Shorter Door-to-ECG Time Is Associated with Improved Mortality in STEMI Patients.

Background: Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) with clinical outcomes has not been directly explored in a contemporary US-based population. Methods: This was a three-year, 10-center, retrospective cohort study of ED-diagnosed patients with STEMI comparing mortality between those who received timely (<10 min) vs. untimely (>10 min) diagnostic ECG. Among survivors, we explored left ventricular ejection fraction (LVEF) dysfunction during the STEMI encounter and recovery upon post-discharge follow-up. Results: Mortality was lower among those who received a timely ECG where one-week mortality was 5% (21/420) vs. 10.2% (26/256) among those with untimely ECGs (p = 0.016), and in-hospital mortality was 6.0% (25/420) vs. 10.9% (28/256) (p = 0.028). Data to compare change in LVEF metrics were available in only 24% of patients during the STEMI encounter and 46.5% on discharge follow-up. Conclusions: D2E within 10 min may be associated with a 50% reduction in mortality among ED STEMI patients. LVEF dysfunction is the primary resultant morbidity among STEMI survivors but was infrequently assessed despite low LVEF being an indication for survival-improving therapy. It will be difficult to assess the impact of STEMI care interventions without more consistent LVEF assessment.

Influence of time-to-diagnosis on time-to-percutaneous coronary intervention for emergency department ST-elevation myocardial infarction patients: Time-to-electrocardiogram matters.

Objectives: Earlier electrocardiogram (ECG) acquisition for ST-elevation myocardial infarction (STEMI) is associated with earlier percutaneous coronary intervention (PCI) and better patient outcomes. However, the exact relationship between timely ECG and timely PCI is unclear. Methods: We quantified the influence of door-to-ECG (D2E) time on ECG-to-PCI balloon (E2B) intervention in this three-year retrospective cohort study, including patients from 10 geographically diverse emergency departments (EDs) co-located with a PCI center. The study included 576 STEMI patients excluding those with a screening ECG before ED arrival or non-diagnostic initial ED ECG. We used a linear mixed-effects model to evaluate D2E's influence on E2B with piecewise linear terms for D2E times associated with time intervals designated as ED intake (0-10 min), triage (11-30 min), and main ED (>30 min). We adjusted for demographic and visit characteristics, past medical history, and included ED location as a random effect. Results: The median E2B interval was longer (76 vs 68 min, p < 0.001) in patients with D2E >10 min than in those with timely D2E. The proportion of patients identified at the intake, triage, and main ED intervals was 65.8%, 24.9%, and 9.7%, respectively. The D2E and E2B association was statistically significant in the triage phase, where a 1-minute change in D2E was associated with a 1.24-minute change in E2B (95% confidence interval [CI]: 0.44-2.05, p = 0.003). Conclusion: Reducing D2E is associated with a shorter E2B. Targeting D2E reduction in patients currently diagnosed during triage (11-30 min) may be the greatest opportunity to improve D2B and could enable 24.9% more ED STEMI patients to achieve timely D2E.

Assessing North Texas Regional Trauma Handoffs: A Multicenter Mixed-Methods Needs Assessment.

INTRODUCTION: Trauma video review of Emergency Medical Services (EMS) handoffs demonstrates frequent problems including interruptions and incomplete information transfer. This study aimed to perform a regional needs assessment of handoff perceptions and expectations to guide future standardization efforts. METHODS: A multidisciplinary team of trauma providers through consensus building created an anonymous survey which was then distributed through the North Central Texas Trauma Regional Advisory Council and four regional level-1 trauma institutions. Qualitative data underwent content analysis; quantitative data are presented with descriptive statistics. RESULTS: Survey responses (n = 249) were submitted by trauma nurses (38%), EMS (24%), emergency physicians (14%), and trauma physicians (13%). Median overall handoff quality was rated well (4, scale 1-5) despite some variability between hospitals (3, scale 1-5). The top five most important handoff details were the same for both stable and unstable patients: primary mechanism, blood pressure, heart rate, Glasgow Coma Scale, and location of injuries. While providers felt neutral about the data order, the vast majority supported immediate bed transfer and primary survey in unstable patients. The majority of receiving providers report interrupting handoff at least once (78%); and 66% of EMS clinicians found interruptions disruptive. Content analysis revealed top priority categories for improvement: environment, communication, information relayed, team dynamics, and flow of care. CONCLUSION: Although our data demonstrated satisfaction and concordance with respect to the EMS handoff, 84% of EMS clinicians reported some to high amounts of variability across institutions. Gaps in the development of standardized handoffs identified include exposure, education, and enforcement of these protocols.

