Initial Experience with the Solitaire X 3 mm Stent Retriever for the Treatment of Distal Medium Vessel Occlusions.

Endovascular therapy (EVT) is the standard treatment for ischemic stroke caused by a large vessel occlusion (LVO). The effectiveness of EVT for distal medium vessel occlusions (MDVOs) is still uncertain, but newer, smaller devices show potential for EVT in MDVOs. The new Solitaire X 3 mm device offers a treatment option for MDVOs. Our study encompassed consecutive cases of primary and secondary MDVOs treated with the Solitaire X 3 mm stent-retriever as first-line EVT device between January and December 2022 at 12 European stroke centers. The primary endpoint was a first-pass near-complete or complete reperfusion, defined as a modified treatment in cerebral infarction (mTICI) score of 2c/3. Additionally, we examined reperfusion results, National Institutes of Health Stroke Scale (NIHSS) scores at 24 h and discharge, device malfunctions, complications and procedural technical parameters. Sixty-eight patients (38 women, mean age 72 ± 14 years) were included in our study. Median NIHSS at admission was 11 (IQR 6-16). In 53 (78%) cases, a primary combined approach was used as the frontline technique. Among all enrolled patients, first-pass mTICI 2c/3 was achieved in 22 (32%) and final mTICI 2c/3 in 46 (67.6%) patients after a median of 1.5 (IQR 1-2) passes. Final reperfusion mTICI 2b/3 was observed in 89.7% of our cases. We observed no device malfunctions. Median NIHSS at discharge was 2 (IQR 0-4), and no symptomatic intracranial hemorrhages were reported. Based on our analysis, the utilization of the Solitaire X 3 mm device appears to be both effective and safe for performing EVT in cases of MDVO stroke.

Reporting guidelines and a touch of critical appraisal.

The biomedical research process must follow certain quality criteria in its design and development to ensure that the results are credible and reliable. Once completed, the time comes to write an article for publication. The article must present in sufficient detail, and in a clear and transparent manner, all the information on the research work that has been carried out. In this way, readers, after a critical reading of the published content, will be able to judge the validity and relevance of the study and, if they so wish, make use of the findings. In order to improve the description of the research process for publication, a series of guidelines have been developed which, in a simple and structured way, guide authors in the preparation of a manuscript. They are presented in the form of a list, flowchart, or structured text, and are an invaluable aid when writing an article. This article presents the reporting guidelines for the most common designs along with the corresponding checklists.

Guías para la elaboración de manuscritos y unas pinceladas de lectura crítica / Reporting guidelines and a touch of critical appraisal

El proceso de investigación biomédica debe seguir unos criterios de calidad en su diseño y elaboración que garanticen que los resultados son creíbles y fiables. Una vez finalizado, llega el momento de escribir un artículo para su publicación. Este debe presentar con suficiente detalle, y de forma clara y transparente, toda la información del trabajo de investigación realizado. De esta forma, los lectores, tras una lectura crítica de lo publicado, podrán juzgar la validez y la relevancia del estudio, y si lo consideran, utilizar los hallazgos. Con el objetivo de mejorar la descripción del proceso de investigación para su publicación, se han desarrollado una serie de guías que, de forma sencilla y estructurada, orientan a los autores a la hora de elaborar un manuscrito. Se presentan en forma de lista, diagrama de flujo, o texto estructurado, y son una ayuda inestimable a la hora de escribir un artículo. Este artículo presenta las guías de elaboración de manuscritos de los diseños más habituales, con sus listas de verificación.(AU)

The biomedical research process must follow certain quality criteria in its design and development to ensure that the results are credible and reliable. Once completed, the time comes to write an article for publication. The article must present in sufficient detail, and in a clear and transparent manner, all the information on the research work that has been carried out. In this way, readers, after a critical reading of the published content, will be able to judge the validity and relevance of the study and, if they so wish, make use of the findings. In order to improve the description of the research process for publication, a series of guidelines have been developed which, in a simple and structured way, guide authors in the preparation of a manuscript. They are presented in the form of a list, flowchart, or structured text, and are an invaluable aid when writing an article. This article presents the reporting guidelines for the most common designs along with the corresponding checklists.(AU)

Early exploration of the economic impact of transradial access (TRA) versus transfemoral access (TFA) for neurovascular procedures in Spain.

