Comparative changes in emergency department patient attendance at the pediatric emergency hospital during the first wave between 2019 and 2020. / Cambios comparativos en la asistencia de pacientes al servicio de emergencia durante la primera ola en el Hospital de Emergencias Pediátricas entre el 2019 y 2020.

The COVID-19 pandemic changed the pattern of patient attendance at healthcare facilities. We describe the comparative changes in the attendance of pediatric patients at the Emergency Department of the Pediatric Emergency Hospital of Lima, Peru, between epidemiological weeks 10 to 48 of 2019 and 2020. Sociodemographic data, patient condition, type of insurance and diagnosis grouped according to ICD-10 code were analyzed. We found a 48.2% reduction in the number of visits in 2020 when compared to 2019, and a five-fold increase in the number of visits from localities other than Metropolitan Lima. Likewise, the probability of diagnosis of "infectious and parasitic diseases" increased by 27% and the probability of diagnosis of "diseases of the respiratory system" decreased by 61%.

La pandemia de la COVID-19 cambió el patrón de asistencia de los pacientes a los centros de salud. Se describen los cambios comparativos en la asistencia de pacientes pediátricos que acudieron al servicio de Emergencia del Hospital de emergencias Pediátricas de Lima, Perú, entre las semanas epidemiológicas 10 a 48 del 2019 y 2020. Se analizaron datos sociodemográficos, condición del paciente, tipo de seguro y diagnóstico agrupado según código CIE-10. Se encontró una reducción del 48,2% en el número de atenciones en el 2020 con respecto al 2019 y un aumento de cinco veces el número de atenciones procedentes de localidades diferentes de Lima Metropolitana. Asimismo, se encontró un aumento del 27% en la probabilidad del diagnóstico de «enfermedades infecciosas y parasitarias¼ y una disminución del 61% en la probabilidad de diagnóstico de «enfermedades del sistema respiratorio¼.

A Chikungunya Outbreak in a Dengue-endemic Region in Rural Northern Coastal Ecuador.

Dengue virus (DENV) reemerged in the Americas in the 1980s and 1990s, whereas chikungunya virus (CHIKV) emerged in 2014. Although CHIKV produced large epidemics from 2014 to 2017, dengue fever has been the prominent arboviral disease identified through passive surveillance, bringing to question the degree to which cases are misdiagnosed. To address this concern, we conducted an active household-based surveillance of arboviral-like illnesses in six rural and remote communities in northern coastal Ecuador from May 2019 to February 2020. Although passive surveillance conducted by the Ecuadorian Ministry of Health reported only DENV cases in the region, more than 70% of the arbovirus-like illnesses detected by active surveillance in our study were positive for CHIKV. These findings underline the need for active surveillance of arboviral infections with laboratory confirmation, especially in rural communities where arboviral illnesses are more likely to be underreported.

Cambios comparativos en la asistencia de pacientes al servicio de emergencia durante la primera ola en el Hospital de Emergencias Pediátricas entre el 2019 y 2020 / Comparative changes in emergency department patient attendance at the pediatric emergency hospital during the first wave between 2019 and 2020

RESUMEN La pandemia de la COVID-19 cambió el patrón de asistencia de los pacientes a los centros de salud. Se describen los cambios comparativos en la asistencia de pacientes pediátricos que acudieron al servicio de Emergencia del Hospital de emergencias Pediátricas de Lima, Perú, entre las semanas epidemiológicas 10 a 48 del 2019 y 2020. Se analizaron datos sociodemográficos, condición del paciente, tipo de seguro y diagnóstico agrupado según código CIE-10. Se encontró una reducción del 48,2% en el número de atenciones en el 2020 con respecto al 2019 y un aumento de cinco veces el número de atenciones procedentes de localidades diferentes de Lima Metropolitana. Asimismo, se encontró un aumento del 27% en la probabilidad del diagnóstico de «enfermedades infecciosas y parasitarias¼ y una disminución del 61% en la probabilidad de diagnóstico de «enfermedades del sistema respiratorio¼.

