Impact of creating a hemodynamics room, a coronary care unit, and a primary angioplasty program on the prognosis of acute coronary syndrome in a district hospital.

OBJECTIVE: This work aims to analyze the prognosis and mortality of patients hospitalized for acute coronary syndrome before and after the implementation of a coronary care unit, hemodynamics room, and the Código Corazón [Infarction Code] primary angioplasty program. METHODS: We conducted an observational, retrospective study that analyzed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events, and mortality over a follow-up period of five years. The results from the post-code period (March 1 - December 31, 2012; n=471) were compared with those from the pre-code period (March 1 - December 31, 2009; n=432). RESULTS: There were no differences in the baseline characteristics of the two groups. However, an increase in ST-elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (p<.001) was observed during the postcode phase. The use of percutaneous coronary intervention was made widespread at the hospital and was used in 64.8% of non-ST-elevation acute coronary syndrome (NSTE-ACS) cases and in 95.5% of STE-ACS cases. A reduction was observed in readmissions (from 38.2% to 25.1% for NSTE-ACS (p=.001) and from 23.7% to 11.0% for STE-ACS (p=.018)), the composite prognostic variable of adverse cardiovascular events and 5-year mortality (from 58.7% to 45% (p=.001) for NSTE-ACS and from 40.8% to 23.8% (p=.009) for STE-ACS), and a decrease in 30-day mortality in STE-ACS (from 11.8% to 3.7%; p=.021). CONCLUSIONS: With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events, and mortality.

Impacto de la creación de una sala de hemodinámica, una unidad coronaria y un programa de angioplastia primaria en el pronóstico del síndrome coronario agudo en un hospital comarcal / Impact of creating a haemodynamics room, a coronary unit and a primary angioplasty programme on the prognosis of acute coronary syndrome in a district hospital

Objetivo Analizar el pronóstico y mortalidad de los pacientes ingresados en un hospital por síndrome coronario agudo antes y después de la implantación de la unidad coronaria, la sala de hemodinámica y el programa de angioplastia primaria (Código corazón). Métodos Estudio observacional y retrospectivo. Se analizaron las características epidemiológicas, las estrategias de reperfusión, los eventos adversos cardiovasculares y la mortalidad durante 5 años de seguimiento. Los resultados del periodo post-código (1 marzo 2012-31 diciembre 2012; n=471) se compararon con la etapa precódigo (1 marzo 2009-31 diciembre 2009; n=432). Resultados No hubo diferencias en las características basales de ambos grupos, pero en la fase poscódigo se observó un incremento del síndrome coronario agudo con elevación del ST (SCACEST) del 17,6 al 34,8% (p<0,001). Se generalizó el intervencionismo coronario percutáneo, que alcanzó cifras del 64,8% en el síndrome coronario agudo sin elevación del ST (SCASEST) y del 95,5% en el SCACEST. Se redujeron los reingresos (38,2 vs. 25,1% en el SCASEST, p=0,001 y 23,7 vs. 11% en el SCACEST, p=0,018), la variable pronóstica combinada de eventos adversos cardiovasculares y mortalidad en 5 años de seguimiento (58,7 vs. 45%, p=0,001 en el SCASEST y 40,8 vs. 23,8%, p=0,009 en el SCACEST) y, además, en el SCACEST disminuyó la mortalidad a los 30 días (11,8 vs. 3,7%, p=0,021). Conclusiones Con los cambios estructurales realizados en el hospital se ha generalizado el intervencionismo coronario percutáneo y ha mejorado el pronóstico de los pacientes con síndrome coronario agudo, disminuyendo los ingresos, los eventos adversos cardiovasculares y la mortalidad (AU)

