Subspecialty Health Care Utilization in Pediatric Patients With Muscular Dystrophy in the United States.

Background and Objectives: Standards of care exist to optimize outcomes in Duchenne and Becker muscular dystrophy (DBMD), caused by alterations in the DMD gene; however, there are limited data regarding health care access in these patients. This study aims to characterize outpatient subspecialty care utilization in pediatric patients with DBMD. Methods: This retrospective cohort study used administrative claims data from IBM MarketScan Medicaid and Commercial Claims and Encounters Research Databases (2013-2018). Male patients 1-18 years with an ICD-9/10 diagnosis code for hereditary progressive muscular dystrophy between January 1, 2013, and December 31, 2017, were included. Participants were stratified into 3 age cohorts: 1-6 years, 7-12 years, and 13-18 years. The primary outcome was rate of annual neurology visits. Secondary outcomes included annual follow-up rates in other subspecialties and proportion of days covered (PDC) by corticosteroids. Results: A total of 1,386 patients met inclusion-347 (25.0%) age 1-6 years, 502 (36.2%) age 7-12 years, and 537 (38.7%) age 13-18 years. Heart failure, respiratory failure, and technology dependence increased with age (p for all<0.05). The rate of neurology visits per person-year was 0.36 and did not differ by age. Corticosteroid use was low; 30% of person-years (1452/4829) had a PDC ≥20%. Medicaid insurance was independently associated with a lower likelihood of annual neurology follow-up (OR 0.23; 95% CI 0.18-0.28). Discussion: The rate of annual neurology follow-up and corticosteroid use in patients with DBMD is low. Medicaid insurance status was independently associated with a decreased likelihood of neurology follow-up, while age was not, suggesting that factors other than disease severity influence neurology care access. Identifying barriers to regular follow-up is critical in improving outcomes for patients with DBMD.

Programmatic Palliative Care Consultations in Pediatric Heart Transplant Evaluations.

Guidelines advocate for integrating palliative care into the management of heart failure (HF) and of children with life-limiting disease. The potential impact of palliative care integration into pediatric HF on patient-centered outcomes is poorly understood. The present study sought to assess the association of programmatic implementation of palliative care into the heart transplant evaluation process with hospital-free days (HFD) and end of life (EOL) treatment choices. The study included patients less than 19 years of age who underwent a heart transplant evaluation between February 2012 and April 2020 at a single center. Patients evaluated in the programmatic palliative care (PPC) era (January 2016-April 2020) were compared to patients evaluated in the pre-PPC era (February 2012-December 2015). The study included 188 patients, with 91 (48%) in the PPC era and 97 (52%) in the pre-PCC era. Children < 1 year of age at the time of the evaluation represented 32% of the cohort. 52% of patients had single ventricle physiology. PPC was not significantly associated with increased HFD (IRR 0.94 [95% CI 0.79-1.2]). PPC was however associated with intensity of EOL care with decreased mechanical ventilation (OR 0.12 [95% CI 0.02-0.789], p = 0.03) and decreased use of ionotropic support (OR 0.13 [95% CI 0.02-0.85], p =0.03). PPC in pediatric heart transplant evaluations may be associated with less invasive interventions at EOL.

Diagnostic Efficacy of Chest Computed Tomography with a Dual-Reviewer Approach in Patients Diagnosed with Pneumonia Secondary to Severe Acute Respiratory Syndrome Coronavirus 2.

To compare the diagnostic effectiveness of chest computed tomography (CT) utilizing a single- versus a dual-reviewer approach in patients with pneumonia secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we conducted a retrospective observational study of data from a cross-section of 4809 patients with probable SARS-CoV-2 from March to November 2020. All patients had a CT radiological report and reverse-transcription polymerase chain reaction (PCR) results. A dual-reviewer approach was applied to two groups while conducting a comparative examination of the data. Reviewer 1 reported 108 patients negative and 374 patients positive for coronavirus disease 2019 (COVID-19) in group A, and 266 negative and 142 positive in group B. Reviewer 2 reported 150 patients negative and 332 patients positive for COVID-19 in group A, and 277 negative and 131 positive in group B. The consensus result reported 87 patients negative and 395 positive for COVID-19 in group A and 274 negative and 134 positive in group B. These findings suggest that a dual-reviewer approach improves chest CT diagnosis compared to a conventional single-reviewer approach.

