[Clinical characteristics and care times in a chest pain unit of the emergency department of an argentine center]. / Características clínicas y tiempos de atención en una unidad de dolor torácico del servicio de emergencias de un centro argentino.

Objectives: . To report the frequency of precordial pain, describe clinical characteristics, and care times. Methods: . Retrospective descriptive study that included consultations in the Chest Pain Unit in 2021 in the emergency department of a private hospital in Argentina. Results: There were 1469 admissions for chest pain, yielding a frequency of 1.09% (95%CI 1.04-1.15). They were 52% men, mean age 62 years (SD ±15); 48% had hypertension and 32% dyslipidemia. The median time to initial ECG was 4.3 min (ICR 2.5-7.5); and 26 min (ICR 14-46) to medical evaluation. A total of 206 (14%) were hospitalized with a median of 3 days, 76% were admitted to a closed unit, 9% required non-invasive ventilation/mechanical ventilaction and in-hospital mortality was 2.9%. Those hospitalized presented shorter delay time to medical attention (p<0.01), and greater performance of complementary studies (p<0.01), with no differences in time to ECG (p=0.22). Conclusions: Care times were within the stipulated standards, being an important indicator of quality. Nursing was crucial, taking care of the correct triage, ECG on admission, and guaranteeing care until medical evaluation.

Relationship Between Sagittal Root Position and Alveolar Wall Thickness of Maxillary Teeth in the Esthetic Area for Immediate Implant Treatment Planning in a Peruvian Population.

OBJECTIVE: The purpose of this retrospective study was to assess facial and palatal alveolar wall thickness (AWT) in relation to sagittal root position (SRP) of maxillary anterior teeth using cone-beam computed tomography (CBCT). METHODOLOGY: 102 CBCT images (60 females, 42 males) of anterior maxillary teeth were reviewed. SRP was classified according to Kan's classification, and AWT was evaluated at coronal (4 mm from the cementoenamel junction), mid-root, and apical (2 mm from the apex) levels of the facial and palatal. Secondary variables of sex, age and tooth type were analyzed. RESULTS: The SRP distribution was 76.6% class I, 11.3% class II, 0.8% class III, and 11.3% class IV. AWT, from thickest to thinnest, was found in palatal apical>mid>coronal, followed by facial coronal>mid>apical. CONCLUSIONS: AWT was thickest in SRP class II, followed by class I and III, and least thick in class IV at all measured areas (P<.05). A significantly higher AWT was associated with class I in central incisors, class II in canine teeth and in males, and class IV in central incisors and canines.

Assessment of Patient Safety Culture in a Pediatric Department.

Background An assessment of the prevalent culture needs to be the first step when building patient safety programs in healthcare organizations to achieve high-quality health care. Objective To conduct a baseline assessment of patient safety culture, to provide insight into the factors that contribute to patient safety, and to use the information to make improvements.  Methods The Hospital Survey on Patient Safety Culture (PSC) questionnaire was conducted from October through December 2020 at the Brookdale Hospital Medical Center (BHMC) Pediatric departments (Pediatric Inpatient Unit, Neonatal Intensive Care Unit [NICU], Pediatric Intensive Care Unit [PICU], and Pediatric Emergency Department) and four community-based ambulatory pediatric practices (Brookdale Family Care Centers [BFCC]). The percentages of positive responses on the 12 patient-safety dimensions and the summation of PSC and two outcomes (overall patient safety grade and adverse events reported in the past year) were assessed. Factors associated with PSC aggregate score were analyzed. Results From the 385 emails that were sent, 136 surveys were considered for analysis. This gives us a response rate of 35.3%. Most of the participants were nurses (58%) with direct contact with patients (94.2%). Most respondents did not report any events (60.7%), whereas 30.3% reported 1-2 events in the past year. The patient safety composites with the highest positive scores were teamwork within units (78%), supervisor/manager expectations and actions promoting patient safety (71.2%), and organizational learning--continuous improvement (66.8%). The composites with the lowest scores were non-punitive response to error (35.9%) and staffing (38%). Conclusions All of our composite measures, with the exception of teamwork within units, appear to be low, which means that all the other composite measures require interventions for improvement of overall safety culture. In order for healthcare leaders and policymakers to establish a culture of safety and improvement, they must create a climate of open communication, continuous learning, and eliminate the fear of blame and punitive feedback.