La percepción social acerca del reciclaje en el municipio de Xalisco, Nayarit / Social perception about recycling in the municipality of Xalisco, Nayarit

En la presente investigación hemos abordado la falta de un programa de reciclaje o manejo adecuado de laseparación de residuos orgánicos e inorgánicos en el Municipio de Xalisco, Nayarit. Por ello es de sumaimportancia difundir y crear conciencia en los habitantes sobre los beneficios de implementar los hábitos degestión de residuos. Para ello, se implementa un enfoque cuantitativo, este estudio tiene como objetivo realizaruna encuesta de la población con la técnica de muestreo no probabilístico por conveniencia, determinando unamuestra de 50 personas, con la finalidad de conocer qué tanta información tienen al respecto sobre losconceptos generales del tema, así como la separación y clasificación de la basura para crear hábitos de laimportancia de hacer un uso adecuado, tomando en cuenta los beneficios de implementar estrategias a travésde la capacitación y concientización de las personas, y dar solución al problema de la basura en el municipio.(AU)

In the present research, we have addressed the lack of a recycling program or adequate management of theseparation of organic and inorganic waste in the Municipality of Xalisco, Nayarit. For this reason, it is of theutmost importance to disseminate and raise awareness among the citizens regarding the benefits ofimplementing waste management habits. In this study, we have surveyed the population by determining a sampleof 50 people to evaluate the knowledge about the general concepts of the subject. We also aimed to createbeneficial habits through the recycling and classification of garbage and thus to solve waste managementproblems.(AU)

Evaluation and management of intimate partner violence in the emergency department.

Intimate partner violence (IPV) and emergency medicine intersect when individuals experiencing IPV present to emergency departments for medical care, either on their own or when brought in by law enforcement authorities for medical evaluation and social services. Coordination of care is required, with particular attention paid to the sensitive nature of the patient's presentation and with an emphasis on trauma-informed care. Emergent medical needs must be balanced with concerns for the patient's emotional well-being and the need for advocacy and social services. This supplement reviews best practices and evidence-based recommendations for the evaluation and management of patients who have experienced IPV, with a focus on the considerations for traumatic injuries in these patients.

Neurological manifestations associated with SARS-CoV-2 infection: an updated review / Manifestaciones neurológicas asociadas con la infección por SARS-CoV-2: una revisión actualizada

Abstract SARS-CoV-2 is a single-stranded RNA virus that belongs to the group of seven coronaviruses that affect humans, and its infection causes the COVID-19 disease. The association between the COVID-19 condition and risk factors of neurological manifestations is unclear to date. This review aims to update the main neurological manifestations associated with SARS-CoV-2 disease. First, we present the hypothesis of the neuroinvasion mechanisms of SARS-CoV-2. Then, we discuss the possible symptoms related to patients with COVID-19 infection in the central and peripheral nervous systems, followed by the perspectives of diagnosis and treatment of possible neurological manifestations. The hypothesis of the neuroinvasion mechanism includes direct routes, as the virus crosses the blood-brain barrier or the ACE2 receptor pathway role, and indirect pathways, such as malfunctions of the immune system and vascular system dysregulation. Various studies report COVID-19 consequences, such as neuroanatomic alterations and cognitive impairment, besides peripheral conditions, such as anosmia, ageusia, and Guillain Barré Syndrome. However, the heterogeneity of the studies about neurologic damage in patients after COVID-19 infection precludes any generalization of current findings. Finally, new studies are necessary to understand the adequate diagnosis, therapeutic method of early treatment, and risk group of patients for neurological manifestations of COVID-19 post-infection.

Resumen El SARS-CoV-2 es un virus de ARN monocatenario que pertenece al grupo de los siete coronavirus que afectan a los humanos y cuya infección causa la enfermedad COVID-19. La asociación entre la infección por COVID-19 y factores de riesgo de manifestaciones neurológicas aún no está clara. Esta revisión tiene como objetivo actualizar la descripción de las principales manifestaciones neurológicas asociadas a la infección por SARS-CoV-2. Presentamos la hipótesis de los mecanismos de neuroinvasión del SARS-CoV-2. Luego discutimos los posibles síntomas asociados a los pacientes con infección por COVID-19 en el sistema nervioso central y periférico y, posteriormente, las perspectivas de diagnóstico y tratamiento de las posibles manifestaciones neurológicas. La hipótesis del mecanismo de neuroinvasión incluye rutas directas cuando el virus cruza la barrera hematoencefálica o tiene acción vía del receptor ACE2 y vías indirectas tales como el mal funcionamiento del sistema inmunitario y la desregulación del sistema vascular. Diversos estudios reportan consecuencias del COVID-19, como la presencia de alteraciones neuroanatómicas y deterioro cognitivo, además de condiciones periféricas como anosmia, ageusia y Síndrome de Guillain Barré. La heterogeneidad de los estudios sobre el daño neurológico en pacientes después de la infección por COVID-19 impide cualquier generalización de los hallazgos actuales. Finalmente, son necesarios nuevos estudios enfocándose en comprender el diagnóstico adecuado, el método terapéutico de tratamiento temprano y el grupo de riesgo para las manifestaciones neurológicas de la pos infección por COVID-19.