ABSTRACT The COVID-19 pandemic changed the pattern of patient attendance at healthcare facilities. We describe the comparative changes in the attendance of pediatric patients at the Emergency Department of the Pediatric Emergency Hospital of Lima, Peru, between epidemiological weeks 10 to 48 of 2019 and 2020. Sociodemographic data, patient condition, type of insurance and diagnosis grouped according to ICD-10 code were analyzed. We found a 48.2% reduction in the number of visits in 2020 when compared to 2019, and a five-fold increase in the number of visits from localities other than Metropolitan Lima. Likewise, the probability of diagnosis of "infectious and parasitic diseases" increased by 27% and the probability of diagnosis of "diseases of the respiratory system" decreased by 61%.

Association between lead source exposure and blood lead levels in some lead manufacturing countries: A systematic review and meta-analysis.

Lead is one of the 10 most toxic chemicals of greatest concern for its effects on public health. Predominantly, in undeveloped countries, high blood lead levels (BLLs) persist in the population. To develop intervention strategies that may reduce lead exposure in populations, it is a priority to know the sources of lead pollution. The objective of this critical review and meta-analysis is to assess whether there is an association between different sources of lead exposure and the mean difference in blood lead levels in people exposed. To identify the major lead source exposure, a statistical analysis was performed on selection studies. This investigation reveals the limited information available on the sources of lead in Mexico and other lead producer countries, such as Croatia, Ecuador, Brazil, South Korea, India, Nigeria, Turkey, and China. Meta-analysis could be performed only in battery, smelting mining, and glazed ceramic workers. Battery manufacturing workers have the highest mean difference level of lead in their blood worldwide. Mexico has the second highest mean difference BLL in battery workers in the world. An interesting difference between the mean difference in BLL in mining workers from uncontrolled industry (-39.38) and controlled industry (-5.68) was found. This difference highlighted the success of applying strict control of lead sources and community education to reduce BLL and its potential harmful effects on human health and the environment. Children living near mining sites have the highest mean difference BLL (-11.1). This analysis may aid in assessing the source of lead exposure associated with a range of BLLs in people. Furthermore, this review highlights several social and cultural patterns associated with lead exposure and lead levels in control populations. These results could help to develop international lead regulations and appropriate public health guidelines to protect people around the world.

[Helicobacter pylori infection and relationship with endoscopic findings in patients treated at a referral endoscopic center in Panama]. / Infección por Helicobacter pylori y relación con hallazgos endoscópicos en pacientes atendidos en un centro endoscópico de referencia en Panamá.

INTRODUCTION: Helycobacter pylori (HP) infection is a public health problem in Latin America with a prevalence of infection of up to 70%. There are endoscopic findings associated with the presence of infection, however we do not know the current prevalence in Panama and if the endoscopic findings are related to HP infection. OBJECTIVE: To assess the frequency of HP infection in patients who underwent upper gastrointestinal endoscopy and its association with HP infection. MATERIALS AND METHODS: An observational, cross-sectional and analytical study was carried out from January 1, 2019 to December 31, 2019 in the Gastroenterology service of Hospital Santo Tomás, Panama city. The frequency of HP infection in patients who underwent upper gastrointestinal endoscopy and the association of endoscopic findings with HP infection was evaluated. RESULTS: In total, 1,281 digestive endoscopies were performed. 21.4% of the patients included in the study confirmed HP infection. In endoscopic findings, the presence of nodular gastritis has an association OR 4.32 (2.74-6.80) with the presence of HP infection. The presence of duodenal ulcer and gastric ulcer were also significantly associated with the presence of HP infection, OR 3.71 (1.21-11.35) and OR: 2.59 (1.36-5.16). CONCLUSION: This is the first study in Panama to evaluate the association of endoscopic findings and the prevalence in a cohort of patients with an indication for upper endoscopy with the probability of Helicobacterpylori infection in the last decade. We conclude that certain endoscopic findings in an appropriate clinical context could increase the diagnostic probability of HP infection in patients seen in Panama.

