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Key points: Racial disparities influence the completion of aspirin (ASA) desensitization and ASA‐exacerbated respiratory disease (AERD) diagnosis age.Public insurance correlates with an official AERD diagnosis after age 50.Social factors, including race and insurance status, impact AERD diagnosis and adherence to ASA desensitization. [ABSTRACT FROM AUTHOR]

Objective To analyze the reasons of late HIV diagnosis in Chengdu, and to provide scientific basis for promoting early detection. Methods A cross - sectional survey was used, and the questionnaires were conducted among HIV/AIDS cases in 9 districts in Chengdu. The socio - demographic data, AIDS knowledge awareness, health seeking habits, testing behavior and other information were collected. The chi - square test and binary Logistic regression model were used to analyze the influencing factors. In - depth interviews were conducted, and the sample size was determined according to the principle of "information saturation". Results A total of 757 HIV/AIDS cases were investigated, of which 258 (34. 1% ) were found late diagnosis. Multivariate Logistic regression analysis showed that the risk of late diagnosis was higher in age group 30 - 49 years old ( aOR = 3. 350, 95% CI: 1.725 -6.506) and "50 years old ( aOR = 3. 913, 95% CI: 1. 876 -8. 161) than 18 -29 years old. Passive detection ( aOR =2. 002, 95% CI: 1. 098 -3. 649) had a higher risk of late diagnosis than active detection. High school education or higher (aOR =0.472, 95% CI: 0.289 -0.770) had a lower risk of late diagnosis than middle school education or lower. Among the 258 late diagnosis cases, 218 (84. 5% ) never had the idea of HIV testing in the past, mainly because they had not heard of AIDS ( 106 cases/48. 6% ) and felt that AIDS was far away from them ( 82 cases/357. 6% ) . Among the 40 cases who had ever considering taking an HIV test, 17 (42.5%) did not take, mainly because they were worried about their privacy being exposed ( 12 casesZ70. 6% ), worried about what others think during the test process ( 7 cases/41. 2% ), and worried about being discriminated against if they tested positive (7 cases/41. 2% ). In - depth interviews were conducted on 16 patients with late diagnosis. The reasons for late diagnosis mainly included $ never heard of AIDS, serious misunderstanding of AIDS cognition, lack of risk perception awareness, and fluke mentality. Conclusion In order to effectively reduce the level of late HIV diagnosis, it is necessary to promote high - quality AIDS health education, improve the awareness of AIDS knowledge and risk perception after high risk behaviors, and encourage people with high risk behaviors to take the initiative to receive HIV testing as soon as possible. Building a supportive social environment to avoid giving up active testing for fear of discrimination is also essential. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) presents a significant global health challenge, often progressing to end-stage renal disease (ESRD) necessitating renal replacement therapy (RRT). Late referral (LR) to nephrologists before RRT initiation is linked with adverse outcomes. However, data on CKD diagnosis and survival post-RRT initiation in Kazakhstan remain limited. This study aims to investigate the impact of late CKD diagnosis on survival prognosis after RRT initiation. Data were acquired from the Unified National Electronic Health System (UNEHS) for CKD patients initiating RRT between 2014 and 2019. Survival post-RRT initiation was assessed using the Cox Proportional Hazards Model. Totally, 211,655 CKD patients were registered in the UNEHS databases and 9,097 (4.3%) needed RRT. The most prevalent age group among RRT patients is 45–64 years, with a higher proportion of males (56%) and Kazakh ethnicity (64%). Seventy-four percent of patients were diagnosed late. The median follow-up time was 537 (IQR: 166–1101) days. Late diagnosis correlated with worse survival (HR = 1.18, p < 0.001). Common comorbidities among RRT patients include hypertension (47%), diabetes (21%), and cardiovascular diseases (26%). The history of transplantation significantly influenced survival. Regional disparities in survival probabilities were observed, highlighting the need for collaborative efforts in healthcare delivery. This study underscores the substantial burden of CKD in Kazakhstan, with a majority of patients diagnosed late. Early detection strategies and timely kidney transplantation emerge as crucial interventions to enhance survival outcomes. [ABSTRACT FROM AUTHOR]

Temple syndrome is a rare imprinting disorder, caused by alterations in the critical imprinted region 14q32 of chromosome 14. It is characterized by pre- and postnatal growth retardation, truncal hypotonia and facial dysmorphism in the neonatal period. We report an 18-year-old girl with a late diagnosis of Temple syndrome presenting with all typical signs and symptoms including small for gestational age at birth, feeding difficulties, muscle hypotonia and delayed developmental milestones, central precocious puberty, truncal obesity and reduced growth. The patient is the second reported in the literature with signs of clinical and biochemical hyperandrogenism and the first treated with Dehydrocortisone®, with a good response. The clinical diagnosis of this patient was made after long-term follow up at a single center for rare endocrine diseases, and a molecular genetics diagnosis of complete hypomethylation of 14q32 chromosome imprinting center (DLK/GTL2) was recently established. Growth hormone treatment was not given and although precocious puberty was treated in line with standard protocols, her final height remained below the target range. Increased awareness of Temple syndrome and timely molecular diagnosis enables improvement of clinical care of these patients as well as prevention of inherent metabolic consequences. [ABSTRACT FROM AUTHOR]

Background: Chromosome 22q11.2 deletion syndrome (22q11DS) is the most common microdeletion syndrome, typically presenting in neonates with congenital cardiac anomalies, hypocalcaemia and thymic hypoplasia. Some patients are diagnosed later in adolescence and adulthood, with less known about the clinical phenotype of these patients. Aim: To summarise key clinical features in cases of 22q11DS diagnosed during adolescence and adulthood. Methods: This is a retrospective cohort study of 22q11DS patients diagnosed after 13 years of age over 2010–2021, with a literature review of published cases highlighting other late diagnoses. The study was performed in a large multicentre tertiary health network in Melbourne, Australia. Patients diagnosed with 22q11DS after the age of 13 years were included in the study. Main outcome measures were key clinical features in cases of late diagnosis of 22q11DS. Results: A literature search yielded 53 published case reports and one cohort study for review (62 subjects). Additionally, 10 cases of late diagnosis of 22q11DS were identified through a retrospective electronic medical chart review. Findings suggest that intellectual disability and learning difficulties, hypocalcaemia with hypoparathyroidism and facial dysmorphism remain key features in patients with a late diagnosis of 22q11DS, with hypocalcaemia being the most common presentation leading to diagnosis. Patients diagnosed in adulthood may lack classical clinical features of congenital cardiac anomalies and thymic hypoplasia. Immunological consequences of 22q11DS are also an important late‐onset consideration. Atypical features may include basal ganglia calcification. Conclusions: Chromosome 22q11DS has diverse clinical features and a highly variable phenotype, likely contributing to underdiagnosis and later diagnoses. [ABSTRACT FROM AUTHOR]

Abstract Background Sickle cell disease is a genetic disease with multisystem involvement. More than 300,000 children are born with sickle cell disease globally, with the majority of cases being in Sub-Saharan Africa. In Uganda, about 20,000 children are born with sickle cell disease annually, with more than three-quarters dying before the age of 5 years. Those who live beyond 5 years tend to have poor health-related quality of life, numerous complications, and recurrent hospitalizations. In developing countries, most symptomatic patients are diagnosed early in childhood. Few of those not screened in childhood tend to present in adulthood with variable symptoms. Case presentation This case reports a 22-year-old African male patient of Toro tribe who presented with paroxysms of multiple joint pain associated with generalized body malaise for about 6 months. He presented as a referral from a lower facility with an unestablished cause of symptoms. Physical examination revealed conjunctival pallor, icterus, and tenderness of joints. Cell counts showed anemia and hemoglobin electrophoresis revealed 87% of sickled hemoglobin. Conclusion This case report pinpoints the importance of considering the diagnosis of sickle cell disease even in adults presenting with symptoms of sickle cell disease. It also adds to the relevance of screening at all age groups, especially in high-endemic regions such as Africa and Asia.

