consent to the use of their child’s data, including photographs, for research purposes and in publications.

Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study

Background In 2007–2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013–2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Still, late HIV diagnosis is a major concern in Mexico due to its association with the development of AIDS development and mortality. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013–2017 National HIV program. Methods Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. Results The study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45 to 43% (P < 0.001) between 2008 and 2012 and 2013–2017 (i.e. before and after the implementation of the 2013–2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013 and 2017 (odds ratio [OR] = 0.96 [95% Confidence interval [CI] [0.93, 0.98]) or in health facilities specialized in HIV care (OR = 0.64 [95% CI 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis. Conclusions The results of this study indicate that the 2013–2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico. We identified several predictors of late diagnosis which could help establishing health policies. The main determinants for late diagnosis were being male, older than 29 years old, and being diagnosed in a Hospital or National Institute.

Steroid osteoporosis within the framework of the Itsenko-Cushing drug syndrome: demonstration of a clinical case

A case of severe systemic osteoporosis complicated by multiple fractures of the ribs and vertebrae in a young patient with late diagnosis of Still's disease as a result of independent long-term uncontrolled use of corticosteroids is presented. Lack of medical supervision, taking a high dose (35 mg / day) of prednisolone without recommendation and control of treatment led to untimely recognition and treatment of the underlying disease and the development of irreversible disabling transformations of the skeleton.