Disparities in Emergency Medical Services Care Delivery in the United States: A Scoping Review.

BACKGROUND: Emergency medical services (EMS) often serve as the first medical contact for ill or injured patients, representing a critical access point to the health care delivery continuum. While a growing body of literature suggests inequities in care within hospitals and emergency departments, limited research has comprehensively explored disparities related to patient demographic characteristics in prehospital care. OBJECTIVE: We aimed to summarize the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group. METHODS: We conducted a scoping review of peer-reviewed and non-peer-reviewed (gray) literature. We searched PubMed, CINAHL, Web of Science, Proquest Dissertations, Scopus, Google, and professional websites for studies set in the U.S. between 1960 and 2021. Each abstract and full-text article was screened by two reviewers. Studies written in English that addressed the underrepresented groups of interest and investigated EMS-related encounters were included. Studies were excluded if a disparity was noted incidentally but was not a stated objective or discussed. Data extraction was conducted using a standardized electronic form. Results were summarized qualitatively using an inductive approach. RESULTS: One hundred forty-five full-text articles from the peer-reviewed literature and two articles from the gray literature met inclusion criteria: 25 studies investigated sex/gender, 61 studies investigated race/ethnicity, and 58 studies investigated both. One study investigated sexual orientation. The most common health conditions evaluated were out-of-hospital cardiac arrest (n = 50), acute coronary syndrome (n = 36), and stroke (n = 31). The phases of EMS care investigated included access (n = 55), pre-arrival care (n = 46), diagnosis/treatment (n = 42), and response/transport (n = 40), with several studies covering multiple phases. Disparities were identified related to all phases of EMS care for underrepresented groups, including symptom recognition, pain management, and stroke identification. The gray literature identified public perceptions of EMS clinicians' cultural competency and the ability to appropriately care for transgender patients in the prehospital setting. CONCLUSIONS: Existing research highlights health disparities in EMS care delivery throughout multiple health outcomes and phases of EMS care. Future research is needed to identify structured mechanisms to eliminate disparities, address clinician bias, and provide high-quality equitable care for all patient populations.

Diversity, Equity, and Inclusion in the United States Emergency Medical Services Workforce: A Scoping Review.

OBJECTIVE: Emergency medical services (EMS) workforce demographics in the United States do not reflect the diversity of the population served. Despite some efforts by professional organizations to create a more representative workforce, little has changed in the last decade. This scoping review aims to summarize existing literature on the demographic composition, recruitment, retention, and workplace experience of underrepresented groups within EMS. METHODS: Peer-reviewed studies were obtained from a search of PubMed, CINAHL, Web of Science, ProQuest Thesis and Dissertations, and non-peer-reviewed ("gray") literature from 1960 to present. Abstracts and included full-text articles were screened by two independent reviewers trained on inclusion/exclusion criteria. Studies were included if they pertained to the demographics, training, hiring, retention, promotion, compensation, or workplace experience of underrepresented groups in United States EMS by race, ethnicity, sexual orientation, or gender. Studies of non-EMS fire department activities were excluded. Disputes were resolved by two authors. A single reviewer screened the gray literature. Data extraction was performed using a standardized electronic form. Results were summarized qualitatively. RESULTS: We identified 87 relevant full-text articles from the peer-reviewed literature and 250 items of gray literature. Primary themes emerging from peer-reviewed literature included workplace experience (n = 48), demographics (n = 12), workforce entry and exit (n = 8), education and testing (n = 7), compensation and benefits (n = 5), and leadership, mentorship, and promotion (n = 4). Most articles focused on sex/gender comparisons (65/87, 75%), followed by race/ethnicity comparisons (42/87, 48%). Few articles examined sexual orientation (3/87, 3%). One study focused on telecommunicators and three included EMS physicians. Most studies (n = 60, 69%) were published in the last decade. In the gray literature, media articles (216/250, 86%) demonstrated significant industry discourse surrounding these primary themes. CONCLUSIONS: Existing EMS workforce research demonstrates continued underrepresentation of women and nonwhite personnel. Additionally, these studies raise concerns for pervasive negative workplace experiences including sexual harassment and factors that negatively affect recruitment and retention, including bias in candidate testing, a gender pay gap, and unequal promotion opportunities. Additional research is needed to elucidate recruitment and retention program efficacy, the demographic composition of EMS leadership, and the prevalence of racial harassment and discrimination in this workforce.

