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Introduction: Systemic Lupus Erythematosus (SLE) warrants an early diagnosis and prompt management. Delay in diagnosis can result in repeated flares, permanent damage, and even death. There is a large variability in the time taken to diagnose SLE across the world. We undertook this study to determine the time taken for diagnosis of SLE in India and to identify the factors associated. Methods: Patients with SLE diagnosed within the previous 1 year as per Systemic Lupus Erythematosus International Collaborating Clinics criteria (SLICC) 2012 criteria were included in a cross-sectional multicentre questionnaire-based survey. Demographic profile, self-reported socioeconomic status as per Kuppuswamy classification of socioeconomic status (version 2022) (SES), and several healthcare related parameters including referral pattern were recorded. Median time taken for diagnosis was used to demarcate early or late diagnosis and associated factors were explored. Results: We included 488 patients with SLE from 10 rheumatology centres. The median time to diagnosis was 6 months Interquartile Range (IQR 3,14.7) and within 3 months in about one third [150(30.7%)]. Very early diagnosis (< 1 month) was established in 78(16.0%) patients. The mean SLE Disease Activity Index (SLEDAI) at diagnosis was 10.28 + 7.24. In univariate analysis, an older age, lower SES, non-southern state of residence and larger family size were significantly associated with late diagnosis. In the multivariate analysis, higher SES (AOR 0.95, 95% CI: 0.92-0.98), multiple organ system involvement at initial presentation (AOR1.75 95%CI: 1.08–2.84) and place of residence in south Indian states (AOR1.92 95%CI: 1.24–2.97) had lesser odds of being associated with late diagnosis. Distance from the closest medical centre/professional did not influence the time to diagnosis. Majority of patients had first consulted a medical graduate (42.5%) or postgraduate doctor (48.2%), and referral to rheumatologist was largely done by postgraduate (65%) doctors. More than half of our patients (61%) self-finance their treatment. Conclusion: Median time to diagnosis of SLE was 6 months, 1/3rd being diagnosed within 3 months and 78(16.0%) with 1 month of symptom onset. Delay in diagnosis was noted in those belonging to lower socioeconomic strata and those with single organ disease. Distance to the health care facility did not influence time to diagnosis. [ABSTRACT FROM AUTHOR]

Vestibular schwannoma (VS) is a benign peripheral nerve sheath tumor involving the vestibulocochlear nerve. Affected patients typically experience a gradual emergence of episodic imbalance and unilateral hearing loss, tinnitus, and headache. Less often, VS may be associated with facial pain; ocular, otic, and taste disturbance; paresthesia of the tongue and face; and temporomandibular disorder-like presentations. There is limited information in the dental literature relating the myriad of oral and maxillofacial manifestations of VS. The objective of this article is to underscore the importance for dental clinicians to seek clinicopathologic correlations with VS-related symptomatology, potentially resulting in a timelier diagnosis and improved patient outcomes. To convey this clinical challenge, a detailed narrative of a 45-year-old patient with an 11-year delay in diagnosis has been reported. In addition, the typical radiographic appearance of an implanted cranial device placed following VS resection has been provided. [ABSTRACT FROM AUTHOR]

Background. Acute leukemia (AL) is the most common childhood cancer with an incidence rate of about 55–62 cases per 1 million children under 18 years of age. Acute leukemia is difficult to diagnose due to nonspecific symptoms, which are often hidden under the “masks” of other diseases. This problem is especially relevant for regions with a population of up to 100,000 people, where AL in children is diagnosed once every 2–5 years causing too low cancer alertness among pediatricians. Aim: to assess the delay in diagnosis depending on the areas of residence in the Tver region and area remoteness from the Tver Regional Clinical Children’s Hospital (RCC H). Material and Methods. The analysis included 35 patients hospitalized in the Department of Oncology and Hematology of the RCC H for the period from 2018 to 2023. The diagnoses were: ALL, C91.0 – 30 (86 %), AML , C92 – 3 (9 %), and AL of unspecified cell type (ALUCL ), C95.0 – 2 (5 %) patients. The mean age was 61 months. Thrombocytopenia and anemia at the time of diagnosis were found in 76 % and 78 %, respectively. Leukocytosis >20×109/L was observed in 58 %, leukopenia 8 weeks – in 3 (9 %) cases. Delayed diagnosis among patients living in the city of Tver and Tver region was observed 8 weeks – in 2 (12 %) vs 2 (10 %) cases, respectively (p=0.37). There was no significant impact of the distance of the residence place from the level 3 children’s hospital providing specialized care (RCC H) on the time of diagnosis. With the removal of 8 weeks was observed in 36, 36, 21 and 7 %, respectively. With the removal of ≥50–≤100 km, the diagnosis was made in the period of 2–4 weeks in 100 % of cases. With the removal of >100 km the diagnosis delay 8 weeks was observed in 30, 30, 20 and 20 %, respectively (p=0.78). Conclusion. The distance from the third-level hospital did not affect the period of diagnosis of AL in children, which is achieved by holding daily on-line conferences with country hospitals and out-patient departments followed by the rapid hospitalization of children with suspected oncohematological disorders in the specialized department.

Abstract Background Imported malaria continues to be reported in Sri Lanka after it was eliminated in 2012, and a few progress to life-threatening severe malaria. Methods Data on imported malaria cases reported in Sri Lanka from 2013 to 2023 were extracted from the national malaria database maintained by the Anti Malaria Campaign (AMC) of Sri Lanka. Case data of severe malaria as defined by the World Health Organization were analysed with regard to patients’ general characteristics and their health-seeking behaviour, and the latter compared with that of uncomplicated malaria patients. Details of the last three cases of severe malaria in 2023 are presented. Results 532 imported malaria cases were diagnosed over 11 years (2013–2023); 46 (8.6%) were severe malaria, of which 45 were Plasmodium falciparum and one Plasmodium vivax. Most severe malaria infections were acquired in Africa. All but one were males, and a majority (87%) were 26–60 years of age. They were mainly Sri Lankan nationals (82.6%). Just over half (56.5%) were treated at government hospitals. The average time between arrival of the person in Sri Lanka and onset of illness was 4 days. 29 cases of severe malaria were compared with 165 uncomplicated malaria cases reported from 2015 to 2023. On average both severe and uncomplicated malaria patients consulted a physician equally early (mean = 1 day) with 93.3% of severe malaria doing so within 3 days. However, the time from the point of consulting a physician to diagnosis of malaria was significantly longer (median 4 days) in severe malaria patients compared to uncomplicated patients (median 1 day) (p = 0.012) as was the time from onset of illness to diagnosis (p = 0.042). All severe patients recovered without sequelae except for one who died. Conclusions The risk of severe malaria among imported cases increases significantly beyond 5 days from the onset of symptoms. Although patients consult a physician early, malaria diagnosis tends to be delayed by physicians because it is now a rare disease. Good access to expert clinical care has maintained case fatality rates of severe malaria at par with those reported elsewhere.

Abstract Background Many patients with head and neck cancer (HNC) often present with advanced disease. This may result from delay in deciding to seek care, delay in reaching the healthcare facility and or delay in accessing care in the healthcare facility. We therefore set out to determine the time to definitive diagnosis and factors associated with delayed diagnosis among patients with HNC at the Uganda Cancer Institute (UCI). Methods A cross-sectional study was conducted at UCI, patients with HNC were recruited. An interviewer administered questionnaire was used to collect data on sociodemographic factors and clinical characteristics, including timelines in months, from symptom onset to deciding to seek care, to reaching the health care facility and to definitive diagnosis. Multivariate Poisson regression analysis was used to calculate odds ratios (ORs) for the factors of association with delayed diagnosis. Results We recruited 160 HNC patients, and 134 patients were analyzed. The median age was 49.5 years (IQR 26.5), 70% (94 of 134) were male, 48% (69 of 134) had below secondary school education, 49% (65 of 134) had a household income 136 USD (aOR: 0.27, p = 0.043) were associated with lower odds of delayed diagnosis. Being the sole bread winner (aOR: 2.15, p = 0.050) increased the odds of delayed diagnosis. Conclusion Most of HNC patients (65%) at UCI had delayed diagnosis. A national care pathway for individuals with suspected HNC should be established and consider rotation of Ear, Nose and Throat surgeons to underserved regions, to mitigate diagnostic delay.