Association Between Periodontal Disease and the Risk of COVID-19 Complications and Mortality: A Systematic Review.

AIM: The COVID-19 pandemic has strained the world's healthcare systems. Studies have identified how the COVID-19 infections are linked to several co-morbidities such as hypertension, diabetes, cardiovascular disease, renal and pulmonary disease. It is known that periodontal disease (PD) shares the same risk factors. Moreover, both diseases are characterized by an exaggerated immune response. The aim of the study was to investigate the available evidence of a potential association between PD and the risk of COVID-19 complications and mortality. MATERIALS AND METHODS: MEDLINE/PubMed, EMBASE, Scopus, and ProQuest were searched. Studies that assess the association between PD and the risk of COVID-19 complications and mortality were eligible for inclusion. Two independent reviewers performed the selection of articles and data extraction. The New Castle Ottawa Scale was used to assess the quality of the selected studies, and the GRADE system was used to evaluate the level of confidence to support the conclusions. RESULTS: Only two studies met the eligibility criteria. One study had a low risk of bias, whereas the other had a high risk of bias. CONCLUSION: The level of confidence in the available evidence is very low. A close association between periodontitis and the risk of COVID-19 complications and mortality can neither be supported nor refuted.

Characteristics of Newborns Born to SARS-CoV-2-Positive Mothers: A Retrospective Cohort Study.

OBJECTIVE: The novel virus known as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has led to a terrifying pandemic. The range of illness severity among children is variable. This study aims to assess the characteristics of newborns born to SARS-CoV-2-positive women compared with those mothers who tested negative. STUDY DESIGN: This was a retrospective cohort study performed at Brookdale Hospital Medical Center in New York City from March to May 2020. Electronic medical records of mother-baby dyads were reviewed. RESULTS: Seventy-nine mothers tested for SARS-CoV-2 were included, out of which 18.98% of mothers tested SARS-CoV-2 positive. We found a significant association between symptoms and SARS-CoV-2 status. We observed a significant association between newborns of SARS-CoV-2 positive and SARS-CoV-2 negative mothers regarding skin-to-skin contact (p < 0.001). Both groups showed significant differences regarding isolation (p < 0.001). Interestingly, regarding SARS-CoV-2 infection in newborns, only one newborn tested SARS-CoV-2 positive and was unstable in the neonatal intensive care unit (NICU). With the multivariable logistic regression model, babies of SARS-CoV-2 positive mothers were three times as likely to have desaturations in comparison to newborns from negative mothers. Also, newborns of SARS-CoV-2-positive mothers were four times more likely to have poor feeding, compared with newborns of SARS-CoV-2-negative mothers. Finally, babies of SARS-CoV-2-positive mothers were ten times more likely to be symptomatic at the 2-week follow-up. CONCLUSION: SARS-CoV-2 has caused major morbidity and mortality worldwide. Neonates born to mothers with confirmed or suspected SARS-CoV-2 are most of the time asymptomatic. However, neonatal critical illness due to SARS-CoV-2 is still a possibility; thus, isolation precautions (such as avoiding skin-to-skin contact and direct breastfeeding) and vertical transmission should be studied thoroughly. In addition, testing these newborns by nasopharyngeal swab at least at 24 hours after birth and monitoring them for the development of symptoms for 14 days after birth is needed. KEY POINTS: · For SARS-CoV-2-positive mothers, reducing transmission of infection to newborns is crucial.. · Newborns of SARS-CoV-2-positive mothers are usually asymptomatic and may not be easily infected.. · Critical illness in the newborn may still happen, so monitoring is needed..

Facilitators and Barriers to Access to Pediatric Medical Services in a Community Hospital.

