Third-level Hospitals Research Articles

Efficacy of Fosfomycin against Planktonic and Biofilm-Associated MDR Uropathogenic Escherichia coli Clinical Isolates.

Urinary tract infections (UTI) are a severe public health problem and are caused mainly by the uropathogenic Escherichia coli (UPEC). Antimicrobial resistance and limited development of new antimicrobials have led to the reuse of old antibiotics such as fosfomycin. The aim of this study was to evaluate the in vitro efficacy of fosfomycin on a collection of multidrug-resistant (MDR) UPEC and the degradative activity on biofilm producers. A total of 100 MDR UPEC clinical isolates were collected from patients at Mexican second- and third-level hospitals. Microorganism identification was performed using an automated system, the evaluation of the susceptibility of clinical isolates to fosfomycin was performed using the resazurin microtiter assay, and the identification of biofilm producers and the effect of fosfomycin in biofilms were evaluated using the crystal violet method. Among planktonic MDR UPEC, 93% were susceptible to fosfomycin. Eighty-three MDR UPEC were categorized as weak (39.8%), moderate (45.2%), and strong (14.5%) biofilm producers. Fosfomycin exhibited degradative activity ranging from 164.4 µg/mL to 1045 µg/mL. Weak producers required statistically lower concentrations of fosfomycin to destroy the biofilm, contrary to moderate and strong producers. In conclusion, fosfomycin could be an option for the treatment of infections caused by MDR UPEC, for which the antimicrobial treatment is more often becoming limited.

Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments: A Multicenter Study in Latin America.

Sepsis is one of the most urgent health care issues worldwide. Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour. A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated. We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of "cold shock," and 13% of "warm shock," 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20-60 minutes) and 40 minutes (IQR, 20-60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30-135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59-278 minutes] vs 42 minutes [30-70 minutes], respectively [ P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001). We found poor adherence to the international recommendations for the treatment of PSS in the first hour at the PED in third-level hospitals in Latin America.

Positive peritoneal swab in SARS-CoV-2 patients undergoing abdominal emergency surgery: effect or cause?

PurposeThe presence of the SARS-CoV-2 in the peritoneal fluid is a matter of debate in the COVID-19 literature. The study aimed to report the prevalence of SARS-CoV-2 in the peritoneal fluid of patients with nasopharyngeal swab tested positive for SARS-CoV-2 undergoing emergency surgery and review the literature.MethodsThe present study was conducted between March 2020 and June 2021. Diagnosis of SARS-CoV-2 positivity was confirmed by preoperative real-time reverse transcriptase-polymerase chain reaction (RT-PCR).ResultsEighteen patients with positive nasopharyngeal swabs were operated in emergency in two third-level Italian hospitals. In 13 of these patients (72%), a peritoneal swab was analyzed: SARS-CoV-2 RNA was found in the abdominal fluid of two patients (15%). Neither of them had visceral perforation and one patient died. In ten patients with negative peritoneal swabs, visceral perforation and mortality rates were 30% and 20%, respectively.ConclusionSARS-CoV-2 peritoneal positivity is rare. Abdominal surgery can, therefore, be safely performed in patients with COVID-19 using standard precautions. The correlation with a visceral perforation is not evaluable. The clinical outcomes seem uninfluenced by the viral colonization of the peritoneum. Assessment in large series to provide definitive answers about the involvement of the SARS-CoV-2 in the peritoneum will be challenging to coordinate.

Post-COVID-19 persistent headache: A multicentric 9-months follow-up study of 905 patients.

Headache is a frequent symptoms of coronavirus disease 2019 (COVID-19). Its long-term evolution remains unknown. We aim to evaluate the long-term duration of headache in patients that presented headache during the acute phase of COVID-19. This is a post-hoc multicenter ambisective study including patients from six different third-level hospitals between 1 March and 27 April 2020. Patients completed 9 months of neurological follow-up. We included 905 patients. Their median age was 51 (IQR 45-65), 66.5% were female, and 52.7% had a prior history of primary headache. The median duration of headache was 14 (6-39) days; however, the headache persisted after 3 months in 19.0% (95% CI: 16.5-21.8%) and after 9 months in 16.0% (95% confidence interval: 13.7-18.7%). Headache intensity during the acute phase was associated with a more prolonged duration of headache (Hazard ratio 0.655; 95% confidence interval: 0.582-0.737). The median duration of headache was 2 weeks, but in approximately a fifth of patients it became persistent and followed a chronic daily pattern.