INTRODUCTION: Transfemoral access (TFA) is the primary access approach for neurointerventional procedures. Transradial access (TRA) is established in cardiology due to its lower complications, yet, it is at its early stages in neuroprocedures. This study performs an early exploration of the economic impact associated with the introduction of TRA in diagnostic and therapeutic neuroprocedures from the Spanish NHS perspective. METHODS: An economic model was developed to estimate the cost and clinical implications of using TRA compared to TFA. Costs considered access-related, complications and recovery time costs obtained from local databases and experts' inputs. Clinical inputs were sourced from the literature. A panel of eight experts from different Spanish hospitals, validated or adjusted the values based on local experience. Hypothetical cohorts of 10,000 and 1000 patients were considered for diagnostic and therapeutic neuroprocedures respectively. Deterministic sensitivity analysis was performed. RESULTS: TRA in diagnostic procedures was associated with lower costs with savings ranging between €486 and €157 depending on the TFA recovery time considered. TRA is estimated to lead to 158 fewer access-site complications. In therapeutic procedures, TRA resulted in 76.4 fewer complications and was estimated to be cost-neutral with an incremental cost of €21.56 per patient despite recovery times were not included for this group. Variation of the parameters in the sensitivity analysis did not change the direction of the results. LIMITATIONS: Clinical data was obtained from literature validated by experts therefore results generalizability is limited. In therapeutic neuroprocedures, there is an experience imbalance between approaches and recovery times were not included hence the total impact is not fully captured. CONCLUSIONS: The early economic model suggests that implementing TRA is associated with reduced costs and complications in diagnostic procedures. In therapeutic procedures, TRA lead to fewer complications and it is estimated to be cost-neutral, however its full potential still needs to be quantified.

Evidentia praxis: nirsevimab y prevención de bronquiolitis en lactantes nacidos a término / Evidentia praxis: Nirsevimab and bronchiolitis prevention in term-born infants

Analizamos la evidencia publicada sobre la eficacia y seguridad de nirsevimab, un anticuerpo monoclonal, empleado para prevenir las infecciones de vías respiratorias bajas (IVRB) por virus respiratorio sincitial (VRS) en el lactante a término. Encontramos un ensayo clínico aleatorizado controlado con placebo doble ciego que incluyó 3012 lactantes, nacidos a término o pretérmino tardío, menores de un año con un seguimiento de al menos 150 días. La calidad de la evidencia se clasificó como baja para IVRB muy grave y moderada para IVRB que precisara asistencia o ingreso. La evidencia se sustenta sobre un escaso número de eventos (para ingresos hospitalarios sólo 29 casos, para IVRB con atención médica 78), por lo que cualquier estimación debe considerarse imprecisa. La eficacia, estimada como reducción relativa del riesgo (RRR) fue del 76,4% (intervalo de confianza del 95% [IC 95]: 62,3 a 85,2) para IVRB por VRS y del 76,8% (IC 95: 49,4 a 89,4%) para ingreso. No se encontraron diferencias en cuanto a seguridad. Existen dudas sobre la importancia clínica, por los criterios de gravedad empleados, y sobre su impacto, con un número necesario a tratar para evitar una IVRB con ingreso de 63 y que requiera asistencia médica de 24. Por la información disponible parece una intervención segura, de la que no esperamos efectos adversos comunes, pero no podemos descartar efectos de baja frecuencia. Asimismo, esperamos contar pronto con estimaciones más precisas de eficacia y seguridad (AU)

We reviewed the published evidence on the efficacy and safety of nirsevimab, a monoclonal antibody, used to prevent respiratory syncytial virus (RSV) associated lower respiratory tract infections (LRTI) in term infants. We have found a randomized double-blind placebo-controlled clinical trial that included 3012 infants, born at term or late preterm, less than one year of age with a follow-up of at least 150 days. The quality of the evidence was classified as low for very severe LRTI and moderate for LRTI requiring medical care or admission. The evidence is based on a small number of events (only 29 cases for hospital admissions, 78 for IVRB with medical care), so any estimate must be considered imprecise. Efficacy, estimated as relative risk reduction (RRR) was 76.4% (95% confidence interval [95 CI]: 62.3 to 85.2) for RSV associated LRTI that required medical care and 76.8% (CI 95: 49.4 to 89.4%) for hospital admission. No differences were found in terms of safety. There are doubts about the clinical importance, due to the severity criteria used, and about its impact, with a number needed to treat of 63 to avoid a LRTI with hospital admission and of 24 to avoid LRTI requiring medical care. Based on the available information, it seems a safe intervention, from which we do not expect common adverse effects, but we cannot rule out low-frequency effects. We also expect to have more precise estimates of efficacy and safety soon. (AU)

Endovascular thrombectomy first-pass reperfusion and ancillary device placement.

