Symptomatic Intracranial Hemorrhage With Tenecteplase vs Alteplase in Patients With Acute Ischemic Stroke: The Comparative Effectiveness of Routine Tenecteplase vs Alteplase in Acute Ischemic Stroke (CERTAIN) Collaboration.

Importance: Symptomatic intracranial hemorrhage (sICH) is a serious complication of stroke thrombolytic therapy. Many stroke centers have adopted 0.25-mg/kg tenecteplase instead of alteplase for stroke thrombolysis based on evidence from randomized comparisons to alteplase as well as for its practical advantages. There have been no significant differences in symptomatic intracranial hemorrhage (sICH) reported from randomized clinical trials or published case series for the 0.25-mg/Kg dose. Objective: To assess the risk of sICH following ischemic stroke in patients treated with tenecteplase compared to those treated with alteplase. Design, Setting, and Participants: This was a retrospective observational study using data from the large multicenter international Comparative Effectiveness of Routine Tenecteplase vs Alteplase in Acute Ischemic Stroke (CERTAIN) collaboration comprising deidentified data on patients with ischemic stroke treated with intravenous thrombolysis. Data from more than 100 hospitals in New Zealand, Australia, and the US that used alteplase or tenecteplase for patients treated between July 1, 2018, and June 30, 2021, were included for analysis. Participating centers included a mix of nonthrombectomy- and thrombectomy-capacity comprehensive stroke centers. Standardized data were abstracted and harmonized from local or regional clinical registries. Consecutive patients with acute ischemic stroke who were considered eligible and received thrombolysis at the participating stroke registries during the study period were included. All 9238 patients who received thrombolysis were included in this retrospective analysis. Main Outcomes and Measures: sICH was defined as clinical worsening of at least 4 points on the National Institutes of Health Stroke Scale (NIHSS), attributed to parenchymal hematoma, subarachnoid, or intraventricular hemorrhage. Differences between tenecteplase and alteplase in the risk of sICH were assessed using logistic regression, adjusted for age, sex, NIHSS score, and thrombectomy. Results: Of the 9238 patients included in the analysis, the median (IQR) age was 71 (59-80) years, and 4449 patients (48%) were female. Tenecteplase was administered to 1925 patients. The tenecteplase group was older (median [IQR], 73 [61-81] years vs 70 [58-80] years; P < .001), more likely to be male (1034 of 7313 [54%] vs 3755 of 1925 [51%]; P < .01), had higher NIHSS scores (median [IQR], 9 [5-17] vs 7 [4-14]; P < .001), and more frequently underwent endovascular thrombectomy (38% vs 20%; P < .001). The proportion of patients with sICH was 1.8% for tenecteplase and 3.6% for alteplase (P < .001), with an adjusted odds ratio (aOR) of 0.42 (95% CI, 0.30-0.58; P < .01). Similar results were observed in both thrombectomy and nonthrombectomy subgroups. Conclusions and Relevance: In this large study, ischemic stroke treatment with 0.25-mg/kg tenecteplase was associated with lower odds of sICH than treatment with alteplase. The results provide evidence supporting the safety of tenecteplase for stroke thrombolysis in real-world clinical practice.

COVID-19 Impact on Acute Ischemic Stroke Treatment at 9 Comprehensive Stroke Centers across Los Angeles.

OBJECTIVE: To describe the impact of COVID-19 on acute cerebrovascular disease care across 9 comprehensive stroke centers throughout Los Angeles County (LAC). METHODS: Volume of emergency stroke code activations, patient characteristics, stroke severity, reperfusion rates, treatment times, and outcomes from February 1 to April 30, 2020, were compared against the same time period in 2019. Demographic data were provided by each participating institution. RESULTS: There was a 17.3% decrease in stroke code activations across LAC in 2020 compared to 2019 (1,786 vs. 2,159, respectively, χ2 goodness of fit test p < 0.0001) across 9 participating comprehensive stroke centers. Patients who did not receive any reperfusion therapy decreased by 16.6% in 2020 (1,527) compared to 2019 (1,832). Patients who received only intravenous thrombolytic (IVT) therapy decreased by 31.8% (107 vs. 157). Patients who received only mechanical thrombectomy (MT) increased by 3% (102 vs. 99). Patients who received both IVT and MT decreased by 31.8% (45 vs. 66). Recanalization treatment times in 2020 were comparable to 2019. CSCs serving a higher proportion of Latinx populations in the eastern parts of LAC experienced a higher incidence of MT in 2020 compared to 2019. Mild increase in stroke severity was seen in 2020 compared to 2019 (8.95 vs. 8.23, p = 0.046). A higher percentage of patients were discharged home in 2020 compared to 2019 (59.5 vs. 56.1%, p = 0.034), a lower percentage of patients were discharged to skilled nursing facility (16.1 vs. 20.7%, p = 0.0004), and a higher percentage of patients expired (8.6 vs. 6.3%, p = 0.008). CONCLUSION: LAC saw a decrease in overall stroke code activations in 2020 compared to 2019. Reperfusion treatment times remained comparable to prepandemic metrics. There has been an increase in severe stroke incidence and higher volume of thrombectomy treatments in Latinx communities within LAC during the pandemic of 2020. More patients were discharged home, less patients discharged to skilled nursing facilities, and more patients expired in 2020, compared to the same time frame in 2019.