Objective: Delay in the diagnosis of tuberculosis (TB) is a significant problem at both individual and community levels. Delayed diagnosis of TB contributes to more severe disease manifestations, higher risk of death, and higher disease transmission in the community. We conducted this study to assess the extent and associated reasons for delay in diagnosis of pulmonary TB. Methods: This study was conducted in the Department of TB and Respiratory Diseases, J. N. Medical College, Aligarh, from June 2020 to May 2022. A total of 2053 new pulmonary TB patients, who first consulted any private healthcare provider (HCP) for treatment, were enrolled in the study. The required information was collected by interview technique using a predesigned questionnaire. Results: A total of 2053 patients were enrolled in the study. There was a significant delay of more than 2 weeks in the diagnosis of pulmonary TB after the onset of symptoms in 94% of patients. The extent of delay ranged from 8 days to 240 days with a mean of 36.33 days. The delay in visiting the HCPs by the patient was not significant. Only 5.85% of patients had a significant delay of more than 2 weeks in seeking any health care after the appearance of symptoms. A delay by HCP contributed to a greater portion of the total delay, with a mean of 31.77 days. The main reason for the delay by HCPs was not investigating TB. The hospital delay was not significant. The mean hospital delay was 5.82 days. Conclusion: The delay in the diagnosis of TB in India is very high. A delay by HCPs contributes to a greater portion of the total delay. Information, Education and Communication (IEC) activities will play an important role in reducing the delay. All HCPs should be actively involved in subjecting the suspects to TB diagnosis at the earliest possible as per National Tuberculosis Elimination Programme (NTEP) guidelines.

Introduction: Lipodystrophy syndromes are rare diseases that can present with a broad range of symptoms. Delays in diagnosis are common, which in turn, may predispose to the development of severe metabolic complications and endorgan damage. Many patients with lipodystrophy syndromes are only diagnosed after significant metabolic abnormalities arise. Prompt action by clinical teams may improve disease outcomes in lipodystrophy syndromes. The aim of the Rapid Action Plan is to serve as a set of recommendations from experts that can support clinicians with limited experience in lipodystrophy syndromes. Methods: The Rapid Action Plan was developed using insights gathered through a series of advisory meetings with clinical experts in lipodystrophy syndromes. A skeleton template was used to facilitate interviews. A consensus document was developed, reviewed, and approved by all experts. Results: Lipodystrophy is a clinical diagnosis. The Rapid Action Plan discusses tools that can help diagnose lipodystrophy syndromes. The roles of clinical and family history, physical exam, patient and family member photos, routine blood tests, leptin levels, skinfold measurements, imaging studies, and genetic testing are explored. Additional topics such as communicating the diagnosis to the patients/ families and patient referrals are covered. A set of recommendations regarding screening and monitoring for metabolic diseases and end-organ abnormalities is presented. Finally, the treatment of lipodystrophy syndromes is reviewed. Discussion: The Rapid Action Plan may assist clinical teams with the prompt diagnosis and holistic work-up and management of patients with lipodystrophy syndromes, which may improve outcomes for patients with this rare disease. [ABSTRACT FROM AUTHOR]

Background: Imported malaria continues to be reported in Sri Lanka after it was eliminated in 2012, and a few progress to life-threatening severe malaria. Methods: Data on imported malaria cases reported in Sri Lanka from 2013 to 2023 were extracted from the national malaria database maintained by the Anti Malaria Campaign (AMC) of Sri Lanka. Case data of severe malaria as defined by the World Health Organization were analysed with regard to patients' general characteristics and their health-seeking behaviour, and the latter compared with that of uncomplicated malaria patients. Details of the last three cases of severe malaria in 2023 are presented. Results: 532 imported malaria cases were diagnosed over 11 years (2013–2023); 46 (8.6%) were severe malaria, of which 45 were Plasmodium falciparum and one Plasmodium vivax. Most severe malaria infections were acquired in Africa. All but one were males, and a majority (87%) were 26–60 years of age. They were mainly Sri Lankan nationals (82.6%). Just over half (56.5%) were treated at government hospitals. The average time between arrival of the person in Sri Lanka and onset of illness was 4 days. 29 cases of severe malaria were compared with 165 uncomplicated malaria cases reported from 2015 to 2023. On average both severe and uncomplicated malaria patients consulted a physician equally early (mean = 1 day) with 93.3% of severe malaria doing so within 3 days. However, the time from the point of consulting a physician to diagnosis of malaria was significantly longer (median 4 days) in severe malaria patients compared to uncomplicated patients (median 1 day) (p = 0.012) as was the time from onset of illness to diagnosis (p = 0.042). All severe patients recovered without sequelae except for one who died. Conclusions: The risk of severe malaria among imported cases increases significantly beyond 5 days from the onset of symptoms. Although patients consult a physician early, malaria diagnosis tends to be delayed by physicians because it is now a rare disease. Good access to expert clinical care has maintained case fatality rates of severe malaria at par with those reported elsewhere. [ABSTRACT FROM AUTHOR]

Background: Many patients with head and neck cancer (HNC) often present with advanced disease. This may result from delay in deciding to seek care, delay in reaching the healthcare facility and or delay in accessing care in the healthcare facility. We therefore set out to determine the time to definitive diagnosis and factors associated with delayed diagnosis among patients with HNC at the Uganda Cancer Institute (UCI). Methods: A cross-sectional study was conducted at UCI, patients with HNC were recruited. An interviewer administered questionnaire was used to collect data on sociodemographic factors and clinical characteristics, including timelines in months, from symptom onset to deciding to seek care, to reaching the health care facility and to definitive diagnosis. Multivariate Poisson regression analysis was used to calculate odds ratios (ORs) for the factors of association with delayed diagnosis. Results: We recruited 160 HNC patients, and 134 patients were analyzed. The median age was 49.5 years (IQR 26.5), 70% (94 of 134) were male, 48% (69 of 134) had below secondary school education, 49% (65 of 134) had a household income < 54 USD. 56% (76 of 134) were sole bread winners, 67% (89 of 134) had good access road condition to the nearest health unit and 70% (91 of 134) presented with tumor stage 4. Median time from onset of symptoms to definitive diagnosis was 8.1 months (IQR 15.1) and 65% (87 of 134) of patients had delayed diagnosis. Good access roads (aOR: 0.26, p = 0.006), secondary school education (aOR: 0.17, p = 0.038), and household income > 136 USD (aOR: 0.27, p = 0.043) were associated with lower odds of delayed diagnosis. Being the sole bread winner (aOR: 2.15, p = 0.050) increased the odds of delayed diagnosis. Conclusion: Most of HNC patients (65%) at UCI had delayed diagnosis. A national care pathway for individuals with suspected HNC should be established and consider rotation of Ear, Nose and Throat surgeons to underserved regions, to mitigate diagnostic delay. [ABSTRACT FROM AUTHOR]

Introduction: different variables have been associated with a worse prognosis of patients with osteosarcoma (OS), highlighting tumor size, location in the axial skeleton and the presence of metastases. The objective of this study is to analyze the prognostic impact of diagnostic delay in osteosarcoma in adults in the Mexican population in a center specialized in sarcomas. Material and methods: retrospective cohort study from January 1, 2005, to December 31, 2016, 96 patients over 21 years of age with a diagnosis of osteosarcoma were analyzed. Results: the median time to diagnosis from the onset of symptoms was six months (range: 2-36). This variable was dichotomized by applying the operator-dependent curve (ROC) analysis and we determined a cut-off value greater than five months, with an area under the curve (AUC) = 0.93 [95% CI 0.86-0.97], sensitivity 93.2% and specificity 94.6%. Conclusion: time until diagnosis is a critical factor in the survival of adult patients with osteosarcoma, highlighting its influence on disease progression and the appearance of metastasis. The correlation between diagnostic delay and an unfavorable prognosis reinforces the need for rapid and efficient evaluation in suspected cases of osteosarcoma. [ABSTRACT FROM AUTHOR]

