ABSTRACT
Objective: To explore the delay in the first diagnosis of tuberculosis patients in Macheng City from 2016 to 2018 and its influencing factors, so as to provide scientific basis for tuberculosis control. Methods A retrospective survey (face-to-face interview) was conducted on 372 new smear positive TB patients registered in the TB special report system of China's disease prevention and control information system from 2016 to 2018, Then the influencing factors of first visit delay were analyzed by single factor analysis and multi factor Logistic regression analysis. Results Among the 372 TB patients, 230 were delayed in the first diagnosis, the delay rate of the first diagnosis was 61.83%, the median delay time of the first diagnosis was 17.0d, and the average delay time was 37.74d.Multivariate logistic regression analysis showed that family financial difficulties (OR = 31.609, 95% CI: 7.240-138.010), no time (OR= 9.597, 95% CI: 2.014-45.729), not care (OR= 13.232, 95% CI: 2.978-58.804), Far away from the clinic (OR= 15.374, 95% CI: 2.896-81.616), non-agricultural occupational (OR = 31.4439, 95% CI: 4.398-224.8049), first visit in township (OR = 0.171, 95% CI: 0.037-0.785), the difference was statistically significant (P 0.05). Conclusion The first diagnosis delay rate of tuberculosis patients in Macheng City is high, some effective measures should be taken to minimize the first visit of TB patients.
ABSTRACT
Objective To analysis of multiple myeloma (MM) and non-MM patients with the same clinical manifestations but significant differences in laboratory findings at the first visit to the Emergency Medicine Department suggesting that patient should be rule out the possibilities of suffering from MM by the attending physicians engaging in a specialty other than hematology as soon as possible to avoid misdiagnosis of MM.Methods Retrospective analysis of clinical features of MM cases from February 2013 to December 2016.Patients with renal dysfunction (serum creatinine ≥ 177 mmol/L),infection,bone pain and anemia were divided into four groups.The non-MM patients with the same clinical symptoms were enrolled as control group.SPSS22.0 and Medcalce 15.10 software were used for analyzing the distinct difference and diagnostic validity of routine laboratory tests in patients with MM and non-MM.Results ①The patients with serum creatinine≥ 177 mmol/L,and unexplained renal insufficiency with blood Ca2+ ＞ 2.39mmol/L,ALB ≤ 30.31 g/L and Hb≤84 g/L should be investigated the possibility of MM.②The patient with poor response to the conventional treatment and unexplained infection with IgM ＜0.42 g/L and ALB≤32.7 g/L or ESR ＞ 82 mm/h and Hb ＜ 100 g/L should be investigated the possibility of MM.③The male patients with the first symptom in bone and joint pain associated with bone damage with urinary protein and blood,and the emergence of Ca2+ ＞ 2.39 mmol/L,ALB ＜ 37.5 g/L,Hb ＜ 104 g/L and TT ＞ 19.8 s were suggested to detect MM.④The poor respose to conventional treatment,unexplained anemia (Hb≤90 g/L),IgM ＜ 0.51 g/L,ALB ＜ 34.1 g/L and GLB ＞ 46.4 g/L suggested to detect MM.Conclusions On the basis of symptoms such as renal insufficiency,infection,bone pain,anemia,routine blood laboratory findings of high calcium,low IgM,low albumin,and high globulin,it was recommended that bone marrow biopsy be made to detect MM.
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Objective:To investigate the relationship between the department where patients with nasopharyngeal carcinomas was first admitted and the delayed diagnoses(or misdiagnosis).Methods:The data of 1998 cases of nasopharyngeal carcinomas were collected and analyzed.Results:The department of otolaryngology and the radiation oncology have the high correction rates for the first diagnosis,but misdiagnosis rates in departments of surgical,internal medicine and traditional Chinese medicine were very poor.Conclusion:The clinical knowledge about nasopharyngeal carcinomas was the most important factor for the first diagnoses.