Infección por Helicobacter pylori y relación con hallazgos endoscópicos en pacientes atendidos en un centro endoscópico de referencia en Panamá

Introducción: La infección por Helycobacter pylori (HP) es un problema de salud pública en Latinoamérica con prevalencia de infección de hasta 70%. Existen hallazgos endoscópicos asociados a la presencia de la infección, no obstante desconocemos la prevalencia actual en Panamá y si los hallazgos endoscópicos se relacionan a infección por HP. Objetivo: Evaluar la frecuencia de infección por HP en los pacientes que se realizaron endoscopia digestiva alta y su asociación con infección por HP. Materiales y métodos: Se realizó un estudio observacional, transversal y analítico, del 1 de enero del 2019 al 31 de diciembre del 2019 en el servicio de Gastroenterología del Hospital Santo Tomás, Ciudad de Panamá. Se evaluó la frecuencia de infección por HP en los pacientes que se realizaron endoscopia digestiva alta y la asociación de hallazgos endoscópicos con infección por HP. Resultados: En total se realizaron 1 281 endoscopias digestivas. El 21,4% de los pacientes incluidos en el estudio se confirmó infección por HP. En los hallazgos endoscópicos la presencia de gastritis nodular tiene una asociación OR 4,32 (2,74-6,80) con la presencia de infección por HP. La presencia de úlcera duodenal y úlcera gástrica también estuvieron asociadas significativamente a la presencia de infección por HP, OR 3,71 (1,21-11,35) y OR: 2,59 (1,36-5,16). Conclusión: Este es el primer estudio en Panamá que evalúa la asociación de hallazgos endoscópicos y la prevalencia en una cohorte de pacientes con indicación de endoscopia alta con la probabilidad de infección por Helicobacter pylori en la última década. Nosotros concluimos que ciertos hallazgos endoscópicos en un contexto clínico apropiado podrían aumentar la probabilidad diagnóstica de infección por HP en pacientes atendidos en Panamá.

Introduction: Helycobacter pylori (HP) infection is a public health problem in Latin America with a prevalence of infection of up to 70%. There are endoscopic findings associated with the presence of infection, however we do not know the current prevalence in Panama and if the endoscopic findings are related to HP infection. Objective: To assess the frequency of HP infection in patients who underwent upper gastrointestinal endoscopy and its association with HP infection. Materials and methods: An observational, cross-sectional and analytical study was carried out from January 1, 2019 to December 31, 2019 in the Gastroenterology service of Hospital Santo Tomás, Panama city. The frequency of HP infection in patients who underwent upper gastrointestinal endoscopy and the association of endoscopic findings with HP infection was evaluated. Results: In total, 1,281 digestive endoscopies were performed. 21.4% of the patients included in the study confirmed HP infection. In endoscopic findings, the presence of nodular gastritis has an association OR 4.32 (2.74-6.80) with the presence of HP infection. The presence of duodenal ulcer and gastric ulcer were also significantly associated with the presence of HP infection, OR 3.71 (1.21-11.35) and OR: 2.59 (1.36-5.16). Conclusion: This is the first study in Panama to evaluate the association of endoscopic findings and the prevalence in a cohort of patients with an indication for upper endoscopy with the probability of Helicobacter pylori infection in the last decade. We conclude that certain endoscopic findings in an appropriate clinical context could increase the diagnostic probability of HP infection in patients seen in Panama.

[Quitting smoking and willingness to pay for cessation in Panama]. / Quiénes quieren dejar fumar y su disposición a pagar por cesación en Panamá.

