Quality indicators and satisfaction with care in patients with systemic lupus erythematosus.

Grading the quality of care in patients with systemic lupus erythematosus and determining its relationship with care satisfaction may recognize gaps that could lead to better clinical practice. Eighteen quality indicators (QIs) were recently developed and validated for patients with SLE based on the 2019 EULAR management recommendations. Few studies have analyzed the relationship between quality of care and care satisfaction in patients with lupus. This was a cross-sectional study. We included patients at least 18 years old who met the EULAR/ACR 2019 classification criteria for SLE. We interviewed patients and retrieved data from medical records to assess their compliance with a set of 18 EULAR-based QIs. We calculated each QI fulfillment as the proportion of fulfilled QI divided by the number of eligible patients for each indicator. Care satisfaction was evaluated with the satisfaction domain of LupusPRO version 1.7. Spearman correlation coefficient was used to determine the relationship between quality of care and care satisfaction. Seventy patients with a median age of 33 (IQR 23-48) were included, 90% were women. Overall adherence was 62.29%. The median care satisfaction was 100. Global adherence to the 18-QIs and the care satisfaction score revealed no correlation (r = 0.064, p = 0.599). Higher QI fulfillment was found in the group with remission versus the moderate-high activity group (p = 0.008). In our study, SLE patients in remission had higher fulfillment of quality indicators. We found no correlation between the quality of care and satisfaction with care.

Health Sentinel: A mobile crowdsourcing platform for self-reported surveys provides early detection of COVID-19 clusters in San Luis Potosí, Mexico.

BACKGROUND: The Health Sentinel (Centinela de la Salud, CDS), a mobile crowdsourcing platform that includes the CDS app, was deployed to assess its utility as a tool for COVID-19 surveillance in San Luis Potosí, Mexico. METHODS: The CDS app allowed anonymized individual surveys of demographic features and COVID-19 risk of transmission and exacerbation factors from users of the San Luis Potosí Metropolitan Area (SLPMA). The platform's data processing pipeline computed and geolocalized the risk index of each user and enabled the analysis of the variables and their association. Point process analysis identified geographic clustering patterns of users at risk and these were compared with the patterns of COVID-19 cases confirmed by the State Health Services. RESULTS: A total of 1554 COVID-19 surveys were administered through the CDS app. Among the respondents, 50.4 % were men and 49.6 % women, with an average age of 33.5 years. Overall risk index frequencies were, in descending order: no-risk 77.8 %, low risk 10.6 %, respiratory symptoms 6.7 %, medium risk 1.4 %, high risk 2.0 %, very high risk 1.5 %. Comorbidity was the most frequent vulnerability category (32.4 %), followed by the inability to keep home lockdown (19.2 %). Statistically significant risk clusters identified at a spatial scale between 5 and 730 m coincided with those in neighborhoods containing substantial numbers of confirmed COVID-19 cases. CONCLUSIONS: The CDS platform enables the analysis of the sociodemographic features and spatial distribution of individual risk indexes of COVID-19 transmission and exacerbation. It is a useful epidemiological surveillance and early detection tool because it identifies statistically significant and consistent risk clusters in neighborhoods with a substantial number of confirmed COVID-19 cases.

Residual nitrite in processed meat products in Costa Rica: Method validation, long-term survey and intake estimations.

Ingestion of high amounts of nitrite due processed meat consumption could produce negative effects in human health. Here, we investigate long-term residual sodium nitrite content in processed meat products in Costa Rica to provide the first estimations of nitrite daily intake. An extensively validated analytical procedure was applied for the long-term analysis of 1350 samples from 2014 to 2018. Mean residual sodium nitrite concentration was 76.5 mg kg-1, ranging from < 11 to 278.0 mg kg-1. Significant differences among product and meat types were found, but no temporal differences were observed. Nitrite daily intake was estimated in 0.0122 ± 0.0039 mg kg-1 bw-1 d-1, which accounts for 17.4% of the acceptable daily intake (ADI). This information underlies the importance of studying residual nitrite kinetics in processed meat products as well as establishing long-term programs for the accurate estimation of nitrite daily intake rates.

A case of round pneumonia due to Enterobacter hormaechei: the need for a standardized diagnosis and treatment approach in adults.

Round pneumonia is an unusual radiological manifestation of a bacterial lung infection. We present the case of an elderly male patient who arrived at the emergency room with a productive cough and exertional dyspnea. His chest x-ray and CT showed a round opacity and air bronchograms in the right upper lobe. Taken together, the patient's symptoms and images strongly suggest a pulmonary infection. Empirical antibiotic therapy with ceftriaxone and clarithromycin was started. The sputum culture was positive for Enterobacter hormaechei and the bacterium was sensitive to levofloxacin; therefore, the antibiotic therapy was changed. Despite the treatment, the patient progressed to respiratory failure and septic shock, dying six days after admission. Although round pneumonia is uncommon, it is a potentially curable disease and clinicians should always consider it in their differential diagnosis.

Is it compatible with breastfeeding? www.e-lactancia.org: Analysis of visits, user profile and most visited products.