Background: Missed medical appointments decrease continuity of medical care, waste resources, and may affect health outcomes. We examined the factors associated with missed children's supervision visits in Eastern Brooklyn, NY, USA. Methods: We surveyed guardians whose children received routine medical care at four pediatric clinics. Participants filled out a questionnaire that queried: demographics, food security, recent relocation, parental support of healthy behaviors, and length of knowing provider. Preexisting disease(s) and missed visits were retrieved from medical records. Regression analyses were used to determine factors that were associated with missing medical appointments. Results: Among 213 families, 33% faced food insecurity and 16.4% reported moving within the past 12 months. Forty percent of children missed at least 1 visit. Food insecurity (adjusted odds ratio [aOR] 2.3, 95% confidence interval [CI 1.0% to 5.2%) and recent relocation (aOR 1.8, 95% CI 1.1-3.4 were associated with missed health supervision visits, whereas greater parental healthy behaviors (aOR 0.5, 95% CI 0.3-0.9) and longer length of knowing provider (aOR 0.8, 95% CI 0.7-1.0) were associated with fewer missed appointments. Conclusion: This study indicates that social inequity may contribute to poor adherence to medical appointments through multiple mechanisms, including food insecurity, lack of social stability, and parental health behaviors. Multidimensional proactive prevention, and reactive tolerance should be considered as opportunities to mitigate the impact of social inequity on health outcomes.

Low Income and Nonadherence to Health Supervision Visits Predispose Children to More Emergency Room Utilization.

Social inequity can have broad health impacts. The purpose of this study was to examine the effects of low income and nonadherence to health supervision visits on emergency room (ER) utilization in Eastern Brooklyn, New York. This study surveyed parents/guardians of children who received routine medical care at Brookdale ambulatory clinics from June 2017 to February 2018. Participants were asked to fill out a questionnaire on social demographics, food insecurity, and relocation. Electronic medical records (EMRs) were reviewed to retrieve numbers of missing health supervision and ER visit in past 12 months. Comorbidity was identified through EMR by International Classification of Diseases. Logistic regression analyses were used to examine the effects of nonadherence to health supervision visits on ER utilization when controlling for demographics, food insecurity, recent moving, and comorbidity. Among 268 participants, 56.0% reported their household income was less than $20,000 annually, 39.6% missed at least 1 health supervision visit, and 31.7% had at least 1 ER visit within the past 12 months. Younger age (adjusted odds ratio [aOR] = 0.92, 95% confidence interval [CI] = 0.86-0.97, P < .01), household income less than $20,000 (aOR = 1.86, 95% CI = 1.02-3.39), preexisting comorbidity (aOR = 2.36, 95% CI = 1.26-4.42), and nonadherence to health supervision visits (aOR = 5.83, 95% CI = 3.21-10.56) were associated with increased ER utilization. Nonadherence to health supervision visits is an independent risk factor and potentially modifiable. Evaluation and remediation should be pursued as a means of improving health outcomes of children in vulnerable circumstances.

THYROID NODULE LOCATION ON ULTRASONOGRAPHY AS A PREDICTOR OF MALIGNANCY.

OBJECTIVE: The diagnostic capacity of ultrasonography (US) for differentiating between malignant and benign thyroid nodules is crucial in preventing unnecessary invasive procedures. This is the first study to evaluate whether thyroid nodule location on US has predictive value for malignancy. METHODS: We retrospectively reviewed data from 219 patients with thyroid nodules who underwent fine-needle aspiration biopsy in 1 year. Patients' demographics as well as nodule's laterality, polarity, morphology, and multinodularity were analyzed. All malignant lesions were confirmed by surgical pathology. RESULTS: The majority of the patients were female (86.2%). Nodules were evenly distributed between the right lobe (46.3%) and left lobe (49.5%). Eight nodules (4.2%) were located in the isthmus. Most nodules (79.3%) were located in the lower pole, while 9.6% were located in the upper pole and 6.9% in the middle pole. Seventy-five patients (39.9%) had multiple nodules. Fourteen nodules were malignant, representing a prevalence of 7.4%. A significantly higher frequency of malignancy was observed in upper pole (22.2%) compared to lower pole (4.7%) and middle pole (15.4%). A multiple logistic regression model confirmed such association after adjusting for age, body mass index, multinodularity, and laterality. The odds of malignancy in the upper pole were 4 times higher than other locations (odds ratio, 4.6; P = .03). CONCLUSION: Our study is the first showing that thyroid nodules located in the upper pole can be considered as having higher risk for malignancy. It may enhance the predictive value of malignancy if it is included in thyroid nodule ultrasound classification guidelines. ABBREVIATIONS: AACE = American Association of Clinical Endocrinologists; ATA = American Thyroid Association; BMI = body mass index; FNA = fine-needle aspiration; TMS = total malignancy score; TTW = taller than wide; US = ultrasonography.

