Peso al nacer en el noroeste argentino. Comparación con una referencia nacional y un estándar internacional / Birth weight in the Northwest region of Argentina. Comparison with a national reference and an international standard

Introducción. El tamaño al nacer se encuentra sujeto a influencias genéticas y ambientales; la altura geográfica es muy influyente. El peso al nacer (PN) es el indicador más utilizado para evaluarlo; existen diferentes estándares y referencias. Debido a la variabilidad de la distribución del PN en relación con la altura en la provincia de Jujuy (Argentina), este trabajo analiza la distribución percentilar del PN para tierras altas (TA) y tierras bajas (TB) jujeñas según edad gestacional (EG) y sexo, y su comparación con una referencia nacional y el estándar internacional INTERGROWTH-21st (IG-21). Población y métodos. Se analizaron los registros de 78 524 nacidos vivos en Jujuy en el período 20092014. Utilizando el método LMS, se estimaron los percentiles 3, 10, 50, 90 y 97 de PN/EG por sexo, para TA (≥2000 msnm), TB (<2000 msnm) y el total provincial, y se compararon gráficamente con la referencia poblacional argentina de Urquía y el estándar IG-21. La significación estadística se determinó mediante la prueba de Wilcoxon. Resultados. El PN en Jujuy presentó distribución heterogénea, con diferencias estadísticamente significativas (p <0,05) entre TB y TA. Al comparar con la referencia nacional y el estándar IG-21, se observaron diferencias por altitud, principalmente en los percentiles 90 y 97 para ambas regiones, y en los percentiles 3 y 10 en TA comparados con el estándar. Conclusiones. Se observó variabilidad de la distribución del PN asociada a la altura geográfica, por lo que, para evaluar el crecimiento intrauterino, resulta fundamental incluir la EG y el contexto donde transcurre la gestación.

Introduction. Size at birth is subject to genetic and environmental influences; altitude is highly influential. Birth weight (BW) is the most widely used indicator to assess size at birth; different standards and references are available. Due to the variability in BW distribution in relation to altitude in the province of Jujuy (Argentina), the purpose of this study is to analyze the percentile distribution of BW in the highlands (HL) and the lowlands (LL) of Jujuy based on gestational age (GA) and sex and compare it with a national reference and the INTERGROWTH-21 st (IG-21) international standard. Population and methods. The records of 78 524 live births in Jujuy in the 2009­2014 period were analyzed. Using the LMS method, the 3 rd, 10 th, 50 th, 90 th, and 97 th percentiles of BW/GA by sex were estimated for the HL (≥ 2000 MASL), the LL (< 2000 MASL), and the total for Jujuy, and compared with the Argentine population reference by Urquía and the IG-21 standard using growth charts. The statistical significance was established using the Wilcoxon test. Results. BW in Jujuy showed a heterogeneous distribution, with statistically significant differences (p < 0.05) between the LL and the HL. When compared with the national reference and the IG-21 standard, differences in terms of altitude were observed, mainly in the 90 th and 97 th percentiles for both regions and the 3 rd and 10 th percentiles in the HL compared with the international standard. Conclusions. BW distribution varied in association with altitude; therefore, to assess intrauterine growth, it is critical to include GA and the environment in which the pregnancy takes place.

Comparison of nutritional status and growth curves of children and adolescents in the city of Goiânia, Goiás: cross-sectional study

ABSTRACT BACKGROUND: Nutritional status and growth curves can affect cognitive development, increase the risk of infection, and contribute to the development of chronic diseases. Its etiology is related to food, socioeconomic, and maternal conditions. However, to date, no data on these parameters exist in the state of Goiás, Brazil. OBJECTIVE: To compare the nutritional status and growth curves of children and adolescents in the city of Goiânia, Goiás, Brazil. DESIGN AND SETTING: This was a cross-sectional study. A total of 529 individuals were recruited from a primary health center in the municipality. METHODS: To assess nutritional status, the sample was divided into three categories: 3-4, 5-10, and 11-19 years, with z-score classification considering body mass index for age. The classification of growth curves was performed considering the median height values for age, assuming two references: (a) young Brazilian population and (b) one recommended for international use. The independent sample T-test was used to compare anthropometric variables. RESULTS: The results showed that the classification of eutrophics represents a predominant percentage between both sexes (men: 03-04 = 55.4%; 05-10 = 57.6%; 11-19 = 53.5 % and women: 03-04 = 53.5%; 05-10 = 63.9%; 11-19 = 56.9%), and growth curves showed differences in specific periods in both sexes. CONCLUSIONS: It can be concluded that children and adolescents from the city of Goiânia present as predominance the eutrophic nutritional status, followed by the risk of overweight, underweight, obesity, and malnutrition of both sexes.

