Access to early diagnosis for attention-deficit/hyperactivity disorder among children and adolescents in Mexico City at specialized mental health services.

BACKGROUND: In Mexico, this pioneering research was undertaken to assess the accessibility of timely diagnosis of Dyads [Children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and their primary caregivers] at specialized mental health services. The study was conducted in two phases. The first phase involved designing an "Access Pathway" aimed to identify barriers and facilitators for ADHD diagnosis; several barriers, with only the teacher being identified as a facilitator. In the second phase, the study aimed to determine the time taken for dyads, to obtain a timely diagnosis at each stage of the Access Pathway. As well as identify any disparities based on gender and socioeconomic factors that might affect the age at which children can access a timely diagnosis. METHOD: In a retrospective cohort study, 177 dyads participated. To collect data, the Acceda Survey was used, based on the robust Conceptual Model Levesque, 2013. The survey consisted of 48 questions that were both dichotomous and polytomous allowing the creation of an Access Pathway that included five stages: the age of perception, the age of search, the age of first contact with a mental health professional, the age of arrival at the host hospital, and the age of diagnosis. The data was meticulously analyzed using a comprehensive descriptive approach and a nonparametric multivariate approach by sex, followed by post-hoc Mann-Whitney's U tests. Demographic factors were evaluated using univariable and multivariable Cox regression analyses. RESULTS: 71% of dyads experienced a late, significantly late, or highly late diagnosis of ADHD. Girls were detected one year later than boys. Both boys and girls took a year to seek specialized mental health care and an additional year to receive a formal specialized diagnosis. Children with more siblings had longer delays in diagnosis, while caregivers with formal employment were found to help obtain timely diagnoses. CONCLUSIONS: Our findings suggest starting the Access Pathway where signs and symptoms of ADHD are detected, particularly at school, to prevent children from suffering consequences. Mental health school-based service models have been successfully tested in other latitudes, making them a viable option to shorten the time to obtain a timely diagnosis.

A Multiplex and Colorimetric Reverse Transcription Loop-Mediated Isothermal Amplification Assay for Sensitive and Rapid Detection of Novel SARS-CoV-2.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a major threat to public health. Rapid molecular testing for convenient and timely diagnosis of SARS-CoV-2 infections represents a challenge that could help to control the current pandemic and prevent future outbreaks. We aimed to develop and validate a multiplex and colorimetric reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay using lyophilized LAMP reagents for sensitive and rapid detection of SARS-CoV-2. LAMP primers were designed for a set of gene targets identified by a genome-wide comparison of viruses. Primer sets that showed optimal features were combined into a multiplex RT-LAMP assay. Analytical validation included assessment of the limit of detection (LoD), intra- and inter-assay precision, and cross-reaction with other respiratory pathogens. Clinical performance compared to that of real-time reverse transcriptase-polymerase chain reaction (RT-qPCR) was assessed using 278 clinical RNA samples isolated from swabs collected from individuals tested for COVID-19. The RT-LAMP assay targeting the RNA-dependent RNA polymerase (RdRp), membrane (M), and ORF1ab genes achieved a comparable LoD (0.65 PFU/mL, CT=34.12) to RT-qPCR and was 10-fold more sensitive than RT-qPCR at detecting viral RNA in clinical samples. Cross-reactivity to other respiratory pathogens was not observed. The multiplex RT-LAMP assay demonstrated a strong robustness and acceptable intra- and inter-assay precision (mean coefficient of variation, 4.75% and 8.30%). Diagnostic sensitivity and specificity values were 100.0% (95% CI: 97.4-100.0%) and 98.6% (95% CI: 94.9-99.8%), respectively, showing high consistency (Cohen's kappa, 0.986; 95% CI: 0.966-1.000; p<0.0001) compared to RT-qPCR. The novel one-step multiplex RT-LAMP assay is storable at room temperature and showed similar diagnostic accuracy to conventional RT-qPCR, while being faster (<45 min), simpler, and cheaper. The new assay could allow reliable and early diagnosis of SARS-CoV-2 infections in primary health care. It may aid large-scale testing in resource-limited settings, especially if it is integrated into a point-of-care diagnostic device.