Depressive symptoms are associated with excess weight and unhealthier lifestyle behaviors in urban adolescents.

BACKGROUND: Adolescence is a critical period for the development of depressive symptoms and obesity. This study examined the association of depressive symptoms with standardized BMI (BMI z-score), lifestyle behaviors, and self-efficacy measures in a sample of urban adolescents. METHODS: A school-based study was conducted among adolescents (N=1508) enrolled from 11 public schools. Depressive symptoms were assessed with Kandel's depressive symptoms scale for adolescents. Fruit and vegetable intake and intake of energy-dense foods were assessed by a short food frequency questionnaire. Sedentary behavior and physical activity (PA) were obtained by self-report. Height and weight were measured directly and BMI z-scores were calculated. Mixed-effects models were used to examine the association of depressive symptoms with BMI z-score and lifestyle behaviors, accounting for clustering at school level and adjusting for confounders. Self-efficacy measures were evaluated as potential mediators. RESULTS: The sample was 53% female, 75% Hispanic, and 82% US born, with a mean age of 13.9 years. Higher depressive symptoms were associated with higher BMI z-score (ß=0.02; p=0.02), intake of energy-dense foods (ß=0.42; p<0.001), and sedentary behavior (ß=0.48; p<0.001), but lower PA (ß=-0.03; p=0.01). There was an interaction by gender in the association of depressive symptoms and PA. Self-efficacy mediated the association of depressive symptoms and PA. CONCLUSIONS: Obesity prevention and treatment programs should consider addressing the role of negative emotions as part of their preventive strategies.

Resistencia antibiótica de streptococcus pneumoniae en portadores nasofaríngeos sanos de siete regiones del Perú / Antibiotic resistance of streptococcus pneumoniae among healthy nasopharyngeal carriers in seven regions of Peru

Objetivos. Determinar el patrón de susceptibilidad antibiótica de cepas de Streptococcus pneumoniae aisladas de portadores nasofaríngeos sanos menores de 2 años de siete regiones del Perú. Materiales y métodos. Entre el 2007 y 2009 se tomaron muestras de hisopado nasofaríngeo a 2123 niños sanos entre 2 y 24 meses de edad en los consultorios de crecimiento y desarrollo (CRED) y vacunación de hospitales y centros de salud de Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, e Iquitos. Se determinó la resistencia a diez antibióticos mediante la prueba de disco-difusión de las cepas de neumococo aisladas. Resultados. Se aislaron 572 cepas. Se encontró altas tasas de resistencia a cotrimoxazol (58%); penicilina (52,2% no-sensibles); tetraciclina (29,1%); azitromicina (28,9%), y eritromicina (26,3%). La resistencia a cloranfenicol fue baja (8,8%). Se encontró 29,5% de multirresistencia. La resistencia a la azitromicina y a la penicilina fue diferente en las siete regiones (p<0,05), hallándose el mayor porcentaje de cepas no-sensibles a penicilina en Arequipa (63,6%), mientras que el menor fue en Cusco (23,4%). Conclusiones. Los elevados niveles de resistencia encontrados para penicilina, cotrimoxazol y macrólidos en cepas de neumococo aisladas de portadores sanos en todas las regiones estudiadas, y su asociación con uso previo de antibióticos, representan un importante problema de salud pública en nuestro país. Esto resalta la necesidad de implementar, a nivel nacional, estrategias para disminuir el uso irracional de antibióticos, sobre todo en la población pediátrica. Es necesario complementar los datos de resistencia a penicilina con la determinación de la concentración mínima inhibitoria para hacer las recomendaciones terapéuticas respectivas.

