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European Review For Medical and... Nov 2022Cervical cancer (CC) is a preventable women's cancer. Vaccination and routine Pap smear screening have reduced cervical cancer-related mortality by 70-80% in the world....
OBJECTIVE
Cervical cancer (CC) is a preventable women's cancer. Vaccination and routine Pap smear screening have reduced cervical cancer-related mortality by 70-80% in the world. The eradication of CC depends on identifying the disease early and removing barriers to its timely detection. This review study was designed to determine diagnostic delay and factors related to delayed CC diagnosis in the world.
MATERIALS AND METHODS
A comprehensive search was carried out in databases including Medline, Web of Science, Core Collection (Indexes = SCI-EXPANDED, SSCI, A & HCI Timespan), and Scopus for articles published up to December 2021. Publications were included if they reported data on the delayed CC, and factors related to diagnosis of CC in women. There was no time restriction in this review.
RESULTS
In total, 45 articles were entered into the study. In studies, advanced stages of CC (IIB to IV) varied from 10.2% to 87.9% due to delayed diagnosis. A delayed CC diagnosis was reported in 4.3%-89.1% of patients. The median and mean days of delayed diagnosis were 59-210 days and 2.92-10.5 months, respectively. Factors related to delayed CC diagnosis were categorized into three components including patient, medical history, and health system delay. Patient delay included socio-demographic, husband/ partner, and knowledge. Medical history included medical issues, obstetrics, and family history. Health system delays included health facilities and levels of accessibility.
CONCLUSIONS
There is an urgent need to shorten the diagnostic journey of CC patients by addressing all the components of diagnostic delay and developing strategies to modify the factors associated with these delays.
Topics: Pregnancy; Humans; Female; Uterine Cervical Neoplasms; Delayed Diagnosis; Vaccination; Obstetrics; Databases, Factual
PubMed: 36459029
DOI: 10.26355/eurrev_202211_30382 -
Annals of Plastic Surgery Apr 2019After nerve injury, disorganized or incomplete nerve regeneration may result in a neuroma. The true incidence of symptomatic neuroma is unknown, and the diagnosis has... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
After nerve injury, disorganized or incomplete nerve regeneration may result in a neuroma. The true incidence of symptomatic neuroma is unknown, and the diagnosis has traditionally been made based on patient history, symptoms, physical examination, and the anatomic location of pain, along with response to diagnostic injection. There are no formally accepted criteria for a diagnosis of neuroma.
MATERIALS AND METHODS
A literature search was performed to identify articles related to neuroma: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and Pubmed, Embase, and the Cochrane Library were searched for all relevant articles pertaining to neuroma. Articles were screened by title and abstract for relevance. If an article was considered potentially relevant, the full article was reviewed. After consideration, 50 articles were included in this systematic review.
RESULTS
No previous articles directly addressed diagnostic criteria for symptomatic neuroma. Factors related to neuroma diagnosis gleaned from previous studies include pain and cold intolerance (patient history), positive Tinel sign or diminished 2-point discrimination (physical examination findings), response to diagnostic nerve block, and presence of neuroma on diagnostic imaging (ultrasound or magnetic resonance imaging). Based on literature review, the importance and number of references, as well as clinical experience, we propose criteria for diagnosis of symptomatic neuroma. To receive a diagnosis of symptomatic neuroma, patients must have (1) pain with at least 3 qualifying "neuropathic" characteristics, (2) symptoms in a defined neural anatomic distribution, and (3) a history of a nerve injury or suspected nerve injury. In addition, patients must have at least 2 of the following 4 findings: (1) positive Tinel sign on examination at/along suspected nerve injury site, (2) tenderness/pain on examination at/along suspected nerve injury site, (3) positive response to a diagnostic local anesthetic injection, and (4) ultrasound or magnetic resonance imaging confirmation of neuroma.
CONCLUSIONS
The diagnosis of neuroma is based on a careful history and physical examination and should rely on the proposed criteria for confirmation. These criteria will be helpful in more precisely defining the diagnosis for clinical and research purposes.
Topics: Biopsy, Needle; Female; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Multimodal Imaging; Neuroma; Pain; Peripheral Nervous System Neoplasms; Physical Examination; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Tomography, X-Ray Computed; Ultrasonography
PubMed: 30855369
DOI: 10.1097/SAP.0000000000001796 -
Cancer Treatment and Research 2021Pain is indelibly associated with the cancer experience. A systematic review and meta-analysis indicate that the prevalence of cancer pain is 55% during anticancer... (Meta-Analysis)
Meta-Analysis
Pain is indelibly associated with the cancer experience. A systematic review and meta-analysis indicate that the prevalence of cancer pain is 55% during anticancer treatment, 66.4% in advanced, metastatic, or terminal disease, and 39.3% after curative treatment.