Evaluación nutricional y de tensión arterial en niños de dos escuelas de población vulnerable de Cutral Co y Plaza Huincul. Estudio cuantitativo y cualitativo / Nutritional status and blood pressure assessment in vulnerable children from two schools in Cutral Co and Plaza Huincul. A quantitative and qualitative study

Introducción. La situación nutricional de los niños constituye un conocimiento fundamental para la programación de intervenciones de atención primaria en el contexto de la actual epidemia de obesidad y de aumento de la prevalencia de síndrome metabólico en la infancia. Por ello, se realizó una evaluación nutricional y de tensión arterial de alumnos de dos escuelas con alta vulnerabilidad social, junto con un análisis cualitativo de los resultados, y se buscó conocer las opiniones de los integrantes de la comunidad para generar un conocimiento útil para la programación de intervención en salud a nivel local. Población y métodos. Estudio trasversal en escuelas seleccionadas intencionalmente, con análisis de los resultados mediante grupos focales. Se utilizaron estándares de la Organización Mundial de Salud (OMS) para peso y talla, del National Center for Health Statistics (NCHS) para índice de masa corporal (IMC), de los National Institutes for Health (NIH) para tensión arterial y las referencias de Fernández J. et al. para circunferencia de cintura. Resultados. De 361 niños evaluados, 20,8% presentaron sobrepeso; 22,2%, obesidad; y 6,5%, valores de hipertensión. Hubo mayor prevalencia de obesidad en varones (p: 0,039), y no se encontró asociación entre hipertensión y obesidad central con edad y sexo. Representantes de la comunidad describieron los contextos sociales que influían en la situación encontrada. Conclusiones. Se definió que esta población presentaba una situación de malnutrición, con alta prevalencia de obesidad. La comunidad analizó los resultados focalizando los puntos a tener en cuenta para la intervención.

Introduction. Knowing the nutritional status of children is critical to plan primary health care interventions in the setting of the present obesity epidemic and the great increase in the prevalence of childhood metabolic syndrome. For this reason, nutritional status and blood pressure were assessed among children from two schools of high social vulnerability, results were qualitatively analyzed, and community members feedback was obtained in order to be fully aware of the situation and accordingly plan local health interventions. Population and methods. Cross-sectional study conducted at purposively selected schools, with results analyzed using focus groups. The following standards were used: the World Health Organization (WHO) growth standards for weight and height; the National Center for Health Statistics (NCHS) for body mass index (BMI); the National Institutes of Health (NIH) for blood pressure; and Fernández J., et al. standards for waist circumference. Results. Three hundred and sixty one children were evaluated; of them, 20.8% were overweight, 22.2% were obese and 6.5% were hypertensive. Obesity was more prevalent in boys (p: 0.039), and no relationship was observed between hypertension and central obesity with age and sex. The social factors that influence this situation were described by community representatives. Conclusions. It was established that this population was malnourished and had a high prevalence of obesity. Results were analyzed by community members who focused on the items to be considered for the intervention

Nutritional status and blood pressure assessment in vulnerable children from two schools in Cutral Co and Plaza Huincul: a quantitative and qualitative study.

INTRODUCTION: Knowing the nutritional status of children is critical to plan primary health care interventions in the setting of the present obesity epidemic and the great increase in the prevalence of childhood metabolic syndrome. For this reason, nutritional status and blood pressure were assessed among children from two schools of high social vulnerability, results were qualitatively analyzed, and community members feedback was obtained in order to be fully aware of the situation and accordingly plan local health interventions. POPULATION AND METHODS: Cross-sectional study conducted at purposively selected schools, with results analyzed using focus groups. The following standards were used: the World Health Organization (WHO) growth standards for weight and height; the National Center for Health Statistics (NCHS) for body mass index (BMI); the National Institutes of Health (NIH) for blood pressure; and Fernández J., et al. standards for waist circumference. RESULTS: Three hundred and sixty one children were evaluated; of them, 20.8% were overweight, 22.2% were obese and 6.5% were hypertensive. Obesity was more prevalent in boys (p: 0.039), and no relationship was observed between hypertension and central obesity with age and sex. The social factors that influence this situation were described by community representatives. CONCLUSIONS: It was established that this population was malnourished and had a high prevalence of obesity. Results were analyzed by community members who focused on the items to be considered for the intervention.