Antifungal and Insecticidal Activities of Selected Plant Species from Cloud Forest of Veracruz, Mexico: A Contribution to the Search of Novel Control Agents against Ambrosia Pest Complexes.

The antifungal and insecticidal activities of 34 extracts from 27 plant species were evaluated against fungal phytopathogens of the genus Fusarium and Xyleborus Scolytine ambrosia beetles involved in Fusarium dieback (FD) and laurel wilt (LW) diseases. Sixteen extracts caused mycelial growth inhibition (MGI) above 23 % at 2 mg mL-1 against F. solani, those from S. nudum and M. argyrophylla exhibited the highest MGI (57 % and 49 %, respectively). Thirteen extracts displayed significant antifungal activity against F. kuroshium, those from C. nocturnum and M. argyrophylla exhibited the highest MGI (100 % and 54.9 %, respectively). Additionally, ten plants extracts caused mortality in at least one of the beetle species tested, mainly from Solanaceae species. In the most active species, 39 phenolics were identified that may have contributed to their biological effects. This study is one of the first to report the potential of plant-derived natural products against the causative agents of FD and LW.

Effect of extrusion and autoclaving on the biological potential of proteins and naturally-occurring peptides from common beans: Antioxidant and vasorelaxant properties.

Aiming to understand the impact of hardening on the biological potential of bean protein and peptides, we evaluated the antioxidant and vasorelaxant properties of common beans after and before hardening. It was also evaluated the effect of extrusion and autoclaving in the biological potential of hardened beans. In general, hardening caused a reduction from 13.5 to 39.6% on the antioxidant activity of the peptide-rich fractions. On the other hand, hardening did not strongly interfere with the vascular reactivity in thoracic aorta rings, being observed maximal relation varying from 801% to 84.7%. The thermal treatment caused a general increase in the antioxidant and vasorelaxant potential of these fractions, being observed EC50 values ranging from 0.22 mg mL-1 to 0.26 mg mL-1. We can conclude that hardening did not seem to affect definitively the bioactivity of the obtained peptide-rich fractions. Finally, this study allows suggesting practical applications of extrusion as a thermal process in the production of functional food ingredients, and as ready-to-eat products presenting nutraceutical potential. In addition, autoclaving can be used as a pre-treatment of the hardened grains aiming to use them as whole grains with potentialized benefits for human health.

Health Care Use of Cardiac Specialty Care in Children With Muscular Dystrophy in the United States.

Background Duchenne and Becker muscular dystrophy are progressive disorders associated with cardiac mortality. Guidelines recommend routine surveillance; we assess cardiac resource use and identify gaps in care delivery. Methods and Results Male patients, aged 1 to 18 years, with Duchenne and Becker muscular dystrophy between January 2013 and December 2017 were identified in the IBM MarketScan Research Database. The cohort was divided into <10 and 10 to 18 years of age. The primary outcome was rate of annual health care resource per person year. Resource use was assessed for place of service, cardiac testing, and medications. Adjusted incidence rate ratios (IRRs) were estimated using a Poisson regression model. Medication use was measured by proportion of days covered. There were 1386 patients with a median follow-up time of 3.0 years (interquartile range, 1.9-4.7 years). Patients in the 10 to 18 years group had only 0.40 (95% CI, 0.35-0.45) cardiology visits per person year and 0.66 (95% CI, 0.62-0.70) echocardiography/magnetic resonance imaging per person year. Older patients had higher rates of inpatient admissions (IRR, 1.46; 95% CI, 1.03-2.09), outpatient cardiology visits (IRR, 2.0; 95% CI, 1.66-2.40), cardiac imaging (IRR, 1.59; 95% CI, 1.40-1.80), and Holter monitoring (IRR, 3.33; 95% CI, 2.35-4.73). A proportion of days covered >80% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was observed in 13.6% (419/3083) of total person years among patients in the 10 to 18 years group. Conclusions Children 10 to 18 years of age have higher rates of cardiac resource use compared with those <10 years of age. However, rates in both age groups fall short of guidelines. Opportunities exist to identify barriers to resource use and optimize cardiac care for patients with Duchenne and Becker muscular dystrophy.

