Is concern for gynaecological alarm symptoms associated with healthcare-seeking? A Danish population-based cross-sectional study

Background Diagnosing cancer at an early stage increases survival, and for most gynaecological cancers the diagnostic pathway is initiated, when women seek medical attention with symptoms. As many factors influence healthcare-seeking, knowledge about these factors is important. Concern can act as a barrier or a trigger for women experiencing gynaecological alarm symptoms. This study aimed to examine whether concern for the symptom or the current health was associated with healthcare-seeking among women with gynaecological alarm symptoms. Methods Some 100,000 randomly selected Danish citizens were invited to a national web-based survey. The questionnaire included items regarding symptom experiences, healthcare-seeking and concern for the experienced symptoms and current health. This study included 5019 women with self-reported gynaecological alarm symptoms (pelvic pain, pain during intercourse, bleeding during intercourse and postmenopausal bleeding). Concern was reported on a 5-point Likert scale from ‘not at all’ to ‘extremely’. Data were analysed using multivariate logistic regression models. Results Women who were ‘extremely’ concerned about a gynaecological alarm symptom had two to six times higher odds of reporting healthcare-seeking compared to women who were ‘not at all’ concerned. Symptom concern was associated with higher odds of healthcare-seeking for all four gynaecological alarm symptoms and the odds increased with increasing levels of concern. Additionally, concern for current health was associated with higher odds of healthcare-seeking. Concern for current health as expressed by others was positively associated with healthcare-seeking but had only minor influence on the association between concern for current health and healthcare-seeking. Conclusions Concern for a gynaecological alarm symptom and for current health was positively associated with healthcare-seeking. The results can be used for future informational health campaigns targeting individuals at risk of postponing warranted healthcare-seeking.

Prevalence of Dysphagia in Dysphonic Patients with Non-Neoplastic Vocal Fold Lesions

Background Dysphagia is the swallowing difficulties and trouble to move liquids, solids, medications and may be saliva from the mouth down to the stomach and is considered a serious red flag or alarm symptom. Aim of the Work to examine the prevalence of dysphagia on basis of subjective and objective measures in patients with the presenting symptom of dysphonia and diagnosed with non-neoplastic vocal fold lesions to consider the potential benefit of swallowing therapy hand in hand with the chosen management line of voice problem in the treatment of these patients if proved to have high prevalence of dysphagia. Subjects and Methods This study was applied on 50 patients with age ranging from 15-50 years diagnosed as being dysphonic secondary to non-neoplastic vocal fold lesions on objective and clinical measures, attending at the Phoniatric outpatient clinic at El-Demerdash hospital and Ain Shams University Specialized hospital. Results After the application of the A-EAT-10 questionnaire on 50 dysphonic patients who were selected to participate in this study, 12 cases (about 24%) were considered dysphagic with score above 3 and underwent VFSS. Within these 12 patients, Zero percent were found complaining of dysphagia according to VFSS. So there is No Correlation between frequencies of dysphagia by A-EAT-10 and by VFSS. Conclusion The present study showed that non-neoplastic vocal fold lesions are not an etiological factor for dysphagia despite the intricacy in the neuromuscular supply of pharynx and larynx. Diagnosis of Dysphagia can’t be confirmed depending only on subjective screening tools like A-EAT-10.

10-years follow-up of patients with stomach cancer - diagnostic defects & dyspepsia as the earliest “alarm symptom”; results of the ”RADIUS” program (“early diagnosis of stomach cancer in dyspepsia”)

In 2019, a retrospective analysis of medical records for 10 previous years (2019-2009) was conducted for 426 patients with confirmed malignant neoplasm (MN) of the stomach registered in 125 outpatient and polyclinic medical and preventive treatment facilities in 12 cities of the Russian Federation. The average age of patients at the time of diagnosis was 61.9 years, the life expectancy after diagnosis being 2.2 years. In 67.4% of patients the diagnosis was made at stages III and IV of the disease. All patients had a history of any upper digestive tract pathology. The record of H. pylori c examination was detected in 16.9% of patients, all of them with positive results. In 64,3% of esophagogastroduodenoscopy (EGDS) protocols there were visible changes in the gastric mucosa. Dynamic EGDS control was performed irregularly. During the whole period of observation, an average of 2.5 biopsies per patient were taken during EGDS. In the clinical diagnosis of “chronic gastritis” morphological examination was performed in 70.0% of patients. Classical “warning signs” were registered on the average 2.4 years before the diagnosis of gastric cancer. Dyspepsia syndrome was registered 4.6 years before cancer verification. The correlation between dyspepsia and the timing of cancer diagnosis was confirmed. Thus, the dyspepsia syndrome can be categorized as “early warning signs”. For the diagnosis of gastric adenocarcinoma, 3D correlation analysis showed a correlation between the number of biopsy samples taken, the number of “warning signs” and the number of years lived after the diagnosis of malignant neoplasms.