Broad antiviral spectrum of glycyrrhizic acid for human and veterinary medicine: reality or fiction?

BACKGROUND: Emerging virus infections provoke health problems in people and animals, which generate social, and economic issues worldwide. This has spurred the search for new pharmacological strategies to confront them. SUMMARY: The purpose of this review is to draw the reader's attention to pharmacological evaluations of glycyrrhizic acid (GA) and its analogs on the broad range of viruses known in human and veterinary medicine. GA is the main water-soluble constituent extracted from the roots of plants from the genus Glycyrrhiza, commonly known as licorice root. It has long been used due to its broad spectrum of bioactivities, including anti-inflammatory, antiulcer, and antitumor properties. It has also been proposed as an antiviral agent. Medicines derived from GA are currently being used to combat acute and chronic hepatitis and herpes viruses. KEY MESSAGES: This review suggests that GA could be a new broad-spectrum antiviral due to its ability to inhibit DNA or RNA viruses both in vitro and in vivo. GA could be a potential drug for preventing and/or treating various viral diseases.

Fallacy of Median Door-to-ECG Time: Hidden Opportunities for STEMI Screening Improvement.

Background ST-segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning for myocardial ischemia. Process measures target median door-to-ECG (D2E) time of 10 minutes. Methods and Results This 3-year descriptive retrospective cohort study, including 676 ED-diagnosed patients with STEMI from 10 geographically diverse facilities across the United States, examines an alternative approach to quantifying performance: proportion of patients meeting the goal of D2E≤10 minutes. We also identified characteristics associated with D2E>10 minutes and estimated the proportion of patients with screening ECG occurring during intake, triage, and main ED care periods. We found overall median D2E was 7 minutes (IQR:4-16; range: 0-1407 minutes; range of ED medians: 5-11 minutes). Proportion of patients with D2E>10 minutes was 37.9% (ED range: 21.5%-57.1%). Patients with D2E>10 minutes, compared to those with D2E≤10 minutes, were more likely female (32.8% versus 22.6%, P=0.005), Black (23.4% versus 12.4%, P=0.005), non-English speaking (24.6% versus 19.5%, P=0.032), diabetic (40.2% versus 30.2%, P=0.010), and less frequently reported chest pain (63.3% versus 87.4%, P<0.001). ECGs were performed during ED intake in 62.1% of visits, ED triage in 25.3%, and main ED care in 12.6%. Conclusions Examining D2E>10 minutes can identify opportunities to improve care for more ED patients with STEMI. Our findings suggest sex, race, language, and diabetes are associated with STEMI diagnostic delays. Moving the acquisition of ECGs completed during triage to intake could achieve the D2E≤10 minutes goal for 87.4% of ED patients with STEMI. Sophisticated screening, accounting for differential risk and diversity in STEMI presentations, may further improve timely detection.

Emergency department management of cellulitis and other skin and soft-tissue infections.

Cellulitis and other skin and soft-tissue infections (SSTIs) are common presentations in the emergency department. This review describes the varied etiologies and patient presentations of the more common SSTIs: cellulitis, abscesses, and necrotizing soft-tissue infections. A discussion of the common diagnoses masquerading as SSTIs is presented, as well as a stepwise approach to avoiding misdiagnosis. Diagnostic studies are also evaluated, including discussions on ultrasound, computed tomography, and clinical decision rules. This review also provides an evidence-based analysis of the controversies in management of abscesses, including the commonly utilized techniques of incision and drainage, irrigation, packing, and concurrent antibiotic therapy.

Estrategias nutricionales implementadas en los paisesandinos. Una mirada a la nutrición escolar en Ecuador, Perú y Bolivia / Nutritional strategies implemented in Andean countries. A look at schoolnutrition in Ecuador, Peru and Bolivia