OBJECTIVE:: To characterize the desire for cessation and willingness to pay for abandonment therapy. MATERIALS AND METHODS:: The data source is the Global Adult Tobacco Survey (GATS). Cessation and willingness to pay were characterized by sociodemographic (SD) and socioeconomic (SE) variables. Logistic regressions were performed to estimate associations. RESULTS:: A greater desire for cessation was observed in variables: women, education, non-governmental and inactive employees, rural areas, occasional smokers and middle income, and greater willingness to pay, in: education, over 60 years old, non-governmental, self-employed, urban area, occasional smokers and low median income. CONCLUSIONS:: There is a high relation between the desire for abandonment, and willingness to pay with SD and SE variables. Cessation therapies can be applied in work centers, and require a change of focus in the intervention.

[Socioeconomic factors associated with the illegal purchase of tobacco products in Panama]. / Factores socioeconómicos asociados con la compra ilegal de productos de tabaco en Panamá.

OBJECTIVE:: To characterize the illegal purchase of tobacco products in Panama and the ssocation with sociodemographic and socioeconomic variables. MATERIALS AND METHODS:: Study population derived from the Global Adult Tobacco Survey (GATS) conducted in 2013. The association of sociodemographic and socioeconomic variables with illegal purchase of tobacco products was estimated by means of logistic regression models. RESULTS:: Men, age group 15 to 39, no formal education, non-governmental, inactive employees,current smoking, lowest quintile of income and living in rural areas were factors associated with the illegal purchase of tobacco products. CONCLUSIONS.: Sociodemographic and socioeconomic factors play an important role in the illegal purchase of tobacco products. These results suggest the importance of surveillance over illicit trade and of the effective implementation of the current laws.

Factores socioeconómicos asociados con la compra ilegal de productos de tabaco en Panamá / Socioeconomic factors associated with the illegal purchase of tobacco products in Panama

Resumen: Objetivo: Caracterizar la compra ilegal de productos derivados del tabaco y su asociación con variables sociodemográficas y socioeconómicas. Material y métodos: La fuente de datos es la Encuesta undial de Tabaco en Adultos de 2013. Se caracterizó la compra ilícita mediante variables sociodemográficas (SOD) y socioeconómicas (SES). Se utilizaron modelos de regresión logística. Resultados: Se encontraron asociaciones de las variables SOD y SES con compra ilegal, particularmente en hombres; grupo etario de 15 a 39 años, educación no formal, empleado de gobierno e inactivos, área urbana, fumador diario y en el primer quintil de ingresos. Conclusiones: Las variables SOD y SES influyen en la compra ilícita. Es importante la vigilancia del comercio ilícito en el segmento minorista y la aplicación efectiva de las normas vigentes.

Abstract: Objective: To characterize the illegal purchase of tobacco products in Panama and the ssocation with sociodemographic and socioeconomic variables. Materials and methods: Study population derived from the Global Adult Tobacco Survey (GATS) conducted in 2013. The association of sociodemographic and socioeconomic variables with illegal purchase of tobacco products was estimated by means of logistic regression models. Results: Men, age group 15 to 39, no formal education, non-governmental, inactive employees,current smoking, lowest quintile of income and living in rural areas were factors associated with the illegal purchase of tobacco products. Conclusions. Sociodemographic and socioeconomic factors play an important role in the illegal purchase of tobacco products. These results suggest the importance of surveillance over illicit trade and of the effective implementation of the current laws.