Retinal perfusion density can predict cardiovascular disease risk in patients with retinal vein occlusion

Purpose: To correlate microvascular changes and assess the relationship between microvascular changes and cardiovascular disease (CVD) risk in patients with retinal vein occlusion (RVO). Methods: Patients over 40 years of age with unilateral RVO were included in this prospective study. Those known to have cardiovascular disease were excluded. A detailed medical history was taken and physical exam was done to measure the height, weight, body mass index (BMI), and systolic blood pressure (SBP). A comprehensive eye check?up was followed by optical coherence tomography angiography (OCTA). Microvascular indices such as vessel density (VD) and perfusion density (PD) were noted. A statistical model was developed for prediction of CVD risk and was integrated with the World Health Organization (WHO)’s risk prediction charts. Results: This study included 42 patients with RVO and 22 controls with an age range of 42–82 years. There were 40 males (62.5%) and 24 females (37.5%). Along with age, SBP, and gender, perfusion density was found to have significant impact on CVD risk (P = 0.030). Reduction in PD was associated with increase in CVD risk. PD had a greater influence on CVD in <50 years age than in >70 years group. Using linear regression, a model with accuracy of 72.1% was developed for CVD risk prediction and was converted into color coded charts similar to WHO risk prediction charts. Conclusion: These findings suggest a significant correlation between microvascular parameters and CVD risk in RVO patients. Based on these parameters, an easy?to?use and color?coded risk prediction chart was developed

Canalización del crecimiento entre los 2 y los 5 años en niños aparentemente sanos con talla baja a los 2 años / Canalization of growth between 2 and 5 years of age in apparently healthy children with short stature at age 2 years

Introducción. El tamaño del recién nacido se asocia a condiciones intrauterinas. El potencial genético se expresa más tarde; la canalización del crecimiento se describe clásicamente hasta los 24 meses. Objetivo. Describir la canalización del crecimiento entre los 2 y los 5 años en niños aparentemente sanos con talla baja a los 2 años. Población y métodos. Estudio de cohorte retrospectiva. Se incluyeron niños seguidos en un hospital universitario de comunidad entre 2003 y 2019, con puntaje Z de talla menor a -2 DE para edad y sexo a los 2 años. Se excluyeron los nacidos prematuros, con bajo peso y con enfermedades crónicas. Se evaluó la trayectoria de crecimiento. Se definió canalización como la adquisición de talla normal para la población general. Resultados. Se incluyeron 64 niños, de los cuales 37 (58 %) presentaron canalización del crecimiento a los 5 años (20 a los 3 años, 8 a los 4 años, y 9 a los 5 años). La velocidad de crecimiento a los 3 y a los 5 años fue significativamente mayor en los que canalizaron en comparación con los que no lo hicieron; hubo una tendencia similar a los 4 años. De los 27 niños con talla baja a los 5 años, 25 tuvieron al menos un registro de velocidad de crecimiento anual menor al percentil 25. Conclusiones. La mayoría de los niños aparentemente sanos con baja talla a los 2 años alcanzan una talla normal a los 5 años. La velocidad de crecimiento anual permite detectar a los niños con riesgo de no canalizar.

Introduction. Newborn size is associated with intrauterine conditions. Genetic potential is expressed later; the canalization of growth is typically described up to 24 months of age. Objective. To describe the canalization of growth between 2 and 5 years of age in apparently healthy children with short stature at age 2 years. Population and methods. Retrospective, cohort study. Children seen at a community teaching hospital between 2003 and 2019, who had a Z-score for height below -2 SDs for age and sex at age 2 years were included. Infants born preterm, with a low birth weight, and chronic conditions were excluded. Growth patterns were assessed. Canalization was defined as reaching a normal stature for the general population. Results. Sixty-four children were included; 37 (58%) showed canalization of growth at 5 years old (20 at 3 years, 8 at 4 years, and 9 at 5 years). The growth rate at 3 and 5 years of age was significantly higher among those who showed canalization compared to those who did not; a similar trend was observed at 4 years of age. Among 27 children with short stature at 5 years of age, 25 had at least 1 annual growth velocity below the 25th centile. Conclusions. Most apparently healthy children with short stature at 2 years old reached a normal stature at 5 years old. The annual growth velocity allows to detect children at risk of not showing canalization.

Statistical process control of manufacturing tablets for antiretroviral therapy

Abstract In this study, the manufacturing process of lamivudine (3TC) and zidovudine (AZT) tablets (150+300 mg respectively) was evaluated using statistical process control (SPC) tools. These medicines are manufactured by the Fundação para o Remédio Popular "Chopin Tavares de Lima" (FURP) laboratory, and are distributed free of charge to patients infected with HIV by the Ministry of Health DST/AIDS national program. Data of 529 batches manufactured from 2012 to 2015 were collected. The critical quality attributes of weight variation, uniformity of dosage units, and dissolution were evaluated. Process stability was assessed using control charts, and the capability indices Cp, Cpk, Pp, and Ppk (process capability; process capability adjusted for non-centered distribution; potential or global capability of the process; and potential process capability adjusted for non-centered distribution, respectively) were evaluated. 3TC dissolution data from 2013 revealed a non-centered process and lack of consistency compared to the other years, showing Cpk and Ppk lower than 1.0 and the chance of failure of 2,483 in 1,000,000 tablets. Dissolution data from 2015 showed process improvement, revealed by Cpk and Ppk equal to 2.19 and 1.99, respectively. Overall, the control charts and capability indices showed the variability of the process and special causes. Additionally, it was possible to point out the opportunities for process changes, which are fundamental for understanding and supporting a continuous improvement environment.