Isolation and Identification of Pennogenin Tetraglycoside from Cestrum nocturnum (Solanaceae) and Its Antifungal Activity against Fusarium kuroshium, Causal Agent of Fusarium Dieback.

Antifungal assay-guided fractionation of the methanolic crude extract of Cestrum nocturnum (Solanaceae), popular known as 'lady of the night', led the isolation and identification of the steroidal saponin named pennogenin tetraglycoside, which was identified for the first time in this plant species by spectroscopic means. The crude extract, fractions and pennogenin tetraglycoside exhibited mycelial growth inhibition of Fusarium solani and F. kuroshium. F. solani is a cosmopolitan fungal phytopathogen that affects several economically important crops. However, we highlight the antifungal activity displayed by pennogenin tetraglycoside against F. kuroshium, since it is the first plant natural product identified as active for this phytopathogen. This fungus along with its insect symbiont known as Kuroshio shot hole borer (Euwallacea kuroshio) are the causal agents of the plant disease Fusarium dieback that affects more than 300 plant species including avocado (Persea americana) among others of ecological relevance. Scanning electron microscopy showed morphological alterations of the fungal hyphae after exposure with the active fractions and 12 phenolic compounds were also identified by mass spectrometry dereplication as part of potential active molecules present in C. nocturnum leaves.

Ectopic Burden via Holter Monitors in Friedreich Ataxia.

BACKGROUND: Friedreich ataxia is the most commonly inherited ataxia; nearly 60% of deaths are cardiac in nature, with one in eight deaths due to arrhythmia. Additional or irregular heartbeats, measured as ectopy, can be quantified using portable heart rhythm monitoring. We sought to describe the ectopic burden in Friedreich ataxia. METHODS: Using a natural history study of patients with Friedreich ataxia at a single center, we analyzed portable heart rhythm monitors (Holters). Ectopic burden was defined as the proportion of atrial or ventricular ectopic beats over total beats. RESULTS: Of 456 patients, 131 had Holters. Sixty-eight (52.0%) were male, median age of symptom onset was 8.0 years (5.0 to 13.0, n = 111), median age at time of Holter was 17.3 years (interquartile range [IQR] 12.9 to 22.8, n = 129), and median duration of illness was 8.7 years (IQR 5.3 to 11.6, n = 110). Median GAA length on the shorter FXN allele was 706.0 (IQR 550.0 to 840.0, n = 112). Eight (7.8%, n = 103) had diminished cardiac function, and 74 (74.0%, n = 100) had ventricular hypertrophy. Ninety patients (83.0%) had atrial ectopy (supraventricular ectopy [SVE]): 85 (78.0%) with rare SVE (>0% to 5%) and five (5.0%) with frequent SVE (>10%). Twenty-five (19.0%) had supraventricular runs, and one (0.8%) had atrial fibrillation/flutter. Forty-five (41.0%) had ventricular ectopy (VE): 43 (39.0%) with rare VE (0% to 5%) and two (2.0%) with moderate VE (5% to 10%). Compared with patients with none and rare SVE, patients with frequent SVE had longer disease duration (18.3 versus 4.6 versus 9.0 years, P = 0.0005). CONCLUSION: Patients with longer disease duration had higher rates of SVE. Heart rhythm monitoring may be considered for risk stratification; however, longitudinal analysis is needed.

Use of Contrast-Enhanced Ultrasound to Determine Thoracic Duct Patency.

The aim of this study was to determine the feasibility of using contrast-enhanced ultrasound (CEUS) evaluation to determine thoracic duct (TD) outlet patency. Nine patients referred for lymphatic imaging and intervention underwent percutaneous intranodal ultrasound contrast injection and conventional lymphangiography (CL). Eight of 9 patients had a patent TD by CEUS and CL. One patient did not have a patent TD. There was 100% agreement between CEUS and CL. These results suggest that CEUS is an imaging modality that might be as accurate as CL in determining TD patency.

Ansiedad y calidad de sueño en estudiantes de medicina: ¿Existe una relación con la anemia? / Anxiety and poor sleep quality in medical students. Is there a relationship with anemia?

Introducción: Los estudiantes de medicina suelen ser vulnerables a sufrir trastornos de salud mental como la ansiedad y una mala calidad de sueño. Ambos pueden repercutir negativamente en su conducta alimentaria, lo cual podría generar problemas de anemia a mediano o largo plazo durante su carrera. Objetivo: Conocer la prevalencia de ansiedad y mala calidad de sueño y evaluar la asociación con la presencia de anemia en estudiantes de medicina de una universidad pública peruana. Material y Métodos: Estudio transversal analítico realizado en 80 estudiantes de medicina del primer al cuarto año. Usamos el Inventario de Ansiedad de Beck (BAI) y el Índice de Calidad de Sueño de Pittsburgh (ICSP) para evaluar síntomas de ansiedad y la calidad de sueño, respectivamente. Incluimos también data sociodemográfica, académica y conductual. Así mismo, determinamos la presencia de anemia a través de la obtención de hemoglobina, siguiendo los procedimientos estipulados por el Ministerio de Salud. Resultados: Encontramos que el porcentaje de ansiedad y mala calidad de sueño fueron de 62,5 por ciento y 63,7 por ciento, respectivamente. Ser mujer (RPa: 1,39; 95 por ciento CI: 1,01-1,91) y tener anemia moderada (RPa: 1,31; CI 95 por ciento: 1,06-1,64) se asociaron a tener ansiedad. Por su parte, los factores asociados a una mala calidad de sueño fueron estar en Clínicas (RPa: 1,54; CI 95 por ciento: 1,17-2,02) y tener anemia moderada (RPa: 1,52; CI 95 por ciento: 1,09-2,11). Conclusión: La ansiedad y la calidad de sueño fueron problemas frecuentes en los estudiantes de medicina evaluados. Tener anemia moderada fue un factor asociado para ambos casos(AU)

Introduction: Medical students are often vulnerable to mental health disorders such as anxiety and poor sleep quality. Both can have a negative impact on their eating behavior, which could generate middle- and long-term anemia-related problems during their studies. Objective: To identify the prevalence of anxiety and poor sleep quality and to evaluate the association with anemia in medical students of a Peruvian public university. Material and Methods: We conducted a cross-sectional analytical study in 80 medical students from the first to the fourth year. We used the Beck Anxiety Inventory (BAI) and the Pittsburgh Sleep Quality Index (PSQI) to assess anxiety symptoms and sleep quality, respectively. We also included sociodemographic, academic, and behavioral data. Likewise, we determined the presence of anemia by obtaining hemoglobin results, following the procedures stipulated by the Peruvian Ministry of Health. Results: We found a percentage of anxiety and poor sleep quality of 62.5 percent and 63,7 percent , respectively. To be female (RPa: 1,39; 95 percent CI: 1,01-1,91) and to have moderate anemia (PRa: 1,31; 95 percent CI: 1,06-1,64) were associated with anxiety. On the other hand, the factors associated with poor sleep quality were to be located in Clinics (PRa: 1,54, 95 percent CI: 1,17-2,02) and to have moderate anemia (PRa: 1,52, CI95 percent : 1,09-2,11). Conclusion: Anxiety and sleep quality were frequent problems in the medical students studied. Moderate anemia was an associated factor for both cases(AU)

Antihyperglycemic and hypoglycemic activity of naturally occurring peptides and protein hydrolysates from easy-to-cook and hard-to-cook beans (Phaseolus vulgaris L.).