Quiénes quieren dejar fumar y su disposición a pagar por cesación en Panamá / Quitting smoking and willingness to pay for cessation in Panama

Resumen: Objetivo: Caracterizar el deseo de cesación y disposición al pago por una terapia de abandono de consumo de tabaco. Material y métodos: La fuente de los datos es la Encuesta Mundial de Tabaco en Adultos (EMTA). Se caracterizó la cesación y la disposición al pago mediante variables sociodemográficas (SOD) y socioeconómicas (SES). Se realizaron regresiones logísticas para estimar asociaciones. Resultados: El mayor deseo de cesación se observó en las mujeres, aspecto educativo, empleado no gubernamental e inactivo, zona rural, fumadores ocasionales, ingresos medios y la mayor disposición al pago, en educación, mayores de 60 años, empleado no gubernamental y cuenta propia, zona urbana, fumadores ocasionales e ingreso medio bajo. Conclusiones: Existe una alta relación entre el deseo de abandono y la disposición al pago con las variables SOD y SES. Las terapias de cesación pueden aplicarse en centros de trabajo y exigen un cambio de enfoque en la intervención.

Abstract: Objective: To characterize the desire for cessation and willingness to pay for abandonment therapy. Materials and methods: The data source is the Global Adult Tobacco Survey (GATS). Cessation and willingness to pay were characterized by sociodemographic (SD) and socioeconomic (SE) variables. Logistic regressions were performed to estimate associations. Results: A greater desire for cessation was observed in variables: women, education, non-governmental and inactive employees, rural areas, occasional smokers and middle income, and greater willingness to pay, in: education, over 60 years old, non-governmental, self-employed, urban area, occasional smokers and low median income. Conclusions: There is a high relation between the desire for abandonment, and willingness to pay with SD and SE variables. Cessation therapies can be applied in work centers, and require a change of focus in the intervention.

Indigenous Ethnicity and Low Maternal Education Are Associated with Delayed Diagnosis and Mortality in Infants with Congenital Heart Defects in Panama.

BACKGROUND: This is the first study in Panama and Central America that has included indigenous populations in an assessment of the association between socioeconomic variables with delayed diagnosis and mortality due to congenital heart defects (CHD). METHODS: A retrospective observational study was conducted. A sample calculation was performed and 954 infants born from 2010 to 2014 were randomly selected from clinical records of all Panamanian public health institutions with paediatric cardiologists. Critical CHD was defined according to the defects listed as targets of newborn pulse oximetry screening. Diagnoses were considered delayed when made after the third day of life for the critical CHD and after the twentieth day of life for the non-critical. A logistic regression model was performed to examine the association between socioeconomic variables and delayed diagnosis. A Cox proportional hazards model was used to assess the relationship between socioeconomic features and mortality. RESULTS: An increased risk of delayed diagnosis was observed in infants with indigenous ethnicity (AOR, 1.56; 95% CI, 1.03-2.37), low maternal education (AOR, 1.57; 95% CI, 1.09-2.25) and homebirth (AOR, 4.32; 95% CI, 1.63-11.48). Indigenous infants had a higher risk of dying due to CHD (HR, 1.43; 95% CI, 1.03-1.99), as did those with low maternal education (HR, 1.95; 95% CI, 1.45-2.62). CONCLUSION: Inequalities in access to health care, conditioned by unfavourable socioeconomic features, may play a key role in delayed diagnosis and mortality of CHD patients. Further studies are required to study the relationship between indigenous ethnicity and these adverse health outcomes.

The combined-disk boronic acid test as an accurate strategy for the detection of KPC carbapenemase in Central America.

INTRODUCTION: Carbapenemase-producing Klebsiella pneumoniae (KPC) outbreaks may cause a huge economical burden on developing countries. Furthermore, KPC can be challenging to detect. We describe the laboratory strategy for the detection of KPC from 2011 to 2013 in a tertiary care hospital in Central America with approximately 1,000 beds. METHODOLOGY: A retrospective analysis of a clinical laboratory database was done to determine the pragmatic application of the combined-disk boronic acid test during a KPC outbreak in Panama. A total of 1,026 Klebsiella pneumoniae isolates were found, of which 133 were positive for KPC. The strategy during two phases was described according to the test employed as a confirmatory test for KPC. After the K. pneumoniae isolates were detected by the VITEK 2 system, blaKPC polymerase chain reaction (PCR) and the combined-disk boronic acid test were employed as a confirmatory test during phase one. The combined-disk boronic acid test was employed as a confirmatory test for KPC during phase two. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of the boronic acid test were 100%, 97%, 91%, and 100%, respectively, when blaKPC PCR was employed as a confirmatory test during the start of the outbreak. Afterwards, modified VITEK 2 system parameters resulted in 116 suspicious KPC samples and the boronic acid test confirmed 102 isolates. CONCLUSIONS: The use of an automated bacterial identification system and the boronic acid test for the detection of KPC was an effective and low-cost strategy for a clinical laboratory in Panama during an outbreak.