Comparison between the World Health Organization and Bahraini children growth standards / Comparação entre as curvas de crescimento para crianças do Bahrein e da Organização Mundial da Saúde

Abstract Objective: The aim of this study was to investigate the growth patterns of Bahraini female and male infants/young children aged 0-24 months in the Kingdom of Bahrain. Methods: A cross-sectional approach was employed to track the growth parameters among healthy Bahraini female and male infants/children aged 0-24 months. A multistage probability sampling criteria was used to collect information from official records. Anthropometric measurements (weight and length) and demographic characteristics on feeding practices were gathered. Generalized Additive Models for Location Scale and Shape (GAMLSS)/Lambda-Mu-Sigma methodology was implemented to select distribution type, optimize smoothing parameters, perform regression of growth models, and construct percentiles and Z-score charts and tables for weight for age, length for age, length for weight, and body mass index (BMI) for age. Results: Findings were compared with WHO Multicentre Growth Reference Study (MGRS) data. A total of 403 healthy infants/children (210 males and 193 females) were recruited. At birth, the mean weight, length, and BMI were 3.2±0.4 kg, 3.1±0.4 kg, 49.7±2.3 cm, 48.8±2.1 cm, 13.2±1.6 kg/m2, and 12.8±1.5 kg/m2 for males and females, respectively. Anthropometrics of males were all statistically significantly higher than those of females at all age levels. The length and weight of the Bahraini infants/children were slightly higher than those of the WHO-MGRS. Conclusion: The outcomes of this study, presented as charts and tables, showed significant differences in comparison with the WHO-MGRS reference charts. Specifically, Bahraini children aged between 0 and 24 months of both sexes were taller and heavier than their cohorts in the MGRS reference charts. Further longitudinal studies are needed for monitoring the growth pattern of children using body composition methods, adiposity markers, and determinant factors of growth to investigate this deviation from the WHO-MGRS.

RESUMO Objetivo: Investigar os padrões de crescimento de lactentes de 0-24 meses dos sexos feminino e masculino, no Reino do Bahrein. Métodos: Estudo transversal de acompanhamento de lactentes saudáveis com 0-24 meses de idade dos sexos feminino e masculino, em Bahrein. A amostragem probabilística de estágios múltiplos foi utilizada para coletar informações dos registros oficiais. Medidas antropométricas (peso, comprimento), práticas alimentares e variáveis demográficas foram coletadas. A metodologia Generalized Additive Models for Location Scale and Shape (GAMLSS)/Lambda-Mu-Sigma (LMS) foi utilizada para selecionar o tipo de distribuição dos parâmetros antropométricos, otimizar os parâmetros de suavização, para fazer a análise de regressão de modelos de crescimento e para construir percentis e gráficos e tabelas de escore Z para peso para idade, comprimento por idade, comprimento por peso e índice de massa corporal (IMC) para idade. Os resultados foram comparados com os dados do Estudo Multicêntrico de Referência de Crescimento da Organização Mundial da Saúde (OMS). Resultados: O total de 403 lactentes (210 do sexo masculino e 193 do feminino) foi incluído no estudo. Ao nascimento, a média de peso, comprimento e IMC foi de 3,2±0,4 kg, 3,1±0,4 kg, 49,7±2,3 cm, 48,8±2,1 cm, 13,2±1,6 kg/m2 e 12,8±1,5 kg/m2 para o sexo masculino e para o feminino, respectivamente. Todos os índices antropométricos foram maiores no sexo masculino. O comprimento e o peso dos lactentes em Bahrein foram ligeiramente superiores aos da OMS. Conclusões: Os lactentes do Bahrein com idade entre 0 e 24 meses de ambos os sexos eram mais altos e mais pesados do que os lactentes analisados na coorte da OMS. Mais estudos longitudinais são necessários para monitorar o padrão de crescimento de crianças usando métodos de composição corporal, marcadores de adiposidade e fatores determinantes do crescimento para investigar esse desvio dos padrões da OMS.

Statistical process control methods for quality inspection of blood component samples: a case study / 中国输血杂志

【Objective】 To explore the analytical methods for detecting data in the process of quality inspection of blood component samples. 【Methods】 The quality inspection data of blood component samples from 2018 to 2022 in our center were collected. Based on the principles of statistical process control, control charts were created using Minitab software to analyze key test items. 【Results】 The P control chart was used to analyze the pass rate of platelet content and revealed one out-of-control point. The normality test was performed on plasma protein content to analyze the causes of data fluctuations for further improvement. The mean and range control chart was utilized for hematocrit measurement, with abnormal data trends detected. Further analysis of the normality test and process capability analysis was conducted, resulting in a Cpk value of 0.67. 【Conclusion】 By applying statistical process control methods, the study employed P control charts to analyze count data in the quality inspection of blood component samples, conducted normality tests for measurement data, and utilized mean and range control charts to identify abnormal data trends. For data conforming to a normal distribution, the process capability index (Cpk) was calculated to explore effective monitoring methods for ensuring stability in the blood supply process.

Comparison of intergrowth-21st and Fenton curves for evaluation of premature newborns / Comparação das curvas de intergrowth-21st e de Fenton para avaliação de recém-nascidos prematuros

Abstract Objectives: to compare the intrauterine and postnatal growth of preterm infants according to the Intergrowth-21st and Fenton curves. Methods: study carried out in a maternity hospital, reference in high-risk pregnancy, with preterm infants born in 2018 who were hospitalized in the neonatal units of the institution. Preterm newborns weighed at least twice after birth were included in the sample and those that were syndromic, malformed or presented fluid retention were excluded. Proportions and means were compared using Pearson's chi-square and Student's t tests for paired samples, respectively. The McNemar test was used to compare categorical variables and the Kappa test to verify the degree of agreement between birth weight classifications obtained by the curves. Results: one hundred and fifty three infants with a median gestational age of 34.4 weeks were included. The incidences of the categories of nutritional status at birth did not differ between the curves. There was perfect agreement between the curves, except when newborns born under 33 weeks of gestational age were evaluated, in which case the agreement was substantial. About 21% of the babies classified as small for gestational age (SGA) by Intergrowth-21st were adequate for gestational age (AGA) according to Fenton and, on average, 20% of cases that had postnatal growth restriction (PNGR) according to Fenton standards were categorized as adequate weight by Intergrowth-21st. Postnatal weight classifications obtained by the evaluated curves had perfect agreement. Conclusions: the differences in theclassifications found between the charts reveal the importance of choosing the growth curve for monitoring preterm infants since behaviors based on their diagnoses can impact the life of this population.

