Factors Contributing to the Delay in Diagnosis and Continued Transmission of Leprosy in Brazil – An Explorative, Quantitative, Questionnaire Based Study

Leprosy is a leading cause of preventable disability worldwide. Delay in diagnosis of patients augments the transmission of infection, and allows progression of disease and more severe disability. Delays in diagnosis greater than ten years have been reported in Brazil. To reduce this delay, it is important to identify factors that hinder patients from presenting to doctors, and those that delay doctors from diagnosing patients once they have presented. This study aimed to explore factors associated with the delayed diagnosis of leprosy in Brazil.This is an exploratory study using a self-constructed questionnaire delivered to patients attending three leprosy referral clinics across three states in Brazil. Data were analysed to determine associations between variables and the time taken for participants to present to the health-service, and between variables and the time taken for doctors to diagnose participants once they had presented. Participants who suspected they had leprosy but feared community isolation were 10 times more likely to wait longer before consulting a doctor for their symptoms (OR 10.37, 95% CI 2.18-49.45, p = 0.003). Participants who thought their symptoms were not serious had a threefold greater chance of waiting longer before consulting than those who did (OR 3.114, 95% CI 1.235-7.856, p = 0.016). Forty-two point six per cent of participants reported initially receiving a diagnosis besides leprosy. These had a three times greater chance of receiving a later diagnosis of leprosy compared to those not misdiagnosed or not given a diagnosis (OR 2.867, 95% CI 1.288-6.384, p = 0.010).This study implies a need for patient education regarding leprosy symptoms and the reduction of stigma to encourage patients to present. The high rate of misdiagnosis reported suggests a need to increase clinician suspicion of leprosy. Further education regarding disease symptoms in medical school curriculums may be advisable

Issues and challenges with information systems for asset management, maintenance and reliability

Technological changes have been happening in production facilities and infrastructure industries in an ever-increasing rate for asset management. maintenance and reliability. The use of an Asset Management System (AMS) in line with ISO55000 as a documented system and supported by information system is a long- term journey and development efforts will continue to be an essential part of its utilisation for retaining value of and realising value from assets. It is essential to regularly update information, systems and technologies to meet operational, legal, and regulatory requirements (Hastings, 2021). Data integrity is important factor in AMS. While changes are inevitable, the use of AMS must incorporate both the need to make changes, and the ability to exercise control over the validity of changes (Hastings, 2021). A management team that meticulously cares about its assets and incorporates a proactive culture by demonstrating leadership and providing necessary support for excellence to asset management supported by data driven risk informed decisions through effective utilisation of information systems is key to success of any organisation. Good practices in data collection, recording and analysis using user-friendly information system, capability and motivation are essential for risk informed and value driven decision making through systems, tools and technologies. This helps in moving to higher levels of asset management maturity and utilisation of information system for reducing costs, risks and enhancing performance. The scope of this article is limited to some sectors, their issues and challenges and related needs in this area from user perspective. It covers literature review along with reflections from industries on the current gaps, lessons learned and opportunities for improvements. © 2022 IEEE

Ordinal and logistic regression models for predictors of longer presentation time and delayed presentation respectively.

<p>Ordinal and logistic regression models for predictors of longer presentation time and delayed presentation respectively.</p

Frequencies and percentages for gender, grade of disability and region of participants’ first consultation with a medical professional.

<p>Frequencies and percentages for gender, grade of disability and region of participants’ first consultation with a medical professional.</p

Frequencies and percentages of participants’ personal and household incomes and highest level of education.

<p>Frequencies and percentages of participants’ personal and household incomes and highest level of education.</p

Ordinal and logistic regression models for predictors of longer diagnosis time and delayed diagnosis respectively.

<p>Ordinal and logistic regression models for predictors of longer diagnosis time and delayed diagnosis respectively.</p

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo