Congenital hypothyroidism is a common inborn endocrine disorder. The majority of cases are asymptomatic, meaning that its DIAGNOSIS may be missed especially in settings where newborn screening is absent. We present a DELAYED DIAGNOSIS case of congenital hypothyroidism and emphasize on the need for high levels of suspicion in order to aid prompt DIAGNOSIS and treatment. Our case is a 3 years and 4 months old male, who was first presented at 5 months of age due to poor growth. He passed meconium after the fourth day of life, developed jaundice in the first week of life, and slept a lot in his neonatal period. He had coarse faces, protruding tongue, widened anterior fontanelle and herniation of umbilicus. He was started on oral 50 micrograms of levothyroxine daily. In resource-limited settings where universal newborn screening is absent, healthcare workers should have a high level of suspicion in picking up the early signs of the condition.

Background and Objectives Investigating the changes in CT scans of patients is one of the most important methods to determine the prognosis of patients with head trauma, which has been considered by researchers. The aim of this study was to determine the findings of DELAYED CT scan in blunt head trauma patients referred to Shahid Bahonar Hospital of Kerman in 2020. Methods This was a descriptive-analytical study. All patients with blunt head trauma underwent the initial Brain CT based on indications according to the guideline after six Hour of monitoring in the emergency room if they hadnchrt any discharge conditions based on the indications in the guideline The brain controls CT was performed. Findings were analyzed by SPSS25 software. Chi-square, Independent T test, ANOVA and logistic regression were used. Results The results showed that 98. 5% of the participants had no changes in their control CT scan. In the change group, 40% of cases had decreased hemorrhage, 35% of cases had increased hemorrhage and 25% of them had new intracranial hemorrhage. There was not also a statistically significant relationship between gender, drug history, outcome, initial CT-Scan findings, age, GCS score, systolic blood pressure, heart rate and duration with CT changes (in unchanged, exacerbated, recovered groups) (P> 0. 05). But the results showed that the frequency of exacerbation of symptoms in people with underlying cranial disease was significantly higher than other groups (P=0. 05). Conclusion According to the results, it is possible that performing a primary CT scan in patients with head trauma in EDs is a good method for assessing the general condition of patients with mild to moderate trauma. However, evaluation of the necessity of control CT scan requires research with a larger sample size and longer follow-up

Introduction: The COVID-19 pandemic has significantly disruptd medical care globally. This study explores the impact of COVID-19 on DELAYED endoscopic procedures via Auckland District Health Board (ADHB). We aimed to investigate whether our patients could potentially be harmed by the lockdown with DELAYED DIAGNOSIS of gastrointestinal malignancy. Methods: All patients on endoscopy lists that were cancelled due to the COVID-19 initial level 4 lockdown were followed. When the DELAYED procedure was completed the endoscopy result and any histology results were collated. Results: 188 patients had their endoscopic procedure DELAYED. Of these, 15 patients had their procedure cancelled: 10 with symptom resolution requiring no further investigation; 1 moved out of ADHB area; 1 was overseas; 1 went private; 1 whose care was taken over by a different medical service, and 1 scheduling error (already had procedure before lockdown). 9 patients did not attend their rescheduled endoscopic procedure. 1 patient was excluded as the endoscopy was a planned colorectal operative procedure in theatre. As of 31 August 2020, 143 patients had completed their DELAYED procedure. The majority of patients had non-significant endoscopic findings but 2 patients were diagnosed with gastrointestinal malignancy (one caecal adenocarcinoma and one rectal adenocarcinoma). The delay in DIAGNOSIS from the cancelled procedure to the actual endoscopy was 75 and 63 days respectively. Conclusion: This study confirms the COVID-19 NZ lockdown did result in DELAYED DIAGNOSIS of gastrointestinal cancers at ADHB. It is too early to know whether this might lead to a worse outcome for those patients but, as the recent reinstitution of level 3 restrictions in Auckland have shown, COVID-19 is not going anywhere soon and we must be able to adapt to these trying conditions. Hence, this study highlights the need to utilise common sense and clinical judgement when triaging to endoscopy – delay or proceed?

Background: Ankylosing spondylitis (AS) is a chronic destructive and inflammatory disease of the axial skeleton manifested by back pain and progressive stiffness of the spine.Objectives: The aim of the present cross-sectional study was to evaluate and identify factors leading to DELAYED DIAGNOSIS of AS in Iranian patients.Patients and Methods: Sixty patients, (53 male, 7 female) with a DIAGNOSIS of AS according to the modified New York criteria were recruited. DIAGNOSIS delay was defined as the interval between a patient's first spondyloarthritic symptoms [inflammatory back pain (IBP), inflammatory arthritis, enthesopathy and uveitis] and a correct DIAGNOSIS of AS.Results: The average age of patients at DIAGNOSIS of AS was 36.4±4.5 years and the average of delay in DIAGNOSIS was 6.2±3.5 years. The most common DIAGNOSIS at the first visit was disc herniation (68.3%). Delay in DIAGNOSIS of Human Leukocyte Antigen (HLA-B27) positive and negative patients were 4.6±2.2 years and 10.1±3.2 years, respectively (P=0.0001). DIAGNOSIS delay in patients with morning stiffness and IBP were significantly shorter than that of patients without these symptoms (P=0.0001 and P=0.001 respectively). Patients with uveitis had the shortest DIAGNOSIS delay (P=0.02). The Bath Ankylosing spondylitis disease activity index (BASDAI) was not significantly different in early (<3years) and late (>3years) DIAGNOSIS (3.3±0.9 and 3.6±0.7 respectively) (P=0.18), but the Both ankylosing spondylitis functional index (BASFI) was significantly different between them (3.3±1.0 and 4.1±0.7 respectively) (P=0.001).Conclusions: In this study, delay in DIAGNOSIS was similar to other studies. Educating physicians to careful history taking especially in the case of IBP, non-musculoskeletal symptoms such as uveitis and precise physical examination are important in early DIAGNOSIS.