Resumo Objetivos: comparar o crescimento intrauterino e pós-natal de prematuros segundo as curvas de Intergrowth-21st e Fenton. Métodos: estudo realizado em uma maternidade de referência em gestação de alto risco com prematuros nascidos em 2018 que ficaram internados nas unidades neonatais da instituição. Foram incluídos os pré-termos pesados em pelo menos dois momentos após o nascimento e excluídos aqueles sindrômicos, malformados ou com retenção hídrica. As proporções e médias foram comparadas a partir dos testes qui-quadrado de Pearson e t de student para amostras emparelhadas, respectivamente. Já o teste de McNemar foi utilizado para comparar as variáveis categóricas e teste Kappa para verificar o grau de concordância entre as classificações de peso ao nascer obtidos pelas curvas. Resultados: foram incluídos 153 lactentes com idade gestacional mediana de 34,4 semanas. As incidências das categorias de estado nutricional ao nascer não diferiram entre as curvas. Houve concordância perfeita entre as mesmas, exceto quando se avaliou os nascidos com menos de 33 semanas, onde a concordância foi substancial. Cerca de 21% dos bebês classificados como pequenos para a idade gestacional (PIG) por Intergrowth-21st foram adequados para idade gestacional (AIG) segundo Fenton e, em média, 20% dos casos que tiveram restrição de crescimento pós-natal (RCPN) de acordo aos padrões de Fenton foram categorizados com peso adequado por Intergrowth-21st. As classificações de peso pós-natal obtidas pelas curvas avaliadas tiveram concordância perfeita. Conclusões: as diferenças de classificação encontradas revelam a importância da escolha da curva de crescimento para monitorização de prematuros visto que, condutas baseadas em seus diagnósticos, podem impactar na vida dessa população.

Predictive Performance Of Different Diagnostic Criteria For Overweight And Obesity Between 2008-2015 In Adolescents

Background: The reference cut-offs for overweight and obesity have evolved from the use of International obesity task force (IOTF) to extended IOTF and revised Indian Academy of Pediatrics (IAP) growth charts. Methods: Secondary analysis of anthropometric data of school-going children from Delhi in the year 2008, 2013 and 2015 was performed. The proportions of children with overweight, obesity, and undernutrition were checked for agreement using different diagnostic cutoffs, and compared at three-time points. Results: Among 8417 adolescents, weighted Kappa statistics showed good agreement between extended IOTF and IAP cutoffs (k=0.933; 95% CI 0.93-0.94), between eIOTF and IOTF (k=0.624; 95% CI 0.619 - 0.629) and between IAP and IOTF (k=0.654; 95% CI 0.645-0.662). A higher proportion of adolescents were diagnosed with obesity with extended IOTF and IAP charts than IOTF charts (P<0.001 for both genders). The mean (SD) BMI showed a rising trend for adolescents overall from 19.61 (3.89) kg/m2 in 2008, 20.44 (4.37) kg/m2 in 2013 and 20.88 (4.60) kg/m2 in 2015 (P<0.001). 158 adolescent (97 girls) were undernourished using combined IAP and extended IOTF criteria. Conclusion: Both extended IOTF and IAP charts showed good agreement for diagnosing overweight and obesity in adolescents. A secular trend in malnutrition was observed in adolescent girls.

Loss sampling methods for soybean mechanical harvest

Harvesting is one of the most important stages of the agricultural production process. However, the lack of monitoring during this operation and the absence of efficient methodologies to quantify losses have contributed to the decline in the quality of the operation. The objective of this study was to monitor mechanized soybean harvest by quantifying losses through two methodologies using statistical process control. The study was conducted in March 2016 in an agricultural area in the municipality of Ribeirão Preto, SP, using a John Deere harvester model 1470 with a tangential-type track system and separation by a straw-blower. The experimental design followed the standards established by statistical process control, and every 8 min of harvest, the total losses by the circular framework and rectangular framework methodologies were simultaneously quantified, totaling 40 points. Data were analyzed using descriptive statistics and statistical process control. The averages of the circular methodology framework were values above those found in the rectangular methodology framework, presenting greater representativeness of losses. The process was considered unable to maintain losses of soybeans at acceptable levels during mechanical harvest throughout the operation of the two frameworks. The circular framework for collecting samples at different locations resulted in higher reliability of data.