Abstract This study examined the prevalence of HIV late diagnosis (LD) and identified associated factors with LD among people living with HIV (PLWH). We extracted sociodemographic, epidemiological, and immunological information between 2018 and 2021 in Hunan, China from the HIV/AIDS Comprehensive Response Information Management System of China. The chi-squared test and multivariable logistic regression model were used to identify the factors associated with LD. Among 22,504 PLWH, 14,988 (66.6%) were diagnosed late. PLWH aged 50 and older had a higher proportion of LD (71.2%) than the younger group (60.0%). Older age, being male, Han ethnicity, being registered in Western Hunan, being transferred from health facilities, and being infected through heterosexual intercourse were associated with LD. Among PLWH younger than 50 years, apart from the factors mentioned above, individuals who had primary school or lower education, were non-student, and were divorced or widowed were more likely to be diagnosed late. Unlike younger PLWH, these factors were not associated with LD in the older group. But regional disparities in LD were more significant among them. LD in PLWH remains a severe issue, especially among older people. The study findings provided valuable insights into designing programs targeting groups at higher risk of LD to reduce its prevalence.

Background: Sickle cell disease is a genetic disease with multisystem involvement. More than 300,000 children are born with sickle cell disease globally, with the majority of cases being in Sub-Saharan Africa. In Uganda, about 20,000 children are born with sickle cell disease annually, with more than three-quarters dying before the age of 5 years. Those who live beyond 5 years tend to have poor health-related quality of life, numerous complications, and recurrent hospitalizations. In developing countries, most symptomatic patients are diagnosed early in childhood. Few of those not screened in childhood tend to present in adulthood with variable symptoms. Case presentation: This case reports a 22-year-old African male patient of Toro tribe who presented with paroxysms of multiple joint pain associated with generalized body malaise for about 6 months. He presented as a referral from a lower facility with an unestablished cause of symptoms. Physical examination revealed conjunctival pallor, icterus, and tenderness of joints. Cell counts showed anemia and hemoglobin electrophoresis revealed 87% of sickled hemoglobin. Conclusion: This case report pinpoints the importance of considering the diagnosis of sickle cell disease even in adults presenting with symptoms of sickle cell disease. It also adds to the relevance of screening at all age groups, especially in high-endemic regions such as Africa and Asia. [ABSTRACT FROM AUTHOR]

Objective: Women are more likely, than men, to be diagnosed late with ADHD but there is a paucity of research on their experiences. This paper reports on women's lived experiences of diagnosis of ADHD in adulthood. Methods: Fifty-two qualitative interviews were undertaken, between March 2022 and March 2023, with women aged 19–56 years. The participants were primarily university students, and were diagnosed, as an adult, with ADHD by a psychiatrist in England, United Kingdom. Interviews were undertaken online, through Microsoft Teams, lasting on average 1 h 15 min. Interviews were transcribed verbatim and thematic analysis generated six themes. Results: Participants reported difficulties in being referred from primary care services to specialist ADHD services. Diagnosis was seen as empowering, but this was often tinged with sadness due to previous experiences which were painful and traumatic. Others struggled to cope with the diagnosis due to 'internalised ableism' and perceived stigma. There was minimal mental health and psychological support from professionals after diagnosis and inadequate follow-up and monitoring of medication. Participants identified numerous reasons for not having been diagnosed as a child including gender and racialised stereotypes, successful masking behaviour, lack of professional knowledge about ADHD, a perceived over-emphasis on diagnosing mental health issues, and women being invisible and not listened to. Discussion: Increased training and awareness are needed for professionals on how ADHD presents in girls to support earlier diagnosis. Specialised ADHD psychological therapies are required, in addition to medication. Support after diagnosis including monitoring of medication needs to be strengthened. [ABSTRACT FROM AUTHOR]

Objective To analyze the late diagnosis of newly reported HIV/AIDS in Hebei province from 2016 to 2022, and to understand the proportion of late diagnosis of HIV/AIDS and its influencing factors. Methods The information of newly reported HIV/AIDS cases in Hebei province from 2016 to 2022 was collected through the national basic information system of HIV/AIDS, and identified relevant cases by definition of late diagnosis. Trend Chi-square test was used to analyze the changing trend of late diagnosis proportion, the influencing factors of late diagnosis were analyzed by Chi-square test and Logistic regression model. Results From 2016 to 2022, 14 689 HIV/AIDS cases were newly reported in Hebei province, and the proportion of late diagnosis was 33.1%. The proportion of late diagnosis showed an upward trend in each year (χ2=69.826, P<0.001). The results of Logistic regression showed that the proportion of late diagnosis was higher in the farmers, the source of testing consulting and medical institutions and other, and the higher age group. The OR (95%CI) of farmers was 1.154 (1.021-1.303) compared with the household workers, and the unemployed. Compared with the custodial population, the OR (95%CI) of testing counseling and medical institutional and other sources were 1.909 (1.236-2.949), 3.205 (2.08-4.938) and 1.808 (1.136-2.875). The OR (95%CI) of each age group was 1.945 (1.469-2.577), 3.279 (2.458-4.375), 3.996 (2.97-5.377), 5.223 (3.87-7.05) and 5.202 (3.814-7.095), respectively. The proportion of late diagnosis varies greatly in different cities, City 5, City 11 and City 1 was higher than the average of the whole province. Conclusion From 2016 to 2022, the proportion of late diagnosis HIV/AIDS cases in Hebei province is increased in each year, and there are big regional differences. Occupation, sample source and age are the influential factors of late diagnosis, targeted measures should be taken to prevent and improve the ability of early detection. [ABSTRACT FROM AUTHOR]

This study examined the prevalence of HIV late diagnosis (LD) and identified associated factors with LD among people living with HIV (PLWH). We extracted sociodemographic, epidemiological, and immunological information between 2018 and 2021 in Hunan, China from the HIV/AIDS Comprehensive Response Information Management System of China. The chi-squared test and multivariable logistic regression model were used to identify the factors associated with LD. Among 22,504 PLWH, 14,988 (66.6%) were diagnosed late. PLWH aged 50 and older had a higher proportion of LD (71.2%) than the younger group (60.0%). Older age, being male, Han ethnicity, being registered in Western Hunan, being transferred from health facilities, and being infected through heterosexual intercourse were associated with LD. Among PLWH younger than 50 years, apart from the factors mentioned above, individuals who had primary school or lower education, were non-student, and were divorced or widowed were more likely to be diagnosed late. Unlike younger PLWH, these factors were not associated with LD in the older group. But regional disparities in LD were more significant among them. LD in PLWH remains a severe issue, especially among older people. The study findings provided valuable insights into designing programs targeting groups at higher risk of LD to reduce its prevalence. [ABSTRACT FROM AUTHOR]

Background: The number of late diagnoses of HIV remains very high in Poland, leading to a high proportion of patients developing and dying of HIV-related diseases. The main reason for this is the very low utilization of HIV testing. Our analyses aimed to investigate knowledge about the indications for HIV testing among medical university students, as well as identify their own HIV testing experiences. Material and methods: A cross-sectional survey study was designed to collect information on the students' demographics and their experiences of HIV testing, as well as their knowledge of virus transmission and the indications for testing. Data were collected as part of the HIV_week@WUM project conducted at the Medical University of Warsaw in parallel with the 18th European AIDS Conference, which took place in Warsaw between 18 and 21 October 2023. Results: In total, 545 questionnaires were collected. The median age of the study participants was 20 (interquartile range (IQR): 19–22 years). The majority of respondents were as follows: women (67.5%), born in Poland (97.8%), and were attending the medical faculty (56.7%). Only 114 (21.43%) participants had ever been tested for HIV. For all modes of HIV transmission, most of the respondents overestimated the risk of acquiring HIV, but, at the same time, they had never been tested for HIV. Conclusions: Only one in five health sciences students has ever had a test for HIV, which is less than estimates for the general population of Warsaw. There is an ongoing need to popularize testing among future health care providers in order to address both the indications for testing for individuals and the better use of HIV testing in clinical practice. [ABSTRACT FROM AUTHOR]

Juvenile-onset systemic lupus erythematosus (JLES) is an autoimmune disease of unknown aetiology. It is more common in girls but can occur in boys. Its onset at an early age is more severe, causing potentially fatal damage if not treated early. It is a polymorphous condition, misleading at first and little known in our African populations. We report a case of 12 years of misdiagnosis in a 17-year-old boy living in a semi-rural environment. This case illustrates the shortage of paediatric rheumatologists and marks a breaking point in the diagnosis of the disease, which is sometimes difficult even for practitioners, making it difficult for sick children to access care. It is important to make the general public, as well as nurses and doctors, aware of the importance of early diagnosis for effective and efficient treatment.