The present study was undertaken to examine the antidiabetic potential of naturally occurring peptides and hydrolysate fractions from easy-to-cook (ETC) and hard-to-cook (HTC) beans. All fractions were tested regarding their in vitro inhibitory activities against α-amylase and α-glucosidase as well as in vivo anti-hyperglycemic and hypoglycemic effects. Results evidenced that the peptide fractions with the lowest molecular weight (<3 kDa) have the highest inhibitory activities, and a 16.9%-89.1% inhibition of α-amylase and 34.4%-89.2% inhibition of α-glucosidase were observed. Regarding the antihyperglycemic activity, the fraction ETCNO3-10 showed a better performance than the positive control (acarbose). In addition, results from hypoglycemic activity evidenced that the tested peptide fractions were able to decrease the glucose levels at the same extension of glibenclamide, maintaining a constant basal glucose level without a postprandial hyperglycemia peak. Finally, it is possible to suggest that the naturally occurring peptides and hydrolysate fractions obtained from ETC and HTC common beans could be used in functional food production or pharmaceutical formulations to prevent diabetes.

Longitudinal growth in patients with single ventricle cardiac disease receiving tube-assisted feeds.

OBJECTIVE: Children with single ventricle cardiac disease (SVCD) have poor growth in early life. Tube-assisted feeding (TF) is used to improve weight gain, but its impact on long-term growth remains unknown. We sought to compare the longitudinal growth of SVCD patients receiving TF after initial cardiac surgery with those fed entirely by mouth. DESIGN: We conducted a retrospective cohort study of SVCD patients who underwent initial surgical palliation between 1999 and 2009. We defined TF as the use of nasogastric, gastrostomy, or jejunostomy TF. We compared maximal attained growth z-scores for each year of life between TF and non-TF patients. A secondary analysis compared surgical and clinical factors between groups. RESULTS: A total of 134 patients were included; 64% were male and 68% underwent the Norwood operation. One third of patients (44) received TF. Adjusting for age, TF patients had an average of 0.56 lower weight-for-age z-score (WAZ) than non-TF patients (P = 0.007) through the age of 6 years. Longitudinal height was not affected by TF status (P = 0.15). In a subanalysis of Norwood patients, TF patients had lower WAZ at initial hospital discharge despite longer LOS. TF patients had diminished WAZ after adjusting for complications, interstage hospitalizations, and timing of subsequent operations. CONCLUSIONS: In this single-center study, patients with SVCD requiring TF at discharge from initial surgical palliation had diminished WAZ at discharge and on long-term follow-up, despite controlling for other identifiable risk factors. Further investigation is needed to understand the mechanisms underlying this phenomenon and to risk stratify infants who go home on TF.

Positive Change in Feedback Perceptions and Behavior: A 10-Year Follow-up Study.

BACKGROUND: Providing and learning from feedback are essential components of medical education, and typically described as resistant to change. But given a decade of change in the clinical context in which feedback occurs, the authors asked if, and how, perceptions of feedback and feedback behaviors might have changed in response to contextual affordances. METHODS: In 2017, the authors conducted a follow-up, ethnographic study on 2 general pediatric floors at the same children's hospital where another ethnographic study on a general pediatric floor was conducted in 2007. Data sources included (1) 21 and 34 hours of observation in 2007 and 2017, respectively, (2) 35 and 25 interviews with general pediatric attending physicians and residents in 2007 and 2017, respectively, and (3) a review of 120 program documents spanning 2007 to 2017. Data were coded and organized around 3 recommendations for feedback that were derived from 2007 data and served as standards for assessing change in 2017. RESULTS: Data revealed progress in achieving each recommendation. Compared with 2007, participants in 2017 more clearly distinguished between feedback and evaluation; residents were more aware of in-the-moment feedback, and they had shifted their orientation from evaluation and grades to feedback and learning. Explanations for progress in achieving recommendations, which were derived from the data, pointed to institutional and national influences, namely, the pediatric milestones. CONCLUSIONS: On the basis of follow-up, ethnographic data, changes in the clinical context of pediatric education may afford positive change in perceptions of feedback and feedback behavior and point to influences within and beyond the institution.

Characteristics and Outcomes of Pediatric Heart Failure-Related Emergency Department Visits in the United States: A Population-Based Study.