BACKGROUND: Recent randomized trials have demonstrated the efficacy of mechanical thrombectomy in treating acute ischemic stroke, however, further research is required to optimize this technique. We aimed to evaluate the impact of guide catheter position and clot crossing on revascularization rates using A Direct Aspiration First Pass Technique (ADAPT). METHODS: Data were collected between January 2018 and August 2019 as part of the Spanish ADAPT Registry on ACE catheters (SARA), a multicenter observational study assessing real-world thrombectomy outcomes. Demographic, clinical, and angiographic data were collected. Subgroup analyses assessed the relationship between guide catheter/microguidewire position and modified Trombolysis in Cerebral Infarction (mTICI) scores. First pass effect (FPE) was defined as mTICI 3 after single pass of the device. RESULTS: From a total of 589 patients, 80.8% underwent frontline aspiration thrombectomy. The median score on the National Institutes of Health Stroke Scale (NIHSS) was 16.0. After adjusting for confounders, the likelihood of achieving FPE (adjusted Odds Ratio (aOR), 0.587; 95% confidence interval (CI), 0.38 to 0.92; p=0.0194) were higher among patients with more distal petrocavernous placement of guide catheter. The likelihood of achieving FPE (aOR, 0.592; 95% CI, 0.39 to 0.90; p=0.0138) and final angiogram complete reperfusion (aOR, 0.465; 95% CI, 0.30 to 0.73; p=0.0008) were higher among patients without microguidewire crossing the clot. No difference was noted for time from arterial puncture to reperfusion in any study group. At the 90-day follow-up, the mortality rate was 9.2% and 65.8% of patients across the entire study cohort were functionally independent (modified Rankin Scale (mRS) 0-2). CONCLUSIONS: Petrocavernous guide catheter placement improved first-pass revascularization. Crossing the occlusion with a microguidewire lowered the likelihood of achieving FPE and complete reperfusion after final angiogram.

Suicidal ideation and suicide attempt in patients with psychiatric disorders in a Mexico City hospital.

BACKGROUND: One of the population groups at higher risk of suicide is that of people who attend mental health institutions. OBJECTIVE: To know the demographic and clinical characteristics of people admitted for suicidal ideation and suicide attempt to the observation area of a psychiatric hospital in a period of 10 non-consecutive months. MATERIAL AND METHODS: Retrospective, descriptive, correlational study. A total of 439 medical records were collected, out of which 62.9% (n = 276) corresponded to women, 36.7% (n = 161) to men and 0.5% (n = 2) to transgender people; age ranged from 17 to 74 years. RESULTS: The highest incidence of cases was observed between 18 and 25 years of age; the most frequent diagnosis was depressive disorder, and 45.5% (n = 200) of the cases had a suicide attempt. The main method for committing a suicidal act was poisoning by taking various medications, followed by self-inflicted injuries with sharp objects. A positive correlation was found between suicide attempt and self-harm (c² = 1.965, p < 0.05). CONCLUSIONS: The findings highlight the importance of early identification of risk factors that may contribute to an increase in suicidal behaviors.

ANTECEDENTES: Uno de los grupos poblacionales en mayor riesgo de suicidio lo constituyen las personas que asisten a instituciones de salud mental. OBJETIVO: Conocer las características demográficas y clínicas de las personas ingresadas por ideación e intento suicida al área de observación de un hospital psiquiátrico en un periodo de 10 meses no consecutivos. MATERIAL Y MÉTODOS: Estudio retrospectivo, descriptivo y correlacional. Se recabaron 439 expedientes, de los cuales las mujeres representaron 62.9 % (n = 276), los hombres 36.7 % (n = 161) y las personas transgénero 0.5 % (n = 2); el rango de edad varió de 17 a 74 años. RESULTADOS: La mayor incidencia de casos se observó entre los 18 y 25 años, el diagnóstico más frecuente fue el trastorno depresivo y 45.5 % (n = 200) de los casos presentó una tentativa suicida. El principal método para cometer un acto suicida fue el envenenamiento por diversos medicamentos seguido por las lesiones autoinflingidas con objeto punzocortante. Se encontró correlación positiva entre intento suicida y autolesiones (c² = 1.965, p < 0.05). CONCLUSIONES: Los hallazgos resaltan la importancia de la identificación temprana de los factores de riesgo que pueden contribuir al incremento del comportamiento suicida.