Avaliação da comunicação para melhoria da qualidade da assistência à saúde em pediatria: estudo descritivo / Assessment of communication to improve health care quality in pediatrics: a descriptive study / Evaluación de la comunicación para mejorar la calidad de la atención en salud en pediatría: estudio descriptivo

OBJETIVO: avaliar a qualidade da comunicação escrita da equipe multiprofissional em uma Unidade de Dependentes de Ventilação Mecânica de um hospital público pediátrico. MÉTODOS: pesquisa descritiva quantitativa, num Hospital Público Pediátrico, em quatro etapas: identificação e priorização de um problema de qualidade; análise das causas do problema; desenvolvimento de critérios para avaliar o nível de qualidade; avaliação do nível de qualidade. RESULTADOS: 75,0% dos não cumprimentos de critérios são sobre registro da data e hora e a utilização do prontuário eletrônico pelos enfermeiros, médicos e técnicos de enfermagem. Os fisioterapeutas apresentaram 32,3% de descumprimento na identificação dos profissionais, os médicos tiveram 8,3%, os enfermeiros 68,3% e os técnicos de enfermagem 86,7%. CONCLUSÕES: foi observado ausência da data e hora nos registros dos médicos e da enfermagem, baixa adesão dos médicos na evolução noturna no prontuário eletrônico, e limitação no acesso e utilização desse sistema pela equipe de enfermagem.

OBJECTIVE: to assess the quality of the written communication of the multiprofessional team in a Unit for Mechanical Ventilation Dependents at a public pediatric hospital. METHODS: a quantitative and descriptive research study conducted at a Public Pediatric Hospital, in four stages, namely: identification and prioritization of a quality problem; analysis of the causes of the problem; development of criteria to evaluate the quality level; and assessment of the quality level. RESULTS: 75.0% of the cases of criterion non-compliance are related to date and time recording and to use of electronic medical charts by nurses, physicians and nursing technicians. Physiotherapists presented 32.3% non-compliance in identification of the professionals; among the physicians, the percentage was 8.3%; in the nurses, 68.3%; and in the nursing technicians, 86.7%. CONCLUSIONS: absence of date and time in the physicians' and Nursing records was observed, as well as low adherence by the physicians to night evolution in electronic medical charts, and limited access and use of this system by the Nursing team.

OBJETIVO: evaluar la calidad de la comunicación escrita del equipo multidisciplinario en una Unidad de Ventilación Mecánica de un hospital pediátrico público. MÉTODO: investigación descriptiva cuantitativa realizada en un Hospital Pediátrico Público en cuatro etapas: identificación y priorización de un problema de calidad; análisis de las causas del problema; desarrollo de criterios para evaluar el nivel de calidad; evaluación del nivel de calidad. RESULTADOS: el 75,0% de los incumplimientos de los criterios están relacionados con el registro de fecha y hora y el uso de la historia clínica electrónica que hacen los enfermeros, médicos y técnicos en enfermería. Los fisioterapeutas presentaron un 32,3% de incumplimiento en la identificación de los profesionales, los médicos un 8,3%, los enfermeros un 68,3% y los técnicos en enfermería un 86,7%. CONCLUSIÓN: se observó que faltaba la fecha y hora en los registros que realizaron los médicos y enfermeros, baja adherencia de los médicos en la evolución nocturna de la historia clínica electrónica y limitado acceso y uso de este sistema por parte del equipo de enfermería.

Progress on extrauterine growth restriction in preterm infants / 国际儿科学杂志

Extrauterine growth restriction(EUGR), caused by perinatal diseases, neonatal morbidities and inadequate nutrition, refers to preterm growth failure in which an anthropometric measure is below the target according to growth charts at a certain point of time after birth.EUGR is prevalent among very preterm and very low birth weight infants, potentially causing the impairment on physical growth, neurodevelopment and cardiometabolic system.Nowadays, many researchers challenge the definition of EUGR and raise arguments about the optimal growth pattern, the growth assessment tools and nutrition strategies of preterm newborns.This article reviews the research progress on extrauterine growth restriction in preterm infants.

Improvement of the visual acuity assessment system in deaf-mute children / 中华实验眼科杂志

Objective:To improve the visual acuity assessment system in deaf-mute children based on an original and fundamentally new chart for visometry.Methods:The study included 31 deaf-mute children (62 eyes) without previously diagnosed ocular pathology at the age of 2-11 years.Visometry was performed using standard Golovin-Sivtsev table (Russian: Таблица Головина-Сивцева) and a fundamentally new original technique Just Evident Images/Jonnazarov Eldor Ikhtiyorovich (abbreviated as JEI/JEI), including cards duplicating optotypes.The set of optotypes in the JEI/JEI chart consists of 13 color and black optotypes of various sizes, equal in width and height, which reflect well-known and easily recognized objects by children even at an early age.Results:When the results of visometry according to the Golovin chart and using the original technique coincided, which occurred in 16(51.6%) and 13(41.9%) cases, respectively, when determining the visual acuity of the right and left eyes, respectively, the effectiveness of both methods was evaluated as identical.In 15(48.4%) and 18(58.1%) cases, when examining the right eye and the left eye, respectively, the visometry data differed with a homogeneous trend: the indicator obtained using the JEI/JEI charts exceeded the same indicator when using the Golovin charts in the range of 0.1-0.4; and in the group of children aged 2-5 years -0.2-0.4.Conclusions:The results obtained indicate the prospects of using the JEI/JEI chart for visometry in deaf-mute children in clinical practice.The developed technique of duplicating optotypes with the help of special cards simplifies and enhances the effectiveness of visometry.