Wearable Devices and Intelligent Application in Women's Postpartum Repair for Smart Healthcare.

Wearable devices are more and more widely used in the field of smart healthcare. The purpose of this study was to explore the effect of contraceptive counseling and education on contraceptive behavior of women after induced abortion. The investigators will explain the situation of this topic to the respondents and select the respondents in strict accordance with the framework requirements of sampling design. All the data are from the induced abortion women in the first-, second-, and third-level hospitals, which reduces the selection bias of the respondents. It is found that the proportion of induced abortion among college students is the highest, reaching 66.03%. This study is helpful to reduce the incidence of unwanted pregnancy, induced abortion, and repeated abortion and improve the reproductive health of women.

Multicenter validation of Early Warning Scores for detection of clinical deterioration in COVID-19 hospitalized patients.

ObjectiveInvestigate the predictive value of NEWS2, NEWS-C, and COVID-19 Severity Index for predicting intensive care unit (ICU) transfer in the next 24 h.DesignRetrospective multicenter study.SettingTwo third-level hospitals in Argentina.PatientsAll adult patients with confirmed COVID-19, admitted on general wards, excluding patients with non-intubated orders.InterventionsPatients were divided between those who were admitted to ICU and non-admitted. We calculated the three scores for each day of hospitalization.VariablesWe evaluate the calibration and discrimination of the three scores for the outcome ICU admission within 24, 48 h, and at hospital admission.ResultsWe evaluate 13,768 days of hospitalizations on general medical wards of 1318 patients. Among these, 126 (9.5%) were transferred to ICU. The AUROC of NEWS2 was 0.73 (95%CI 0.68–0.78) 24 h before ICU admission, and 0.52 (95%CI 0.47–0.57) at hospital admission. The AUROC of NEWS-C was 0.73 (95%CI 0.68–0.78) and 0.52 (95%CI 0.47–0.57) respectively, and the AUROC of COVID-19 Severity Index was 0.80 (95%CI 0.77–0.84) and 0.61 (95%CI 0.58–0.66) respectively. COVID-19 Severity Index presented better calibration than NEWS2 and NEWS-C.ConclusionCOVID-19 Severity index has better calibration and discrimination than NEWS2 and NEWS-C to predict ICU transfer during hospitalization.

Mortality and evolution between community and hospital-acquired COVID-AKI.

Acute kidney injury (AKI) is associated with poor outcomes in COVID patients. Differences between hospital-acquired (HA-AKI) and community-acquired AKI (CA-AKI) are not well established. Prospective, observational cohort study. We included 877 patients hospitalized with COVID diagnosis at two third-level hospitals in Mexico. Primary outcome was all-cause mortality at 28 days compared between COVID patients with CA-AKI and HA-AKI. Secondary outcomes included the need for KRT, and risk factors associated with the development of CA-AKI and HA-AKI. A total of 377 patients (33.7%) developed AKI. CA-AKI occurred in 202 patients (59.9%) and HA-AKI occurred in 135 (40.1%). Patients with CA-AKI had more significant comorbidities, including diabetes (52.4% vs 38.5%), hypertension (58.4% vs 39.2%), CKD (30.1% vs 14.8%), and COPD (5.9% vs 1.4%), than those with HA-AKI. Patients' survival without AKI was 87.1%, with CA-AKI it was 75.4%, and with HA-AKI it was 69.6%, log-rank test p < 0.001. Only age > 60 years (OR 1.12, 95% CI 1.06-1.18, p <0.001), COVID severity (OR 1.09, 95% CI 1.03-1.16, p = 0.002), the need in mechanical lung ventilation (OR 1.67, 95% CI 1.56-1.78, p <0.001), and HA-AKI stage 3 (OR 1.16, 95% CI 1.05-1.29, p = 0.003) had a significant increase in mortality. The presence of CKD (OR 1.48, 95% CI 1.391.56, p < 0.001), serum lymphocytes < 1000 μL (OR 1.03, 95% CI 1.00-1.07, p = 0.03), the need in mechanical lung ventilation (OR 1.06, 95% CI 1.02-1.11, p = 0.003), and CA-AKI stage 3 (OR 1.37, 95% CI 1.29-1.46, p < 0.001) were the only variables associated with a KRT start. We found that COVID patients who are complicated by CA-AKI have more comorbidities and worse biochemical parameters at the time of hospitalization than HA-AKI patients, but despite these differences, their probability of dying is similar.