Objective: Delay in the diagnosis of tuberculosis (TB) is a significant problem at both individual and community levels. Delayed diagnosis of TB contributes to more severe disease manifestations, higher risk of death, and higher disease transmission in the community. We conducted this study to assess the extent and associated reasons for delay in diagnosis of pulmonary TB. Methods: This study was conducted in the Department of TB and Respiratory Diseases, J. N. Medical College, Aligarh, from June 2020 to May 2022. A total of 2053 new pulmonary TB patients, who first consulted any private healthcare provider (HCP) for treatment, were enrolled in the study. The required information was collected by interview technique using a predesigned questionnaire. Results: A total of 2053 patients were enrolled in the study. There was a significant delay of more than 2 weeks in the diagnosis of pulmonary TB after the onset of symptoms in 94% of patients. The extent of delay ranged from 8 days to 240 days with a mean of 36.33 days. The delay in visiting the HCPs by the patient was not significant. Only 5.85% of patients had a significant delay of more than 2 weeks in seeking any health care after the appearance of symptoms. A delay by HCP contributed to a greater portion of the total delay, with a mean of 31.77 days. The main reason for the delay by HCPs was not investigating TB. The hospital delay was not significant. The mean hospital delay was 5.82 days. Conclusion: The delay in the diagnosis of TB in India is very high. A delay by HCPs contributes to a greater portion of the total delay. Information, Education and Communication (IEC) activities will play an important role in reducing the delay. All HCPs should be actively involved in subjecting the suspects to TB diagnosis at the earliest possible as per National Tuberculosis Elimination Programme (NTEP) guidelines. [ABSTRACT FROM AUTHOR]

Purpose: Shorter time from symptoms recognition to diagnosis and timely treatment would be expected to improve the survival of patients with breast cancer (BC). This review identifies and summarizes evidence on time to diagnosis and treatment, and associated factors to inform an improved BC care pathways in Low- and Middle-Income Countries (LMICs). Methods: A systematic search was conducted in electronic databases including Medline, Embase, PsycINFO and Global Health, covering publications between January 1, 2010, and November 6, 2023. Inclusion criteria encompassed studies published in English from LMICs that reported on time from symptoms recognition to diagnosis and/or from diagnosis to treatment, as well as factors influencing these timelines. Study quality was assessed independently by two reviewers using a standard checklist. Pre-contact, post-contact and treatment intervals and delays in these intervals are presented. Barriers and facilitators for shorter time to diagnosis and treatment found by individual studies after adjusting with covariates are summarized. Results: The review identified 21 studies across 14 countries and found that BC cases took a longer time to diagnosis than to treatment. However, time to treatment also exceeded the World Health Organization (WHO) recommended period for optimal survival. There was inconsistency in terminology and benchmarks for defining delays in time intervals. Low socioeconomic status and place of residence emerged as frequent barriers, while initial contact with a private health facility or specialist was commonly reported as a facilitator for shorter time to diagnosis and treatment. Conclusions: Guidelines or consensus recommendations are essential for defining the optimal time intervals to BC diagnosis and treatment. Our review supported WHO's Global Breast Cancer Initiative recommendations. Increasing public awareness, strengthening of healthcare professional's capacities, partial decentralization of diagnostic services and implementation of effective referral mechanisms are recommended to achieve a shorter time to diagnosis and treatment of BC in LMICs.

IntroductionLipodystrophy syndromes are rare diseases that can present with a broad range of symptoms. Delays in diagnosis are common, which in turn, may predispose to the development of severe metabolic complications and end-organ damage. Many patients with lipodystrophy syndromes are only diagnosed after significant metabolic abnormalities arise. Prompt action by clinical teams may improve disease outcomes in lipodystrophy syndromes. The aim of the Rapid Action Plan is to serve as a set of recommendations from experts that can support clinicians with limited experience in lipodystrophy syndromes.MethodsThe Rapid Action Plan was developed using insights gathered through a series of advisory meetings with clinical experts in lipodystrophy syndromes. A skeleton template was used to facilitate interviews. A consensus document was developed, reviewed, and approved by all experts.ResultsLipodystrophy is a clinical diagnosis. The Rapid Action Plan discusses tools that can help diagnose lipodystrophy syndromes. The roles of clinical and family history, physical exam, patient and family member photos, routine blood tests, leptin levels, skinfold measurements, imaging studies, and genetic testing are explored. Additional topics such as communicating the diagnosis to the patients/families and patient referrals are covered. A set of recommendations regarding screening and monitoring for metabolic diseases and end-organ abnormalities is presented. Finally, the treatment of lipodystrophy syndromes is reviewed.DiscussionThe Rapid Action Plan may assist clinical teams with the prompt diagnosis and holistic work-up and management of patients with lipodystrophy syndromes, which may improve outcomes for patients with this rare disease.

Background. Early initiation of Rheumatoid Arthritis (RA) treatment leads to better outcomes and low disease activity. In spite of these, there is a significant delay between symptom onset and the initiation of therapy. Objective. This study aimed to investigate this diagnostic delay and to analyze its associated factors and outcomes. Patients and method. This cross sectional study included 167 RA patients fulfilling the 2010 American College of Rheumatology/ European League against Rheumatism (ACR/EULAR) classification criteria. All patients were subjected to full clinical, laboratory and radiological assessment and treatment received, also; Disease Activity Score (DAS-28) &functional disability evaluation using Modified Health Assessment Questionnaire (MHAQ) MHAQ were reported. Diagnostic delay was assessed regarding duration, associated factors and outcomes. Furthermore, RA patients were divided into early and late diagnosis group with cutoff of one year and were compared regarding different disease parameters. Results. The median (IQR) lag in diagnosis of RA patients was 12 months (4 24), MHAQ score was significantly positively correlated with delay in diagnosis (P=0.02). Early diagnosis group patients were statistically significantly urban resident (P= 0.01), employed (P= 0.02), with higher educational level (P=0.02), lower functional index MHAQ (P= 0.02), and were significantly visiting Rheumatology specialty early in the disease compared to late diagnosis group (P=

Abstract Background Delay in the diagnosis of childhood cancer is one of the major health problem that contribute to decreased survival rates of children particularly in developing nations. Despite advances in the field of pediatric oncology, cancer remains a leading cause of death in children. Diagnosis of childhood cancer as early as possible is crucial to reduce mortality. Therefore, the aim of this study was to assess delay in diagnosis and associated factors among children with cancer admitted to pediatric oncology ward, University of Gondar comprehensive specialized hospital, Ethiopia 2022. Method Institutional-based retrospective cross-sectional study design was conducted from January1, 2019 to December 31, 2021 at University of Gondar comprehensive specialized hospital. All 200 children were included in the study and Data were extracted through structured check-list. The data were entered using EPI DATA version 4.6 and exported to STATA version 14.0 for data analysis. Results From the total of two hundred pediatric patients 44% had delayed diagnosis and the median delay diagnosis was 68 days. Rural residence (AOR = 1.96; 95%CI = 1.08–3.58), absence of health insurance (AOR = 2.21; 95%CI = 1.21–4.04), Hodgkin lymphoma (AOR = 9.36; 95%CI = 2.1-41.72), Retinoblastoma (AOR = 4.09; 95%CI = 1.29–13.02), no referral (AOR = 6.3; 95%CI = 2.15–18.55) and absence of comorbid disease (AOR = 2.14; 95%CI = 1.17–3.94) were significant factors associated with delay in diagnosis. Conclusion and recommendation Delayed in diagnosis of childhood cancer was relatively lower than previous studies and most influenced by the child’s residency, health insurance, type of cancer and comorbid disease. Thus; every effort should be made to promote public and parental understanding of childhood cancer, promote health insurance and referral.