Espondiloartrosis cervical e hipertrofia del ligamento amarillo / Cervical Spondyloarthrosis and Hypertrophy of the Yellow Ligament

RESUMEN Introducción: La espondiloartrosis cervical es una enfermedad articular crónica degenerativa, es la afección articular más frecuentemente observada en la población madura y una de las principales causas de discapacidad en todo el mundo, por lo que es importante el diagnóstico y tratamiento en las fases tempranas. Objetivo: Informar un caso clínico representativo de espondiloartrosis cervical e hipertrofia del ligamento amarillo. Presentación del caso: Paciente femenina de 49 años que seis años atrás sufrió una caída, y se golpeó el occipucio contra la pared, lo que le provocó pérdida transitoria del conocimiento y dolor en la región cervical; tres años después comenzó con limitación a los movimientos laterales del cuello, malestar y dolor sordo, referido a la nuca y al cuello. Conclusiones: El diagnóstico de espondiloartrosis cervical e hipertrofia del ligamento amarillo representa un desafío clínico, por lo poco común de la enfermedad a esta edad. El caso presentado es una paciente con alteraciones estructuradas en el esqueleto axial y gran repercusión anatómica y funcional debido a un relativo diagnóstico tardío, con evolución insatisfactoria. Por tanto, conviene conocer la enfermedad para realizar una detección precoz y ofrecer mejor atención terapéutica(AU)

ABSTRACT Introduction: Cervical spondyloarthrosis is a chronic degenerative joint disease, it is the most frequent joint condition in the mature population and one of the main causes of disability throughout the world, so diagnosis and treatment in the early stages are important. Objective: To report a representative clinical case of cervical spondyloarthrosis and hypertrophy of the yellow ligament. Case presentation: A 49-year-old female patient suffered a fall six years ago, hitting her occiput against the wall, causing her temporary loss of consciousness and pain in the cervical region. Three years later, she began with limitation of lateral neck movements, discomfort and dull pain, referred to the nape and neck. Conclusion: The diagnosis of cervical spondyloarthrosis and hypertrophy of the yellow ligament represents a clinical challenge, due to the rare nature of the disease at this age. The case reported is a patient with structured alterations in the axial skeleton and great anatomical and functional repercussions due to a relatively late diagnosis, with unsatisfactory evolution. Therefore, it is convenient to know the disease in order to early detect it and to offer better therapeutic care(AU)

Validación de los instrumentos para medir factores que influyen en el diagnóstico leucemia linfoblástica en niños / Validation of instruments to measure factors that influence the diagnosis of lymphoblastic leukemia in children

La leucemia linfoide aguda (LLA) es el cáncer más frecuente en niños. A nivel mundial se estima que cerca del 30% corresponde a la totalidad de las neoplasias malignas que se presentan en niños y de estas, más del 75% son LLA. Por esto, nos vimos en la necesidad de elaborar un instrumento para medir factores que influyen en el diagnóstico. Porque un diagnóstico oportuno contribuye a mejorar la tasa de vida de estos pacientes. Objetivo: Validar instrumentos para medir los factores que influyen diagnóstico leucemia linfoblástica en niños. Metodología: Esta es una investigación mixta, corte transversal de tipo exploratorio. Diseño descriptivo no experimental. Para validar el instrumento cuantitativo se utilizó una muestra piloto con 15 padres de familia o representes de niños diagnosticados con leucemia linfoblástica aguda, seleccionado y elegido de forma aleatoria probabilística. Para el instrumento cualitativo se utilizó a una sola madre de un niño diagnosticado con leucemia, validado por juicio de cinco expertos, tres oncólogos con experiencia y 2 enfermeras magistradas con experiencia en oncología infantil y alfa de Cronbach. Resultados: Después de la revisión y validación de los instrumentos cuantitativo y cualitativos por los 5 expertos, la calificación obtenida es una puntuación de muy confiable 94,9 para el instrumento cuantitativo y una puntación de muy confiable de 96 puntos, para el instrumento cualitativo. Los puntajes alcanzados dan la seguridad para estructura y proceso, por medio del Coeficiente Alfa de Cronbach y validez de contenido y de constructo. Conclusión: estos instrumentos, quedan validados por juicio de expertos como herramientas muy confiables para obtener datos que se requieran para la investigación científica(AU)