Background: Undescended testis (UDT) is the most common endocrine disorder in male children. DELAYED DIAGNOSIS and treatment of UDT lead to complications such as infertility, malignancy and testis rotation.Objective: The aim of this study was to evaluate the causes of delay in proper treatment of patients with undescended testis in our population.Materials and Methods: An observational, descriptive, cross sectional study of 143 male patients, who applied to Shahid Sadoughi University Hospitals for orchiopexy operation was performed. The maximum recommended age for orchiopexy was 18 months.Results: The mean age at referral was 5.34 years. Only 44 (30.8%) cases were operated on before the age of 18 months. The most common reasons of delay in treatment were absence of early diagnose (42.5%), parent's unawareness of surgery necessity and its complications associated (33.7%) and parent's disregard (23.5%). Only 19.6% of patients were diagnosed at born in the hospital. 49% of parents had the correct information for proper operation age and 40.6% of them had enough information about necessity of surgery and side effects of disease. Parent’s literacy, place of living and type of cryptorchidism had no significant relation with delay DIAGNOSIS (p>0.05).Conclusion: These results revealed that late DIAGNOSIS by physician and lack of insight of parents are the main reasons in DELAYED DIAGNOSIS and treatment of UDT. Therefore, education of parents and careful physical examination of the babies at birth and regular follow-up until 18 months can prevent the delay in DIAGNOSIS.

Background: DELAYED graft function is a main complication after deceased donor kidney transplantation that adversely affects graft outcome. Difficulties in prediction and early detection of DELAYED graft function have hindered the ability to perform proper therapeutic interventions. We investigated whether measuring urinary interleukin 18 and neutrophil gelatinase-associated lipocalin as markers of ischemia reperfusion injury could predict DELAYED graft function in deceased donor kidney transplant patients. Methods: We studied 69 patients undergoing kidney transplantation from deceased donor during early October 2013 to December 2014 at the Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Serial urine samples at 2, 24, and 48 h after transplantation were analyzed for interleukin 18 and neutrophil gelatinase-associated lipocalin levels. Results: Thirteen patients (18. 9%) developed DELAYED graft function. Urine interleukin 18 to urine creatinine ratio was significantly higher in patients with DELAYED graft function compared to those with non-DELAYED graft function, at 2 (P=0. 003), 24 (P<0. 001) and 48 h (P=0. 018) points. The levels of neutrophil gelatinase-associated lipocalin to urine creatinine ratio were significantly higher in the group with DELAYED graft function at the 24 (P=0. 004) and 48 h (P=0. 015) points. The receiver– operating characteristic curve analysis suggested that both urinary biomarkers at 24 h after transplantation had better accuracies for prediction of DELAYED graft function. In multivariate analysis, only urinary interleukin 18 to urine creatinine ratio improved the ability of clinical model for predicting DELAYED graft function. Conclusion: Urinary interleukin 18 to urine creatinine ratio at 24 h posttransplantation, along with traditional markers such as relative fall in serum creatinine, urine output and other risk factors for DELAYED graft function, increased the ability to predict DELAYED graft function.

Background: The tendency of myxofibrosarcoma (MFS) to have a non-nodular appearance on magnetic resonance imaging (MRI) may present a challenge in detection of local recurrence. Appropriate index of suspicion of expected imaging appearance can alleviate this challenge. Objectives: Our objectives were to determine if: 1) imaging pattern at recurrence is associated with DELAYED DIAGNOSIS, and 2) appearance at recurrence can be predicted based on appearance at presentation. Patients and Methods: A retrospective cohort study was performed. Two analysis groups were used: patients with recurrence captured on MRI (objective 1) and patients with MRI prior to resection and at recurrence (objective 2). Three radiologists scored images independently and in consensus as infiltrative (tail-like spread), focal (absence of spread), or mixed. Consensus results were used for analysis with Fisher’ s exact test. Results: There was substantial agreement among the 3 readers (k = 0. 72, 95% confidence interval: 0. 59-0. 85). Half of all infiltrative cases were associated with a delay in DIAGNOSIS, compared to 10% of mixed or focal cases; however, there was no statistically significant association between infiltrative pattern at recurrence and DELAYED DIAGNOSIS (P = 0. 08). In 70% of cases, recurrence had the same appearance as presentation, suggesting a trend; however, there was no association between appearance at baseline and recurrence (P = 0. 1). Conclusion: Imaging appearance at baseline does not reliably predict imaging appearance at recurrence. Therefore, a high index of suspicion for the infiltrative pattern is required in assessment of post-operative MRIs in patients with MFS.