Lidocaína para el alivio del dolor en pacientes de cuidados paliativos, una serie de casos / Lidocaine for pain relief in palliative care patients, a case series

Introducción. El dolor neuropático afecta al 2 % de la población y 15 de cada 100 pacientes que acuden a consulta médica, sufren de dolor neuropático. Este tipo de dolor es muy común en pacientes con cáncer. Objetivo. Determinar si el uso de lidocaína en infusión endovenosa disminuye el dolor neuropático en los cuidados paliativos con tratamiento opioide. Metodología. Serie de casos de tres pacientes en cuidados paliativos que presentaron dolor neuropático y se les administraron múltiples infusiones de lidocaína intravenosa como coadyuvante para el manejo del dolor, se describieron las dosis utilizadas, el número de infusiones, se evaluó la mejoría del dolor a través de la escala visual análoga y se monitorizaron los posibles efectos secundarios. Resultados. Caso 1: escala visual análoga al ingreso 9/10; 24 horas posinfusión de lidocaína: 4/10. Caso 2: escala visual análoga al ingreso 6/10; 24 horas posinfusión de lidocaína 2/10. Caso 3: escala visual análoga al ingreso 8/10; 24 horas posinfusión 2/10. Conclusión. La infusión intravenosa de lidocaína al 2 % disminuyó el dolor neuropático en los tres pacientes del estudio, sin embargo, el alivio fue transitorio y el efecto positivo se perdió con el paso del tiempo

Introduction. Neuropathic pain affects 2 % of the population and 15 out of 100 patients who go to a physician suffer from neuropathic pain. This type of pain is common in cancer patients. Objective. To determine if the use of lidocaine in intravenous infusion reduces neuropathic pain in palliative care with opioid treatment. Methodology. Case series of three patients in palliative care who presented neuropathic pain and underwent multiple infusions of intravenous lidocaine as an adjuvant for pain management; the doses used and the number of infusions were described, pain improvement was evaluated through the visual analog scale and possible side effects were monitored. Results. Case 1: visual analogue scale on admission 9/10; 24 hours post lidocaine infusion: 4/10. Case 2: visual analogue scale on admission 6/10; 24 hours post lidocaine infusion 2/10. Case 3: visual analogue scale on admission 8/10; 24 hours post-infusion 2/10. Conclusion.Intravenous infusion of 2 % lidocaine reduced neuropathic pain in the three patients of the study, however, the relief is transitory, and the positive effect is lost over time.

Ideación e intento suicida en pacientes con padecimientos psiquiátricos en un hospital de la Ciudad de México / Suicidal ideation and suicide attempt in patients with psychiatric disorders in a Mexico City hospital

Resumen Antecedentes: Uno de los grupos poblacionales en mayor riesgo de suicidio lo constituyen las personas que asisten a instituciones de salud mental. Objetivo: Conocer las características demográficas y clínicas de las personas ingresadas por ideación e intento suicida al área de observación de un hospital psiquiátrico en un periodo de 10 meses no consecutivos. Material y métodos: Estudio retrospectivo, descriptivo y correlacional. Se recabaron 439 expedientes, de los cuales las mujeres representaron 62.9 % (n = 276), los hombres 36.7 % (n = 161) y las personas transgénero 0.5 % (n = 2); el rango de edad varió de 17 a 74 años. Resultados: La mayor incidencia de casos se observó entre los 18 y 25 años, el diagnóstico más frecuente fue el trastorno depresivo y 45.5 % (n = 200) de los casos presentó una tentativa suicida. El principal método para cometer un acto suicida fue el envenenamiento por diversos medicamentos seguido por las lesiones autoinflingidas con objeto punzocortante. Se encontró correlación positiva entre intento suicida y autolesiones (χ2 = 1.965, p < 0.05). Conclusiones: Los hallazgos resaltan la importancia de la identificación temprana de los factores de riesgo que pueden contribuir al incremento del comportamiento suicida.

Abstract Background: One of the population groups at higher risk of suicide is that of people who attend mental health institutions. Objective: To know the demographic and clinical characteristics of people admitted for suicidal ideation and suicide attempt to the observation area of a psychiatric hospital in a period of 10 non-consecutive months. Material and methods: Retrospective, descriptive, correlational study. A total of 439 medical records were collected, out of which 62.9% (n = 276) corresponded to women, 36.7% (n = 161) to men and 0.5% (n = 2) to transgender people; age ranged from 17 to 74 years. Results: The highest incidence of cases was observed between 18 and 25 years of age; the most frequent diagnosis was depressive disorder, and 45.5% (n = 200) of the cases had a suicide attempt. The main method for committing a suicidal act was poisoning by taking various medications, followed by self-inflicted injuries with sharp objects. A positive correlation was found between suicide attempt and self-harm (χ2 = 1.965, p < 0.05). Conclusions: The findings highlight the importance of early identification of risk factors that may contribute to an increase in suicidal behaviors.