Introducción: La nutrición es sumamente importantepara el normal desarrollo de los seres humanos, por lo tanto,es importante conocer el proceso que se ha llevado a cabopara mejorar los procesos de alimentación escolar en AméricaLatina, tomando como referencia a los países andinos. Se manifiesta que en América Latina el Programa de Alimentación Escolar (PAE) es de gran envergadura por losobjetivos, la cobertura y los recursos que asigna el Estadopara su operación, haciendo de este uno de los programas sociales de mayor importancia en la región. La presente investigación cumple con los siguientes objetivos: Descripción sobre estrategias nutricionales que han mejorado los índices de nutrición escolar en Ecuador, Boliviay Perú. Identificación de los alimentos que no contribuyen a unanutrición adecuada para los niños. Material y métodos: Se realizó una búsqueda bibliográfica en bases de datos de la Organización de Naciones Unidas(ONU), Organización de las Naciones Unidas para la Agri cultura y la Alimentación (FAO) y Ministerios de Educación de lospaíses sudamericanos. Para complementar la investigacióntambién se buscaron artículos en Association for Computing Machinery (ACM) y Scopus, empleando los términos: estrategias nutricionales, nutrición infantil, escolares en Sudamérica,malnutrición, PAE. En la presente investigación se aplica la descripción histórica y comparativa de ciertos proyectos de nutrición escolarque han sido ejecutados desde el 2008 hasta 2018 en los países andinos. Resultados: Los países sudamericanos, especialmente losandinos han reformado sus procesos de alimentación escolar,mejorando así también aspectos sociales como la economía y la educación, basados en estrategias de equidad que promueven la incorporación y estabilidad de los estudiantes alsector académico.(AU)

Introduction: Nutrition is extremely important for thenormal development of human beings, therefore, it is important to know the process that has been carried out to improveschool feeding processes in Latin America, taking the Andeancountries as a reference.It is clear that in Latin America the School Feeding Program(PAE) is of great importance due to its objectives, coverageand the resources allocated by the State for its operation,making it one of the most important social programs in theregion. This research has the following objectives: Description on nutritional strategies that have improvedschool nutrition indices in Ecuador, Bolivia and Peru. Identification of foods that do not contribute to adequatenutrition for children. Material and methods: A bibliographic search was carried out in databases of the United Nations (UN), Food andAgriculture Organization of the United Nations (FAO) andMinistries of Education of South American countries. To complement the research, articles were also searched in theAssociation for Computing Machinery (ACM) and Scopus, using the terms: nutritional strategies, child nutrition, schoolchildren in South America, malnutrition, PAE.The present research applies the historical and comparativedescription of certain school nutrition projects that have beenimplemented from 2008 to 2018 in the Andean countries. Results: South American countries, especially the Andeancountries have reformed their school nutrition processes, thusalso improving social aspects such as economy and education, based on equity strategies that promote the incorporation and stability of students to the academic sector. Discussion / conclusions: The PAE, work under thecomprehensive protection approach, contributing mainly tothe guarantee of two fundamental rights: education and foodfor children and adolescents enrolled in the public education system.(AU)

Solid lipid nanoparticles by Venturi tube: preparation, characterization and optimization by Box-Behnken design.

In this study, a Venturi tube is proposed as an efficient static mixer incorporated into a continuous recirculation system for obtaining solid lipid nanoparticles (SLN) of monoolein. The device's operating principle consists of producing a turbulent flux in the throat of a Venturi tube. Taking advantage of this effect SLN of monoolein were obtained by rapid diffusion of the organic phase into the aqueous phase (stabilizer), causing lipid aggregation on the nanometric particles. The main aim of the present study was to evaluate the critical factors for obtaining the SLN of monoolein in order to control the independent variables of this methodology. A Box-Behnken design was used to study such independent variables (factors) as injection rate (X1), recirculation rate (X2), and stabilizer (X3) on the dependent variables; namely, process yield (Y1), particle size (Y2), polydispersity index (Y3) and zeta potential (Y4). The optimum operating conditions for preparing SLN were: injection rate, 1.6 mL/min; recirculation rate, 4.2 L/min; and stabilizer concentration, 1.0 w/v, with a value of D = 0.84. The predicted responses of the particle size were 212.0 nm, with a polydispersity index of 0.21, a zeta potential of -19.9 mV, and a process yield of 96.0%. Under the same operating condition, SLN formed with different lipids and stabilizers were obtained with nanometric size and zeta potential of ∼ -30.0 mV. Results show that the Venturi tube method is an innovative and versatile technique for preparing SLN of nanometric size with high process yields through a turbulent flow.

Treatment of Serious Occlusal Instability Associated with Temporomandibular Disorders (TMDs) Through Implant and Dynamic Occlusal Schemes Rehabilitation. A Case Report

ABSTRACT: A case report of 35 years old male patient, partially edentulous with occlusal instability, Disc Displacement with Reduction (DDWR), Local Muscle Soreness (LMS) and Alteration of vertical dimension is presented. Rehabilitation was planned to achieve predictability of long-term treatment, providing static and dynamic occlusal stability. A therapeutic occlus ion with premature contact in the right premolar sector was planned. Implants and cemented/screwed crowns were used to obtain contacts in the molar area. The restoration of dynamic occlusal schemes was made by direct adhesive technique in the anterior sector and Curve of Spee (COS) compensation with temporary anchoring for molar inclusion was used. Patient presents objective and subjective improvements associated with the treatment performed. Temporomandibular disorder is stabilized and controlled by a specialist.