Acute lymphoid leukemia (ALL) is the most common cancer in children. Worldwide, it estimated that about 30% corresponds to all malignant neoplasms that occur in children and of these, more than 75% are ALL. For this reason, we saw the need to develop an instrument to measure factors that influence the diagnosis. Because a timely diagnosis contributes to improving the life rate of these patients. Objective: To validate instruments to measure the factors that influence lymphoblastic leukemia diagnosis in children. Methodology: This is a mixed investigation, exploratory cross-section. Descriptive non-experimental design. A pilot sample used to validate the quantitative instrument, with 15 parents or representatives of children diagnosed with acute lymphoblastic leukemia, selected and chosen in a probabilistic random way. For the qualitative instrument, a single mother of a child diagnosed with leukemia was used, validated by the judgment of five experts, three experienced oncologists and two magistrate nurses with experience in childhood oncology and Cronbach's alpha. Results: After the review and validation of the quantitative and qualitative instruments by the five experts, the score obtained is a very reliable score of 94.9 for the quantitative instrument and a very reliable score of 96 points for the qualitative instrument. The scores achieved provide security for structure and process, through Cronbach's Alpha Coefficient and content and construct validity. Conclusion: Expert judgment validated these instruments as very reliable tools to obtain data required for scientific research(AU)

Frecuencia de lesiones orales y variantes de lo normal en pacientes del Departamento de Estomatología de la Universidad Autónoma de Ciudad Juárez / Frequency of oral lesions and variants of the normal in patients from the Department of Stomatology, Autonomous University of Ciudad Juarez

Introducción: La exploración intraoral detallada es la clave en el diagnóstico temprano de lesiones potencialmente agresivas; de estamanera, se le ofrece al paciente un tratamiento adecuado y oportuno,reduciendo al máximo posibles complicaciones que pongan en peligrosu integridad y deterioren su calidad de vida. Objetivo: Determinar la frecuencia de lesiones y condiciones de la mucosa bucal en pacientes mayores de 18 años de la clínica de diagnóstico del Departamento de Estomatología de la Universidad Autónoma de Ciudad Juárez, Chihuahua...

Introduction: A detailed intraoral examination is key in the early diagnosis of potentially aggressive lesions; in this way, the patient isoff ered an adequate and timely treatment, reducing to the maximumpossible complications that could endanger his integrity and deterioratehis quality of life. Aim: To determine the frequency of lesions and conditions of the buccal mucosa in patients older than 18 years of the diagnostic clinic of the Department of Stomatology at the Autonomous University of Ciudad Juarez, Chihuahua...

Oportunidade perdida para diagnóstico oportunista de diabetes mellitus em comunidades quilombolas do sudoeste da Bahia, Brasil / Missed opportunity for timely diagnosis of diabetes mellitus in Afrodescendant communities in the southwest of the state of Bahia, Brazil

O objetivo deste estudo foi estimar prevalência e fatores associados com oportunidade perdida para diagnóstico oportunista de diabetes (PDO) em comunidades quilombolas de Vitória da Conquista, Bahia. Trata-se de um estudo de corte-transversal de base populacional em amostra probabilística (n = 797). Para esta análise 548 indivíduos foram elegíveis considerando os critérios de risco: idade igual ou superior a 45 anos, índice de massa corporal elevado e hipertensão arterial. A prevalência de PDO foi estimada em 42,6%. Regressão logística demonstrou estarem estatisticamente associados, independentemente ao desfecho: autoavaliação de saúde boa/muito boa; não medir pressão arterial no último ano; não ter realizado consulta médica nos últimos doze meses; e, índice de acesso de serviços ruim. O elevado PDO apontado associou-se à baixa utilização e pior marcador de acesso aos serviços de saúde. Ações direcionadas ao diagnóstico e prevenção de DM devem priorizar populações de maior risco e incluir capacitação, treinamento das equipes de saúde da família e melhoria da estrutura e atenção nas unidades de saúde. Uma maior integração entre ações básicas de saúde e nível especia lizado pode impactar positivamente no diagnóstico precoce, e redução de possíveis complicações associadas a diabetes nesta população.

The scope of this study was to estimate the prevalence and associated factors of missed opportunities for timely diagnosis of diabetes mellitus in Afrodescendant communities in Vitoria da Conquista in the state of Bahia. It involved a population-based cross-sectional study based on a probability sample (n=797), where 548 individuals were eligible for analysis considering the risk criteria: age of 45 years old and above, increased Body Mass Index and hypertension. The prevalence of diabetes mellitus was estimated at 42.6%. Logistic regression indicated the following statistically associated factors: self-assessed good/very good health conditions; not measuring blood pressure and not consulting with a physician in the past twelve months; and poor access to health services. The high prevalence was associated with factors related to low utilization and poor access to health services. Actions for the diagnosis and prevention of diabetes should prioritize populations at risk, including better education and training of family health care teams, and improvement of attendance at health care units. Enhanced integration between primary and secondary health care actions can positively impact early diagnosis, treatment and reduction of potential complications associated with diabetes in this population.