Background: Hidradenitis suppurativa (HS) is rare in Africans and so not commonly documented in this population. Aim: We aimed to document the hospital prevalence, sociodemographic factors, delay in diagnosis, and factors associated with a delay in diagnosis. Materials and Methods: This multicentre retrospective study of 64 HS patients was conducted across seven outpatient dermatology clinics in Nigeria. Data spanning 2017 and 2022 were retrieved following ethical approval. Extracted information included age at onset, age at diagnosis, delay in diagnosis, gender, family history of HS, body mass index, smoking history, socioeconomic status, and Hurley stage. Data were analysed using IBM Statistics version 26. For all statistical tests, P < 0.05 was considered statistically significant. Results: Thirteen thousand six-hundred and two new patients composed of 5850 males and 7752 females attended the clinics and 64 of them had HS giving a hospital prevalence of 0.47% (64/13,602). Most of the HS (70.3%) were female. The median (interquartile range) age of the patients was 30 (24, 36) years and the age range was 12–59 years. Age at diagnosis was 20–39 years in 76.6%. There was a delay in diagnosis in 45.3%, a significant relationship between delay in diagnosis with duration and severity of HS with P < 0.001 and P < 0.005, respectively. Conclusion: HS is uncommon in Nigeria. Diagnosis is frequently delayed and patients present with a severe form of the disease. Furthermore, HS is rare among individuals with a low socioeconomic status. There is a need for more awareness and prompt referral of this debilitating disease at the primary health-care level.

Introduction: The incidence of cancer is increasing throughout the world. However, early detection of cancers is associated with a favourable outcome. Stomach cancer is one of the most common cancers of gastrointestinal tract. Majority patients visit physicians in developed stages. Objective: To evaluate the reporting pattern of stomach cancer patients living in Kashmir valley in order to determine the median time of delay from the beginning of symptoms to diagnosis. Method: Total 116 proven stomach cancer patients were evaluated for the pattern of presentation at endoscopy laboratory of Super Speciality Hospital, Shireen Bagh Kashmir from April 2019 to September 2020.Results: In this study, the mean age (SD) of participants was 60.22 ± (11.90) years. Majority of the participants (69.8%) were males. Cases were predominantly from the rural area (58%).Only 15.5 % of the cases were diagnosed within one month of their symptoms while as 3.4% of the cases had a total delay of more than 12 months. The study found a considerable total delay in the diagnosis of stomach cancer. The mean of the patient delay was 45.6 days. The median total delay was 20 weeks. Conclusion: Since stomach cancer has high mortality and morbidity rates associated, creating awareness among the population and training of physicians regarding timely referral of patients seems important.

In Slovenia, cancer care services were exempt from government decrees for COVID-19 containment. Nevertheless, cancer control can be impacted also by access to other health services and changes in health-seeking behaviour. In this follow up study, we explored changes in cancer burden and cancer care beyond the first months after the onset of the COVID-19 epidemic.

Background: In multisystem inflammatory syndrome in children (MIS-C), diagnostic delay could be associated with severity. This study aims to measure the time to diagnosis in MIS-C, assess its impact on the occurrence of cardiogenic shock, and specify its determinants. Methods: A single-center prospective cohort observational study was conducted between May 2020 and July 2022 at a tertiary care hospital. Children meeting the World Health Organization MIS-C criteria were included. A long time to diagnosis was defined as six days or more. Data on time to diagnosis were collected by two independent physicians. The primary outcome was the occurrence of cardiogenic shock. Logistic regression and receiver operating characteristic curve analysis were used for outcomes, and a Cox proportional hazards model was used for determinants. Results: Totally 60 children were assessed for inclusion, and 31 were finally analyzed [52% males, median age 8.8 (5.7–10.7) years]. The median time to diagnosis was 5.3 (4.2–6.2) days. In univariable analysis, age above the median, time to diagnosis, high C-reactive protein, and high N-terminal pro-B-type natriuretic peptide (NT-proBNP) were associated with cardiogenic shock [odds ratio (OR) 6.13 (1.02–36.9), 2.79 (1.15–6.74), 2.08 (1.05–4.12), and 1.70 (1.04–2.78), respectively]. In multivariable analysis, time to diagnosis ≥ 6 days was associated with cardiogenic shock [adjusted OR (aOR) 21.2 (1.98–227)]. Time to diagnosis ≥ 6 days had a sensitivity of 89% and a specificity of 77% in predicting cardiogenic shock; the addition of age > 8 years and NT-proBNP at diagnosis ≥ 11,254 ng/L increased the specificity to 91%. Independent determinants of short time to diagnosis were age < 8.8 years [aHR 0.34 (0.13–0.88)], short distance to tertiary care hospital [aHR 0.27 (0.08–0.92)], and the late period of the COVID-19 pandemic [aHR 2.48 (1.05–5.85)]. Conclusions: Time to diagnosis ≥ 6 days was independently associated with cardiogenic shock in MIS-C. Early diagnosis and treatment are crucial to avoid the use of inotropes and limit morbidity, especially in older children. [ABSTRACT FROM AUTHOR]

Objective: Characterization of the stages that patients with JIA pass until diagnosis, and analysis of the different causes that lead to a delay in JIA diagnosis in Israel.Methods: The study is a retrospective, cohort study that was done in eight pediatric rheumatology centers in Israel. All patients diagnosed with JIA between October 2017 and October 2019 were included in the study. Demographic, clinical, and data regarding the referral's physicians were collected from hospital and community medical charts.Results: Of 207 patients included in the study, 201 cases were analyzed, 71.1% of the population were female. Patients on average, were evaluated during the diagnostic process by three (3.1) different physicians. In most cases, they initially met with a pediatrician in the community setting (61.2%), and later, most commonly referred to a rheumatologist by the community pediatrician (27.8%). The median time until diagnosis was 56.0 days (range: 1.0-2451.0 days). Patients diagnosed with polyarticular and enthesitis related-/spondyloarthritic (ERA/SPA) JIA subtypes had the longest period until diagnosis (median: 115.5 and 112.0 days, respectively). Younger age correlated with a quicker diagnosis, and females were diagnosed earlier compared to males. Fever at presentation significantly shortened the time to diagnosis (P<0.01), whereas involvement of the small joints/sacroiliac joints significantly lengthened the time (P<0.05).Conclusion: This is the first nationwide multicenter study that analyzes obstacles in the diagnosis of JIA in Israel. Raising awareness of JIA, especially for patients with ERA/SPA, is crucial in order to avoid delays in diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Delay in the diagnosis of childhood cancer is one of the major health problem that contribute to decreased survival rates of children particularly in developing nations. Despite advances in the field of pediatric oncology, cancer remains a leading cause of death in children. Diagnosis of childhood cancer as early as possible is crucial to reduce mortality. Therefore, the aim of this study was to assess delay in diagnosis and associated factors among children with cancer admitted to pediatric oncology ward, University of Gondar comprehensive specialized hospital, Ethiopia 2022. Method: Institutional-based retrospective cross-sectional study design was conducted from January1, 2019 to December 31, 2021 at University of Gondar comprehensive specialized hospital. All 200 children were included in the study and Data were extracted through structured check-list. The data were entered using EPI DATA version 4.6 and exported to STATA version 14.0 for data analysis. Results: From the total of two hundred pediatric patients 44% had delayed diagnosis and the median delay diagnosis was 68 days. Rural residence (AOR = 1.96; 95%CI = 1.08–3.58), absence of health insurance (AOR = 2.21; 95%CI = 1.21–4.04), Hodgkin lymphoma (AOR = 9.36; 95%CI = 2.1-41.72), Retinoblastoma (AOR = 4.09; 95%CI = 1.29–13.02), no referral (AOR = 6.3; 95%CI = 2.15–18.55) and absence of comorbid disease (AOR = 2.14; 95%CI = 1.17–3.94) were significant factors associated with delay in diagnosis. Conclusion and recommendation: Delayed in diagnosis of childhood cancer was relatively lower than previous studies and most influenced by the child's residency, health insurance, type of cancer and comorbid disease. Thus; every effort should be made to promote public and parental understanding of childhood cancer, promote health insurance and referral. [ABSTRACT FROM AUTHOR]