Analysis on the distribution status and concentration degree of radiological diagnosis and treatment resources in Beijing

Objective To analyze the distribution status and agglomeration degree of radiological diagnosis and treatment resources in Beijing, and provide references for rationally coordinating the allocation of radiological diagnosis and treatment resources, formulating resource allocation policies, and promoting the stable development and efficient use of radiological diagnosis and treatment resources. Methods Based on the medical radiation protection monitoring data of Beijing medical and health institutions from 2019 to 2020, the current situation of radiological diagnosis and treatment resources is described by the number of radiological diagnosis and treatment resources, the average service volume, and the resource composition, and the distribution of radiological diagnosis and treatment resources in Beijing is evaluated with the aid of the agglomeration degree. Results The number of radiological diagnostic equipment, the number of service personnel, and the number of radiological workers engaged in third-level hospitals is the largest; for the number of service personnel for each type of single equipment, third-level hospitals account for a larger proportion, and radiotherapy and nuclear medicine services are concentrated in third-level hospitals. Human resource pressure and equipment service pressure are relatively high in third-level hospitals. First-level hospitals mainly undertake radiological diagnosis services. There is little difference in the amount of radiological diagnosis services per capita between second-level hospitals and third-level hospitals. Nuclear medicine and radiotherapy in third-level hospitals per capita service volume is significantly higher than that insecond-level hospitals. Radiological diagnosis and radiotherapy resources are concentrated in urban areas to a large extent. Conclusion There are obvious differences in the utilization of radiological diagnosis and treatment resources in different levels of hospitals. There is a significant concentration of radiological diagnosis and treatment resources in various districts. There is a certain degree of unbalanced distribution and inadequate utilization of radiological diagnosis and treatment resources in Beijing. 摘要： 目的 开展北京市放射诊疗资源分布现状与集聚度分析, 为合理统筹放射诊疗资源配置、制定政策、促进放射 诊疗资源稳定发展与高效利用提供参考。 方法 基于 2019—2020 年北京市医疗卫生机构医用辐射防护监测数据, 通 过放射诊疗资源数量、平均服务量、资源构成等指标描述放射诊疗资源现状, 借助集聚度指标评价北京市放射诊疗资 源分布均衡程度。 结果 三级医院放射诊断设备配备数量、服务人次及放射工作人员数最多；单台设备服务人次三级 医院占比较大, 且放射治疗、核医学服务集中于三级医院。三级医院的人力资源与设备服务压力均相对较大, 一级医 院主要承担放射诊断服务, 二级医院与三级医院人均放射诊断服务量差别不大, 三级医院核医学和放射治疗人均服务 量显著高于二级医院。放射诊疗资源在城区集聚程度较大。 结论 不同级别医院放射诊疗资源利用率存在明显差异, 各区放射诊疗资源存在显著集聚现象, 北京市放射诊疗资源存在一定程度的分布不均衡、利用不充分问题。