Abstract This study investigated the association between serum albumin concentration and 12-weeks mortality of HIV/AIDS with late diagnosis in China. This retrospective cohort study included, 1079 inpatients diagnosis with late HIV/AIDS between January 2018 and December 2021. Disease progression was estimated based on the 12-weeks mortality rate. Cox proportional hazards regression models were used to evaluate the relationship between serum albumin levels and disease progression. The effects of serum albumin levels on mortality was estimated via Kaplan–Meier curves. The mortality risk decreased by 7% with every 1 g/L increase in serum albumin after adjustment ([HR] = 0.93, 95% CI: 0.88–0.97). Compared with that of the low (< 28 g/L) serum albumin group, the middle (28–34 g/L) group’s mortality risk decreased by 70% (HR = 0.30, 95% CI: 0.15–0.59), and that of the high (≥ 34 g/L) group decreased by 40% (HR = 0.6, 95% CI: 0.29–1.23) after adjustment. Our findings suggest a positive correlation between the increase in serum albumin levels upon admission and a decrease in mortality at 12 weeks post-discharge among patients with late AIDS/HIV diagnosis. Further research is needed to characterize the role of serum albumin in 12-weeks mortality prevention in patients with a late diagnosis.

Introduction. The esophagus cancer patients needs early diagnosis to achieve better prognosis. The delay barriers increase progression of diseases to higher stages. The aim of work was to identify and explore the barriers in diagnosis of esophagus cancer and chart the time duration in this process. Material and Methods. The study was conducted in Jinnah Hospital Lahore (JHL), a teaching care hospital of Allama Iqbal Medical College, during a period of one year from July 2019 to July 2020. There were 49.42 % female and 50.57 % male patients. Results. Mean age found to be 56 years. Mean Total delay (TD ) time was 206 days and median Total delay (TD ) time in days were 197 days with 25th and 75th (157, 246) percentiles respectively. Longest delays were found in 51–60 age group and age related (r=0.94) significantly to delays (p=0.0004). Initial symptom of weight loss shows maximum delay and symptoms are highly correlated (r=0.94) with delay (p=0.004). The low income group presents maximum delay. Mean patient delay (PD ) time in days were 142 days with 135 Median and (88, 195) 25th and 75th percentile respectively. Mean, Median, 25th and 75th percentiles for Physician delays (PhyD) times were (20, 18, 16, 23) respectively. Treatment delay (TD ) time (Mean, Median) in days were (18, 18.52) with 25th and 75th (14, 22) percentiles. The education significantly reduces the delays with correlation (r=0.91) and significance (p=0.02). Mean system delay (SD ) time were 25 days and median were 24 days with 25th and 75th (20, 31) percentiles. Conclusion. Illiteracy, financial problems, and unavailability of information related to the cancer and health care system, very limited number of health facilities remains the main causes of these delays.

This study investigated the association between serum albumin concentration and 12-weeks mortality of HIV/AIDS with late diagnosis in China. This retrospective cohort study included, 1079 inpatients diagnosis with late HIV/AIDS between January 2018 and December 2021. Disease progression was estimated based on the 12-weeks mortality rate. Cox proportional hazards regression models were used to evaluate the relationship between serum albumin levels and disease progression. The effects of serum albumin levels on mortality was estimated via Kaplan–Meier curves. The mortality risk decreased by 7% with every 1 g/L increase in serum albumin after adjustment ([HR] = 0.93, 95% CI: 0.88–0.97). Compared with that of the low (< 28 g/L) serum albumin group, the middle (28–34 g/L) group's mortality risk decreased by 70% (HR = 0.30, 95% CI: 0.15–0.59), and that of the high (≥ 34 g/L) group decreased by 40% (HR = 0.6, 95% CI: 0.29–1.23) after adjustment. Our findings suggest a positive correlation between the increase in serum albumin levels upon admission and a decrease in mortality at 12 weeks post-discharge among patients with late AIDS/HIV diagnosis. Further research is needed to characterize the role of serum albumin in 12-weeks mortality prevention in patients with a late diagnosis. [ABSTRACT FROM AUTHOR]

This study describes the presentation and initial management of anorectal malformation (ARM); evaluating the frequency, causes and consequences of late diagnosis. A prospective, population cohort study was undertaken for newly diagnosed ARMs in the UK and Ireland from 01/10/2015 and 30/09/2016. Follow-up was completed at one year. Data are presented as n (%), appropriate statistical methods used. Factors associated with late diagnosis; defined as: detection of ARM either following discharge or more than 72 h after birth were assessed with univariable logistic regression. Twenty six centres reported on 174 cases, 158 of which were classified according to the type of malformation and 154 had completed surgical data. Overall, perineal fistula was the most commonly detected anomaly 43/158 (27%); of the 41 of these children undergoing surgery, 15 (37%) had a stoma formed. 21/154 (14%, CI 95 {9–20}) patients undergoing surgery experienced post-operative complications. Thirty-nine (22%) were diagnosed late and 12 (7%) were detected >30 days after birth. Factors associated with late diagnosis included female sex (OR 2.06; 1.0–4.26), having a visible perineal opening (OR 2.63; 1.21–5.67) and anomalies leading to visible meconium on the perineum (OR 18.74; 2.47–141.73). 56/174 (32%) had a diagnosis of VACTERL association (vertebral, anorectal, cardiac, tracheal, oesophageal, renal and limb); however, not all infants were investigated for commonly associated anomalies. 51/140 (36%) had a cardiac anomaly detected on echocardiogram. There is room for improvement within the care for infants born with ARM in the UK and Ireland. Upskilling those performing neonatal examination to allow timely diagnosis, instruction of universal screening for associated anomalies and further analysis of the factors leading to clinically unnecessary stoma formation are warranted. II (Prospective Cohort Study <80% follow-up). [ABSTRACT FROM AUTHOR]

Despite remarkable improvement in the human immunodeficiency virus (HIV) and hepatitis C virus (HCV) care continuum, the rate of late diagnosis of HIV and HCV in high-income countries remains unacceptably high. Testing relies mainly on primary care physicians' identification of risk factors. We aimed to adapt an analogic to an online questionnaire to help HIV and HCV screening and perform a pilot study to assess its accuracy and acceptability. We used the Delphi method to adapt a previously validated analogical questionnaire to a user-friendly online tool. It aimed to identify participants who should be screened for HIV or HCV and those who should be referred for pre-exposure prophylaxis (PrEP). We then designed a proof-of-concept pilot study from July to October 2022 to test its feasibility and suitability for use on a larger scale and to assess its accuracy in identifying patients at risk for HIV or HCV or with indication for PrEP. The final questionnaire consisted of 37 questions. A total of 142 participants provided informed consent, and 102 completed the questionnaire: 41 random patients recruited at the primary care level, 10 participants recently diagnosed with HIV, 20 participants with HIV on follow-up, 21 participants from the PrEP program, and 10 patients diagnosed with HCV. The tool adequately indicated the need for testing in more than 98% of participants with confirmed HIV/HCV infections or in the PrEP program. Furthermore, it adequately assessed PrEP referral in 94% of participants already on PrEP or with known HIV infection. Participants were highly satisfied with the tool, and 98% of them recommended its use. A self-administered web-based tool to identify patients who should be tested for HIV or HCV or referred to PrEP could simplify patient selection and help reduce late diagnosis. [ABSTRACT FROM AUTHOR]