RESUMEN: Se presenta el caso clínico de un paciente masculino de 35 años, parcialmente desdentado con inestabilidad oclusal, Desplazamiento Discal con Reducción (DDWR), Dolor Muscular Local (LMS) y Alteración de la dimensión vertical. La rehabilitación se planificó para lograr la previsibilidad del tratamiento a largo plazo, proporcionando estabilidad oclusal estática y dinámica. Se planificó una oclusión terapéutica con contacto prematuro en el sector premolar derecho. Se utilizaron implantes y coronas cementadas / atornilladas para obtener contactos en la zona de los molares. La restauración de esquemas oclusales dinámicos se realizó mediante técnica de adhesivo directo en el sector anterior y se utilizó compensación de Curva de Spee (COS) con anclaje temporal para inclusión molar. El paciente presenta mejoras objetivas y subjetivas asociadas al tratamiento realizado. El trastorno temporomandibular es estabilizado y controlado por un especialista.

Comparing the Timeliness of Treatment in Younger vs. Older Patients with ST-Segment Elevation Myocardial Infarction: A Multi-Center Cohort Study.

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) predominantly affects older adults. Lower incidence among younger patients may challenge diagnosis. OBJECTIVES: We hypothesize that among patients ≤ 50 years old, emergent percutaneous coronary intervention (PCI) for STEMI is delayed when compared with patients aged > 50 years. METHODS: This 3-year, 10-center retrospective cohort study included emergency department (ED) STEMI patients ≥ 18 years of age treated with emergent PCI. We excluded patients with an electrocardiogram (ECG) completed prior to ED arrival or a nondiagnostic initial ECG. Our primary outcome was door-to-balloon (D2B) time. We compared characteristics and outcomes among younger vs. older STEMI patients, and among age subgroups. RESULTS: There were 576 ED STEMI PCI patients, of whom 100 were ≤ 50 years old and 476 were > 50 years old. Median age was 44 years in the younger cohort (interquartile range [IQR] 41-47) vs. 62 years (IQR 57-70) among older patients. Median D2B time for the younger cohort was 76.5 min (IQR 67.5-102.5) vs. 81.0 min (IQR 65.0-105.5) in the older cohort (p = 0.91). This outcome did not change when ages 40 or 45 years were used to demarcate younger vs. older. The younger cohort had a higher prevalence of nonwhite races (38% vs. 21%; p < 0.001) and those currently smoking (36% vs. 23%; p = 0.005). The very young (≤30 years; 6/576) and very old (>80 years; 45/576) had 5.51 and 2.2 greater odds of delays. CONCLUSION: We found no statistically significant difference in D2B times between patients ≤ 50 years old and those > 50 years old. Nonwhite patients and those who smoke were disproportionately represented within the younger population. The very young and very old had higher odds of D2B times > 90 min.

Tratamiento ortobiológico con plasma rico en plaquetas. Revisión sistemática y clasificación de la evidencia / Orthobiologic treatment with platelet-rich plasma. Systematic review and classification of evidence

Introducción. El empleo del plasma rico en plaquetas (PRP) o plasma autólogo con una cifra de plaquetas superior a la del plasma basal, ha tomado un auge notorio para estimular la regeneración tisular en las afecciones musculoesqueléticas y de tejidos blandos. El objetivo de este estudio fue revisar sistemáticamente la eficacia del tratamiento con PRP en algunas lesiones musculoesqueléticas y de tejidos blandos en cirugía plástica y maxilofacial, así como en odontología y dermatología, con su nivel de evidencia y grado de recomendación. Metodología. Se utilizaron los buscadores PubMed, Google Académico y la Biblioteca Cochrane con terminología MeSH. Se analizaron un total de 44 artículos que cumplieron los criterios de inclusión y exclusión. Resultados. El análisis de los estudios encontró que el nivel de evidencia fue de 1 en el 75%, nivel 2 en el 15,9%, nivel 3 en el 6,8%, y nivel 4 en el 2,2%. El grado de recomendación se distribuyó entre bueno y favorable; el 40,9% de los estudios reflejaron grado A, 50% grado B y 9% grado C. No obstante, el 50% de los estudios reportaron en sus conclusiones que hay una deficiencia en el diseño metodológico, con inconsistencia en sus resultados. Conclusión. Estos hallazgos señalan que en la evidencia encontrada se observan resultados contradictorios, la mayoría de ellos no muestran una prueba firme que apoye el empleo rutinario del PRP, porque sus diseños y poder estadístico son de baja calidad. Hace falta unificar criterios y diseños de investigación con evidencia científica altamente recomendable, para que el uso del PRP como agente ortobiológico en estas patologías, pueda ser ampliamente aceptado