Influence of sociodemographic factors on academic performance in the subject of human gross anatomy / Influencia de los factores sociodemográficos en el rendimiento académico en la asignatura de anatomía macroscópica humana

SUMMARY: It has been demonstrated that the teaching and learning process of human anatomy is influenced by different external factors that can affect, in the short and long term, the academic and professional performance of medical students. In this sense, the present work aims to determine the relationship between sociodemographic factors and the academic performance of students belonging to the program of Medicine and Surgery of the Universidad del Valle, in Cali-Colombia, who were enrolled in the course of Human Gross Anatomy. Based on the organization of the course plan, the average grades obtained by the students in the different exams taken in the course were compared. Through a survey, sociodemographic data that have been reported as influential factors in academic performance were asked. The first stage of the analysis consisted of identifying the characteristics of the variables, then the correlation of the sociodemographic variables with the students' academic performance, and finally, a multiple linear regression model was implemented. Although the results did not show statistically significant correlations between the variables analyzed, a close relationship was observed with the sex and place of origin of the students, obtaining that women and students from other towns and cities presented lower academic performance compared to their peers. This highlights the importance of including activities to strengthen the learning process, as well as guiding support programs to maintain academic performance and reduce the inequality gap.

Se ha demostrado que en el proceso de enseñanza y aprendizaje de la anatomía humana inciden diferentes factores externos que pueden afectar, a corto y largo plazo, el desempeño académico y profesional de los estudiantes de Medicina. En este sentido, el presente trabajo tiene como objetivo determinar la relación existente entre los factores sociodemográficos y el rendimiento académico de los estudiantes que pertenecen al programa de Medicina y Cirugía de la Universidad del Valle, en Cali-Colombia, matriculados en la asignatura de Anatomía Macroscópica Humana. A partir de la organización del plan del curso, se comparó el promedio de las notas obtenidas por los estudiantes en los diferentes exámenes realizados en la asignatura. A través de una encuesta, se preguntaron algunos datos sociodemográficos que han sido reportados como factores influyentes en el rendimiento académico. La primera etapa del análisis consistió en identificar las características de las variables, a continuación, la correlación de las variables sociodemográficas con el desempeño académico de los estudiantes y, finalmente, se implementó un modelo de regresión lineal múltiple. Si bien los resultados no arrojaron correlaciones estadísticamente significativas entre las variables analizadas, sí se observó una estrecha relación con el sexo y el lugar de procedencia de los estudiantes, obteniendo que las mujeres y los estudiantes foráneos presentaron menor rendimiento académico en comparación con los demás compañeros. Esto resalta la importancia de incluir actividades que permitan fortalecer el proceso de aprendizaje, así como guiar programas de apoyo para mantener el rendimiento académico y disminuir la brecha de desigualdad.

Competencies for quality spiritual care in palliative care in Latin America: from the Spirituality Commission of the Latin American Association for Palliative Care.

Spiritual care is an essential part of quality palliative care. However, the literature regarding spiritual care competencies in Latin America is limited. Herein we propose the basic quality standards for spiritual care in palliative care according to best professional practices and provide a common vocabulary and required competencies for quality clinical spiritual care. Both elements, quality standards and a common vocabulary, are part of an essential step implementing continuous educational initiatives among interdisciplinary palliative care teams in Latin America. Members of the Spirituality Commission of the Latin American Association for Palliative Care and three members of independent professional palliative care organizations identified and reviewed our proposed spiritual care competencies and created a consensus document describing the competencies for general spiritual care. In the context of palliative care in Latin America, general spiritual care is provided by members of interdisciplinary teams. We proposed six competencies for high-quality general spiritual care and their observable behaviors that every member of an interdisciplinary palliative care team should have to provide quality clinical spiritual care in their daily practice: (I) personal, spiritual, and professional development; (II) ethics of spiritual care; (III) assessment of spiritual needs and spiritual care interventions; (IV) empathic and compassionate communication; (V) supportive and collaborative relationships among the interdisciplinary team; and (VI) inclusivity and diversity.

