RESUMO
Objective:To investigate the clinical and imaging features of population receiving opportunistic screening for lung cancer and in convalescent stage of COVID-19.Methods:Cross-sectional study and analysis was performed on the patients who underwent chest low-dose CT examination for cancer prevention in Cancer Hospital of Chinese Academy of Medical Sciences from December 28, 2022 to January 19, 2023. All the patients completed the COVID-19 questionnaire. A total of 334 questionnaires were sent out, all of which were recovered, and 321 valid questionnaires were collected, among them, 293 questionnaires were included in the analysis. Statistical analysis was conducted according to the questionnaire information, clinical symptoms and chest CT imaging results. The potential influencing factors of COVID-19 infection were explored, and the imaging characteristics of COVID-19 infection and early stage of lung cancer were compared.Results:A total of 293 patients underwent lung cancer screening during the convalescent stage of COVID-19 infection. A total of 231 (78.8%) cases had cough and 228 (77.8%) cases had fever. 214 (73.0%) cases still had clinical symptoms within 2 weeks after nucleic acid or antigen test showing negative, especially for cough in 171 (58.4%) cases, fatigue in 79 (25.3%) cases and sputum in 73 (24.9%) cases. There were 54 (18.4%) cases with positive chest CT changes. The main imaging findings showed that there were 46 cases with new patchy shadows, 25 cases with linear opacities, 10 cases with ground-glass opacities, 10 cases with nodular like shadows and 2 cases with consolidation, and most lesions were in the subpleural area of both lungs. Univariate analysis showed that positive CT findings were correlated with the time from positive detection of COVID-19 to screening ( P=0.026), age ( P<0.001) and underlying diseases ( P=0.006). Multivariate analysis showed that age≥65 years old ( OR=6.425, 95% CI: 2.688-15.358; P<0.001) and underlying diseases ( OR=2.292, 95% CI: 1.120-4.691; P=0.023) were risk factors for pulmonary imaging changes of COVID-19 infection. For lung cancer opportunistic screening, 36 (12.3%) cases showed ground-glass opacities in bilateral or unilateral lung lobes, among which 4 cases were suspected to be atypical adenomatous hyperplasia and 2 cases s were suspected to be early stage of lung cancer. Conclusions:Abnormal clinical symptoms and chest CT findings are still observed in the patients during the convalescent stage of COVID-19 infection. Age≥65 years, underlying diseases were the high-risk factors for the changes in chest CT imaging after COVID-19 infection. Attention should be paid to the differential diagnosis of chest CT findings between changes in the convalescent stage of COVID-19 and early stage of lung cancer.
RESUMO
Introduction: Hypertension and Diabetes are two of the most common chronic non-communicable diseases and multifactorial disorders affecting both developed and developing countries. Method: A cross sectional study was conducted for a period of 3 months among patients’ attendees above the age of 30 years in a tertiary care hospital of Mangalore, between July - September 2018. Data was collected from 150 patient attendees by personal interviews followed by anthropometry, blood pressure measurement and random blood sugar and entered into Microsoft excel. Analysis was done using Statistical package for social sciences (SPSS) software version 21. Results: It was seen that 72(48%) were Normotensive, 44 (29.3%) were Pre- hypertensive and 34 (22.7%) were Hypertensive while 65(43.3%) had a random blood sugar of > 140 mg/dl. There was an association between hypertension and age, gender, type of family, occupation, religion, alcohol intake, smoking habits and physical activity which was statistically significant (p< 0.05). While age more than 45 years, illiteracy, belonging to Christian faith, having a family history of diabetes mellitus and being obese/ overweight were associated with a random blood sugar of >140 mg/dl which was statistically significant (p< 0.05). It was also seen that 23(67.6%) of hypertensive attendees and 18(40.9%) of pre- hypertensive attendees also had diabetes as a comorbidity. Conclusion: Opportunistic screening of individuals for hypertension and diabetes will help in early detection of these diseases. This will help in early prevention and timely treatment
RESUMO
Objective:To explore whether the regular feedback system in opportunistic screening of colorectal cancer can improve the adenoma detection rate (ADR) of endoscopists.Methods:This study was an observational study, divided into three stages: the baseline stage before intervention (the pre-intervention period), the regular feedback stage (the intervention period) and the post-intervention stage (the post-intervention period). In the pre-intervention period, all patients who underwent opportunistic screening of colorectal cancer in Department of Gastroenterology in Beijing Shijitan Hospital Affiliated to Capital Medical University from June 2017 to May 2018 were reviewed, and the ADR of each endoscopist was calculated. In the intervention period from June 2018 to November 2018, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist during the previous month was calculated at the beginning of each month and feedback was provided in the form of a report. In the post-intervention period from December 2018 to January 2019, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist was calculated after the feedback stopped. ADR and polyp detection rate (PDR) of three stages were compared.Results:A total of 1 768, 1 308 and 344 patients were enrolled for opportunistic screening of colorectal cancer during the pre-intervention, the intervention and the post-intervention period respectively. Eight endoscopists participated in the whole process of this study. The total ADR increased from 23.70% (419/1 768) in the pre-intervention period to 33.72% (441/1 308) in the intervention period ( χ2=37.449, P<0.05). Two months after intervention, ADR decreased slightly to 33.14% (114/344), but was still higher compared with before ( χ2=13.602, P<0.05). The total PDR increased from 47.17% (834/1 768) in the pre-intervention period to 52.68% (689/1 308) in the intervention period ( χ2=9.111, P<0.05). Two months after the intervention, PDR increased slightly to 53.78% (185/344), and still higher compared with before ( χ2=5.035, P<0.05). Conclusion:Regular feedback to endoscopists can improve ADR in opportunistic screening of colorectal cancer.