Topics: Cancer Pain; Humans; Neoplasms; Prevalence
PubMed: 34542872
DOI: 10.1007/978-3-030-81526-4_1 -
The European Journal of General Practice Dec 2022Many medical family history (FH) tools are available for various settings. Although FH tools can be a powerful health screening tool in primary care (PC), they are... (Review)
Review
BACKGROUND
Many medical family history (FH) tools are available for various settings. Although FH tools can be a powerful health screening tool in primary care (PC), they are currently underused.
OBJECTIVES
This review explores the FH tools currently available for PC and evaluates their clinical performance.
METHODS
Five databases were systematically searched until May 2021. Identified tools were evaluated on the following criteria: time-to-complete, integration with electronic health record (EMR) systems, patient administration, risk-assessment ability, evidence-based management recommendations, analytical and clinical validity and clinical utility.
RESULTS
We identified 26 PC FH tools. Analytical and clinical validity was poorly reported and agreement between FH and gold standard was commonly inadequately reported and assessed. Sensitivity was acceptable; specificity was found in half of the reviewed tools to be poor. Most reviewed tools showed a capacity to successfully identify individuals with increased risk of disease (6.2-84.6% of high and/or moderate or increased risk individuals).
CONCLUSION
Despite the potential of FH tools to improve risk stratification of patients in PC, clinical performance of current tools remains limited as well as their integration in EMR systems. Twenty-one FH tools are designed to be self-administered by patients.
Topics: Electronic Health Records; Humans; Medical History Taking; Primary Health Care; Risk Assessment
PubMed: 35510897
DOI: 10.1080/13814788.2022.2061457 -
International Journal of Dermatology Mar 2022Balloon cell melanoma (BCM) is a rare presentation of malignant melanoma characterized by large, foamy melanocytes lacking pigmentation. This is a comprehensive review... (Review)
Review
Balloon cell melanoma (BCM) is a rare presentation of malignant melanoma characterized by large, foamy melanocytes lacking pigmentation. This is a comprehensive review of the clinical, dermoscopic, and histological features among BCM cases reported in the literature. A systematic review of all case reports and series published since 1970 was conducted via MEDLINE, Embase, and Web of Science, using "balloon cell melanoma" and synonymous search terms. Our systematic search identified 76 cases (49% male, 51% female) of BCM in the literature. The mean age at presentation was 57.81 years. Prior skin cancer, particularly melanoma (47%), accounted for 58% of pertinent medical history. Prominent clinical exam findings included raised (46%), ulcerated (73%) lesions larger than 1 cm (68%) in the lower extremities (35%). Median Breslow thickness of primary BCM cases was 2.5 mm. Hairpin vessels (75%) and structureless architecture (75%) were predominant on dermoscopy. Notable histopathology included large (47%), vacuolated (58%) cells with foamy cytoplasm (62%) and conspicuous nucleoli (27%). Positive S-100 immunohistochemistry (73%) was most frequently employed to diagnose BCM. We observed 47% primary and 53% metastatic BCM cases. Of metastatic BCMs, balloon cells in the primary lesion were unknown in 48%, devoid in 33%, and present in 20% of cases. All metastases displayed predominant balloon cell morphology. BCM may represent an advanced phase in the progression of malignant melanoma. Improved awareness of BCM characteristics among clinicians may reduce the risk of misdiagnoses.
Topics: Dermoscopy; Female; Humans; Immunohistochemistry; Male; Melanocytes; Melanoma; Skin Neoplasms
PubMed: 33645660
DOI: 10.1111/ijd.15448 -
Clinical Neurology and Neurosurgery Apr 2017Cerebral small vessel disease is considered hereditary in about 5% of patients and is characterized by lacunar infarcts and white matter hyperintensities on MRI. Several... (Review)
Review
Cerebral small vessel disease is considered hereditary in about 5% of patients and is characterized by lacunar infarcts and white matter hyperintensities on MRI. Several monogenic hereditary diseases causing cerebral small vessel disease and stroke have been identified. The purpose of this systematic review is to provide a guide for determining when to consider molecular genetic testing in patients presenting with small vessel disease and stroke. CADASIL, CARASIL, collagen type IV mutations (including PADMAL), retinal vasculopathy with cerebral leukodystrophy, Fabry disease, hereditary cerebral hemorrhage with amyloidosis, and forkhead box C1 mutations are described in terms of genetics, pathology, clinical manifestation, imaging, and diagnosis. These monogenic disorders are often characterized by early-age stroke, but also by migraine, mood disturbances, vascular dementia and often gait disturbances. Some also present with extra-cerebral manifestations such as microangiopathy of the eyes and kidneys. Many present with clinically recognizable syndromes. Investigations include a thorough family medical history, medical history, neurological examination, neuroimaging, often supplemented by specific examinations e.g of the of vision, retinal changes, as well as kidney and heart function. However molecular genetic analysis is the final gold standard of diagnosis. There are increasing numbers of reports on new monogenic syndromes causing cerebral small vessel disease. Genetic counseling is important. Enzyme replacement therapy is possible in Fabry disease, but treatment options remain overall very limited.