Seorang penderita dengan enteropatik artritis

Abstrak. Enteropatik artritis adalah bentuk artritis yang terkait dengan penyakit peradangan usus kronis /irritable bowel disease (IBD) dengan manifestasi tersering berupa kolitis ulseratif, dan penyakit Crohn. Ini merupakan salah satu manifestasi klinis dari spondiloartritis seronegatif. Diare dan artritis merupakan dua hal yang sering muncul sebagai gejala klinis pada enteropatik artritis. Salah satu alarm symptom pasien enteropatik artritis adalah buang air besar (BAB) cair dan berdarah. Berikut dilaporkan seorang pasien dengan keluhan BAB berdarah yang disebabkan enteropatik artritis yang mendapat terapi non farmakologis dan farmakologis, pasien mengalami perbaikan secara klinis dan dapat menjalani terapi lanjutan secara optimal melalui poli rheumatologi. Kata kunci: Enteropatik artritis, diare berdarah, colitis Abstrak. Enteropathic arthritis is a form of arthritis which associated with chronic inflammatory bowel disease (IBD). The most common manifestations are ulcerative colitis and Crohn's disease. This is one of the clinical spectrum of seronegative spondylarthritis. Diarrhea and arthritis are two symptoms that often appear as clinical manifestation in enteropathic arthritis. One of the alarm symptoms of enteropathic arthritis patients is haematoschezia. In this article, we reported a patient with bloody diarrhea caused by enteropathic arthritis. He received non-pharmacological and pharmacological therapy, and experienced clinical improvement. He then can undergo optimal further therapy through poly rheumatology. Keywords: arthritis enteropathic, bloody diarrhea, colitis

Measurement of faecal haemoglobin with a faecal immunochemical test can assist in defining which patients attending primary care with rectal bleeding require urgent referral

Background Current guidelines document persistent rectal bleeding as an alarm symptom in patients presenting to primary care. We studied whether a faecal immunochemical test could assist in their assessment. Methods From December 2015, faecal immunochemical tests were routinely available to primary care when assessing patients with new-onset bowel symptoms: general practitioners were encouraged to include faecal haemoglobin concentration (f-Hb) within any referral to secondary care. Results with f-Hb ≥10 μg Hb/g faeces were defined as positive. The incidence of significant bowel disease (SBD: colorectal cancer [CRC], higher-risk adenoma [HRA: any ≥1 cm, or three or more] and inflammatory bowel disease [IBD]) at subsequent colonoscopy, referred symptoms and f-Hb were recorded. Results Of 1447 patients with a faecal immunochemical test result and colonoscopy outcome, SBD was diagnosed in 296 patients (20.5%; 95 with CRC, 133 with HRA, and 68 with IBD). Four hundred and sixty-two patients (31.9%) reported rectal bleeding: 294 had f-Hb ≥10 μg Hb/g faeces. At colonoscopy, 105/294 had SBD versus 14/168 with rectal bleeding and f-Hb <10 μg Hb/g faeces ( P < 0.0001), comprising one case of CRC (0.6%), 12 HRA (7.1%) and one new case of IBD (0.6%); further, the single cancer and 8 of the 12 HRA were located in the descending colon. Conclusion Patients with rectal bleeding and f-Hb <10 μg Hb/g faeces are unlikely to have SBD and could be investigated by sigmoidoscopy alone. Using the faecal immunochemical test to guide investigation of patients with rectal bleeding is a rational and practical way forward.

Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal bleeding in primary care: a cohort study

Background Rectal bleeding is considered an alarm symptom for colorectal cancer (CRC) but it is common and mostly caused by benign conditions. Qualitative faecal immunochemical tests (FITs) for occult blood have been used as diagnostic aids for many years in Sweden when CRC is suspected. The study aimed to evaluate the usefulness of FITs requested by primary care physicians for patients with and without histories of rectal bleeding, in the diagnosis of CRC. Methods Results of all FITs requested in primary care for symptomatic patients in the Örebro region during 2015 were retrieved. Data on each patient’s history of rectal bleeding was gathered from electronic health records. Patients diagnosed with CRC within 2 years were identified from the Swedish Cancer Register. The analysis focused on three-sample FITs, the customary FIT in Sweden. Results A total of 4232 patients provided three-sample FITs. Information about the presence/absence of rectal bleeding was available for 2027 patients, of which 59 were diagnosed with CRC. For 606 patients with the presence of rectal bleeding, the FIT showed sensitivity 96.2%, specificity 60.2%, positive predictive value 9.8% (95% CI 6.1–13.4) and negative predictive value 99.7% (95% CI 99.2–100) for CRC. For 1421 patients without rectal bleeding, the corresponding figures were 100%, 73.6%, 8.3% (95% CI 5.6–10.9) and 100% (95% CI 99.6–100). Conclusion The diagnostic performance of a qualitative three-sample FIT provided by symptomatic patients in primary care was similar for those with and without a history of rectal bleeding. FITs seem useful for prioritising patients also with rectal bleeding for further investigation.