Assessment of the Possible Association of Air Pollutants PM10, O3, NO2 With an Increase in Cardiovascular, Respiratory, and Diabetes Mortality in Panama City: A 2003 to 2013 Data Analysis.

In recent years, Panama has experienced a marked economic growth, and this, in turn, has been associated with rapid urban development and degradation of air quality. This study is the first evaluation done in Panama on the association between air pollution and mortality. Our objective was to assess the possible association between monthly levels of PM10, O3, and NO2, and cardiovascular, respiratory, and diabetes mortality, as well as the seasonal variation of mortality in Panama City, Panama.The study was conducted in Panama City, using air pollution data from January 2003 to December 2013. We utilized a Poisson regression model based on generalized linear models, to evaluate the association between PM10, NO2, and O3 exposure and mortality from diabetes, cardiovascular, and respiratory diseases. The sample size for PM10, NO2, and O2 was 132, 132, and 108 monthly averages, respectively.We found that levels of PM10, O3, and NO2 were associated with increases in cardiovascular, respiratory, and diabetes mortality. For PM10 levels ≥ 40 µg/m3, we found an increase in cardiovascular mortality of 9.7% (CI 5.8-13.6%), and an increase of 12.6% (CI 0.2-24.2%) in respiratory mortality. For O3 levels ≥ 20 µg/m3 we found an increase of 32.4% (IC 14.6-52.9) in respiratory mortality, after a 2-month lag period following exposure in the 65 to <74 year-old age group. For NO2 levels ≥20 µg/m3 we found an increase in respiratory mortality of 11.2% (IC 1.9-21.3), after a 2-month lag period following exposure among those aged between 65 and <74 years.There could be an association between the air pollution in Panama City and an increase in cardiovascular, respiratory, and diabetes mortality. This study confirms the urgent need to improve the measurement frequency of air pollutants in Panama.

Analysis of mortality trends due to cardiovascular diseases in Panama, 2001-2014.

OBJECTIVE: Cardiovascular diseases (CVDs) are still the leading cause of death worldwide despite the recent decline in mortality rates attributable to CVD in Western Europe and the Americas. The aim of this study is to investigate mortality trends due to ischaemic heart disease (IHD) and stroke in Panama from 2001 to 2014, as well as the mortality differences by sex and age groups. METHODS: Data were obtained from the National Mortality Register. The International Classification of Diseases 10th revision codes (ICD-10) I20-I25 and I60-I69 were used for IHD and stroke, respectively. Age-adjusted mortality rates were calculated using the world population of the WHO as standard. Trends were analysed using Joinpoint Regression Program and annual percentage changes (APC) were estimated. RESULTS: From 2010, the IHD mortality trend began to decline in the whole population of Panama (APC -4.7%, p<0.05). From 2001 to 2014, a decline in the trend for IHD mortality was observed (APC -1.7%, p<0.05) in women, but not in men. Stroke mortality showed a significant annual decline during the study period (APC -3.8%, p<0.05) and it was more pronounced in women (APC -4.5%, p<0.05) than in men (APC -3.3%, p<0.05). CONCLUSIONS: In Panama, the mortality rates from IHD and stroke have declined in recent years. Better access to healthcare, improved treatment of acute IHD and stroke, low tobacco consumption and better control of hypertension probably account for a significant part of this mortality reduction.