OBJECTIVES: To describe the frequency, characteristics, and outcomes of heart failure-related emergency department (ED) visits in pediatric patients. We aimed to test the hypothesis that these visits are associated with higher admission rates, mortality, and resource utilization. STUDY DESIGN: A retrospective analysis of the Nationwide Emergency Department Sample for 2010 of patients ≤18 years of age was performed to describe ED visits with and without heart failure. Cases were identified using International Classification of Disease, Ninth Revision, Clinical Modification codes and assessed for factors associated with admission, mortality, and resource utilization. RESULTS: Among 28.6 million pediatric visits to the ED, there were 5971 (0.02%) heart failure-related cases. Heart failure-related ED patients were significantly more likely to be admitted (59.8% vs 4.01%; OR 35.3, 95% CI 31.5-39.7). Among heart failure-related visits, admission was more common in patients with congenital heart disease (OR 5.0, 95% CI 3.3-7.4) and in those with comorbidities including respiratory failure (OR 78.3, 95% CI 10.4-591) and renal failure (OR 7.9, 95% CI 1.7-36.3). Heart failure-related cases admitted to the hospital had a higher likelihood of death than nonheart failure-related cases (5.9% vs 0.32%, P < .001). Factors associated with mortality included respiratory failure (OR 4.5, 95% CI 2.2-9.2) and renal failure (OR 7.8, 95% CI 2.9-20.7). Heart failure-related ED visits were more expensive than nonheart failure-related ED visits ($1460 [IQR $861-2038] vs $778 [IQR $442-1375] [P < .01].) CONCLUSIONS: Heart failure-related visits represent a minority of pediatric ED visits but are associated with increased hospital admission and resource utilization.

Preocupación amiiental entre población universiaria: representaciones socialess e implicación personal en temas ambientales en la universidad de aniooquia / Envirnmental conncern among university population: social representations and personal involvement in environmental issues at university of antioquia

En el artículo, derivado de investigación, se muestran las dificultades identificadas en la ciudadela de la Universidad de Antioquia al momento de construir una definición de ambiente en la cual se incluya al ser humano como parte integral del mismo. Para tal fin se aplicaron dos encuestas, la primera que fue denominada "prueba piloto" sirvió para afinar las preguntas usadas en el campo de la psicología a la hora de abordar la preocupación ambiental, ésta es, la escala de Likert; la segunda, fue la encuesta depurada y aplicada entre empleados, docentes y estudiantes de la ciudad universitaria, que ofreció los elementos necesarios para analizar las representaciones sociales del ambiente que comprenden la valoración de los problemas ambientales, el nivel de implicación personal y la capacidad de acción, permitiendo una lectura desde la perspectiva antropológica de las relaciones entre los humanos y el ambiente en ese contexto social.

This article, derived from research, shows the difficulties identified in the Citadel of the University of Antioquia when it comes to constructing a definition of the environment in which the human being, as an integral part, must be included. For this purpose, two surveys were applied, the first one which was called "a pilot test" served to refine the questions used in the field of psychology in addressing environmental concerns, this is, the Likert scale; the second one, was a refined survey that was applied among employees, teachers, and students, at the University Campus, which offered the elements needed to analyze the social representations comprising the assessment of environmental problems, the level of personal involvement, and the capacity of action, allowing a reading from the anthropological perspective of relationships between humans and the environment in this social context.

Carpal and cubital tunnel syndrome: who gets surgery?