Background: Autism has been considered a 'male‐dominant' condition. However, recent research suggests that autistic females are underdiagnosed, misdiagnosed, and later diagnosed. Females may also have different and more nuanced behavioral profiles. To examine diagnosis rates of females, we used 20 years of state‐wide data to characterize historical trends in the diagnosis of autism in females to determine whether the proportion of females diagnosed with autism has changed over time. Methods: Data were drawn from 10,247 participants (males = 8,319, females = 1928) who received an autism diagnosis between 2000 and 2021 from state‐wide autism centers associated with the University of North Carolina TEACCH Autism Program. Results: The rates of females diagnosed with autism increased at a greater rate compared with males. Age of diagnosis remained consistently higher for females. Late diagnosis (defined as 13+) increased over time across both males and females, however, was more commonly associated with females, particularly those with co‐occurring intellectual disability. Conclusions: Our results indicate that the proportion of females diagnosed with autism has increased steadily over a 20‐year period, which likely reflects greater societal knowledge of how autism may manifest differentially in females. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is prevalent worldwide. The incidence of autism has increased worldwide. However, there is a dearth of data in sub-Saharan Africa. The study is aimed at determining the clinical and sociodevelopmental profile of children with ASD in a tertiary hospital in Nigeria. Materials & Methods This study is a six-year retrospective review of the medical records of children who presented with clinical autism diagnoses at the Department of Pediatrics, University of Calabar Teaching Hospital. Relevant data were extracted from the medical records of those who met the diagnostic criteria. Descriptive statistics were presented in proportions, percentages, and tables. Results Of the 1806 children with neurological disorders seen in the clinic within the study period, twenty-eight were found to have symptoms of autism based on the American Psychiatric Association›s Diagnostic and Statistical Manual V (DSM -5) criteria, giving a prevalence of 1.6%. The mean age at diagnosis was 3.8 ±1.4 (range 2 to 10) years, with a male-tofemale ratio of 3:1. About two-thirds of the children diagnosed were older than three years. Seven percent of the children had siblings with autism, 53.5% of children with autism in the study had hyperactivity as comorbidity, while seizures were found in 7% of cases. Conclusion The prevalence of ASD among children seen in Calabar is 1.6%. Hyperactivity, mental retardation, and seizure disorders are associated comorbidities in the study. Late presentation is a common feature in this facility. Thus, increasing awareness is essential to enhance early recognition, timely diagnosis, and appropriate intervention. [ABSTRACT FROM AUTHOR]

Timely HIV diagnosis and medical engagement are crucial for effective viral load suppression and treatment as prevention. However, significant delays persist, particularly in Africa, including Ghana. This study focused on Ghanaian men whose route of exposure to HIV was through same-gender sexual contact (MSM), a group disproportionately impacted by HIV. Using structured surveys, we investigated the sociodemographic factors associated with late HIV diagnosis, a topic with limited existing research. Results indicate that older age groups were associated with an increased risk of late diagnosis compared to the 18–24 age group. Among the demographic variables studied, only age showed a consistent association with late HIV diagnosis. This study underscores the importance of targeted interventions to address HIV diagnosis disparities among MSM in Ghana, particularly for older age groups. The findings emphasize the need for tailored interventions addressing age-related disparities in timely diagnosis and engagement with medical services among this population. Such interventions can play a crucial role in reducing the burden of HIV within this community and fostering improved public health outcomes. [ABSTRACT FROM AUTHOR]

Objective To analyze the epidemiological characteristics and treatment-related deaths within 12 months of HIV/AIDS patients aged 50 and above reported in a province, providing a basis for targeted prevention and control measures. Methods Data on HIV/AIDS cases aged 50 and above reported in a province from 2010 to 2019 were collected from the China CDC Information System for Comprehensive Prevention and Control of AIDS, and the epidemiological characteristics and treatment-related deaths within 12 months were analyzed* The comparison of rates was performed using the 於 test, trend changes were analyzed using the trend 於 test, and the comparison of CD4+ T lymphocyte detection results between groups was performed using non -parametric tests. Results From 2010 to 2019, a total of 2 875 cases of HIV/AIDS aged 50 and above were reported in the province, accounting for 19.4% of the total cases (14 819 cases). The proportion of new cases increased from 10.3% in 2010 to 24.6% in 2019, with a statistically significant difference (於通= 126.741, P < 0.001), and the annual reported incidence showed an increasing trend (於施厨二936.20& P < 0.001). The male-to-female ratio was 53:1, with an average age of (58.40±7.50) years. The majority were farmers, accounting for 49.0% (1 408/2 875). The primary education level accounted for 42.0% (1 208/2 875). The majority were identified by medical institutions, accounting for 64.5% (1 854/2 875); sexual transmission was the primary route, accounting for 96.8% (2 784/2 875). Among male cases, same -sex transmission accounted for 49.5% (1 423/2 416). Among female cases, non-marital heterosexual transmission and spousal transmission accounted for 49.0% (212/433) and 51.0% (221/433), respectively. The median CD4+ T lymphocyte count at the initial test was 266 cells/mm3. There was a statistically significant difference in CD4+ T lymphocyte counts between males and females (Z=-5.395, P < 0.001). The treatment rate within 12 months of diagnosis was 56.7% (1 632/2 875), showing an increasing trend each year (%2 =115.054, P < 0.001). The mortality rate within 12 months of diagnosis was 15.2% (433/2,875), showing a decreasing trend each year (%2 =61.654, P < 0.001). Conclusion The number and proportion of HIV/AIDS cases aged 50 and above in the province have been increasing annually. It is necessary to strengthen targeted health education and interventions for this population as well as expand testing to achieve early detection and treatment. [ABSTRACT FROM AUTHOR]

Family and friends may play an important role both in the identification and diagnosis of any condition, as well as in the provision of support afterwards. However, when the diagnosis is autismand it arrives late, as is often the case with autistic women, we find the double stigma of experiencing the repercussions of a late diagnosis, along with the disbelief of those closest to them. This study aims to analyse and understand the experiences of autistic women with their family and friends throughout the diagnostic process and subsequent help-seeking endeavors. A total of 21 Spanish autistic women aged between 20 and 58 years answered a series of open-ended questions--respecting the participants' preferred modality. From the thematic analysis, two main themes emerged regarding the reactions of family and friends, dividing the experiences into two temporal phases: when disclosing the diagnosis and sometime later. Most participants noted that their relatives did not believe them, reacted in a hostile way, or did not give it any importance at the time of disclosure. As a result, their relationship deteriorated even further over time. In contrast, their friends served as pillars of support from the beginning, along with their partners and the associations they attended, because of which they met more autistic women who became their "family". Thus, another consequence of late diagnosis in autistic women is highlighted, the incomprehension or disbelief from their relatives, and the important role of friendships among women and among autistic women. [ABSTRACT FROM AUTHOR]

Congenital adrenal hyperplasia (CAH) and Williams Syndrome (WS; MIM # 194050) are distinct genetic conditions characterized by unique clinical features. 21-Hydroxylase deficiency (21-OHD; MIM #201910), the most common form of CAH, arises from mutations in the CYP21A2 gene, resulting in virilization of the external genitalia in affected females, early puberty in males, and short stature. Williams syndrome, caused by a microdeletion of 7q11.23, presents with distinctive facial features, intellectual disability, unique personality traits, early puberty, and short stature. This case report describe the clinical features of a 4-year-old girl referred due to progressive virilization and developmental delay. Genetic analysis confirmed concurrent CAH and WS, identifying a novel mutation in the CYP21A2 gene (c.1442T>C). Following corticosteroid therapy initiation, the patient developed central precocious puberty. This case report delves into the pubertal change patterns in a patient affected by overlapping genetic conditions, providing valuable insights in to the intricate clinical manifestation and management of these rare complex disorders. [ABSTRACT FROM AUTHOR]