Objectives: Retrospectively analyze head and neck Langerhans Cell Histiocytosis at a rural tertiary referral center and compare results with previously published data. Methods: Electronic health record review was performed from 2003 to 2019. Patients with biopsy proven LCH with primary head and neck involvement were included. Demographics, presentation, imaging characteristics, treatment modality, delay in diagnosis (DD, ≥60 days), and outcomes were analyzed and reported. Results: Twenty-four patients were included. The most common presenting symptoms were otorrhea (n = 6) and scalp pain or swelling (n = 6). All patients had bony involvement. The most common site was facial or skull lesions (n = 20). Most skull lesions (75%) demonstrated CNS risk. Six patients were treated with primary surgery, 15 with primary chemotherapy, and 3 with surgery plus adjuvant chemotherapy. Nine patients experienced relapse of disease with median time to documented relapse of 11.4 months; all were treated with salvage chemotherapy to achieve complete remission (median follow-up: 72 months). Patients most likely to relapse were those with multisystem disease (5/7, 71.4%), temporal bone lesions (4/7, 57.1%), and DD (7/12, 58.3%). Of the 9 total patients who experienced relapse, 78% had a delay in diagnosis. Conclusions: LCH is a complex disease process in which diagnosis can be delayed if not considered in the differential. Within the head and neck, the skull, including isolated temporal bone involvement, is the most common site of involvement. Treatment modality does not appear to have an influence on relapse rates. Relapse was more likely to occur in the first year after treatment and close monitoring is required. [ABSTRACT FROM AUTHOR]

Background. Early initiation of Rheumatoid Arthritis (RA) treatment leads to better outcomes and low disease activity. In spite of these, there is a significant delay between symptom onset and the initiation of therapy. Objective. This study aimed to investigate this diagnostic delay and to analyze its associated factors and outcomes. Patients and method. This cross sectional study included 167 RA patients fulfilling the 2010 American College of Rheumatology/ European League against Rheumatism (ACR/EULAR) classification criteria. All patients were subjected to full clinical, laboratory and radiological assessment and treatment received, also; Disease Activity Score (DAS-28) &functional disability evaluation using Modified Health Assessment Questionnaire (MHAQ) MHAQ were reported. Diagnostic delay was assessed regarding duration, associated factors and outcomes. Furthermore, RA patients were divided into early and late diagnosis group with cutoff of one year and were compared regarding different disease parameters. Results. The median (IQR) lag in diagnosis of RA patients was 12 months (4 24), MHAQ score was significantly positively correlated with delay in diagnosis (P=0.02). Early diagnosis group patients were statistically significantly urban resident (P= 0.01), employed (P= 0.02), with higher educational level (P=0.02), lower functional index MHAQ (P= 0.02), and were significantly visiting Rheumatology specialty early in the disease compared to late diagnosis group (P= <0.0001). Conclusion. Early diagnosis is still suboptimal. Unemployment, specialty visited first other than rheumatology, female gender, rural residence, and lower educational level was associated with the delay in diagnosis in RA patients. Patients with delayed diagnosis showed worse functional disability index. [ABSTRACT FROM AUTHOR]

Abstract Background Tuberculosis (TB) remains a main public health concern in the world resulting in significant morbidity and mortality as well as in Ethiopia. In Ethiopia, there are various primary studies with inconsistent findings. Delay in the diagnosis of TB is determined by different factors like the type of TB, marital status, TB-HIV co-infection, employment status, place of residence, educational status, type of first visited a health facility, and gender of the patient. This review will produce pooled evidence on delay in diagnosis and associated factors among TB that might have huge public health impacts, like unfavorable treatment outcomes, increase transmission of the disease in the community for better intervention. Methods The presence of systematic reviews and meta-analysis on similar topics was checked and the topic was registered on PROSPERO to prevent duplication with the registration number of (CRD42020158963). Both published and unpublished studies conducted in Ethiopia from 2002 to April 1 2020 were searched thoroughly using electronic databases. Data were analyzed using STATA version 14. Heterogeneity was checked by using I2 and Cochrane Q test. In the presence of heterogeneity, a random effect model was employed to estimate the pooled magnitude and determinants of diagnosis delay of TB. Publication bias was checked by using the graphical funnel plot and Egger’s statistical test. Result The Pooled magnitude of tuberculosis diagnosis delay in Ethiopia was 45.42% [95%CI 34.44, 56.40]. Residing in urban, having educational status and patients with positive serostatus were protective against TB diagnostic delay while having extra-pulmonary TB and not being married were risk factors for delaying TB diagnosis. Conclusion TB diagnosis delays in Ethiopia are significantly high. Sociodemographic and institutional factors were significantly contributing to the delay. Therefore, national TB control programs need to identify and address gaps, barriers, and weaknesses along the entire patient care cascade, to improve appropriately.

Rapidly progressive glomerulonephritis (RPGN) is a severe type of nephritic syndrome that involves progressive loss of kidney function and can lead to significant morbidity and mortality. RPGN has many etiologies, of which pauci-immune crescenting glomerulonephritis (PICGN) is the most common; however, patients often present with nonspecific symptoms, which can lead to a delay in diagnosis and treatment. We describe one such case that was correctly identified only after multiple clinic and hospital encounters. Following the correct diagnosis, the patient was started on induction therapy with corticosteroids and rituximab with plans for outpatient maintenance therapy. We have included a discussion of the pathogenesis, epidemiology, diagnosis and treatment of RPGN, highlighting the importance of early recognition of the disease in achieving better patient outcomes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mavratsas et al.)

Causes of delay in presentation of breast cancer has been categorised into 'Primary Delay' (delay by the patient or her family); 'Secondary Delay' (delay by the doctors in the first contact — family physician or quacks/alternative medicine practitioners); 'Tertiary Delay' (delay in the system in a specialist breast care unit e.g. waiting list, delayed reporting, doctors on leave, strikes); and 'Quaternary Delay' (e.g. patient hopping from one competent breast cancer specialist to another or mid-course attrition to alternative treatments). In India, many patients have blind belief and high attrition towards the quacks and alternative medicine practitioners. Our study was to assess whether these 'Secondary and Quaternary Delays', particularly the attrition towards the alternative non-modern medical practitioners, have any effect on the delayed presentation and advancement of the overall anatomical staging among the breast cancer patients. We performed a retrospective observational study, based on 'Triple Assessment' and pre-structured Questionnaire. All pathologically confirmed female breast cancer patients admitted from 02/2017 to 08/2018 in the department of General Surgery in our Institute were included. Male breast cancer, histopathologically unconfirmed/inconclusive breast lumps, patients with previous breast surgery/radiotherapy/chemotherapy were excluded. Data from 267 patients was analysed. The mean age at presentation of breast cancer was 47.54 years. The average delay between the onset of the first symptom and the histological diagnosis was 13.76 ± SD 13.08 months. About half (50.2%) of our patients visited the non-modern medical practitioners at least once during their disease. The mean delay in diagnosis was significantly higher (p < 0.0001) among them. The average 'Secondary Delay' was significantly higher among those who visited the non-modern medical practitioners (9.7 ± SD 9.38 months). The average delay between the visit to the first doctor and the histological diagnosis was also significantly higher among them (18.35 ± 14 months). Patients with attrition to non-modern medical practitioners also were diagnosed in higher cT stages: cT4a (66.67%, 2 of 3) and cT4b (60%, 33 of 55). Most (56.9%) of stage IIIB patients visited the non-modern medical practitioners before their diagnosis. Patients who visited the non-modern medical practitioners had significantly more delay in the diagnosis of breast cancer. The 'Secondary and Quaternary Delays' form the major portion in the overall delay and lead to advancement of the anatomical staging of the disease. Creating public awareness, proper training and 'continued medical education' for primary care physicians, and the AYUSH practitioners are required. Further population-based studies are advised. [ABSTRACT FROM AUTHOR]

Abstract Background The main genetic causes of homocystinuria are cystathionine beta-synthase (CBS) deficiency and the remethylation defects. Many patients present in childhood but milder forms may present later in life. Some countries have newborn screening programs for the homocystinurias but these do not detect all patients. Results HCU Network Australia is one of the very few support groups for patients with homocystinurias. Here we report the results of its survey of 143 patients and caregivers from 22 countries, evaluating current diagnostic pathways and management for the homocystinurias. Most (110) of the responses related to patients with CBS deficiency. The diagnosis was made by newborn screening in 20% of patients and in 50% of the others within 1 year of the initial symptom but in 12.5% it took over 15 years. The delay was attributed mainly to ignorance of the disease. Physicians need to learn to measure homocysteine concentrations in children with neurodevelopmental problems, and in patients with heterogeneous symptoms such as thromboembolism, dislocation of the optic lens, haemolytic uraemic syndrome, and psychiatric disease. Even when the diagnosis is made, the way it is communicated is sometimes poor. Early-onset CBS deficiency usually requires a low-protein diet with amino acid supplements. More than a third of the participants reported problems with the availability or cost of treatment. Only half of the patients always took their amino acid mixture. In contrast, good adherence to the protein restriction was reported in 98% but 80% said it was hard, time-consuming and caused unhappiness. Conclusions There is often a long delay in diagnosing the homocystinurias unless this is achieved by newborn screening; this survey also highlights problems with the availability and cost of treatment and the palatability of protein substitutes.