Objectives. To determine the pattern of antibiotic susceptibility of isolated Streptococcus pneumoniae strains of healthy nasopharyngeal carriers younger than 2 years in seven regions of Peru. Materials and methods. Between 2007 and 2009, nasopharyngeal swab samples were collected among 2123 healthy children aged 2-24 months in growth and development medical practices (CRED) and vaccination offices of hospitals and health centers in Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, and Iquitos. The resistance to ten antibiotics through disk diffusion sensitivity testing of isolated pneumococcus strains was determined. Results. 572 strains were isolated. High rates of resistance to co-trimoxazole (58%), penicillin (52.2% non-sensitive); tetracycline (29,1%); azithromycin (28,9%), and erythromycin (26,3%). Resistance to chloramphenicol was low (8.8%). Multiresistance was found at 29.5%. Resistance to azithromycin and penicillin was different in all seven regions (p<0,05), the highest percentage of non-sensitive strains being found in Arequipa (63,6%), whereas the lowest percentage was found in Cusco (23.4%). Conclusions. High levels of resistance found to penicillin, co-trimoxasole and macrolides in isolated pneumococcus strains of healthy carriers in all studied regions, and their association to a previous use of antibiotics, represent a significant public health problem in our country. This emphasizes the need to implement nationwide strategies to reduce the irrational use of antibiotics, especially among children. It is necessary to complement data of resistance to penicillin with the determination of minimal inhibitory concentration to make proper therapeutic recommendations.

[Antibiotic resistance of streptococcus pneumoniae among healthy nasopharyngeal carriers in seven regions of Peru]. / Resistencia antibiótica de streptococcus pneumoniae en portadores nasofaríngeos sanos de siete regiones del Perú

OBJECTIVES: To determine the pattern of antibiotic susceptibility of isolated Streptococcus pneumoniae strains of healthy nasopharyngeal carriers younger than 2 years in seven regions of Peru. MATERIALS AND METHODS: Between 2007 and 2009, nasopharyngeal swab samples were collected among 2123 healthy children aged 2-24 months in growth and development medical practices (CRED) and vaccination offices of hospitals and health centers in Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, and Iquitos. The resistance to ten antibiotics through disk diffusion sensitivity testing of isolated pneumococcus strains was determined. RESULTS: 572 strains were isolated. High rates of resistance to co-trimoxazole (58%), penicillin (52.2% non-sensitive); tetracycline (29,1%); azithromycin (28,9%), and erythromycin (26,3%). Resistance to chloramphenicol was low (8.8%). Multiresistance was found at 29.5%. Resistance to azithromycin and penicillin was different in all seven regions (p<0,05), the highest percentage of non-sensitive strains being found in Arequipa (63,6%), whereas the lowest percentage was found in Cusco (23.4%). CONCLUSIONS: High levels of resistance found to penicillin, co-trimoxasole and macrolides in isolated pneumococcus strains of healthy carriers in all studied regions, and their association to a previous use of antibiotics, represent a significant public health problem in our country. This emphasizes the need to implement nationwide strategies to reduce the irrational use of antibiotics, especially among children. It is necessary to complement data of resistance to penicillin with the determination of minimal inhibitory concentration to make proper therapeutic recommendations.

[Pneumococcal serotypes in carrier children prior to the introduction of anti-pneumococcal vaccines in Peru]. / Serotipos de neumococo en niños portadores antes de la vacunación antineumocócica en el Perú.