Incidence of liver cirrhosis causes a significant increase in global mortality and an increasing incidence of alcohol-related diseases. Aim: To establish the relationship between alcohol as a leading etiologic factor and high Child-Pugh score in newly diagnosed cases with liver cirrhosis. Materials and methods: Retrospective study of 361 newly diagnosed cases with liver cirrhosis treated at the Gastroenterology Clinic of UMHAT Pleven EAD in the period 2017-2021 was performed. A documentary method was used for its implementation. The necessary information was collected from the patient hospital records upon the first patient hospitalization. All patients, of whom 258 (71%) were men and 103 (29%) were women, were over the age of 18 years. The average age of the studied group was 57.8 years. ± 11.4 years. In 244 (67.5%) of them, the main etiological factor was purely alcohol etiology. The analysis of the results was done by Cross tabulation and Chi-square test. The obtained results were processed with IBM SPSS 26 and Excel statistics. A value of p < 0.05 was accepted as a level of significance. Results: The distribution of cases by Child shows that 98 (27%) were in Child A, 141 (39%) were in Child B, and 122 (34%) were in Child C. 101 (41.4%) of them were with purely alcohol etiology at 244 (67.5%) in Child C. The total share of decompensated cases in Child B and C in cases with alcohol alone or in combination with Hepatitis B or S in 262 (72.6%) persons reaches 81.3%, compared to all other etiologies, where the same is 50.5%. The obtained result confirms a significant relationship between a high Child-Pugh score and alcohol etiology (p = 0.000). Of all the 122 individuals in Child C, 106 (86.9%) of them have an alcoholic etiology alone or in combination. A comparison between purely viral and alcohol-combined etiologies found that "pure" cases were largely compensated unlike the combined cases, which were mostly decompensated, with no cases in Child A identified. Conclusion: A high Child-Pugh score in liver cirrhosis is associated with the leading alcoholic etiology and its late diagnosis. [ABSTRACT FROM AUTHOR]

The purpose of this study is to analyze scientific productions on the late diagnosis of Autism Spectrum Disorder. To carry out this research, articles were consulted in the Scielo and BvS virtual libraries, using specific descriptors. There was a lack of available material on the subject in Portuguese. This is due to the predominant focus of the scientific community on the early diagnosis of children with Autism Spectrum Disorder, which has negative impacts on the quality of life of patients in adulthood. It is crucial to raise awareness and awareness among healthcare professionals so that they consider the possibility of diagnosing autism spectrum disorder in adults. This is essential to serve a significant portion of the population who may be experiencing the challenges associated with ASD during adulthood. [ABSTRACT FROM AUTHOR]

New case‐finding opportunities are needed to achieve hepatitis C virus (HCV) elimination in England by the year 2030. HCV antenatal testing is not offered universally in England but is recommended for women with risk factors for HCV (e.g. injecting drug use, being born in a high‐prevalence country). The aim of this analysis was to investigate the missed opportunities for HCV antenatal testing among women who had given birth and were subsequently diagnosed with HCV at some time after childbirth. By linking data on live births (2010–2020) to laboratory reports of HCV diagnoses (1995–2021), we identified all women who were diagnosed with HCV after the date of their first childbirth. This group was considered to potentially have experienced a missed opportunity for HCV antenatal testing; HCV‐RNA testing and treatment outcomes were also obtained for these women. Of the 32,295 women who gave birth between 2010 and 2020 with a linked diagnosis of HCV (median age: 34 years, 72.1% UK‐born), over half (n = 17,123) were diagnosed after childbirth. In multivariable analyses, the odds of being diagnosed with HCV after childbirth were higher in those of Asian Bangladeshi, Black African or Chinese ethnicity and among those born in Africa. Over four‐fifths (3510/4260) of those eligible for treatment were linked to treatment, 30.7% (747/2435) of whom had a liver scarring level of at least moderate and 9.4% (228/2435) had cirrhosis. Given the potential opportunity to identify cases of HCV with targeted case‐finding through antenatal services, universal opt‐out testing should be considered in these settings. [ABSTRACT FROM AUTHOR]

This narrative review critically examines the underexplored domain of aging in individuals with Autism Spectrum Disorder (ASD), highlighting the unique challenges and support needs faced by older adults on the spectrum. Despite increased recognition of ASD in younger populations, a significant knowledge and resource gap persists for older adults, who often navigate aging without adequate support or understanding. The review synthesizes research on the aging process in ASD, detailing specific challenges such as increased healthcare barriers, social isolation risks, and the complexities surrounding late diagnosis. It underscores the dire need for tailored intervention strategies and support mechanisms, critiquing the current inadequacies in addressing these needs. Furthermore, the review explores policy implications, advocating for a shift in the conceptualization and accommodation of autistic aging within healthcare and social services. It calls for a comprehensive, multi-disciplinary approach to research and support, urging collaboration among researchers, practitioners, policymakers, and the autistic community to ensure that aging individuals with ASD receive the necessary resources for a dignified life. Through a detailed synthesis of existing literature, this review illuminates the urgent need for focused attention on the aging ASD population, proposing future research directions that prioritize inclusivity and specificity in support strategies. It represents a call to action for developing a holistic framework that acknowledges and addresses the unique experiences of older adults with ASD, aiming for a future where they are supported comprehensively as they age. [ABSTRACT FROM AUTHOR]

Introduction. Early diagnosis and treatment improve clinical outcomes, especially in chronic arthritis (CA) and systemic connective tissue disorders (SCTD). Thanks to clinical research from the 1990s on and innovative drugs, 55 million life-years have been saved. The COVID-19 pandemic brought on medical challenges in rheumathology. Objective. The study objective was to research early diagnosis, time of the introduction of innovative therapy, participation in clinical research, influence of gender, age, and corticosteroid treatment on hospitalization rate due to COVID-19 infection in CA and SCTD patients. Method. In November 2022 we performed the crosssectional study in CA and/or SCTD patients using an online questionnaire. The first part of the analyzed questions referred to sociodemographic characteristics and data concerning rheumatic disease - rheumatoid arthritis (RA) and other rheumatic diseases. The second part referred to COVID-19. Data were analyzed by descriptive statistics and Pearson's Chi-square test using SPSS 29. Results. Out of the total of 176 participants, RA was present in 60,8%. The time from the symptom onset to diagnosis was longer than two years. RA was more frequently diagnosed in the first six months (p < 0,05 - males). The innovative therapy was used by 59,7% of the participants. The majority of RA patients got innovative therapy after five years from disease onset, which is later than in other CAs (p < 0,05 - females). There were 23,3% of the participants who took part in clinical research, more those with RA (p < 0,05 - females). Corticosteroid therapy influenced a higher rate of hospitalization during COVID-19 infection (p < 0,05 - females). Conclusion. Males suffering from RA were diagnosed sooner, while females with RA participated more in clinical research but were later introduced to innovative therapy. The use of glucocorticoid therapy in the treatment of CA and SCTD increased the risk of hospitalization due to COVID-19 infection.