Economic impact of the first pass effect in mechanical thrombectomy for acute ischaemic stroke treatment in Spain: a cost-effectiveness analysis from the national health system perspective.

OBJECTIVE: The mechanical thrombectomy (MT) benefit is related to the degree of reperfusion achieved. First pass effect (FPE) is defined as complete/near revascularisation of the large-vessel occlusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after a single device pass. This study assessed the health benefit and economic impact of achieving FPE for acute ischaemic stroke (AIS) patients from the Spanish National Health System (NHS) perspective. DESIGN: A lifetime Markov model was used to estimate incremental costs and health outcomes (measured in quality-adjusted life-years (QALYs)) of patients that achieve FPE. A subanalysis of the Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischaemic Stroke (STRATIS) registry was performed to obtain clinical outcomes. The base case included all patients that achieved at least a final mTICI ≥2 b, while the alternative scenario included all patients regardless of their final mTICI (0-3). Treatment costs were updated to reflect current practice based on expert panel consensus, while other acute and long-term costs were obtained from a previous cost-effectiveness analysis of MT performed in Spain. Sensitivity analyses were performed to assess the model's robustness. SETTING: Spanish healthcare perspective. PARTICIPANTS: AIS patients in Spain. INTERVENTIONS: FPE following MT. OUTCOME MEASURES: The model estimated QALYs, lifetime costs and net monetary benefit for the FPE and non-FPE group, depending on the inclusion of reperfusion groups and formal care costs. RESULTS: STRATIS subanalysis estimated significantly better clinical outcomes at 90 days for the FPE group in all scenarios. In the base case, the model estimated lifetime cost saving per patient of €16 583 and an incremental QALY gain of 1.2 years of perfect health for the FPE group. Cost savings and QALY gains were greater in the alternative scenario (-€44 289; 1.75). In all scenarios, cost savings were driven by the long-term cost reduction. CONCLUSION: Achieving FPE after MT can lead to better health outcomes per AIS patient and important cost savings for the Spanish NHS.

Notas acerca de la transfusión sanguínea en México / Notes about blood transfusion in Mexico

Resumen: La historia de la transfusión sanguínea es apasionante. En México, esta práctica se inició en el siglo XIX y a partir de entonces los avances y contribuciones de investigadores y clínicos fueron decisivos para su desarrollo e implementación en la práctica clínica. El objetivo de este trabajo es hacer una breve revisión histórica de la transfusión sanguínea en México.

Abstract: The history of blood transfusions is exciting. In Mexico this practice began in the XIX century and from this time the advances and contributions of researchers and clinicians were decisive for its development and implementation in the clinical practice. The aim of this paper is to make a brief review of the history of blood transfusion in Mexico.

Evaluation of Telehealth Service for COVID-19 Outpatients: A Dashboard to Measure Healthcare Quality and Safety.

Due to the COVID-19 pandemic, changes and improvements regarding the organization have been made to adapt quickly at the Emergency Department (ED) of the Hospital Italiano de Buenos Aires, Argentina. This article describes the design, implementation, and use of an electronic dashboard which provided monitoring of patients discharged home, during follow-up with telehealth. It was useful to access essential information to organize and coordinate professional work and patients' surveillance, providing highly relevant data in real-time as proxy variables for quality and safety during home isolation. The implemented tool innovated in the integration of technologies within a real context. The information management was crucial to optimize services and decision-making, as well to guarantee safety for healthcare workers and patients.

Impact of COVID-19 Pandemic on Telehealth and In-Person Visits: Implications from an Emergency Department in Argentina.

Since Argentina's government declared a national emergency to combat the COVID-19 pandemic with a lockdown status, it has produced consequences on the healthcare system. We aimed to quantify the effect on the Emergency Department (ED) visits at Hospital Italiano de Buenos Aires. Our electronic health data showed that ED in-person visits declined 46% during the COVID-19 pandemic, from an overall of 176,370 visits during 2019 to 95,421 visits during 2020. Simultaneously, there was a telehealth visits boom when mandatory quarantine began (March 20, 2020): from a median of 12 daily in February 2020 to a median of 338 daily in April 2020; reaching a maximum daily peak of 1,132 on March 26 2020. For a while, teleconsultations replaced ED visits. Then, when face-to-face visits began to increase, teleconsultations began to decrease slowly, as the phenomenon reversed.

Impact of a virtual learning environment on the conscious prescription of antibiotics among Colombian dentists.