Nutritional status and blood pressure assessment in vulnerable children from two schools in Cutral Co and Plaza Huincul: a quantitative and qualitative study. / Nutritional status and blood pressure assessment in vulnerable children from two schools in Cutral Co and Plaza Huincul: a quantitative and qualitative study.

INTRODUCTION: Knowing the nutritional status of children is critical to plan primary health care interventions in the setting of the present obesity epidemic and the great increase in the prevalence of childhood metabolic syndrome. For this reason, nutritional status and blood pressure were assessed among children from two schools of high social vulnerability, results were qualitatively analyzed, and community members feedback was obtained in order to be fully aware of the situation and accordingly plan local health interventions. POPULATION AND METHODS: Cross-sectional study conducted at purposively selected schools, with results analyzed using focus groups. The following standards were used: the World Health Organization (WHO) growth standards for weight and height; the National Center for Health Statistics (NCHS) for body mass index (BMI); the National Institutes of Health (NIH) for blood pressure; and Fernández J., et al. standards for waist circumference. RESULTS: Three hundred and sixty one children were evaluated; of them, 20.8

were overweight, 22.2

were obese and 6.5

were hypertensive. Obesity was more prevalent in boys (p: 0.039), and no relationship was observed between hypertension and central obesity with age and sex. The social factors that influence this situation were described by community representatives. CONCLUSIONS: It was established that this population was malnourished and had a high prevalence of obesity. Results were analyzed by community members who focused on the items to be considered for the intervention.

Seguimiento normas de bioseguridad personal auxiliar de enfermería servicio de urgencias E.S.E. Hospital de Santa Mónica. Dosquebradas

El presente trabajo pretende identificar la aplicación de las Normas de Bioseguridad en los procedimientos realizados en el servicio de Urgencias de la E.S.E. Hospital Santa Mónica de Dosquebradas, por parte del personal auxiliar de enfermería, durante el período comprendido entre el 23 de junio y el 5 de agosto de 2005. En un primer momento se verificó mediante la observación directa, el cumplimiento de dichas normas de bioseguridad en el personal auxiliar de enfermería, obteniendo los siguientes resultados: el 30 por cien del personal no utiliza la blusa de bioseguridad, ni manipula adecuadamente la ropa contaminada; el 40 por cien no realiza el lavado de manos antes, durante y después de la administración de medicamentos; el 20 por cien maneja inadecuadamente las jeringas y el 40 por cien no aplica la norma establecida al manejar equipos de oxigenoterapia. Con base en los resultados obtenidos se diseñó un folleto y se realizó una intervención educativa con el personal evaluado, haciéndose seguimiento posterior de las actividades realizadas en el servicio de urgencias.

Síndrome hemolítico urémico / Hemolytic uremic syndrome

Se describen 20 niños con síndrome hemolítico urémico tratados entre junio de 1979 y Agosto de 1985, 85% menores de 2 años. Las manifestaciones prodrómicas más frecuentes fueron las gastrointestinales. Siete niños mantuvieron diuresis normales y 4 sufrieron convulsiones. Se efectuó diálisis peritoneal en 3 pacientes con buena evolución. Fallecieron 2 niños, de los restantes, sólo una presenta proteinuria moderada persistente después de 4 años y 4 meses de seguimiento

Tuberculosis renal en pediatría / Renal Tuberculosis in pediatrics

Se analizaron 16 observaciones clínicas de pacientes con tuberculosis renal, de 6 a 15 años de edad, en un período de 21 años. La frecuencia con que se identificó la enfermedad aumentó en los últimos 8 años. La mayoría de los pacientes era de procedencia urbana. La macrohematuria y la enuresis fueron los principales motivos de consulta. En la urografía excretora los hallazgos radiológicos correspondían a los grados. O, I y II de la clasificación de Lattimer modificada, en el 75% de los casos. En todos los pacientes el diagnóstico fue confirmado: por la identificación de bacilo de Koch en la orina (entre 3- y 5- cultivo) en 87,5% de los casos e histología característica en el 12,5% de los casos. La respuesta al tratamiento fue satisfactoria en los pacientes que completaron el seguimiento de control