Background: Tuberculosis (TB) remains a main public health concern in the world resulting in significant morbidity and mortality as well as in Ethiopia. In Ethiopia, there are various primary studies with inconsistent findings. Delay in the diagnosis of TB is determined by different factors like the type of TB, marital status, TB-HIV co-infection, employment status, place of residence, educational status, type of first visited a health facility, and gender of the patient. This review will produce pooled evidence on delay in diagnosis and associated factors among TB that might have huge public health impacts, like unfavorable treatment outcomes, increase transmission of the disease in the community for better intervention.Methods: The presence of systematic reviews and meta-analysis on similar topics was checked and the topic was registered on PROSPERO to prevent duplication with the registration number of (CRD42020158963). Both published and unpublished studies conducted in Ethiopia from 2002 to April 1 2020 were searched thoroughly using electronic databases. Data were analyzed using STATA version 14. Heterogeneity was checked by using I2 and Cochrane Q test. In the presence of heterogeneity, a random effect model was employed to estimate the pooled magnitude and determinants of diagnosis delay of TB. Publication bias was checked by using the graphical funnel plot and Egger's statistical test.Result: The Pooled magnitude of tuberculosis diagnosis delay in Ethiopia was 45.42% [95%CI 34.44, 56.40]. Residing in urban, having educational status and patients with positive serostatus were protective against TB diagnostic delay while having extra-pulmonary TB and not being married were risk factors for delaying TB diagnosis.Conclusion: TB diagnosis delays in Ethiopia are significantly high. Sociodemographic and institutional factors were significantly contributing to the delay. Therefore, national TB control programs need to identify and address gaps, barriers, and weaknesses along the entire patient care cascade, to improve appropriately. [ABSTRACT FROM AUTHOR]

Background: The first pillar of the End-TB Strategy is "early diagnosis and prompt treatment". Nevertheless, long delays in starting tuberculosis (TB) treatment are reported. We aimed to describe the demographics and clinical features of TB in the west of Ireland and better understand the delays in treatment. Methods: We conducted a retrospective chart review of all patients diagnosed with active TB who attended the Galway University Hospital (GUH) TB clinic from 2014 to 2018. Results: Eighty-five patients were diagnosed with TB and attended our clinic. Ten (12%) patients were receiving immunosuppressive therapy, 8 (9%) had drug resistance, and 41 (48%) had extra-pulmonary disease. Patients with extra-pulmonary disease had a longer length of stay before treatment (11 vs. 4 days; p = 0.006). Patients older than 55 had a longer length of stay before (16 vs. 5 days, p = 0.0001) and during (36 vs. 11 days, p = 0.004) treatment and were readmitted more frequently than younger patients. A total of 36% of patients were born outside Ireland. Non-Irish patients were younger (mean age 35 vs 48; p = 0.004) and more frequently had drug resistance (19% vs. 4%, p = 0.02). The median time from symptom onset to hospital presentation was 76 days (IQR 35–146 days) and the median time from first hospital presentation to TB treatment was 11 days (IQR 5–51 days). Conclusion: TB patients experienced long symptom durations in the community prior to presentation. Many TB patients experienced delays in diagnosis and treatment following presentation. Both pre-hospital and in-hospital delays need to be addressed in order to 'End-TB'. [ABSTRACT FROM AUTHOR]

Abstract Background Talaromyces marneffei infection is an important opportunistic infection associated with acquired immune deficiency syndrome (AIDS). However, it is unusual in patients with non-AIDS and other non-immunosuppressed conditions. We report a case of delayed diagnosis of disseminated T. marneffei infection in non-AIDS, non-immunosuppressive and non-endemic conditions. Case presentation We describe a previously healthy 24-year-old man who complained of a 3-month history of intermittent diarrhea and a recent week of uncontrollable high fever. The HIV antibody test was negative. Enhanced abdominal computed tomography (CT) and integrated 18F-2-deoxy-2-fluoro-D-glucose position emission tomography/computed tomography (FDG PET/CT) both suspected malignant lymphoma. However, a large number of yeast-like cells were found in macrophages in cervical lymph node samples by hematoxylin and eosin stain and silver hexamine stain. Subsequent blood culture suggested T. marneffei infection. Metagenomic Next Generation Sequencing (mNGS) results suggested T. marneffei as the dominant pathogen. Unfortunately, the patient continued to develop acute liver failure and died due to adverse events associated with amphotericin B. Conclusions Early diagnosis in HIV-negative patients who are otherwise not immunosuppressed and endemic poses a serious challenge. T. marneffei infection is an FDG-avid nonmalignant condition that may lead to false-positive FDG PET/CT scans. Nevertheless, integrated FDG PET/CT is necessary in patients with fever of unknown origin in the early period to perform earlier biopsy for histopathology and culture in highly avid sites and to avoid delays in diagnosis and treatment.

The COVID-19 pandemic has disrupted the provision and use of healthcare services throughout the world. In Slovenia, an epidemic was officially declared between mid-March and mid-May 2020. Although all non-essential health care services were put on hold by government decree, oncological services were listed as an exception. Nevertheless, as cancer control depends also on other health services and additionally major changes in people’s behaviour likely occurred, we aimed to analyse whether cancer diagnosis and management were affected during the COVID-19 epidemic in Slovenia.

The outbreak of COVID-19 caused by SARS-CoV-2 in Wuhan and other cities of China is a growing global concern. Delay in diagnosis and limited hospital resources lead to a rapid spread of COVID-19. In this study, we investigate the effect of delay in diagnosis on the disease transmission with a new formulated dynamic model. Sensitivity analyses and numerical simulations reveal that, improving the proportion of timely diagnosis and shortening the waiting time for diagnosis can not eliminate COVID-19 but can effectively decrease the basic reproduction number, significantly reduce the transmission risk, and effectively prevent the endemic of COVID-19, e.g., shorten the peak time and reduce the peak value of new confirmed cases and new infection, decrease the cumulative number of confirmed cases and total infection. More rigorous prevention measures and better treatment of patients are needed to control its further spread, e.g., increasing available hospital beds, shortening the period from symptom onset to isolation of patients, quarantining and isolating the suspected cases as well as all confirmed patients.