Introduction. The use of platelet-rich plasma (PRP), autologous plasma with a number of platelets higher than that of basal plasma, after having been subjected to some extraction and concentration process, has taken a noticeable rise to stimulate tissue regeneration in musculoskeletal and soft tissue disorders. The objective of this study is to systematically review the efficacy of treatment with PRP in some musculoskeletal and soft tissue injuries, in plastic and maxillofacial surgery, as well as in dentistry and dermatology, with their level of evidence and grade of recommendation. Methodology. The search was performed using MeSH terms in PubMed, Google Scholar and the Cochrane Library. A total of 44 articles that met the inclusion and exclusion criteria were analyzed. Results. Analysis of the studies found that the level of evidence was level 1 in 75%, level 2 in 15.9%, level 3 in 6.8%, and level 4 in 2.2%. The grade of recommendation was distributed between good and favorable; 40.9% reflected grade A, 50% grade B, and 9% grade C. However, 50% of the studies reported in their conclusions that there is a deficiency in the methodology, with inconsistency in their results. Conclusion. These findings indicate that the evidence found shows contradictory results, most of them do not show a firm proof that supports their routine use, because their designs and statistical power are of low quality. It is necessary to unify criteria and research designs with highly recommended scientific evidence, so that the use of PRP as an orthobiological agent in these pathologies could be widely accepted

Homocisteína y trastornos neurocognitivos. ¿Una luz al final del túnel? / Homocysteine and neurocognitive disorders. A light at the end of the tunnel?

El deterioro cognitivo es uno de los procesos que acompañan al envejecimiento y puede depender de factores nutricionales, genéticos o ambientales. La identificación de factores de riesgo modificables proporciona un enfoque esencial para la prevención de dicho deterioro y de los trastornos neurocognitivos. Uno de los factores de riesgo involucrados es la elevada concentración de homocisteína plasmática, la cual se ha relacionado con hallazgos histopatológicos en demencia senil y enfermedad de Alzheimer. Los diferentes estudios sobre esta asociación revelan inconsistencia o contradicción en los resultados. El propósito de esta revisión es relacionar la posible interacción de tres factores en la instalación y progresión del deterioro neurocognitivo: a) factores de tipo nutricional (homocisteína, ácido fólico y vitamina B12), b) la utilización de pruebas para el diagnóstico de disfunción o deterioro cognitivo como el Mini Examen del Estado Mental, y c) la presencia de variantes genéticas polimórficas de la enzima metilentetrahidrofolato reductasa. Una consecuencia directa de esta triple relación es que el tratamiento con ácido fólico y vitamina B12 logra disminuir las elevadas concentraciones de homocisteína plasmática, asumiendo que una mejoría en los síntomas clínicos de deterioro cognitivo puede retrasar los cambios relacionados con progresión a estados demenciales. La intervención temprana mediante políticas de promoción y prevención de la salud mental puede ser efectiva si se comienza con la administración de ácido fólico y vitamina B12 en los estadios iniciales de la alteración cognitiva, logrando así reducir sus funestas consecuencias. Las políticas de salud pública centradas en la salud mental de ancianos pueden identificar a las personas con disfunción cognitiva inicial a través de la promoción de la salud y medidas preventivas; en esta etapa puede ser posible la administración de vitaminas B para reducir o minimizar la progresión del deterioro cognitivo, que podría conducir a trastornos neurocognitivos como la demencia y la enfermedad de Alzheimer

Cognitive impairment is one of the processes that accompany aging and may depend on nutritional, genetic or environmental factors. The identification of modifiable risk factors provides a crucial approach for the prevention of cognitive decline and neurocognitive disorders. One of the risk factors is the high concentration of plasma homocysteine and it has been associated to histopathological changes in senile dementia and Alzheimer´s disease. Clinical trials about this association has shown inconsistent and contradictory results. The purpose of this review is to describe the possible interaction of three factors related with cognitive impairment: a) nutritional factors (homocysteine, folic acid and vitamin B12), b) the use of mental tests such as the Mini Mental State Examination for the diagnosis of cognitive dysfunction, and c) the presence of polymorphic genetic variants of the methylenetetrahydrofolate reductase enzyme. A direct consequence of this triple relationship is the treatment with folic acid and vitamin B12, which decrease high concentrations of plasma homocysteine, with a potential for improvement of the clinical symptoms of cognitive decline, and possibly a delay in the progression towards neurocognitive disorder. Public health policies focused on mental health of older adults can identify people with initial cognitive dysfunction through health promotion and preventive measures, where it can be possible to administer B vitamins in order to reduce or minimize the progression of cognitive decline, that could lead to mental disturbances such as neurocognitive disorders

Measuring outcome differences associated with STEMI screening and diagnostic performance: a multicentred retrospective cohort study protocol.