Appropriate antibiotic prescription contributes to reducing bacterial resistance; therefore, it is critical to provide training regarding this challenge. The objective of this study was to develop a virtual learning environment for antibiotic prescription and to determine its impact on dentists' awareness, attitudes, and intention to practice. First, the learning content on multimedia resources was developed and distributed into three challenges that participants had to overcome. Then, a quasi-experimental study was performed in which the virtual learning environment was implemented on dentists from seven Colombian cities. The median of correct answers and the levels of awareness, attitudes, and intention to practice were compared before, immediately after, and 6-months post-intervention. Wilcoxon signed-rank and McNemar's tests were used to determine the differences. A total of 206 participants who finished the virtual learning environment activities exhibited a favorable and statistically significant impact on the median of correct answers of awareness (p < 0.001), attitudes (p < 0.001), and intention to practice (p = 0.042). A significant increase occurred in the number of participants with a high level of awareness (p < 0.001) and a non-significant increase in participants with high levels of attitudes (p = 0.230) and intention to practice (p = 0.286). At 6 months, the positive effect on the median of correct answers on awareness and intention to practice persisted (p < 0.001); however, this was not evident for attitudes (p = 0.105). Moreover, there was a significant decrease in the number of participants who showed low levels of awareness (p = 0.019) and a slight increase in those with high levels of the same component (p = 0.161). The use of a virtual learning environment designed for dentists contributed to a rapid improvement in awareness and intention to practice antibiotic prescription; however, their attitudes and information retention need reinforcement.

[Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960)]. / Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960).

Poliomyelitis emerged in Europe as an epidemic disease at the end of the 19th century. During the thirties of the twentieth century it reached great intensity in the United States and Canada, but it was after the Second World War when the disease became a serious world public health problem, which punished several countries of the world, including Mexico. Poliomyelitis is a very contagious viral disease that invades the central nervous system (destroys motor neurons) that frightened the Mexican population in the first half of the twentieth century, not so much by high mortality and morbidity figures but by its paralytic sequels, like the disability, and by the fact that it affected one of the most vulnerable population groups: children. The disease mainly affected children under five years of age, being rare in the first months of life of the newborn due to the protective effect of immunity that the mother transfers to the son through breast milk; After eight months, at the end of the feed, the infant could be infected by poliovirus by invading the spinal cord and producing paralysis, most commonly of the legs or trunk. Likewise, it caused a paralysis in the respiratory muscles (diaphragm) of children, who had to help them to breathe since, if not, they were suffocated, so they were introduced in machines commonly known as steel lungs or lungs of Emerson type (machine that allows a person to breathe when he lost control of his respiratory muscles, such as the diaphragm, invented in 1928 by the American engineer Philip Drinker).

La poliomielitis emergió en Europa como enfermedad epidémica a finales del siglo XIX. Durante los años treinta del siglo XX alcanzó gran intensidad en los Estados Unidos y Canadá, pero fue tras la Segunda Guerra Mundial cuando la enfermedad se convirtió en un grave problema de salud pública mundial que castigó terriblemente a varios países del mundo, incluyendo a México. La poliomielitis es una enfermedad viral muy contagiosa que invade el sistema nervioso central (destruye las neuronas motoras) que atemorizó a la población mexicana en la primera mitad del siglo XX, no tanto por las altas cifras de mortalidad y morbilidad sino por sus secuelas paralíticas, como la invalidez, y por el hecho de que afectó a uno de los grupos poblacionales más vulnerables: los niños. La enfermedad afectaba principalmente a los niños menores de cinco años, siendo poco frecuente en los primeros meses de vida del recién nacido debido al efecto protector de la inmunidad que le transfiere la madre al hijo a través de la leche materna; después de ocho meses, al término de la alimentación, el infante podía ser infectado por el poliovirus invadiendo la medula espinal y produciendo la parálisis, más comúnmente de las piernas o tronco. Asimismo, ocasionaba una parálisis en los músculos respiratorios (diafragma) de los niños, a quienes había que auxiliarlos a respirar ya que, si no, se asfixiaban, por lo que se les introducía en unas máquinas conocidas comúnmente como pulmones de acero o pulmotores de tipo Emerson (máquina que permite a una persona respirar cuando esta perdió el control de sus músculos respiratorios, como el diafragma, inventada en 1928 por el ingeniero estadounidense Philip Drinker).