Introduction: The aim of this study was to prove if the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in a delay in diagnosis and treatment of prostate cancer (PC)., Methods: A monocentric, retrospective analysis was conducted at a university cancer center. Included were all patients with untreated PC diagnosed between January 2019 and December 2021. The observation covered 22 months of the SARS-CoV-2 pandemic and 14 months preceding it., Results: Nine hundred sixty-nine men prior (T0) and 1,343 during the pandemic (T1) were included. Mean age was 68.0 (SD 8.2). Median initial prostate-specific antigen was 8.1 ng/mL (T0) and 7.9 ng/mL (T1, p = 0.288). Time from biopsy to tumor board (T0: 1.3 months vs. T1: 0.9 months, p = 0.001), to staging (T0: 1.1 months vs. T1: 0.75 months, p = 0.707), and to therapy (T0: 3.0 months vs. T1: 2.0 months, p < 0.001) was shortened during the pandemic. Classified by d'Amico, a significant shift toward higher risk groups was seen (p = 0.024). Local staging showed an insignificant increase in locally advanced PCs. Metastatic diseases decreased from 10.3% to 8.9% (p = 0.433). Pathological staging showed pT3+ in 44.4% versus 44.7% (p = 0.565) and pN+ in 9.9% versus 9.6% (p = 0.899)., Conclusion: Regarding the diagnosis and treatment of PC, we could not demonstrate any delays due to the SARS-CoV-2 pandemic., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background: Sociodemographic and clinical factors associated with diagnostic delays in pediatric, adolescent, and young adult cancers are poorly understood., Methods: Using the Optum Labs Data Warehouse's de-identified claims data for commercial health plan enrollees, we identified children (0-14 years) and adolescents/young adults (AYAs) (15-39 years) diagnosed with one of 10 common cancers from 2001 to 2017, who were continuously enrolled for 6 months preceding diagnosis. Time to diagnosis was calculated as days between first medical encounter with possible cancer symptoms and cancer diagnosis date. Median times from first symptom to diagnosis were compared using Wilcoxon rank sum test. Multivariable unconditional logistic regression identified sociodemographic factors associated with longer time (>3 months) to cancer diagnosis (from symptom onset)., Results: Of 47,296 patients, 87% presented prior to diagnosis with symptoms. Patients with central nervous system (CNS) tumors were most likely to present with symptoms (93%), whereas patients with cervical cancer were least likely (70%). Symptoms varied by malignancy. Of patients with symptoms, thyroid (105 days [range: 50-154]) and cervical (104 days [range: 41-151]) cancer had the longest median time to diagnosis. Females and patients at either end of the age spectrum were more likely to experience diagnosis delays of more than 3 months., Conclusion: In a commercially insured population, time to diagnosis varies by cancer type, age, and sex. Further work is needed to understand the patient, provider, and health system-level factors contributing to time from symptom onset to diagnosis, specifically in the very young children and the young adult patient population going forward., (© 2024 Wiley Periodicals LLC.)

This study aimed to systematically review the literature on the impact of delay in diagnosis and treatment of oral cavity cancer. PubMed and Embase were systematically searched for articles reporting impact of delay in diagnosis and treatment on cancer-stage and survival of oral cavity cancer. Studies comprising at least ten patients, and published since the year 2000, were included. Sixteen studies (n = 45,001, range: 62–18,677 per study, 83% men), from Australia, Asia, Europe, North America and South America, met the inclusion criteria. Eleven studies (n = 1,460) examined delay in diagnosis, while five studies (n = 43,541) reported delay in treatment. Eight of the eleven studies, examining delay in diagnosis (n = 1,220), analyzed the correlation between delay in diagnosis and tumor stage at diagnosis. Three studies found a significant correlation between patient delay and advanced stage at diagnosis (p < 0.05), whereas three other studies did not. The studies reporting a significant correlation were from Asian countries, whereas the three studies that did not find a correlation were from other continents. Studies reporting on professional delay and total diagnostic delay, generally, did not find a significant correlation with advanced cancer at diagnosis. Time to treatment (TTI), defined as time from diagnosis to treatment, was found significantly correlated with survival in three studies (p < 0.01, p < 0.001, p < 0.05), and nonsignificant in two studies. A significant correlation between patient delay and advanced stage cancer was reported in Asian studies only, while professional delay and total diagnostic delay were generally found to be non-correlated with advanced stage cancer at diagnosis. TTI was in some studies reported to be correlated with poorer outcome, while other studies did not report a correlation. One study presented that there was no clear advantage in overall survival (OS) for patients treated within 30 days, compared to patients treated between 30 and 44 days. [ABSTRACT FROM AUTHOR]

Shorter time from symptoms recognition to diagnosis and timely treatment would be expected to improve the survival of patients with breast cancer (BC). This review identifies and summarizes evidence on time to diagnosis and treatment, and associated factors to inform an improved BC care pathways in Low- and Middle-Income Countries (LMICs). A systematic search was conducted in electronic databases including Medline, Embase, PsycINFO and Global Health, covering publications between January 1, 2010, and November 6, 2023. Inclusion criteria encompassed studies published in English from LMICs that reported on time from symptoms recognition to diagnosis and/or from diagnosis to treatment, as well as factors influencing these timelines. Study quality was assessed independently by two reviewers using a standard checklist. Pre-contact, post-contact and treatment intervals and delays in these intervals are presented. Barriers and facilitators for shorter time to diagnosis and treatment found by individual studies after adjusting with covariates are summarized. The review identified 21 studies across 14 countries and found that BC cases took a longer time to diagnosis than to treatment. However, time to treatment also exceeded the World Health Organization (WHO) recommended period for optimal survival. There was inconsistency in terminology and benchmarks for defining delays in time intervals. Low socioeconomic status and place of residence emerged as frequent barriers, while initial contact with a private health facility or specialist was commonly reported as a facilitator for shorter time to diagnosis and treatment. Guidelines or consensus recommendations are essential for defining the optimal time intervals to BC diagnosis and treatment. Our review supported WHO's Global Breast Cancer Initiative recommendations. Increasing public awareness, strengthening of healthcare professional's capacities, partial decentralization of diagnostic services and implementation of effective referral mechanisms are recommended to achieve a shorter time to diagnosis and treatment of BC in LMICs. • Standard guidelines defining time intervals and delays are required. • Time to diagnosis and treatment exceeded the recommended time in LMICs. • Low socioeconomic status was the most frequent barrier. • The common facilitator was the first point of contact being private facility or specialist. • Awareness, capacity building, and proper referral mechanisms can decrease delays. [ABSTRACT FROM AUTHOR]

Background: Complications in dengue usually occur between day four and day six after fever onset. Hence, early diagnosis and haematological monitoring are vital. Among all hospital reported dengue deaths in Myanmar in 2017-18, we assessed the i) patient profile, ii) proportion of patients who arrived with a dengue diagnosis at admission and iii) delays in diagnosis after fever onset. Methods: This was a descriptive study involving secondary data. For all the notified deaths, death investigation forms were not available in prescribed format and therefore, data were extracted from hospital case records. Results: Of 304 deaths, 184 (60.5%) were female and 233 (76.6%) were less than 10 years old. Township level hospitals or below reported 36 deaths (11.8%) and the remaining deaths were from higher level facilities. Dengue was diagnosed before admission in 26 (8.5%) people and 169 (55.6%) were in shock at admission. Of 208 with date of fever onset recorded, the median diagnosis delay was four (interquartile range-IQR: 3, 5) days. Patient level delay (median three days) was a major contributor to the diagnosis delay. Conclusions: Most of the patients who died did not have a diagnosis of dengue before admission. This calls for an urgent review of health system preparedness in peripheral health facilities to suspect, diagnose, monitor, refer and treat dengue in children and patient level factors for better understanding of the reasons of delay. Timely filling of death investigation forms in a prescribed format and quarterly death reviews based on these is recommended.

Background: The main genetic causes of homocystinuria are cystathionine beta-synthase (CBS) deficiency and the remethylation defects. Many patients present in childhood but milder forms may present later in life. Some countries have newborn screening programs for the homocystinurias but these do not detect all patients.Results: HCU Network Australia is one of the very few support groups for patients with homocystinurias. Here we report the results of its survey of 143 patients and caregivers from 22 countries, evaluating current diagnostic pathways and management for the homocystinurias. Most (110) of the responses related to patients with CBS deficiency. The diagnosis was made by newborn screening in 20% of patients and in 50% of the others within 1 year of the initial symptom but in 12.5% it took over 15 years. The delay was attributed mainly to ignorance of the disease. Physicians need to learn to measure homocysteine concentrations in children with neurodevelopmental problems, and in patients with heterogeneous symptoms such as thromboembolism, dislocation of the optic lens, haemolytic uraemic syndrome, and psychiatric disease. Even when the diagnosis is made, the way it is communicated is sometimes poor. Early-onset CBS deficiency usually requires a low-protein diet with amino acid supplements. More than a third of the participants reported problems with the availability or cost of treatment. Only half of the patients always took their amino acid mixture. In contrast, good adherence to the protein restriction was reported in 98% but 80% said it was hard, time-consuming and caused unhappiness.Conclusions: There is often a long delay in diagnosing the homocystinurias unless this is achieved by newborn screening; this survey also highlights problems with the availability and cost of treatment and the palatability of protein substitutes. [ABSTRACT FROM AUTHOR]