INTRODUCTION: Advances in ST-segment elevation myocardial infarction (STEMI) management have involved improving the clinical processes connecting patients with timely emergency cardiovascular care. Screening upon emergency department (ED) arrival for an early ECG to diagnose STEMI, however, is not optimal for all patients. In addition, the degree to which timely screening and diagnosis are associated with improved time to intervention and postpercutaneous coronary intervention outcomes, under more contemporary practice conditions, is not known. METHODS: We present the methods for a retrospective multicentre cohort study anticipated to include 1220 patients across seven EDs to (1) evaluate the relationship between timely screening and diagnosis with treatment and postintervention clinical outcomes; (2) introduce novel measures for cross-facility performance comparisons of screening and diagnostic care team performance including: door-to-screening, door-to-diagnosis and door-to-catheterisation laboratory arrival times and (3) describe the use of electronic health record data in tandem with an existing disease registry. ETHICS AND DISSEMINATION: The completion of this study will provide critical feedback on the quality of screening and diagnostic performance within the contemporary STEMI care pathway that can be used to (1) improve emergency care delivery for patients with STEMI presenting to the ED, (2) present novel metrics for the comparison of screening and diagnostic care and (3) inform the development of screening and diagnostic support tools that could be translated to other care environments. We will disseminate our results via publication and quality performance data sharing with each site. Institutional ethics review approval was received prior to study initiation.

Preparation of nanodispersions by solvent displacement using the Venturi tube.

The Venturi tube (VT) is an apparatus that produces turbulence which is taken advantage of to produce nanoparticles (NP) by solvent displacement. The objective of this study was to evaluate the potential of this device for preparing NP of poly-ε-caprolactone. Response Surface Methodology was used to determine the effect of the operating conditions and optimization. The NP produced by VT were characterized by Dynamic Light-Scattering to determine their particle size distribution (PS) and polydispersity index (PDI). Results showed that the Reynolds number (Re) has a strong effect on both PS and process yield (PY).The turbulence regime is key to the efficient formation of NP. The optimal conditions for obtaining NP were a polymer concentration of 1.6 w/v, a recirculation rate of 4.8 L/min, and a stabilizer concentration of 1.1 w/v. The predicted response of the PY was 99.7%, with a PS of 333 nm, and a PDI of 0.2. Maintaining the same preparation conditions will make it possible to obtain NP using other polymers with similar properties. Our results show that VT is a reproducible and versatile method for manufacturing NP, and so may be a feasible method for industrial-scale nanoprecipitation production.

Performance of Emergency Department Screening Criteria for an Early ECG to Identify ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Timely diagnosis of ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) is made solely by ECG. Obtaining this test within 10 minutes of ED arrival is critical to achieving the best outcomes. We investigated variability in the timely identification of STEMI across institutions and whether performance variation was associated with the ED characteristics, the comprehensiveness of screening criteria, and the STEMI screening processes. METHODS AND RESULTS: We examined STEMI screening performance in 7 EDs, with the missed case rate (MCR) as our primary end point. The MCR is the proportion of primarily screened ED patients diagnosed with STEMI who did not receive an ECG within 15 minutes of ED arrival. STEMI was defined by hospital discharge diagnosis. Relationships between the MCR and ED characteristics, screening criteria, and STEMI screening processes were assessed, along with differences in door-to-ECG times for captured versus missed patients. The overall MCR for all 7 EDs was 12.8%. The lowest and highest MCRs were 3.4% and 32.6%, respectively. The mean difference in door-to-ECG times for captured and missed patients was 31 minutes, with a range of 14 to 80 minutes of additional myocardial ischemia time for missed cases. The prevalence of primarily screened ED STEMIs was 0.09%. EDs with the greatest informedness (sensitivity+specificity-1) demonstrated superior performance across all other screening measures. CONCLUSIONS: The 29.2% difference in MCRs between the highest and lowest performing EDs demonstrates room for improving timely STEMI identification among primarily screened ED patients. The MCR and informedness can be used to compare screening across EDs and to understand variable performance.