Herramientas de monitoreo y control estadístico para enfermedades infecciosas: Caso de la COVID-19 en Cuba / Statistical monitoring and control tools for infectious diseases: Case of COVID-19 in Cuba

En el control de enfermedades infecciosas resulta esencial usar modelos epidemiológicos, sin embargo, existen herramientas que permiten el monitoreo y control estadístico de la transmisión de este tipo de enfermedad en el tiempo. El objetivo de este trabajo de investigación fue proporcionar un análisis de la dinámica diaria de transmisión de la COVID-19 en Cuba mediante dos cartas de control, basadas en un modelo probabilístico fundamentado en las distribuciones binomial y Poisson. Los dos métodos se aplicaron, utilizando los reportes diarios publicados por el Ministerio de Salud Pública, a un proceso cuya variable en estudio es de atributos y con poca información sobre su estabilidad. Las cartas aplicadas fueron clave para mejorar la estabilidad del proceso, en la medida en que se detectaron, identificaron y sugirió la eliminación de causas especiales para reducir la variación; y en el monitoreo para asegurar que las mejoras a generarse se puedan conservar(AU)

In the control of infectious diseases it is essential to use epidemiological models; however, there are tools that allow monitoring and statistical control of the transmission of this type of disease over time. The objective of this research work was to provide an analysis of the daily dynamics of COVID-19 transmission in Cuba through two control charts, based on a probabilistic model based on the binomial and Poisson distributions. The two methods were applied, using the daily reports published by the Ministry of Public Health, to a process whose variable under study is attributes type and with little information on its stability. The applied charts were key to improve the stability of the process, insofar as they were detected, identified and suggested the elimination of special causes to reduce the variation; and in monitoring to ensure that the improvements to be generated can be preserved(AU)

Consideraciones legales sobre las notas de evolución en odontología / Legal considerations on medical charts in dentistry

El expediente clínico es considerado un documento de importancia médica y legal en donde se integran los datos necesarios para registrar el diagnóstico y los tratamientos realizados en cada paciente. Uno de los elementos más importantes dentro del expediente clínico son las notas de evolución, documentos con los que el odontólogo informa sobre el estado general del paciente y los tratamientos realizados cita tras cita. Existen legislaciones específicas en México que orientan al estomatólogo sobre los componentes mínimos necesarios que una nota de evolución debe tener; sin embargo, una de las omisiones más comunes de los odontólogos es que, por desconocimiento, no se dé la debida importancia a la elaboración de una adecuada nota de evolución, aumentando el riesgo de problemas legales. El objetivo del presente artículo es analizar la importancia de las notas de evolución dentro del expediente clínico, destacando su importancia clínica y legal (AU)

The clinical file is considered a document of medical and legal importance where the data necessary to record the diagnosis and the treatments performed on each patient are integrated. One of the most important elements within the clinical records are the medical charts, documents through which de dentist reports on the general condition of the patient and the treatments performed appointment after appointment. There are specific laws in Mexico that guide the stomatologist on the minimum necessary components that a medical chart must have, however, one of the most common omissions of dentist is that, due to ignorance, due importance is not given to the preparation of an adequate medical chart, increasing the risk of legal problems. The aim of this article is to analyze the importance of the evolution charts within the clinical records, highlighting their clinical and legal importance (AU)

Agreement analysis between sonographic estimates and birth weight, by the WHO and intergrowth-21st tables, in newborns of diabetic mothers / Análise de concordância entre estimativas ultrassonográficas e peso ao nascer, pelas tabelas da OMS e Intergrowth-21st, em recém-nascidos de mães diabéticas

Abstract Objective To analyze the agreement, in relation to the 90th percentile, of ultrasound measurements of abdominal circumference (AC) and estimated fetal weight (EFW), between the World Health Organization (WHO) and the International Fetal and Newborn Growth Consortium for the 21st Century (intergrowth-21st) tables, as well as regarding birth weight in fetuses/newborns of diabetic mothers. Methods Retrospective study with data from medical records of 171 diabetic pregnant women, single pregnancies, followed between January 2017 and June 2018. Abdominal circumference and EFW data at admission (from 22 weeks) and predelivery (up to 3 weeks) were analyzed. These measures were classified in relation to the 90th percentile. The Kappa coefficient was used to analyze the agreement of these ultrasound variables between the WHO and intergrowth-21st tables, as well as, by reference table, these measurements and birth weight. Results The WHO study reported 21.6% large-for-gestational-age (LGA) newborns while the intergrowth-21st reported 32.2%. Both tables had strong concordances in the assessment of initial AC, final AC, and initial EFW (Kappa = 0.66, 0.72 and 0.63, respectively) and almost perfect concordance in relation to final EFW (Kappa = 0.91). Regarding birth weight, the best concordances were found for initial AC (WHO: Kappa = 0.35; intergrowth-21st: Kappa= 0.42) and with the final EFW (WHO: Kappa = 0.33; intergrowth- 21st: Kappa = 0.35). Conclusion The initial AC and final EFW were the parameters of best agreement regarding birth weight classification. The WHO and intergrowth-21st tables showed high agreement in the classification of ultrasound measurements in relation to the 90th