RESUMO
Background: Cancer of the uterine cervix is the second most common cancer among women world-wide and accounts for 17% of all cancer deaths among females aged 30-69 years in India. Locally advanced cervical cancer is rampant in Bihar because of the high prevalence of associated risk factors. However, there is lack of organized screening programmes and treatment facilities for these patients. Thus, the study aimed at screening women for cervical cancer opportunistically during their visit to the health centres and to assess the various socio-demographic and other risk factors associated with positive screening test results.Methods: Using purposive sampling technique, all women aged 18-59 years who visited the centre for any purpose were interviewed using a pre-designed questionnaire. All eligible women were screened using the conventional Pap Smear and evaluation was done using the 2014 Bethesda system. This study is still underway and 71 women have been screened so far. An interim analysis was done.Results: Only 4.23% of the women ever had Pap smear testing in their life earlier. Mean age was 35.3±9.12 years and majority of the women were married and multi-parous. Vaginal discharge (55.74%) was the most common perceived gynecological morbidity. Most (36.62%) smears were reported as inflammatory cervical smears while epithelial cell abnormalities were seen in 4 (5.63%) cases.Conclusions: This study reiterates the need to start organized cervical screening program not only at tertiary center but also at primary health centers which will definitely help to reduce the burden to some extent
RESUMO
Background: Hypertension is a major public health problem in India and considered as a silent killer disease. The national program for prevention and control of cancer, diabetes, CVD and stroke (NPCDCS) recommended opportunistic screening for hypertension at all levels health facility. The present study was conducted with the objectives to estimate the magnitude of hypertension among the General OPD attendees aged 18 years and above in tertiary care hospital in a district of West Bengal and to find out the factors influencing hypertension among them.Methods: The study was a hospital based observational, descriptive study with cross sectional design and conducted among 244 study participants in 2018. Study variables included socio demographic factors and both modifiable and non-modifiable risk factors for hypertension.Results: In this study 40.2% subjects had normal blood pressure, 18.4% were known hypertensive and 101 (41.3%) people were newly diagnosed as having high blood pressure. Among known hypertensive, 75% had poor control of hypertension. Age, religion, family history of hypertension, body mass index (BMI) and central obesity had significant association with hypertension.Conclusions: The study recommended strengthening of opportunistic screening of all patients for hypertension at all levels of health care, especially through the village health nutrition day platform and providing treatment free of cost. Awareness generation and counselling for lifestyle modification should also be strengthened.
RESUMO
Background: Type2 diabetes is characterized by a long asymptomatic period commonly to be diagnosed when complications appear. The risk factors associated with diabetes are age, hypertension, dyslipidemia, smoking, alcohol, obesity & others. The role of early detection and adequate treatment of diabetes and related complications patients and health services is the basis for present study.Methods: The present study was conducted at S.N. Medical College, Agra, India on 86 consecutive newly diagnosed cases of type 2 diabetes. All individuals aged ≥ 20 years of age, who were not known diabetic, presenting to medicine department were included in the study for the targeted and opportunistic screening duration of January 2011 to June 2012.Results: The prevalence rates of vascular complications in this study group were analyzed statistically. The findings are the mean age was 54.27±9.27 years. 72.09% of newly diagnosed type 2 diabetes patients were aged above 50 years. Maximum number of patients were overweight (37.20%) followed by obese (32.55%). Hypertension was present in 30.23%, prevalence of CAD was 9.30%, and none had evidence of PVD and Cerebrovascular disease.Conclusions: Macrovascular complications were present in 9.30% of asymptomatic newly diagnosed type 2 diabetes patients. In the study present study found that there was a significant association of these risk factors were identified and treated as early as possible to decrease the progression of vascular complications.