INTRODUCTION: One of the factors to influence abandoning breastfeeding is mothers' use of medications. The www.e-lactancia.org website is a reliable source in Spanish and English for online free-access information about the compatibility of medications with breastfeeding. The aim of this study was to analyse the search profiles, and groups and products, searched the most on this website. MATERIALS AND METHODS: A retrospective and descriptive study of the e-lactancia.org website during 2014-2018. Google Analytics was used for data collection. The following variables were analysed: number of users and queries; professional profile; country; language; users' and groups' access modes/devices; most searched products. RESULTS: We found 16,821.559 users and 63,783.866 pages. Of users, 62.7 % were "mother/father", and 31.9 % were health professionals. Visits came mostly from: Spain (25.86 %); Mexico (16.87 %); Argentina (7.99 %); Chile (7.31 %). The preferred access mode and device were organic searches (62.1 %) and mobile phones (73.4 %), respectively. Phytotherapy (14.4 %), antibacterial agents (12.3 %) and NSAIDs (12.3 %) were the most searched groups, and ibuprofen (6.25 %) was the most popular product. CONCLUSION: Users and consultations in e-lactation increased significantly during the study period. Mothers/fathers were the main website users, followed by health professionals. The main consulted groups were antibacterial agents, NSAIDs and systemic phytotherapy. Ibuprofen, paracetamol and amoxicillin stood out as the most consulted products. These results revealed increase Internet resources use to solve parents and health professionals' breastfeeding doubts. Future research should study how users (parents, health professionals) interact with this information.

Assessment of drinking water suitability in low income rural areas: a case study in Sixaola, Costa Rica.

Vegas-Las Palmas is a rural settlement located in the southern Caribbean region of Costa Rica on the border with Panama. Its population does not have access to potable water, and inhabitants depend on water from wells at the water table level to meet their needs. These wells lack basic infrastructure to protect this water from contamination. In this study, water quality was evaluated at 12 wells from 2014 to 2016 (n = 72). The results revealed high concentrations of faecal coliforms and Escherichia coli with maximum values of 4.6 × 104 MPN/100 mL and 1.1 × 104 MPN/100 mL, respectively. In addition, maximum values of pH, conductivity, turbidity, Ca, Mg, K, Fe, Mn, Cd and Pb were found to be outside the standard limits (nationally and internationally) for potable water. Possible sources of water contamination are associated with the geomorphological characteristics of the area, as well as with hydrometeorological and anthropogenic factors such as the lack of sewerage, the presence of latrines, animals near the wells and the use of agrochemicals. The water quality was heterogeneous among wells, and all of them were found to have conditions that caused water to be unfit for human consumption.

Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras.

Iron supplements are often prescribed during infancy but their benefits and risks have not been well documented. We examined whether iron supplements affect growth or morbidity of breast-fed infants. Full-term infants in Sweden (n = 101) and Honduras (n = 131) were randomly assigned to three groups at 4 mo of age: 1) placebo from 4 to 9 mo; 2) placebo from 4 to 6 mo and iron supplements [1 mg/(kg. d)] from 6 to 9 mo; or 3) iron supplements from 4 to 9 mo. All infants were exclusively or nearly exclusively breast-fed to 6 mo and continued to be breast-fed to at least 9 mo. Growth was measured monthly and morbidity data were collected every 2 wk. Among the Swedish infants, gains in length and head circumference were significantly lower in those who received iron than in those given placebo from 4 to 9 mo. The same effect on length was seen in Honduras, but only at 4-6 mo among those with initial hemoglobin (Hb) > or =110 g/L. There was no significant main effect of iron supplementation on morbidity, nor any significant interaction between iron supplementation and site, but for diarrhea (with both sites combined), there was an interaction between iron supplementation and initial Hb. Among infants with Hb < 110 g/L at 4 mo, diarrhea was less common among those given iron than in those given placebo from 4-9 mo, whereas the opposite was true among those with Hb > or = 110 g/L (P < 0.05). We conclude that routine iron supplementation of breast-fed infants may benefit those with low Hb but may present risks for those with normal Hb.

Crecimiento bacteriano en leche humana

Se cultivaron 40 muestras de leche humana extraídas con bomba eléctrica y manualmente para estudiar el crecimiento bacteriano tanto en condiciones de refrigeración como a temperatura ambiente. Se obtuvo 40% de positividad en los cultivos con 23% de microorganismos patógenos. La menor presencia de cultivos positivos se observó entre las muestras extraídas manualmente y mantenidas en refrigeración. Hasta las 6 horas no hubo diferencia significativa entre grupo refrigerado y el mantenido a temperatura ambiente

Parasitismo intestinal en la infancia

Se estudiaron las caracteristicas de la infestación parasitaria en un grupo de pacientes pediatricos que acudio a la consulta externa del HSS de San Pedro Sula, encontrandose una prevalencia de 43%, con leve predominio de protozoos sobre helmintos. Se vió mayor afectación del estado nutricional asociada a la infestación por helmintos que por protozoos