Resumo Objetivo Analisar a concordância, em relação ao percentil 90, das medidas ultrassonográficas da circunferência abdominal (CA) e peso fetal estimado (PFE), entre as tabelas da Organização Mundial de Saúde (OMS) e do International Fetal and Newborn Growth Consortium for the 21st Century integrowth-21st, bem como em relação ao peso ao nascer em fetos/recém-nascidos de mães diabéticas. Métodos Estudo retrospectivo com dados de prontuários de 171 gestantes diabéticas, com gestações únicas, seguidas entre Janeiro de 2017 e Junho de 2018. Foram analisados dados da CA e do PFE na admissão (a partir de 22 semanas) e no pré-parto (até 3 semanas). Essas medidas foram classificadas em relação ao percentil 90. O coeficiente Kappa foi utilizado para analisar a concordância entre as tabelas da OMS e Intergrowth-21st, assim como, por tabela de referência, entre as medidas e o peso ao nascer. Resultados O estudo da OMS relatou 21,6% dos recém nascidos grandes para a idade gestacional (GIG) enquanto que o estudo do intergrowth-21st relatou 32,2%. Ambas as tabelas tiveram fortes concordâncias na avaliação da CA inicial e final e PFE inicial (Kappa= 0,66, 0,72 e 0,63, respectivamente) e concordância quase perfeita em relação ao PFE final (Kappa= 0,91).Emrelação ao peso ao nascer, asmelhores concordâncias foram encontradas para aCAinicial (OMS: Kappa= 0,35; intergrowth-21st: Kappa= 0,42) e como PFE final (OMS: Kappa = 0,33; intergrowth-21st: Kappa= 0,35). Conclusão A CA inicial e o PFE final foram os parâmetros de melhor concordância em relação à classificação do peso ao nascer. As tabelas da OMS e intergrowth-21st mostraram alta concordância na classificação das medidas ultrassonográficas em relação ao percentil 90. Estudos são necessários para confirmar se alguma dessas tabelas é superior na previsão de resultados negativos a curto e longo prazo no grupo GIG.

Local references for ultrasound-estimated fetal weight based on 2, 211 singleton pregnancies in the City of Curitiba, south of Brazil / Referências locais para o peso fetal estimado por ultrassom baseado em 2. 211 gestações únicas na cidade de Curitiba, Sul do Brasil

Abstract Objective To develop reference curves of estimated fetal weight for a local population in Curitiba, South of Brazil, and compare them with the curves established for other populations. Methods An observational, cross-sectional, retrospective study was conducted. A reference model for estimated fetal weight was developed using a local sample of 2,211 singleton pregnancies with low risk of growth disorders and well-defined gestational age. This model was compared graphically with the Hadlock and Intergrowth 21st curves. Results Reference curves for estimated fetal weight were developed for a local population. The coefficient of determination was R2 = 99.11%, indicating that 99.11% of the fetal weight variations were explained by the model. Compared with Hadlock curves, the 50th, 90th, and 97th percentiles in this model were lower, whereas the 10th percentile nearly overlapped, and the 3rd percentile was slightly higher in the proposed model. The percentiles were higher in the proposed model compared with the Intergrowth 21st curves, particularly for the 3rd, 10th, and 50th percentiles. Conclusion We provide a local reference curve for estimated fetal weight. The proposed model was different from other models, and these differences might be due to the use of different populations for model construction.

Resumo Objetivo Desenvolver curvas de referência para o peso fetal estimado em uma população de Curitiba, Sul do Brasil, e compará-las com curvas estabelecidas para outras populações. Métodos Foi realizado um estudo observacional, transversal e retrospectivo. Um modelo de referência para o peso fetal estimado foi desenvolvido usando uma amostra local de 2.211 gestações únicas de baixo risco de distúrbios do crescimento e idade gestacional bem definida. Este modelo foi comparado graficamente com as curvas de Hadlock e Intergrowth 21st. Resultados As curvas de referência para o peso fetal estimado foram desenvolvidas para uma população local. O coeficiente de determinação foi de R2 = 99,11%, indicando que 99,11% das variações do peso fetal foram explicadas pelo modelo. Em comparação com as curvas de Hadlock, os percentis 50, 90, e 97 neste modelo foram inferiores, enquanto o percentil 10 quase se sobrepôs, e o percentil 3 foi ligeiramente superior no modelo proposto. Os percentis foram maiores no modelo proposto em comparação com as curvas do Intergrowth 21st, particularmente para os percentis 3, 10, e 50. Conclusão Fornecemos uma curva de referência local para o peso fetal estimado. O modelo proposto foi diferente de outros modelos, e essas diferenças podem ser devido ao uso de diferentes populações para a construção do modelo.

Referencias de peso, estatura e índice de masa corporal para niñas y niños ecuatorianos de 5 a 19 años de edad / Growth references for weight, height, and body mass index for Ecuadorian children and adolescents aged 5-19 years

Introducción. La evaluación del crecimiento durante la infancia y la adolescencia es un componente fundamental de la atención de salud en todos sus niveles, pues es parte del diagnóstico nutricional y permite la detección oportuna de patologías relacionadas. Ecuador, al no disponer de referencias nacionales de crecimiento, ha adoptado los estándares internacionales de la Organización Mundial de la Salud. El objetivo de este estudio fue construir referencias nacionales de peso, estatura e índice de masa corporal para niños, niñas y adolescentes.Métodos. Se investigaron escolares y adolescentes ecuatorianos entre 5 y 19 años de edad durante 1999 y 2012. Los centilos 3, 10, 25, 50, 75, 90 y 97 de peso, talla e índice de masa corporal fueron estimados por el método LMS para datos transversales, que utiliza la transformación Box-Cox para normalizar la distribución de los datos a cada edad.Resultados. Participaron 5934 sujetos sanos (2788 niños y 3146 niñas). Los niños pesaban más y eran más altos que las niñas. En todos los casos, los valores mostraron un aumento creciente conforme la edad avanzaba. A los 18 años, las diferencias entre sexos promediaron 8 kg y 12,5 cm.Conclusión. Las tablas y curvas producto de este estudio constituyen la primera referencia descriptiva del crecimiento de niños ecuatorianos de 5-19 años. Son un importante instrumento de evaluación nutricional. Su implementación en la atención primaria de salud permitirá complementar el diagnóstico nutricional que, tradicionalmente, se realiza sobre la base de los estándares internacionales de la Organización Mundial de la Salud.