ObjectiveTo investigate the late diagnosis of HIV infection and associated factors in Jiading District between 1998 and 2022， and to provide the information for the development of AIDS prevention and control strategy.MethodsInformation of newly reported HIV/AIDS cases in Jiading District between 1998 and 2022 were obtained from the National Information System for Comprehensive AIDS Prevention and Control. Logistic regression was used to explore the associated factors of late diagnosis of HIV infection.ResultsIn total， 809 HIV/AIDS cases was newly reported， 324 of which were late diagnosis with the overall rate of late diagnosis of 40.1%. Despite an increased tendency from 2016 to 2018， the rate of late diagnosis showed a downward trend from 1998 to 2015. The late diagnosis rate was 29.5% in 2015. From 2016 to 2022， the average rate was 34.9%. The average age of cases with a late diagnosis was 44.8±14.6 years old. Age groups over 50 had the highest risk，at 57.7%， accounting for 35.8% of all cases of late diagnosis. All age groups older than 30（OR=1.37‒3.50） had a higher rate of late diagnosis than the group between age 21 and 30. In comparison to patients at VCT clinic， the rate of late diagnosis among sexually transmitted disease （STD） outpatients （OR=2.23， 95%CI：1.42‒3.49） and other clinical patients （OR=2.75， 95%CI：1.88‒4.01） was higher.ConclusionThe late diagnosis rate of HIV infection is relatively high in Jiading District. AIDS education and prevention activities should be strengthened among people aged over 50 years. For early detection of HIV infection， VCT clinic platform’s function should be fully utilized. Medical institutions should pay attention to HIV testing in patients.

Asl&inodot;han Candevir,1 Ferit Kuscu,1 Behice Kurtaran,1 Süheyla Kömür,1 Ay&scedil;e Seza &Idot;nal,1 Damla Ertürk,2 Ye&scedil;im Ta&scedil;ova1 1Infectious Diseases, Çukurova University, Adana, Türkiye; 2Infectious Diseases, Health Sciences University Izmir Tepecik Education and Research Hospital, &Idot;zmir, TürkiyeCorrespondence: Asl&inodot;han Candevir, Infectious Diseases Department, Çukurova University Medical School, Adana, Türkiye, Tel +90 5335775954, Email acandevir@gmail.comBackground: Late presentation for HIV care, continues to be a challenge, leading to increased morbidity, mortality, and society costs. The study aimed to determine the rates of late diagnosis (LD) and patient characteristics in Turkey, utilizing the new definition excluding recently infected.Methods: The study included patients admitted to the hospital between 1998 and 2023, with at least 1 year of follow-up. Patients without a CD4 count at their initial admission were excluded. Two definitions of presentation were used: LD, (CD4< 350 cells/mL or AIDS-defining event) and advanced disease (AD), (CD4< 200 cells/mL or AIDS-defining event). Individuals with recent evidence of infection were reclassified as “not late”.Results: Out of the 914 patients meeting the criteria and the analysis focused on 794 treatment-naïve patients, with 90.6% being male and an average age of 36.0 ± 12.0 years. Using the previous definition, 48.9% were diagnosed as late, while the new definition identified 47.2%. A total of 183 patients (23%) were diagnosed with AD, and 25.9% of the diagnoses occurred during the COVID-19 Pandemic. The rate of LD increased during the pandemic compared to before (55.8% vs 44.2%, p=0.005), as did the rate of AD (30.1% vs 20.6%, p=0.007). There was no significant relationship between gender and LD. Patients with LD were older (median ages were 31 vs 36 in groups, p< 0.001), had poorer virological response, higher mortality rates (4.8% vs 1.2%, p=0.003), and shorter survival compared to those without (log rank=0.004).Conclusion: HIV patients with LD have poorer prognosis with older age as well as disruption of health services during the pandemic as risk factors. To improve outcomes, multicenter studies should investigate missed opportunities and specific risk factors in our region, and we should screen at-risk populations, promote awareness among underdiagnosed populations, and advocate testing even in disastrous situations.Plain Language Summary: Late diagnosis of HIV remains a challenge, leading to increased health problems, deaths, and societal costs. This study aimed to determine the rates of late diagnosis and patient characteristics in Turkey, using a new definition that excludes recently infected individuals. The study included 794 treatment-naïve patients, mostly male with an average age of 36 years. With the new definition, 47.2% were diagnosed late, and 23% had advanced disease. The pandemic period saw higher rates of late diagnosis (55.8% vs 44.2%) and advanced disease (30.1% vs 20.6%). Gender did not significantly affect late diagnosis. Patients with late diagnosis were older, had lower CD4 counts, poorer treatment response, higher mortality rates (4.8% vs 1.2%), and shorter survival. Older age and disruptions in healthcare during the pandemic were identified as risk factors for late diagnosis. To improve outcomes, multicenter studies should investigate missed opportunities and specific risk factors, while focusing on screening high-risk populations, raising awareness among underdiagnosed groups, and promoting testing even during challenging situations.Keywords: human immunodeficiency virus, HIV, late diagnosis, new definition, risk factors

Background: Cervical cancer is the leading cause of cancer mortality among women in Kenya. Two thirds of cervical cancer cases in Kenya are diagnosed in advanced stages. We aimed to identify factors associated with late diagnosis of cervical cancer, to guide policy interventions. Methods: An unmatched case control study (ratio 1:2) was conducted among women aged ≥ 18 years with cervical cancer at Kenyatta National and Moi Teaching and Referral Hospitals. We defined a case as patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥ 2A and controls as those with stage ≤ 1B. A structured questionnaire was used to document exposure variables. We calculated adjusted odds ratio (aOR) to identify any associations. Results: We enrolled 192 participants (64 cases, 128 controls). Mean age 39.2 (±9.3) years, 145 (76 %) were married, 77 (40 %) had primary level education, 168 (88 %) had their first pregnancy ≤ 24 years of age, 85 (44 %) were > para 3 and 150 (78 %) used contraceptives. Late diagnosis of cervical cancer was associated with cost of travel to cancer centres > USD 6.1 (aOR 6.43 95% CI [1.30, 31.72]), age > 50 years (aOR 4.71; 95% CI [1.18, 18.80]), anxiety over cost of cancer care (aOR 5.6; 95% CI [1.05, 32.72]) and ultrasound examination during evaluation of symptoms (aOR 4.89; 95% CI [1.07–22.42]). Previous treatment for gynecological infections (aOR 0.10; 95% CI [0.02, 0.47]) was protective against late diagnosis. Conclusion: Cost of seeking care and the quality of the diagnostic process were important factors in this study. Decentralization of care, innovative health financing solutions and clear diagnostic and referral algorithms for women presenting with gynecological symptoms could reduce late-stage diagnosis in Kenya.

Family and friends may play an important role both in the identification and diagnosis of any condition, as well as in the provision of support afterwards. However, when the diagnosis is autism and it arrives late, as is often the case with autistic women, we find the double stigma of experiencing the repercussions of a late diagnosis, along with the disbelief of those closest to them. This study aims to analyse and understand the experiences of autistic women with their family and friends throughout the diagnostic process and subsequent help-seeking endeavors. A total of 21 Spanish autistic women aged between 20 and 58 years answered a series of open-ended questions—respecting the participants' preferred modality. From the thematic analysis, two main themes emerged regarding the reactions of family and friends, dividing the experiences into two temporal phases: when disclosing the diagnosis and sometime later. Most participants noted that their relatives did not believe them, reacted in a hostile way, or did not give it any importance at the time of disclosure. As a result, their relationship deteriorated even further over time. In contrast, their friends served as pillars of support from the beginning, along with their partners and the associations they attended, because of which they met more autistic women who became their “family”. Thus, another consequence of late diagnosis in autistic women is highlighted, the incomprehension or disbelief from their relatives, and the important role of friendships among women and among autistic women.

The authors report the natural history of three patients with late-diagnosed Classic Galactosemia (CG) (at 16, 19 and 28 years). This was due to a combination of factors: absence of neonatal screening, absence of some typical acute neonatal symptoms, and negative galactosemia screening. This report underlines the value of neonatal screening and the importance of further diagnostic testing in case of late-onset manifestations.