RESUMO
Objective To investigate the role and significance of opportunistic screening in cervical cancer screening for elderly women aged≥65 years old. Methods The screening data of 1 304 elderly women (≥65 years old) who underwent opportunistic screening for cervical cancer at the Cancer Hospital, Chinese Academy of Medical Sciences, between January 1, 2010, and December 31 st, 2018, were analyzed retrospectively. Women who underwent cervical cytology tests and human papillomavirus (HPV) testing were divided into two groups according to age as following 65-69 and ≥70 years old. Women with abnormal cytology or who were hrHPV-positive were followed up. The cervical cytological abnormalities and high-risk HPV infection rates in women aged≥65 years in opportunistic screening were analyzed. Results Of all cases, 175 had abnormal cytology or were hrHPV-positive. Among the 1 304 women, 69 were TCT-positive, with a positivity rate of 5.3%, including 17 cases (24.6%) of high-degree squamous intraepithelial neoplasia and 3 cases (4.4%) of squamous cell carcinoma. The total abnormality rate of TCT in the 65-to 69-year age group (6.7%, 43 cases) was significantly higher than that in the≥70 age group (3.9%, 26 cases), and the difference was statistically significant between the two groups (P=0.024). The overall prevalence of hrHPV infection was 10.7% (139/1 304). HPV58 (31/174, 17.9%) was identified as the most common high-risk HPV type, followed by HPV16, HPV52, HPV33, and HPV31. Follow-up showed that 50.3% of the women had never been screened in the past 10 years, and no statistically significant difference in TCT abnormality and hrHPV infection positivity rate were found between those who had been screened (80 cases) and those who had not been screened at least once in 5 years (87 cases) (P>0.05). Conclusion Attention should be paid to the screening for cervical cancer in elderly women aged ≥65 years old. Opportunistic screening is a supplement to the population-based organized cervical cancer screening. The termination age of cervical cancer screening for elderly women may be appropriately extended.
RESUMO
The screening, early diagnosis and early treatment project of the upper gastrointestinal cancer had achieved good results since its launch. However, from a national perspective, the endoscopic screening of upper gastrointestinal cancer was still not optimistic, such as the poor rate of the early diagnosis, the low rate of 5-year survival in rural areas, and the disparity of the standardized screening and diagnosis in different areas. Therefore, the situation of upper gastrointestinal cancer prevention and treatment is still severe. Under the guidance of the "Healthy China 2030" plan, based on the international experience and domestic actual circumstance, it is suggested that the screening of high-risk population in high-risk areas should be changed into the opportunistic screening in primary medical institutions. The opportunistic screening could expand the coverage of the screening, early diagnosis and early treatment project of the upper gastrointestinal cancer, and increase the early diagnosis rate in rural areas and primary medical institutions, which could improve the 5-year survival rate of patients with the upper gastrointestinal cancer, and then achieve the sustainable development of the cancer prevention and treatment in China.
RESUMO
Background:Screening of colorectal cancer (CRC) and colorectal adenoma (CRA), the precursor of CRC, is crucial for CRC prevention.It is believed that opportunistic screening of CRC in high risk population would narrow down the screening scope and save the health resources, and is suitable for the present status in China.Aims:To analyze the performance of high risk factors in predicting CRC/CRA, for exploring the feasibility of opportunistic screening for CRC in high risk population.Methods:A total of 1 862 outpatients and health examination subjects undergoing colonoscopy from Feb.2015 to Aug.2016 at the PLA 281 Hospital were recruited and asked to complete a questionnaire of high risk factors for CRC and CRA before colonoscopy.The questionnaire was designed based on the updated consensus on the screening and management of early colorectal cancer and precancerous lesion in China.Using the results of colonoscopy as gold standard, the predictive performance of high risk factors for CRC/CRA was analyzed.Results:Four hundred and sixty-eight (25.1%) individuals with high risk factors for CRC/CRA were screened out by the questionnaire.The detection rate of CRC in individuals with high risk factors was significantly higher than those without (17.5% vs.0.9%, P=0.000).The sensitivity, specificity, positive and negative predictive values of high risk factors in predicting CRC were 87.2%, 78.2%, 17.5% and 99.1%, respectively, and the missed diagnosis rate was 12.8%.For CRC/CRA, the corresponding figures were 83.2%, 87.0%, 57.3%, 96.1% and 16.8%, respectively.The risk ratios (RR) of high risk factors for CRC and CRC/CRA were 20.35 and 14.78, respectively.Conclusions:Opportunistic screening of CRC in high risk population is feasible and applicable in China under present condition.