Topics: Alopecia; Animals; Brain; Cerebral Infarction; Cerebral Small Vessel Diseases; Humans; Leukoencephalopathies; Spinal Diseases; Stroke
PubMed: 28254515
DOI: 10.1016/j.clineuro.2017.02.015 -
American Journal of Public Health Apr 2016To describe salient epidemiological characteristics of Zika virus outbreaks across the world and to examine the clinical presentations, complications, and atypical... (Review)
Review
OBJECTIVES
To describe salient epidemiological characteristics of Zika virus outbreaks across the world and to examine the clinical presentations, complications, and atypical manifestations related to their occurrence in recent history.
METHODS
We conducted a systematic review of the literature by searching through MEDLINE, Embase, and Global Health Library, as well as the epidemiological bulletins and alerts from the World Health Organization, the Pan American Health Organization, and the European Centre for Disease Prevention and Control over the period 1954 to 2016.
RESULTS
The search yielded 547 records. We retained 333 for further analysis, to which we added 11 epidemiological bulletins from various sources. Of these, we systematically reviewed 52 articles and reports, revealing some epidemiological features and patterns of spread of the Zika virus worldwide, as well as pathological outcomes suspected to be linked to Zika outbreaks. Neurologic disorders among zika patients were similar in Brazil and French Polynesia but a causal link is not established. Incidence of zika infection in pregnant women is not known. In Brazil, during the zika outbreak the incidence of microcephaly increased more than 20 times. Among 35 infants with microcephaly, born from women suspected to have Zika infection during pregnancy in northeast Brazil, 74% of the mothers reported rash during the first and second trimester.
CONCLUSIONS
On February 1, 2016, The World Health Organization declared the ongoing Zika crisis an emergency and that, although not yet scientifically proven, the link between the virus and growing numbers of microcephaly cases was "strongly suspected." However, the causal relationship between zika and microcephaly is not universally accepted. Public Health Implications. The current situation with regard to Zika is not encouraging, because there is no vaccine, no treatment, and no good serological test, and vector control remains a challenge.
Topics: Adult; Animals; Brazil; Disease Outbreaks; Female; Global Health; History, 20th Century; History, 21st Century; Humans; Infant; Microcephaly; Nervous System Diseases; Pregnancy; World Health Organization; Zika Virus; Zika Virus Infection
PubMed: 26959260
DOI: 10.2105/AJPH.2016.303112 -
The Cochrane Database of Systematic... Jun 2017Chronic idiopathic axonal polyneuropathy (CIAP) is an insidiously progressive sensory or sensorimotor polyneuropathy that affects elderly people. Although severe... (Review)
Review
BACKGROUND
Chronic idiopathic axonal polyneuropathy (CIAP) is an insidiously progressive sensory or sensorimotor polyneuropathy that affects elderly people. Although severe disability or handicap does not occur, CIAP reduces quality of life. CIAP is diagnosed in 10% to 25% of people referred for evaluation of polyneuropathy. There is a need to gather and review emerging evidence on treatments, as the number of people affected is likely to increase in ageing populations. This is an update of a review first published in 2004 and previously updated in 2006, 2008, 2011 and 2013.
OBJECTIVES
To assess the effects of drug therapy for chronic idiopathic axonal polyneuropathy for reducing disability and ameliorating neurological symptoms and associated impairments, and to assess any adverse effects of treatment.
SEARCH METHODS
In July 2016, we searched Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews in the Cochrane Library, MEDLINE, Embase, and the Web of Science. We searched two trials registries for ongoing trials. We also handsearched the reference lists of relevant articles, reviews and textbooks identified electronically, and we would have contacted authors and other experts in the field to identify additional studies if this seemed useful.
SELECTION CRITERIA
We sought all randomised or quasi-randomised (alternate or other systematic treatment allocation) trials that examined the effects of any drug therapy in people with CIAP at least one year after the onset of treatment. People with CIAP had to fulfil the following criteria: age 40 years or older, distal sensory or sensorimotor polyneuropathy, absence of systemic or other neurological disease, chronic clinical course not reaching a nadir in less than two months, exclusion of any recognised cause of the polyneuropathy by medical history taking, clinical or laboratory investigations, and electrophysiological studies in agreement with axonal polyneuropathy, without evidence of demyelinating features. The primary outcome was the proportion of participants with a significant improvement in disability. Secondary outcomes were change in the mean disability score, change in the proportion of participants who make use of walking aids, change in the mean Medical Research Council sum score, degree of pain relief and/or reduction of other positive sensory symptoms, change in the proportion of participants with pain or other positive sensory symptoms, and frequency of adverse effects.