Hirschsprung Disease (HD) is typically diagnosed in the neonatal period. A small subset of patients have a prolonged course of abdominal distention and constipation prior to diagnosis. Late HD is defined as having been diagnosed at greater than or equal to one year of age. The literature is limited and offers conflicting data on the implications of a late diagnosis. We aim to investigate the presentation, operative approach, and functional outcomes of a large cohort of patients with a late HD diagnosis. All patients with a late diagnosis of HD (after 1 year of age) at our institution between 1997 and 2021 were included. Twenty-eight patients were diagnosed with HD at a median age of 3.4 years. Chronic constipation, failure to thrive, and enterocolitis occurred in 100 %, 31 %, and 14 %, respectively. All patients underwent contrast enema and biopsies during their workup, identifying primarily rectosigmoid disease (n = 27) and total colonic aganglionosis (n = 1). Surgical intervention was performed in 27 patients, with 4 patients (15 %) needing a stoma (3 with plan for staged pull-through, 1 long-term stoma) and 23 patients (85 %) undergoing a single-stage pull-through. Postoperative complications included Hirschsprung-associated enterocolitis (n = 5), ostomy prolapse and revision (n = 2), abdominal distention requiring ileostomy creation (n = 2), redo pull-through (n = 2), retroperitoneal hematoma (n = 1), and cecostomy tube placement (n = 1). At a median follow-up of 5.4 years, 83 % of eligible patients achieved fecal continence with 43 % needing laxatives for persistent constipation. Recognizing a late presentation of HD requires a high index of suspicion. Patients with a late diagnosis did not experience an increased rate of permanent stoma, complications, or redo surgery compared to rates reported for the larger HD population. Similar long-term functional outcomes were achieved compared to the larger HD population. IV. • Late diagnosis of Hirschsprung Disease is marked by a long-standing history of constipation with most patients having rectosigmoid disease. • Immediate post-operative and long-term functional outcomes in patients with a late diagnosis of Hirschsprung Disease are comparable to outcomes in the larger population with Hirschsprung Disease. [ABSTRACT FROM AUTHOR]

Undiagnosed HIV infection is a prominent clinical issue throughout Europe that requires the continuous attention of all healthcare professionals and policymakers to prevent missed testing opportunities and late diagnosis. This systematic review aimed to evaluate interventions to increase HIV testing rates and case detection in European hospitals. Out of 4598 articles identified, 29 studies fulfilled the selection criteria. Most of the studies were conducted in single Western European capital cities, and only one study was from Eastern Europe. The main interventions investigated were test-all and indicator-condition-based testing strategies. Overall, the prevalence of undiagnosed HIV was well above 0.1%. The studied interventions increased the HIV testing rate and the case detection rate. The highest prevalence of undiagnosed HIV was found with the indicator-condition-driven testing strategy, whereas the test-all strategy had the most profound impact on the proportion of late diagnoses. Nevertheless, the HIV testing rates and case-finding varied considerably across studies. In conclusion, effective strategies to promote HIV testing in European hospitals are available, but relevant knowledge gaps regarding generalizability and sustainability remain. These gaps require the promotion of adherence to HIV testing guidelines, as well as additional larger studies representing all European regions. [ABSTRACT FROM AUTHOR]

The article describes, from a first-person female perspective, the experience of an autism diagnosis in adulthood and the attempt to cope with it and build a new identity through visual art. Once again, it has been shown that contemporary art, by publically presenting minority experiences, can be an ideal tool for discourse on socially up-to-date issues and may cause a change in attitudes. Therefore, the artistic activism of minority representatives is vital. In the last few years, more and more autistic women worldwide have been diagnosed in adulthood. Many autistic females are not understood by the social environment or even therapists – because knowledge of autism is mainly built on its male phenotype. Autistic women diagnosed in (late) adulthood are trying to build their new autistic identity in various ways, including creative and artistic actions. Art activities seem beneficial in meaning-making the experience of being on the spectrum. Publicly displaying one's artistic creations addressing the topic of autism is a form of social activism and may result in challenging stereotypes– as shown in this article by the example of the exhibition of a female artist on the spectrum in a contemporary art gallery. [ABSTRACT FROM AUTHOR]

Breast cancer is the first cancer in women in terms of incidence and mortality. In Morocco, it is a public health problem. Its prognosis is strongly linked to the stage at which it is diagnosed. It is a pathology for which diagnosis means are highly developed today, ranging from early detection to the demonstration of infra-clinical lesions, which has markedly improved the prognosis in developed countries. This work aims to identify the factors that lead patients to consult at an advanced stage in our daily practice. It is a retrospective study carried out from January 2018 to December 2018 including 525 patients with breast cancer followed in the medical oncology department of the Mohammed VI University Hospital in Marrakech. The average age was 54. The average time for consultation was 10.3 months. 63% of patients were from rural areas. Delayed diagnosis affected women above 35 years of age (80%). The most common method of detection was selfexamination in 74% of cases. Inflammation (2.66%), ulceration (1.14%), signs of metastases (17.14%), and isolated breast nodes (79.4%) were other reasons for consultation. 82.2% of patients were locally advanced at the time of diagnosis. The time for treatment in our study was 3.7 weeks. In our practice, it is the conjunction of ignorance, poverty, socio-cultural habits, and difficult geographical access that are the essential factors in the late diagnosis of breast cancer. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Facultad de Medicina Humana is the property of Instituto de Investigaciones en Ciencias Biomedicas de la Universidad Ricardo Palma and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Introduction The age of diagnosis is crucial for optimal health outcomes; however, some individuals with Autism Spectrum Disorder (ASD) may not be diagnosed until adulthood. Limited information is available about the lived experience of receiving a diagnosis during adulthood. Thus, we aimed to investigate stakeholders’ experiences about the ASD diagnosis during adulthood. Method We interviewed 18 individuals including 13 adults with ASD who had received a late diagnosis during adulthood and 5 parents of individuals with ASD from various Canadian provinces. Results Using a thematic analysis, three main themes emerged: (a) noticing differences and similarities, (b) hindering elements to diagnosis, and (c) emotional response to diagnostic odyssey. Conclusion This study adds to the literature about experiences of receiving ASD diagnosis in adulthood. Given the impact of diagnosis on individuals, it is important to minimize the barriers to ensure individuals who require ASD-related supports can access them in a timely and effective manner. This study highlights the importance of receiving an ASD diagnosis and facilitates positive health outcomes. The findings from the current study can be used to guide adult diagnostic processes and practices to help make ASD diagnosis more accessible.

Despite remarkable improvement in the human immunodeficiency virus (HIV) and hepatitis C virus (HCV) care continuum, the rate of late diagnosis of HIV and HCV in high-income countries remains unacceptably high. Testing relies mainly on primary care physicians’ identification of risk factors. We aimed to adapt an analogic to an online questionnaire to help HIV and HCV screening and perform a pilot study to assess its accuracy and acceptability. We used the Delphi method to adapt a previously validated analogical questionnaire to a user-friendly online tool. It aimed to identify participants who should be screened for HIV or HCV and those who should be referred for pre-exposure prophylaxis (PrEP). We then designed a proof-of-concept pilot study from July to October 2022 to test its feasibility and suitability for use on a larger scale and to assess its accuracy in identifying patients at risk for HIV or HCV or with indication for PrEP. The final questionnaire consisted of 37 questions. A total of 142 participants provided informed consent, and 102 completed the questionnaire: 41 random patients recruited at the primary care level, 10 participants recently diagnosed with HIV, 20 participants with HIV on follow-up, 21 participants from the PrEP program, and 10 patients diagnosed with HCV. The tool adequately indicated the need for testing in more than 98% of participants with confirmed HIV/HCV infections or in the PrEP program. Furthermore, it adequately assessed PrEP referral in 94% of participants already on PrEP or with known HIV infection. Participants were highly satisfied with the tool, and 98% of them recommended its use. A self-administered web-based tool to identify patients who should be tested for HIV or HCV or referred to PrEP could simplify patient selection and help reduce late diagnosis.

