Incidence of retinopathy of prematurity type 1 and type 2 in a regional Hospital of Social Security in the state of Queretaro, Mexico (2017-2018).

BACKGROUND: Retinopathy of prematurity (ROP), the primary cause of blindness in children, is a potential complication for 7.7% of live births in Mexico. Given that less than one-third of all neonatal intensive care units follow Mexican National ROP guidelines, there have been few reports regarding the incidences of types 1 and 2 ROP. METHODS: This was a retrospective study that investigated the incidence and onset of ROP in a representative sample of children in Mexico. We analyzed the results obtained by the ROP Detection and Treatment Program, compliant with the Mexican National ROP guidelines, over a 1-year period. This study included 132 children who were born prematurely, were initially screened between October 2, 2017 and October 1, 2018, and underwent follow-up based on their risk group (in accordance with the Mexican National ROP guidelines). RESULTS: The mean gestational age (GA) at birth was 32 weeks and 3 days (32w3d) (95% CI, ± 3 days), and the mean birth weight (BW) was 1594 g (95% CI, ± 96 g). The clinical features were as follows: 36.4% had immature retina without ROP, 22.0% had mild ROP, 5.3% had type 2 ROP, 27.3% had type 1 ROP, and 1.5% had advanced disease. Premature children with ROP requiring treatment (i.e., type 1 ROP + advanced ROP) were born at an MGA of 30w4d (95% CI, ± 5d; range, 26-35 weeks); their MBW was 1316 g (95% CI, ± 110 g; range, 830-2220 g). Diagnosis of ROP requiring treatment was made at a mean postmenstrual age (PMA) of 37w3d (95% CI, ± 5d; range, 31w1d to 42w1d). CONCLUSION: In Mexico, screening and close ophthalmological follow-up of children who present with risk factors of birth weight < 1750 g and gestational age ≤ 34 weeks, both of which are observed more frequently in children with type 1 ROP, appears essential for implementing timely treatments (within 72 h). This is particularly important for children with PMA between 36 and 38 weeks, which is considered to be the peak age for disease stages that require timely intervention.

Rapid assessment of avoidable blindness and diabetic retinopathy in individuals aged 50 years or older in Costa Rica.

In the present study, we examined the causes and the prevalence of avoidable blindness and visual impairment, as well as the prevalence of diabetic retinopathy in individuals aged ≥50 years in Costa Rica, in order to provide baseline data for the initial planning and monitoring of ongoing blindness intervention programs. The assessment was based on the standardized methodology of the Rapid Assessment of Avoidable Blindness and Diabetic Retinopathy, a population-based survey for blindness and visual impairment. From 3,255 eligible subjects, 76.6% were examined. The adjusted prevalence of bilateral blindness [presenting visual acuity (VA) in the better eye of less than 3/60] was 1.7% (95% confidence interval, 1.2%-2.2%), with avoidable causes (treatable and preventable) accounting for 68.8% of cases. The main causes of blindness were cataract (52.1%), glaucoma (6.3%), and diabetic retinopathy (6.3%); these data were similar to those for other neighboring countries. Cataract surgical coverage (CSC) in the survey area was estimated as 88.9% for individuals with blindness (VA, <3/60), 76.6% for those with a VA of <6/60, and 60.3% for those with a VA of <6/18. The most common barriers against cataract surgery in individuals with a best-corrected VA of ≤6/60 included "need not felt" (48.8%) and "fear" (14.6%). Among individuals with a past history of cataract surgery, only 57.1% showed a "good" or "very good" outcome (VA, ≥6/18). Finally, 23.5% individuals with known or newly diagnosed diabetes showed retinopathy and/or maculopathy, with 6.2% exhibiting sight-threatening diabetic retinopathy (proliferative retinopathy, referable maculopathy, or both). Our findings indicate the need to overcome barriers against surgery for cataract, which is the main cause of avoidable blindness, to increase CSC, and to improve surgical outcomes. Moreover, improved methods for diabetic retinopathy screening can ensure prompt identification of patients with a risk of blindness. Glaucoma screening is also necessary for areas with a high prevalence.

Responsabilidad de la gerencia de salud en la seguridad y atención de los pacientes: el caso del incendio en el Hospital Calderón Guardia / Responsability of the health management in the security and attention of patients: the case of the fire at Calderón Guardia Hospital

El día 12 de julio de 2005 se presentó un incendio en el Hospital Calderón Guardia con dificultad para la evacuación de los pacientes y la pronta atención del incendio debido a la falta de medidas de seguridad, tan básicas como escaleras de emergencia y mangueras funcionantes; además, el incendio fue provocado y no accidental. En Costa Rica existe desde enero de 2005 un reglamento que establece las medidas de seguridad necesarias en el caso de un incendio; aunque ha sido considerado por algunas personas como demasiado estricto. Los otros hospitales de la Caja Costarricense del Seguro Social, con la excepción del Hospital Nacional de Niños, no reúnen la mayoría de condiciones de seguridad en caso de un incendio. Se analiza que es responsabilidad de la Caja Costarricense del Seguro Social y de la dirección de cada hospital velar por la seguridad de sus pacientes y la calidad de su atención. Es su obligación ser garantes de la salud de sus usuarios.

On July 12th, 2005, the fire that struck at the Calderon Guardia Hospital, presented difficulties of evacuation of patients and the prompt attention of the fire due to a lack of security measures such as emergency ladders and working hoses; furthermore, the flames were induced, not accidental. In Costa Rica, there is a regulation, since January 2005, which indicates security measures necessary is case of a fire; although it's considered by some to be very strict. The other Hospitals of Caja Costarricense del Seguro Social, with the exception of Hospital Nacional de Niños, do not count with the majority of security conditions required in case of a fire. The responsibilities of the Caja Costarricense del Seguro Social and the direction of each hospital to watch over the security of their patients y the quality of their attention, are analyzed. It is their obligation to guarantee the health of their patients.