OBJECTIVES: To determine the carriage rate and serotype distribution of Streptococcus pneumoniae in the nasopharynx of healthy children younger than 2 years prior to the universal use of the pneumococcal conjugate vaccines in Peru. MATERIALS AND METHODS: Between 2007 and 2009 we collected nasopharyngeal swab samples from 2,123 healthy children aged 2 to 24 months in the vaccination and healthy children consultation offices of pediatric hospitals and health centers in 7 cities in Peru: on the coast (Lima, Piura), highlands (Cusco, Abancay, Arequipa and Huancayo) and amazon basin (Iquitos). The pneumococcal strains were isolated and identified at the central laboratory of the project in Lima, and serotyped by Quellung reaction in the pneumococcal reference laboratory at the Center for Diseases Control and Prevention (CDC). RESULTS: We found 27% (573/2123) of pneumococcal nasopharyngeal healthy carrier children. Among the 526 analyzed strains, we found 42 serotypes; the most common were: 19F (18.1%), 6B (14.3%); 23F (8.9%) and 14 (6.5%). CONCLUSIONS: The distribution of vaccine serotypes in the analyzed strains was of 50% for the serotypes present in the seven-valent vaccine, 50.2% for the serotypes present in the ten-valent vaccine and 57.2% for those present in the thirteen-valent vaccine.

Serotipos de neumococo en niños portadores antes de la vacunación antineumocócica en el Perú / Pneumococcal serotypes in carrier children prior to the introduction of anti-pneumococcal vaccines in Peru

Objetivos. Determinar la frecuencia y distribución de serotipos de S. pneumoniae en portadores nasofaríngeos sanos menores de dos años previa al uso universal de la vacuna conjugada antineumocócica en el Perú. Materiales y métodos. Entre los años 2007 y 2009 se tomaron muestras de hisopado nasofaríngeo a 2123 niños sanos entre 2 y 24 meses de edad en los consultorios de crecimiento y desarrollo o vacunación de hospitales y centros de salud de siete ciudades del Perú: costa (Lima, Piura); sierra (Cusco, Abancay, Arequipa y Huancayo) y selva (Iquitos). Las cepas de neumococo fueron aisladas e identificadas en el laboratorio central del proyecto en Lima y serotipificadas por reacción de Quellung en el Laboratorio de Referencia de Neumococo del Centro de Control y Prevención de Enfermedades. Resultados. Se encontró 27,0% (573/2123) de portadores nasofaríngeos sanos de neumococo. En las 526 cepas analizadas se encontraron 42 serotipos; los más frecuentes fueron: 19F (18,1%), 6B (14,3%); 23F (8,9%) y 14 (6,5%). Conclusiones. La distribución de serotipos vacunales en las cepas analizadas fue de 50,0% para los serotipos presentes en la vacuna conjugada heptavalente; 50,2% para los serotipos presentes en la vacuna decavalente y 57,2% para la vacuna 13-valente.

Objectives. To determine the carriage rate and serotype distribution of Streptococcus pneumoniae in the nasopharynx of healthy children younger than 2 years prior to the universal use of the pneumococcal conjugate vaccines in Peru. Materials and methods. Between 2007 and 2009 we collected nasopharyngeal swab samples from 2,123 healthy children aged 2 to 24 months in the vaccination and healthy children consultation offices of pediatric hospitals and health centers in 7 cities in Peru: on the coast (Lima, Piura), highlands (Cusco, Abancay, Arequipa and Huancayo) and amazon basin (Iquitos). The pneumococcal strains were isolated and identified at the central laboratory of the project in Lima, and serotyped by Quellung reaction in the pneumococcal reference laboratory at the Center for Diseases Control and Prevention (CDC). Results. We found 27% (573/2123) of pneumococcal nasopharyngeal healthy carrier children. Among the 526 analyzed strains, we found 42 serotypes; the most common were: 19F (18.1%), 6B (14.3%); 23F (8.9%) and 14 (6.5%). Conclusions. The distribution of vaccine serotypes in the analyzed strains was of 50% for the serotypes present in the seven-valent vaccine, 50.2% for the serotypes present in the ten-valent vaccine and 57.2% for those present in the thirteen-valent vaccine.