Introduction. The assessment of growth during childhood and adolescence is a critical component of health care at all levels, but it is also part of nutritional status diagnosis and the timely detection of related conditions. Ecuador lacks national growth references, so it has decided to adopt the international standards proposed by the World Health Organization. The objective of this study was to develop national references for weight, height, and body mass index for children and adolescents.Methods. Ecuadorian schoolchildren and adolescents aged 5-19 years were studied between 1999 and 2012. The LMS method for cross-sectional data, which uses the Box-Cox transformation to normalize data distribution at each age, was applied to estimate the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th centiles for weight, height, and body mass index.Results. A total of 5934 healthy subjects (2788 boys and 3146 girls) participated. Boys were heavier and taller than girls. In all cases, values increased with age. At 18 years old, the differences between sexes averaged 8 kg and 12.5 cm.Conclusion. The tables and curves obtained with this study are the first descriptive growth references for Ecuadorian children and adolescents aged 5-19 years. They are relevant for nutritional assessment. Their use at the primary level of care will aid in nutritional status diagnosis, which has traditionally been done based on the World Health Organization's international standards.

Progresión de talla y peso en niños y niñas entre 6 y 12 años y su diferencia con las tablas de Ramos Galván 40 años después / Height and weight progression patterns in Mexican children aged between 6 and 12 years and differences with Ramos-Galvan growth charts 40 years later

Resumen Introducción: El peso y la talla de niños y adolescentes son un reflejo del estado de salud y desarrollo socioeconómico de la población. Objetivo: Evaluar las progresiones de talla y peso de niños y niñas mexicanos y compararlas con las tablas del doctor Ramos Galván a 40 años de distancia. Método: Encuesta transversal realizada en población del Programa Nacional de Activación Física Ponte al 100, que incluye niños y niñas de seis a 12 años. Resultados: Se evaluaron 43 670 niños y 44 103 niñas, que se estratificaron por sexo y edad. La progresión de talla entre los seis y 12 años fue de 21 cm en hombres y de 22 cm en mujeres; la progresión de peso fue de 9.86 y 10.05 kg, respectivamente para hombres y mujeres. La proporción de niños de seis y 12 años con sobrepeso fue de 11.2 y 9 % y con obesidad, de 14.7 y 15 %. La proporción de niñas de seis y 12 años con sobrepeso fue de 8.2 y 9.1 % y con obesidad, de 21.7 y 13.3 %, respectivamente. Al comparar los valores obtenidos con los de las tablas del doctor Ramos Galván para niños y niñas, el promedio de diferencia fue de 2 cm. Conclusiones: No se documentó un incremento secular de la talla ni del peso en los últimos 40 años.

Abstract Introduction: Children and adolescents weight and height are a reflection of the health status and socioeconomic development of a population. Objective: To evaluate height and weight progression patterns of Mexican children and compare them with Dr. Ramos-Galván growth charts 40 years later. Method: Cross-sectional survey conducted on the population of the National Physical Activation Program Ponte al 100, which includes boys and girls aged 6-12 years. Results: 43,670 boys and 44,103 girls were assessed, stratified by gender and age. The height progression pattern between six and 12 years was 21 cm in males and 22 cm in females, whereas the weight progression pattern was 9.86 and 10.05 kg, respectively, for males and females. The proportion of 6- and 12-year-old boys who were overweight was 11.2 and 9%, while 14.7 and 15% were obese. The proportion of 6- and 12-year-old girls who were overweight was 8.2 and 9.1%, whereas 21.7 and 13.3%, respectively, were obese. When the obtained values were compared with those of Dr. Ramos Galván growth charts for boys and girls, the average difference was 2 cm. Conclusions: No secular height or weight increase within the last 40 years was documented.

Impact of Using Different Growth References on Interpretation of Anthropometric Parameters of Children Aged 8-15 Years

Objective: To compare the effect of the application of threegrowth references (Agarwal, 1992; Indian Academy ofPaediatrics (IAP), 2015; and World Health Organisation (WHO),2007) on interpretation of anthropometric parameters inschoolchildren.Setting: Cross-sectional school-based study.Participants: Children 8-15 years studying in one governmentschool and one private school of Delhi.Procedure: The age- and gender-specific standard deviationscores of height-for-age and BMI-for-age were estimated foreach student enrolled, using the three growth referencesindependently.Main outcome measure: The proportion of children withshort stature, thinness and overweight/ obesity determined byeach growth reference were compared.Results: A total of 1237 students participated in the study. Asignificantly higher proportion of children (both sexes) wereclassified to have short stature using WHO 2007 reference(8.8%) as compared to the Agarwal (3.3%) charts and IAP, 2015references (3.6%). The combined prevalence of overweight andobesity was highest (34.8%) by the IAP, 2015 reference asagainst 32% by Agarwal charts and 29.1% by WHO, 2007reference. Good agreement existed between the IAP, 2015reference and Agarwal charts in classifying subjects intodifferent BMI categories (Kappa=0.82) and short stature(Kappa=0.99).Conclusions: In view of differences noted, use of nationalpopulation derived reference data is suggested to correctlydefine growth trajectories in children.