Introduction: There are no previous published reports on primary pediatric tumors of the central nervous system (CNS) in Qatar. We undertook this retrospective cohort study to review the diagnosis of CNS tumors in children in Qatar to analyze the presentation characteristics including symptoms, referral pathways, and time to diagnosis. Methods: All children registered with Pediatric Neuro-Oncology service (PNOS) were included in the study. Data from the time of diagnosis (October 2007 to February 2020) were reviewed retrospectively. Presenting symptoms were recorded and pre-diagnosis symptom interval (PSI) was calculated from the onset of the first symptom to the date of diagnostic imaging. Results: Of the 61 children registered with PNOS during the study period, 51 were included in the final analysis. Ten children were excluded because they were either diagnosed outside Qatar (n = 7) or were asymptomatic at the time of diagnosis (n = 3). The median age was 45 (range 1–171) months. Common tumor types included low-grade glioma (LGG) (47.1%) and medulloblastoma/primitive neuro-ectodermal tumors (PNET) (23.5%). Nine children had an underlying neurocutaneous syndrome. Thirty-eight patients (74.5%) had at least one previous contact with healthcare (HC) professional, but 27 (52%) were still diagnosed through the emergency department (ED). Presenting symptoms included headache, vomiting (36.2%), oculo-visual symptoms (20.6%), motor weakness (18.9%), seizures, ataxia (17.2% each), irritability, cranial nerve palsies (12% each), and endocrine symptoms (10.3%). Median PSI was 28 days (range 1–845 days) for all CNS tumors. Longest PSI was seen with germ cell tumors (median 146 days), supratentorial location (39 days), and age above 3 years (30 days). Tumor characteristics of biological behavior (high-grade tumor) and location (infratentorial) were significantly associated with shorter PSI, as were presenting symptoms of ataxia, head tilt, and altered consciousness. Conclusions: Although overall diagnostic times were acceptable, some tumor types were diagnosed after a significant delay. The awareness campaign, such as the "HeadSmart" campaign in the United Kingdom (UK), can improve diagnostic times in Qatar. Further research is required to better understand the reasons for the delay. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Introduction: different variables have been associated with a worse prognosis of patients with osteosarcoma (OS), highlighting tumor size, location in the axial skeleton and the presence of metastases. The objective of this study is to analyze the prognostic impact of diagnostic delay in osteosarcoma in adults in the Mexican population in a center specialized in sarcomas., Material and Methods: retrospective cohort study from January 1, 2005, to December 31, 2016, 96 patients over 21 years of age with a diagnosis of osteosarcoma were analyzed., Results: the median time to diagnosis from the onset of symptoms was six months (range: 2-36). This variable was dichotomized by applying the operator-dependent curve (ROC) analysis and we determined a cut-off value greater than five months, with an area under the curve (AUC) = 0.93 [95% CI 0.86-0.97], sensitivity 93.2% and specificity 94.6%., Conclusion: time until diagnosis is a critical factor in the survival of adult patients with osteosarcoma, highlighting its influence on disease progression and the appearance of metastasis. The correlation between diagnostic delay and an unfavorable prognosis reinforces the need for rapid and efficient evaluation in suspected cases of osteosarcoma.

Objective Identifying the factors responsible for the delay in the diagnosis of tuberculosis (TB). Patients and methods In this retrospective study, data on pulmonary and extrapulmonary forms of TB, registered for the treatment at the directly observed treatment, short course, centre were analysed. Results Of 163 patients, 34 (20.86%) were diagnosed at the first visit. The delay in seeking medical care ranged from 0 to 25 days from the diagnosis. A total of 110 (67%) patients started on the same day or the day after diagnosis, less than 1 month in 33 (20.25%) and 1–3 months in 83 (51%). Delay from patient and health services (both combined) ranged from half a month to 48 months; the mean±SD diagnostic delay was 4.09±4.19 days (range: 0–24 days), whereas the mean±SD treatment delay (n=162) was 2.19±3.89 days. of the 124 patients who received medical help, 90% of them did so within six months of onset of Symptoms. There was a statistically significant difference in patients’ delay in receiving the treatment/medical care by sex. Mean±SD delay for pulmonary and extrapulmonary TB was 48±24 and 240±386 days, respectively. Conclusion Delay in diagnosis is a preventable factor. Patient delay is longer compared with healthcare delays. Active surveillance, even in the urban areas by healthworkers, may help in reducing this delay.

Abstract The objective of this analysis was to evaluate the change over time in age at first symptoms, age at diagnosis, and delay in diagnosis using data from the Icatibant Outcome Survey (IOS). Patients with a diagnosis of C1-INH-HAE who were born before the year 1990 and who were diagnosed before they reached 25 years of age were included in the analysis. Both age at diagnosis and delay in diagnosis of C1-INH-HAE appear to decline with later decade of birth, despite wide variation across the countries assessed, suggesting that improved disease awareness causes increased rates of earlier diagnosis over time. Our findings demonstrate that some patients are still experiencing long delays to diagnosis, indicating an ongoing need for improved disease awareness.

Abstract Background Typically, women in South Africa (SA) are diagnosed with breast cancer when they self-present with symptoms to health facilities. The aim of this study was to determine the pathway that women follow to breast cancer care and factors associated with this journey. Methods A cross-sectional study was conducted at a tertiary hospital in the Western Cape Province, SA, between May 2015 and May 2016. Newly diagnosed breast cancer patients were interviewed to determine their socio-demographic profile; knowledge of risk factors, signs and symptoms; appraisal of breast changes; clinical profile and; key time events in the journey to care. The Model of Pathways to Treatment Framework underpinned the analysis. The total time (TT) between a woman noticing the first breast change and the date of scheduled treatment was divided into 3 intervals: the patient interval (PI); the diagnostic interval (DI) and the pre-treatment interval (PTI). For the PI, DI and PTI a bivariate comparison of median time intervals by various characteristics was conducted using Wilcoxon rank-sum and Kruskal-Wallis tests. Cox Proportional-Hazards models were used to identify factors independently associated with the PI, DI and PTI. Results The median age of the 201 participants was 54 years, and 22% presented with late stage disease. The median TT was 110 days, with median patient, diagnostic and pre-treatment intervals of 23, 28 and 37 days respectively. Factors associated with the PI were: older age (Hazard ratio (HR) 0.59, 95% CI 0.40–0.86), initial symptom denial (HR 0.43, 95% CI 0.19–0.97) and waiting for a lump to increase in size before seeking care (HR 0.51, 95% CI 0.33–0.77). Women with co-morbidities had a significantly longer DI (HR 0.67, 95% CI 0.47–0.96) as did women who mentioned denial of initial breast symptoms (HR 4.61, 95% CI 1.80–11.78). The PTI was associated with late stage disease at presentation (HR 1.78, 95% CI 1.15–2.76). Conclusion The Model of Pathways to Treatment provides a useful framework to explore patient’s journeys to care and identified opportunities for targeted interventions.

Tucson, Arizona, USA, is a highly coccidioidomycosis-endemic area. We conducted a retrospective review of 815 patients in Tucson over 2.7 years. Of 276 patients with coccidioidomycosis, 246 had a delay in diagnosis; median delay was 23 days. Diagnosis delay was associated with coccidioidomycosis-related costs totaling $589,053 and included extensive antibacterial drug use.

Objective: Cancer has been one of the most critical health problems during the past decades which requires serious consideration, especially in developing countries. Methods: 80 parents of children with different types of cancers were studied via both questionnaire and person-to-person interviews after declaring their informed consent. Results: The highest delay in patients' initial referral was due to the following factors: lack of attention or ignoring the first symptoms, delay in referring to the physician, low economic status and even lack of family support for the patient. In addition, visiting several doctors after the initial diagnosis, uncertainty about the first proposed method, and the high cost of treatment can be mentioned as the main causes of delays in the start of treatment. Conclusion: Education plays an important role in identifying the signs of cancer. In addition, proper relationship and cooperation between the health system and physicians as well as provision of adequate information to patients could lead to the long-term cooperation of these patients in continuing their treatment. [ABSTRACT FROM AUTHOR]