Introduction: This study aimed to identify factors associated with late diagnosis and clinically monitor newly diagnosed HIV/AIDS patients. Method: Retrospective study, based on secondary data from a specialized unit at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the University of Sao Paulo. Data collection included sociodemographic, behavioral, clinical, and laboratory data of newly diagnosed HIV patients between 2015 and 2019. Data analysis was undertaken using inferential statistical tests. Results: A total of 314 individuals were newly diagnosed with HIV/AIDS, 86.6% (272) had a late diagnosis and 53.8% (169) were diagnosed very late. Using the adjusted odds ratio, we observed that bisexual and MSM patients were less likely to have a late diagnosis compared to straight patients. Individuals who entered through the emergency department and Outpatient Clinic had a lower chance of having a very late diagnosis compared to those diagnosed in the ward/inpatient unit. Having a higher education and university education were protective factors against having a very late diagnosis of HIV infection compared to elementary school education only. In addition, male patients were more likely to have a very late diagnosis compared to female patients. Conclusions: This study evidenced a high prevalence of late and very late diagnoses. Therefore, attention should be directed towards factors related to late and very late presentation. [ABSTRACT FROM AUTHOR]

Maxillofacial trauma is a serious problem that has progressively increased. According to data from the World Health Organization, traumas are among the main causes of illness and death. It is estimated that, in 2010, there were about 8.5 million deaths due to the consequences of these worldwide, and head and face injuries may have been responsible for half of these traumatic deaths. This article consists of an integrative review, in which it aims to discuss the possible complications caused by the late treatment of Le Fort type fractures, aiming at raising the awareness of health professionals and patients about the importance of early treatment. This is an integrative review, in which a search was carried out in the databases. Delayed treatment of Le Fort-type fractures can lead to a series of significant complications, affecting both the patient's functionality and esthetics. Le Fort fractures are complex facial injuries that involve the maxilla region, an essential part of the facial bone structure. In short, Le Fort-type fractures represent a complex challenge in the field of maxillofacial trauma. Its classification into different types helps in understanding the anatomical areas involved. [ABSTRACT FROM AUTHOR]

Copyright of Health & Society is the property of Instituto de Ensino e Pesquisa Periodicojs and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. It is generally diagnosed and surgically repaired early in life, with good overall outcomes. Case presentation We report the case of a patient incidentally diagnosed with paucisymptomatic TOF at the age of 56 years old, during investigations for carbon monoxide poisoning. The patient had a history of thyroidectomy, arterial hypertension, and four uncomplicated vaginal deliveries. Conclusions This case shows us that some patients with TOF can reach older ages without surgical correction. Late surgical repair should be meticulously decided on a case basis.

Abstract Background Breast cancer is the most frequently diagnosed cancer in women worldwide. The objective of this study was to identify factors associated with late diagnosis of breast cancer in Togolese women. Methods We conducted a prospective cross-sectional study with descriptive and analytical purposes on cases of breast cancer in women in 2021, in Togo. The patients included in this study were women followed in the gynecology department for stages III and IV breast cancer. Results We included 62 cases of breast cancer. The average age of the patients was 38.6 ± 12.5 years with extremes of 17 and 76 years. The breast nodule was the most common reason for consultation in 75.8% of cases. The histological types diagnosed were invasive carcinoma of non-specific type (58; 93.55%), mucinous carcinoma (3; 4.84%) and lobular carcinoma (1; 1.61%). For the stage of the cancer, 43 patients were stage III (69.4%) and 19 stage IV (30.6%). In multivariate analysis, the factors associated with late diagnosis of breast cancer were: fear of diagnosis (aOR = 1.29; p = 0.0014), long delay in diagnosis (aOR = 2.62; p = 0.0001) and failure to perform breast self-examination (aOR = 1.68; p = 0.0022). Conclusion The fear of the diagnosis, the absence of self-examination of the breasts and the use of traditional treatment and self-medication in first intention constituted the essential factors of the late diagnosis of breast cancer. Strategies should be put in place at the national level to impact on these factors for an early diagnosis of breast cancer.

Abstract Background Treatment as prevention evolved into the universal HIV test-and-treat (UTT) strategy, which entails testing to the general population and treatment to every people living with HIV. We investigated universal testing (UT) performance and its determinants in urban Ethiopia and explore magnitude of late diagnosis and its impact on disease stages. Method We used data from the Ethiopia Population Based HIV Impact assessment (EPHIA), conducted in 2017/2018 which was a cross-sectional and household-based study. For current analysis, we considered self-report first diagnosis to estimate universal testing irrespective of their serostatus and also consider HIV LAg avidity vs viral load vs plasma antiretroviral drug level algorithm to categorize the late diagnosis. We finally evaluate disease stages using CD4 count and viral load. A 2-level multilevel mixed-effect logistic regression model was employed. The effects of individual-level predictors were quantified by the estimates from the fixed-effect part of the model with p-value

Background: Esophagus cancer is cancer of poor prognosis, of often late diagnosis. The objective of this study was to describe the factors associated with esophagus cancers in the Togolese population. Methods: It was a retrospective descriptive, cross-sectional study, on esophagus cancers histologically diagnosed at the Pathological Laboratory of Lomé over a period of 31 years (1990-2021). Results: We have collected 144 cases of esophagus cancer. The average age of patients was 57 ± 12 years, and the sex ratio was 2.34. The most applicant service was the service of Hepato Gastroenterology of CHU Campus (30.6%). Alcohol (57.6%), tobacco (45.8%) were the most present risk factors. Biopsies were the most addressed (97.2%). The average duration of symptom evolution was 6.42 months and the main symptom at the time of diagnosis was dysphagia (36.8%). The location of cancer was the lower third for 71.5% of cases. At histology, epidermoid carcinoma was the dominant type (90.3%). Male sex was statistically associated with the occurrence of epidermoid carcinoma and female sex with the occurrence of adenocarcinoma (P <.001). Alcohol, smoking, and consumption of hot foods were statistically associated with the occurrence of epidermoid carcinoma in this study (P <.05). Conclusion: Esophagus cancer remains a serious condition for late diagnosis. These are mainly epidermoid carcinomas and having alcohol and tobacco as risk factors. The awareness of the population on the main risk factors would reduce the incidence of oesophagus cancers within the Togolese population. [ABSTRACT FROM AUTHOR]

Female Phenotype Theory (FPT) suggests that autistic women often present with less obvious social impairments than autistic men. We examined the possibility of an exaggerated female phenotype among undiagnosed but probably autistic women. In two nationwide online surveys, we compared self-reported social functioning and mental health between diagnosed autistic women and women without diagnosis who scored ≥ 32 on the Autism Quotient. Compared to diagnosed autistic women, probably autistic women had higher empathy and general social functioning, and were more likely to have received a diagnosis of Borderline Personality Disorder. Autistic women had typically received more mental health diagnoses prior to their ASC diagnosis than autistic men. These findings shed light on the history of misdiagnosis experienced by many autistic women. [ABSTRACT FROM AUTHOR]

Background and Objectives: Type I dentin dysplasia (DD-I) is a rare genetic disorder with autosomal dominant or recessive inheritance at risk of late or long-misunderstood diagnosis because the teeth, compared to other degenerative dentin diseases, do not have coronal defects and/or alterations but only at the root level (absent, conical, pointed roots, and obliterated pulp canals). The first radiographic suspicion often occurs only in case of sudden mobility and/or abscesses of the permanent teeth. Genetic tests confirm the diagnosis. Case Presentation: This case report describes the oral and radiographic characteristics of two siblings, 12 and 10 years old, a male and a female, at an early age affected by DD-I, whose diagnosis was made for a first orthodontic visit. The father and the older child had already undergone dental and orthodontic treatments, respectively, without the disease being suspected by the dentist. Results: Genetic tests support the diagnosis of DD-I. Following the diagnosis, the patients began a process of close periodic checks every 3–4 months to monitor their situation. The male child lost upper lateral incisors, which were then replaced with a light nylon removable prosthesis. Conclusions: The ability to recognize the radiographic features characteristic of DD-I is very important to avoid prejudicial diagnostic delays and to be able to plan the long-term treatment of these patients better, especially when the pathology was primarily misrecognized in the family. [ABSTRACT FROM AUTHOR]