DATA COLLECTION AND ANALYSIS
Two review authors independently reviewed the results of the literature search and extracted details of trial methodology and outcome data of all potentially relevant trials.
MAIN RESULTS
We identified 39 studies and assessed them for possible inclusion in the review, but we excluded all of them because of insufficient quality or lack of relevance. We summarised evidence from non-randomised studies in the Discussion.
AUTHORS' CONCLUSIONS
Even though CIAP has been clearly described and delineated, no adequate randomised or quasi-randomised controlled clinical treatment trials have been performed. In their absence there is no proven efficacious drug therapy.
Topics: Aged; Axons; Chronic Disease; Gait Ataxia; Humans; Leg; Polyneuropathies
PubMed: 28631805
DOI: 10.1002/14651858.CD003456.pub3 -
The Breast Journal 2023Idiopathic granulomatous mastitis is a rare and benign disease that primarily affects young women of reproductive age. Various factors have been suggested as possible... (Meta-Analysis)
Meta-Analysis Review
Idiopathic granulomatous mastitis is a rare and benign disease that primarily affects young women of reproductive age. Various factors have been suggested as possible causes, including pregnancy, breastfeeding, history of taking birth control pills, hyperprolactinemia, smoking, and history of trauma. Due to unknown etiology, opinions on its treatment have varied, resulting in differing recurrence rates and side effects. Therefore, conducting a comprehensive systematic review and meta-analysis can aid in understanding the causes and recurrence of the disease, thereby assisting in the selection of effective treatment and improving the quality of life. A systematic literature review was conducted using predefined search terms to identify eligible studies related to risk factors and recurrence up to June 2022 from electronic databases. Data were extracted and subjected to meta-analysis when applicable. A total of 71 studies with 4735 patients were included. The mean age of the patients was 34.98 years, and the average mass size was 4.64 cm. About 3749 of these patients (79.17%) were Caucasian. Patients who mentioned a history of pregnancy were 92.65% with 76.57%, 22.7%, and 19.7% having a history of breastfeeding, taking contraceptive pills, and high prolactin levels, respectively. Around 5.6% of patients had previous trauma. The overall recurrence rate was 17.18%, with recurrence rates for treatments as follows: surgery (22.5%), immunosuppressive treatment (14.7%), combined treatment (14.9%), antibiotic treatment (6.74%), and observation (9.4%). Only antibiotic and expectant treatments had significant differences in recurrence rates compared to other treatments ( value = 0.023). In conclusion, factors such as Caucasian race, pregnancy and breastfeeding history, and use of contraceptive hormone are commonly associated with the disease recurrence. Treatment should be tailored based on symptom severity and patient preference, with surgery or immunosuppressive options for recurrence.
Topics: Pregnancy; Female; Humans; Adult; Granulomatous Mastitis; Quality of Life; Breast Neoplasms; Neoplasm Recurrence, Local; Immunosuppressive Agents; Anti-Bacterial Agents; Contraceptive Agents; Recurrence
PubMed: 37794976
DOI: 10.1155/2023/9947797 -
BJU International Oct 2017Active surveillance (AS) is an increasingly prevalent treatment choice for low grade prostate cancer. Eligibility criteria for AS are varied and it is unclear if family... (Meta-Analysis)
Meta-Analysis Review
Active surveillance (AS) is an increasingly prevalent treatment choice for low grade prostate cancer. Eligibility criteria for AS are varied and it is unclear if family history of prostate cancer should be used as an exclusion criterion when considering men for AS. To determine whether family history plays a significant role in the progression of prostate cancer for men undergoing active surveillance, PubMed searches of 'family history and prostate cancer', 'family history and prostate cancer progression' and 'factors of prostate cancer progression' were used to identify research publications about the relationship between family history and prostate cancer progression. These searches generated 536 papers that were screened and reviewed. Six publications were ultimately included in this analysis. Review of the six publications suggests that family history does not increase the risk of prostate cancer progression, whilst a subgroup analysis in one study found that family history increases the risk of prostate cancer progression only in African-Americans. A family history of prostate cancer does not appear to increase a patient's risk of having more aggressive prostate cancer and is therefore unlikely to be an important factor in determining eligibility for AS. Further studies are needed to better understand the relationship between race, family history, and eligibility for AS.
Topics: Aged; Early Detection of Cancer; Genetic Predisposition to Disease; Humans; Incidence; Male; Middle Aged; Observational Studies as Topic; Patient Selection; Pedigree; Prostate-Specific Antigen; Prostatic Neoplasms; Risk Assessment; United States; Watchful Waiting
PubMed: 28371016
DOI: 10.1111/bju.13862