BACKGROUND: Despite the prevalence of carpal and cubital tunnel syndrome, and relief of symptoms following timely surgical release, it is unclear how nonclinical patient characteristics affect disease management. QUESTIONS/PURPOSES: We examined the effects of a variety of factors, such as age, gender, and socioeconomic status on the management of both carpal and cubital tunnel syndromes. PATIENTS AND METHODS: We retrospectively reviewed the records of all 273 patients seen by two hand surgeons with a diagnosis of either carpal or cubital tunnel syndrome between January 2005 and January 2007. Demographic, clinical (diagnosis, treatment), and socioeconomic (insurance type, median income) information was collected. Census data (2000) were used to collect information on median household income. The average age was 52 years (range, 19-87 years), and 65% of the patients were women (n = 178). Eighteen patients had Workers Compensation. Of the 273 patients, 86 (32%) had two or more diagnoses. RESULTS: Among patients with carpal tunnel syndrome, there was a higher proportion of female patients compared to male patients (68% versus 32%); male patients with multiple neuropathies had higher rates of surgery than their female counterparts (63% versus 41%). Only increasing age was associated with increasing likelihood of surgery. Among multiple-diagnosis patients, those with Workers Compensation (n = 6) had higher wait times for surgery than their counterparts (n = 46) (126 days versus 26 days). CONCLUSION: Patient age was the most important predictor of surgical release, and among those with multiple neuropathies, male patients were more likely to have surgery than female patients. Patients with Workers Compensation may experience long wait times to surgery. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Prevalencia de caries dental en preescolares con dentición decidua área Metropolitana del Valle de Aburrá / Prevalence of dental caries in preschool children with primary dentition area Metropolitan of Valle the Aburra

Introducción y Objetivo: El diagnóstico de caries de la infancia temprana debe ser una prioridad en todos los sistemas de salud. El propósito del estudio fue describir la situación de caries dental en niños con dentición decidua completa, pertenecientes a un estrato socioeconómico 2 y 3 del área metropolitana del Valle de Aburrá. Materiales y Métodos: Se hizo un estudio descriptivo en 447 niños entre 2 y 4 años de edad, seleccionados de los registros de Susalud, con confiabilidad del 95%y un error de muestreo de 5%. Se realizó un examen clínico por 3 examinadores estandarizados en el Sistema Internacional de Evaluación y Detección de Caries Dental (ICDAS). (Kappa 0.73 – 0.85). Resultados: La prevalencia de niños con caries dental fue de 74.7% y un promedio de 7.3±9.1 superficies afectadas, la experiencia de caries fue 74.9% con un promedio ceo-s de 7.7±9.7 superficies afectadas. La prevalencia de niños con al menos una superficie afectada por lesión no cavitada fue del 73.4%. La prevalencia de caries dental fue significativamente mayor en la IPS La Playa (70.2%) que en Itagüí (62.8%). Conclusión: El uso de sistemas de diagnóstico de caries dental que incluyen la lesión no cavitada es de gran importancia, el elevado porcentaje de caries dental encontrado en este grupo de la población indica la necesidad de un diagnóstico precoz y al mismo tiempo de desarrollar actividades terapéuticas y preventivas específicas y oportunas para este grupo de edad.

Introduction and Objective: Dental caries diagnosis during early childhood should be a priorityin all health systems. The purpose of this study was to describe the initial dental caries situation in children with complete deciduous teeth, both genders, with lower and middle lower social-economic level from an urban area in Medellín. Materials and Methods: A randomly selected sample of 447children between 2 and 4 years old was calculated; the sample was taken from the Susalud database, with 95% reliability, power of 80% and an error of 5%. A clinical test was performed by 3 calibrated examiners according to the International Dental Caries Detection and Assessment System (ICDAS)(Kappa 0.73 – 0.85). A WHO periodontal probe (11.5) was used for caries detection. Results: Treated and untreated dental caries prevalence of children was 74.7% with a specific mean of 9.7 ± 9.3 (SD), affected surfaces, prevalence of children having surfaces affected by non- treated dental decay was 74.9% while the dmf-s mean was 7.6 ± 7.7 (SD). 73.4% of children had at least one non-cavitated affected surface. Dental caries prevalence at “La Playa” Dental Clinic (70.2%) was higher than the“Itagúi” Dental Clinic (62.8%) with a significant statistical difference (p value = 0.01 chi). The dmf-smean according to Dental Clinic was 0.8 ± 2.7 (SD) in Itagui and 1.5 ± 3.9 at La Playa. Conclusions: The use of diagnostic systems that include non-cavited lesions is very important, the high percentage of decay at this age indicates the early presence of this illness, thus the importance of an early diagnosisand at the same time the implementation of specific treatment and prevention.