RESUMO
Detection and treatment of gastric cancer (GC) in early stages is the most effective approach for improving prognosis. Patients with early gastric cancer (EGC), defined as a type of cancer affecting only mucosa and submucosa, has a good prognosis in the long-term, and if some criteria are met, endoscopic therapy is curative. Unfortunately EGC diagnosis is rare, except in case of some Asian countries, where more than 50% of tumors are diagnosed in this stage. In Japan, the main technique for early diagnosis is opportunistic screening, i.e. endoscopy performed for different reasons. Some of the factors that affect endoscopic diagnose include: characteristics of the lesion (some cases slight changes in color or in the surface, a location that is difficult to detect, except in retro view); elements associated with the endoscopic technique (lesions hidden underneath gastric contents, non-systematic visualization, not enough time for exploration); and early access to the procedure (long waiting lists, lack of clinic or epidemiology screening criteria, lack of risk-stratification looking for pre-malignant lesions to establish endoscopic follow-up). Know and act upon the mentioned factors is a path that has proven to improve EGC diagnosis and therefore, improve prognosis.
Detectar y tratar el cáncer gástrico (CG) en una etapa inicial constituye la estrategia más efectiva para mejorar el pronóstico de esta patología. Pacientes con CG incipiente (CGI), definido como el que compromete sólo la mucosa y la submucosa, tienen un muy buen pronóstico a largo plazo y si se cumplen algunos criterios, el tratamiento endoscópico es curativo. Desgraciadamente el diagnóstico de CGI es infrecuente en todo el mundo, a excepción de algunos países asiáticos donde más de la mitad de los tumores se diagnostican en esta etapa. En Japón la principal vía por la que se realiza este diagnóstico precoz es mediante el tamizaje oportunista, es decir, la endoscopia que se realiza de manera cotidiana por diferentes motivos. Dentro de los factores que afectan la capacidad diagnóstica de la endoscopia destacan: las características de la lesión (algunos casos con discretos cambios de color o superficie, ubicación habitualmente en áreas de mejor visualización en retrovisión); factores asociados a la técnica endoscópica (contenido gástrico que puede ocultar lesiones, visualización no sistemática, tiempo insuficiente de exploración); y el acceso oportuno a ella (largas listas de espera, falta de criterios de selección clínicos o epidemiológicos, falta de estratificación del riesgo mediante la búsqueda de lesiones premalignas para definir intervalos de seguimiento endoscópico). Conocer y actuar sobre los factores descritos es un camino que ha demostrado su utilidad en mejorar el diagnóstico del CGI y así mejorar su pronóstico.
Assuntos
Humanos , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/diagnóstico , Estadiamento de Neoplasias , Neoplasias Gástricas/prevenção & controle , Neoplasias Gástricas/epidemiologia , Adenocarcinoma/prevenção & controle , GastroscopiaRESUMO
Crohn’s disease( CD)is a chronic,progressive and destructive intestinal inflammatory disease, frequently associated with tissue and functional damage in intestinal tract. There is no specific clinical feature at its early stage,30% ~ 50% of the patients are associated with various complications at the time of diagnosis and are quite difficult to cure. Opportunistic screening performed in high risk population is a valuable strategy for early finding(pre-lesion of CD) and early diagnosis( CD without complication). Colonoscopy and screening of serum and fecal markers might be the methods for early diagnosis. Early treatment may alter the natural history of the disease.
RESUMO
Objective To retrospectively analyze medical data of patients with colorectal cancer (CRC) so as to provide evidence for clinical use of opportunistic screening.Methods A total of 2450 CRC patients (male 1377,female 1073) who were treated at five hospitals in North China during October 2001 and September 2011 and had complete medical records and pathological results were recruited.The correlations of incidenceofCRCwithage,gender,tumorlocationandhistologicaltypeswere analyzed.Results Of all the CRC patients,those less than 50 years old accounted for 18.14％ ; and the incidence of CRC was substantially increased in those over 50 years old.Seventy-three percent of tumor occurred at the rectum and sigmoid colon,6％ at descending colon,7％ at transverse colon and 14％ at ascending colon.Moderately,well or poorly differentiated adenocarcinoma accounted for 50.33％,40.35％and 9.32％,respectively.Histological differentiation was not correlated with age and gender ( P ＞ 0.05 ).Conclusions Age and gender should not be considered a determination of opportunistic screening for CRC.Colonoscopy is recommended as an alternative CRC screening procedure.