Is healthcare-seeking with gynaecological alarm symptoms influenced by personal and professional relations? A Danish population-based, cross-sectional study

ObjectivesTo identify the personal and professional relations of women experiencing gynaecological alarm symptoms, to analyse if involving a personal relation is related to healthcare-seeking with gynaecological alarm symptoms, and to analyse if having an available social network is associated with involvement of this relation.DesignWeb-based, population-based, cross-sectional questionnaire survey.SettingThe general population in Denmark.ParticipantsThe study invited 100 000 individuals randomly drawn from the Danish Civil Registration System. Pregnant women and women who did not answer relevant questions about social network were excluded. A total of 5053 women who experienced at least one gynaecological alarm symptom were included in the study.Primary and secondary outcomes(1) Personal and professional relations that women experiencing gynaecological alarm symptoms involve; (2) the association between involving a personal relation and healthcare-seeking; and (3) the association between having an available social network and involvement of this relation.ResultsThe general practitioner (GP) was the most involved professional relation, while the spouse/partner was the most involved personal relation. When experiencing gynaecological alarm symptoms, more than 50% of women did not involve a professional relation and 20% did not involve a personal relation. For all four gynaecological alarm symptoms, the odds of involving the GP were higher in the oldest age group. Women were two to seven times more likely to involve their GP if they had personal relation involvement. No statistically significant association was found between having an available social network and involving the GP.ConclusionInvolving a personal relation in healthcare-seeking was associated with increased involvement of the GP, who consequently was the most involved professional relation when experiencing gynaecological alarm symptoms. Spouse/partner was the most involved personal relation. The oldest age group had the highest odds of involving the GP. No association was found between having an available social network and involving the GP.

The diagnostic value of a change in bowel habit for colorectal cancer within different age groups

Background Change in bowel habit as a sole alarm symptom for colorectal cancer is disputed. Objective We investigated the diagnostic value of change in bowel habit for colorectal cancer, particularly as a single symptom and within different age groups. Methods This retrospective cohort study examined colorectal cancer fast track referrals and outcomes across four Swedish hospitals (April 2016–May 2017). Entry criteria constituted one or more of three alarm features: anaemia, visible rectal bleeding, or change in bowel habit for more than 4 weeks in patients over 40 years of age. Patients were grouped as having only change in bowel habit, change in bowel habit plus anaemia/bleeding or anaemia/bleeding only. Results Of 628 patients, 22% were diagnosed with colorectal cancer. There were no cases of colorectal cancer in the only change in bowel habit group under 55 years, while this was 6% for 55–64 years, 8% for 65–74 years and 14% for 75 years and older. Among subjects under 55 years, 2% with anaemia/bleeding had colorectal cancer, this increased to 34% for 55 years and older ( P < 0.0001). Change in bowel habit plus anaemia/bleeding gave a colorectal cancer prevalence of 16% in under 55 years and increased to 30% for 55 years and older ( P = 0.07). Conclusion Change in bowel habit as the only alarm feature has a low diagnostic yield for colorectal cancer in patients under 55 years.

Difficulty swallowing

Dysphagia is a difficulty in the process of swallowing. Dysphagia is an alarm symptom, and therefore requires referral to secondary care for investigations. There are multiple causes, divided into oesophageal, neurological, surgical, and extrinsic obstruction. This chapter covers the approach to diagnosis, key diagnostic tests, therapies, prognosis, and dealing with uncertainty.

Clinical profile of cases of dysphagia presenting in ENT department: a study from rural tertiary care center

<p class="abstract"><strong>Background:</strong> Swallowing is a complex motor reflex requiring coordination among the neurologic system and muscles of the oropharynx and oesophagus. Disorders both benign and malignant may interfere with the process and cause dysphagia. We hereby undertake a study in a rural tertiary care centre to study the clinical profile of cases of dysphagia and to find the relative incidence of various etiologies of dysphagia.</p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted upon both out and indoor patients coming to Department of Otorhinolaryngology from January 2016 to January 2017 with predominant symptom of difficulty in swallowing for both solids, liquids or either. Detailed history &amp; examination was done. Further endoscopy, barium swallow, fine needle aspiration cytology (FNAC) &amp; biopsies were done as required. A total of 140 cases were taken into consideration. </p><p class="abstract"><strong>Results:</strong> The mean age was 52.5 years with 60% patients males and 40% females. The commonest etiology of dysphagia was Gastroesophageal reflux disease (GERD) occupying 28.57%of cases. Among them 65% werefemales majority in the age group of 45-55 years. The 2^nd common cause of dysphagia was growth pharynx 18.5% of cases. Among them 19 cases were diagnosed as growth oropharynx and 7 cases as growth supraglottis extending to hypopharynx. 88.46% were males and all were smokers. The 3^rd common etiology of dysphagia was obstructive oesophageal causes which included oesophageal malignancies, oesophageal webs, strictures and diverticula in the frequency of 16%, 3%, 3% and 6% respectively. Oesophageal malignancies were mainly adenocarcinoma, all males who were chronic smokers.</p><p><strong>Conclusions:</strong> Dysphagia is a commonly encountered clinical problem &amp; limited studies exist regarding the prevalence of dysphagia etiologies. It is an alarm symptom, malignancy should be ruled out, and warrants early intervention. </p>