Objective This work aims to analyze the prognosis and mortality of patients hospitalized for acute coronary syndrome before and after the implementation of a coronary care unit, hemodynamics room, and the Código Corazón [Infarction Code] primary angioplasty program Methods We conducted an observational, retrospective study that analyzed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events, and mortality over a follow-up period of five years. The results from the post-code period (March 1 – December 31, 2012; n=471) were compared with those from the pre-code period (March 1 – December 31, 2009; n=432). Results There were no differences in the baseline characteristics of the two groups. However, an increase in ST-elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (p<.001) was observed during the postcode phase. The use of percutaneous coronary intervention was made widespread at the hospital and was used in 64.8% of non-ST-elevation acute coronary syndrome (NSTE-ACS) cases and in 95.5% of STE-ACS cases. A reduction was observed in readmissions (from 38.2% to 25.1% for NSTE-ACS (p=.001) and from 23.7% to 11.0% for STE-ACS (p=.018)), the composite prognostic variable of adverse cardiovascular events and 5-year mortality (from 58.7% to 45% (p=.001) for NSTE-ACS and from 40.8% to 23.8% (p=.009) for STE-ACS), and a decrease in 30-day mortality in STE-ACS (from 11.8% to 3.7%; p=.021). Conclusions With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events and mortality (AU)

Impact of creating a haemodynamics room, a coronary unit and a primary angioplasty programme on the prognosis of acute coronary syndrome in a district hospital. / Impacto de la creación de una sala de hemodinámica, una unidad coronaria y un programa de angioplastia primaria en el pronóstico del síndrome coronario agudo en un hospital comarcal.

OBJECTIVE: To analyse the prognosis and mortality of patients hospitalised for acute coronary syndrome before and after the implementation of a coronary unit, haemodynamics room and the Código corazón primary angioplasty programme. METHODS: We conducted an observational and retrospective study that analysed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events and mortality for 5 years of follow-up. The results of the post-code period (March 1 - December 31, 2012; n=471) were compared with those of the pre-code stage (March 1 - December 31, 2009; n=432). RESULTS: There were no differences in the baseline characteristics of the 2 groups; however, an increase in ST-segment elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (P<.001) was observed during the post-code phase. The use of percutaneous coronary intervention was made widespread at the hospital, achieving rates of 64.8% in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and of 95.5% in STE-ACS. Readmissions were reduced (from 38.2% to 25.1% for NSTE-ACS [P=.001] and from 23.7% to 11.0% for STE-ACS [P=.018]), the combined prognostic variable of adverse cardiovascular events and mortality at 5 years of follow-up was reduced (from 58.7% to 45% [P=.001] for NSTE-ACS and from 40.8% to 23.8% [p=.009] for STE-ACS), and 30-day mortality was decreased for STE-ACS (from 11.8% to 3.7%; P=.021). CONCLUSIONS: With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events and mortality.

Dental caries experience in Mexican schoolchildren from rural and urban communities.

OBJECTIVE: To compare dental caries experience in Mexican rural and urban settings. DESIGN: Cross-sectional samples of schoolchildren. SETTING: A school in Mexico City and a rural school in a remote area of the Oaxaca State in Southern Mexico. SAMPLE AND METHODS: A total of 347, 9- to 10-year-old schoolchildren (rural area, 131 children; urban, 216) was examined by two standardised dentists using the WHO 1987 criteria. OUTCOME MEASURES: Data were analysed in terms of central tendency measures and 95 per cent confidence intervals. RESULTS: Caries prevalence was 91.6 per cent in the urban area, and 54.4 per cent in the rural area (P < 0.05). DMFT in 10-year olds was 1.93 (sd 1.72) and 0.40 (sd 0.76) in urban and rural areas respectively (95 per cent CI 1.16-1.89). The entire DMFT/dmft indices in the rural group were made up of the decayed component. CONCLUSIONS: There is a large difference in the prevalence and distribution of dental caries between rural and urban Mexican children. Dental treatment background also differs markedly. Findings highlight the need to establish distinct preventative and rehabilitative treatment strategies tailored to meet the specific needs of different population groups.

Prevalence and severity of dental fluorosis in a Mexican community with above-optimal fluoride concentration in drinking water.

The purpose of this study was to determine the prevalence and severity of dental fluorosis in children living in a community at 2066 m above sea level. The water fluoride concentration of this community was 2.8 ppm. The population selected encompassed 10-12-yr-old schoolchildren who were life-long residents of the area. The modified Dean Index was used to estimate the severity of fluorosis. A total of 93 children participated in the study. They all showed evidence of dental fluorosis. Fifty-seven percent had moderate fluorosis, and 19% severe fluorosis. The high prevalence and severity of fluorosis in the population examined emphasized the need to study the factors determining dental fluorosis in Mexican communities.