Aspectos históricos, clínicos y epidemiológicos de la poliomielitis en México (1946 - 1960) / Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960)

La poliomielitis emergió en Europa como enfermedad epidémica a finales del siglo XIX. Durante los años treinta del siglo XX alcanzó gran intensidad en los Estados Unidos y Canadá, pero fue tras la Segunda Guerra Mundial cuando la enfermedad se convirtió en un grave problema de salud pública mundial que castigó terriblemente a varios países del mundo, incluyendo a México. La poliomielitis es una enfermedad viral muy contagiosa que invade el sistema nervioso central (destruye las neuronas motoras) que atemorizó a la población mexicana en la primera mitad del siglo XX, no tanto por las altas cifras de mortalidad y morbilidad sino por sus secuelas paralíticas, como la invalidez, y por el hecho de que afectó a uno de los grupos poblacionales más vulnerables: los niños. La enfermedad afectaba principalmente a los niños menores de cinco años, siendo poco frecuente en los primeros meses de vida del recién nacido debido al efecto protector de la inmunidad que le transfiere la madre al hijo a través de la leche materna; después de ocho meses, al término de la alimentación, el infante podía ser infectado por el poliovirus invadiendo la medula espinal y produciendo la parálisis, más comúnmente de las piernas o tronco. Asimismo, ocasionaba una parálisis en los músculos respiratorios (diafragma) de los niños, a quienes había que auxiliarlos a respirar ya que, si no, se asfixiaban, por lo que se les introducía en unas máquinas conocidas comúnmente como pulmones de acero o pulmotores de tipo Emerson (máquina que permite a una persona respirar cuando esta perdió el control de sus músculos respiratorios, como el diafragma, inventada en 1928 por el ingeniero estadounidense Philip Drinker).

Poliomyelitis emerged in Europe as an epidemic disease at the end of the 19th century. During the thirties of the twentieth century it reached great intensity in the United States and Canada, but it was after the Second World War when the disease became a serious world public health problem, which punished several countries of the world, including Mexico. Poliomyelitis is a very contagious viral disease that invades the central nervous system (destroys motor neurons) that frightened the Mexican population in the first half of the twentieth century, not so much by high mortality and morbidity figures but by its paralytic sequels, like the disability, and by the fact that it affected one of the most vulnerable population groups: children. The disease mainly affected children under five years of age, being rare in the first months of life of the newborn due to the protective effect of immunity that the mother transfers to the son through breast milk; After eight months, at the end of the feed, the infant could be infected by poliovirus by invading the spinal cord and producing paralysis, most commonly of the legs or trunk. Likewise, it caused a paralysis in the respiratory muscles (diaphragm) of children, who had to help them to breathe since, if not, they were suffocated, so they were introduced in machines commonly known as steel lungs or lungs of Emerson type (machine that allows a person to breathe when he lost control of his respiratory muscles, such as the diaphragm, invented in 1928 by the American engineer Philip Drinker).

Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up.

Introduction: To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods: We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until ED-readmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results: We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID-19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31-3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009). Conclusion: The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety.

Introducción: Describir las características de los pacientes COVID-19 con síntomas leves dados de alta desde la Central de Emergencias de Adultos (CEA) y seguidos en forma ambulatoria mediante telemedicina. Estimar las tasas de re-consulta a CEA y hospitalización, y explorar los factores asociados a estos desenlaces. Métodos: Cohorte retrospectiva de Junio a Agosto 2020 en el Hospital Italiano de Buenos Aires, que incluyó personas COVID-19 con síntomas leves. Se siguieron durante 14 días hasta la ocurrencia de re-consulta en CEA y/o hospitalización. Se utilizaron modelos de Kaplan-Meier y regresión logística. Resultados: De un total de 1.239 pacientes, con una mediana de 41 años y 53,82% varones, 167 pacientes re-consultaron a CEA, con una tasa de incidencia global a los 14 días del 13,08% (IC del 95% 11,32 a 15,08). De estos, 83 requirieron hospitalización (media de 4,98 días), el 6% no se relaciona con COVID-19 y 5 pacientes fallecieron. Después del ajuste por factores confundidores (edad ≥65, sexo, diabetes, hipertensión, ex tabaquismo, tabaquismo activo, fiebre, diarrea y saturación de oxígeno), encontramos asociaciones significativas: tabaquismo anterior (ORa 2,09, IC95% 1,31-3,34, p0=0,002), fiebre (ORa 1,56, IC95% 1,07-2,28, p=0,002) y saturación de oxígeno (ORa 0,82, IC95% 0,71-0,95, p=0,009). Conclusión: La tasa del 13% de re-consulta a CEA durante 14 días de seguimiento resultó muy significativa para la gestión hospitalaria, la calidad del desempeño y la seguridad del paciente.