A nationwide survey of acute pancreatitis:a report from 126 hospitals in China

Objective: To investigate the current status of acute pancreatitis(AP) diagnosis and treatment in hospitals of different levels in China. Methods: A cross-sectional survey was conducted. The Acute Pancreatitis Diagnosis and Treatment Practice Questionnaire was designed and sent to the members of the Group of Pancreatic Surgery Chinese Society of Chinese Medical Association Branch and some other hospitals online from 8th to 24th December, 2020. Observation indicators included general information, AP diagnosis and assessment, treatment strategies, follow-up information, and comparisons of clinical practice between 3A-level and non-3A-level hospitals were performed. Counting data was used χ 2 test or Fisher exact test. Results: A total of 126 valid questionnaires were collected in final analysis, of which 75.4% (95/126) were from 3A-level hospitals, 15.9%(20/126) and 8.7%(11/126)were from other third-level and second-level hospitals,respectively. Of all participants, 88.1% (111/126)used classic AP diagnostic criteria, and 88.1% (111/126)conducted severity assessment. The revised Atlanta classification and determinant-based classification were commonly used, accounting for 72.1%(80/111) and 22.5%(25/111), respectively. 70.6%(89/126)used predictive models, including APACHE Ⅱ score, imaging models(modified CT severity index or Balthazar scoring) and Ranson criteria. For patients with early pancreatic or peripancreatic infection, 75.4%(95/126) preferred antibiotic therapy, and for those with infected walled-off necrosis, 61.1% (77/126) preferred percutaneous catheter drainage.When surgical intervention required,preferred methods were laparoscopic transabdominal surgery(37.3%, 47/126) and open surgery(25.4%,32/126). 61.1%(77/126) accepted "delayed surgery" notion. 32.5%(41/126) routinely used the step-up approach. For mild biliary acute pancreatitis, 44.4%(56/126) underwent cholecystectomy during the same hospital admission. Regarding follow-up, ideal overall follow-up periods were 6 months(46.0%,57/124) and 12 months(33.1%, 41/124), and follow-up interval was 3 months(50.8%,63/124) and 1 month(23.4%, 29/124). Comparing clinical practice of AP between 3A-level hospitals and non-3A-level hospitals, we found that the former had a significantly higher proportion of annual AP admission number of over 100(34.7%(33/95) vs.12.9%(4/31), χ 2=5.372, P=0.020), and higher proportion of routine severity assessment(68.4%(65/95) vs. 35.5%(11/31), χ²=11.107, P=0.004), higher proportion of routine severity prediction(45.3%(43/95) vs. 12.9%(4/31), χ²=13.549, P=0.001). When surgical intervention required, the proportion of step-up approach was significantly higher(37.9%(36/95) vs.16.1%(5/31), χ 2=8.512, P=0.017). Significantly more participants preferred that follow-up should be completed by full-time staff(35.8%(34/95) vs. 22.6%(7/31), χ²=8.154, P=0.043) in 3-A level hospitals. Conclusions: The standardization of AP diagnosis is relatively high in China. However, standardized assessment of severity and prediction need to be further prompted, especially in non-3A-level hospitals. Regarding AP treatment, especially the minimally invasive intervention strategy would be the focus of the promotion of standardized AP practice in the future.

Economic burden of age-related macular degeneration in routine clinical practice: the RAMDEBURS study

PurposeTo describe and evaluate the main direct health costs, in routine clinical practice, of age-related macular degeneration (AMD) patients, from hospital perspective, in Spain.MethodsRetrospective, multicenter, and observational study conducted on five third-level Spanish hospitals, between December 2018 and December 2019. The study included patients who were diagnosed of AMD before December 2018. Direct healthcare costs were obtained from a Spanish database. Study variables included demographic and clinical variables, and resources, such as treatment, diagnostic tests, medical examination, and surgery. Among the 1414 screened AMD patients, 1164 patients were included. In the overall study patients, the total cost was €5,386,511.0, with a mean cost per patient of €4627.6 ± 2383.9. The largest cost items were diagnostic examinations (€2.832.902,0) and vascular endothelial growth factor inhibitors (anti-VEGF) treatment (€2.038.257,2). Bevacizumab was administered to 325 (27.9%) patients, ranibizumab to 328 (28.2%), and aflibercept to 626 (53.8%); 115 (10.7%) patients received two anti-VEGF treatments, while 90 (7.7%) did not receive any. Over the course of the study, a total of 6,057 anti-VEGF injections were administered, with a mean (95% confidence interval) of 4.8 (4.4–5.2) injections per patient. Regarding safety, 29 patients experience injection-related adverse events, among them 12 patients had cataract and 11 ones elevated intraocular pressure (IOP). The incidence of endophthalmitis was 0.5% (6/1164).ConclusionsAMD was associated with considerable healthcare costs for regional healthcare systems. Diagnostic examinations, particularly OCT examinations, and anti-VEGF treatment represented the largest cost items.

Assessment of quality benchmarks in adenoma detection in Mexico.

Background and study aims Several Latin American countries, including Mexico, have reported an increase in colorectal cancer (CRC) mortality. The effectiveness of a colonoscopy in preventing CRC depends on the quality of the procedure, for which the adenoma detection rate (ADR) is one of the most trusted indicators. Awareness of ADR can improve the quality of colonoscopies through proper feedback and training of the specialists. The goal of this study was to estimate the ADR among Mexican endoscopists with experience in CRC screening and to compare it with previously reported data from this country. Methods We carried out a retrospective study to analyze ADR data in Mexico. The information was obtained from a group of certified endoscopists and compared with the former published data from Mexico. Results We found a current ADR of 24.6 % (95 %CI, 22.4 %–26.8 %) from 1,478 colonoscopies performed by eight endoscopists in two third-level private hospitals. The average ADR reported in previous publications was 15.2 % (95 %CI, 13.3 %–17.1 %). Statistical analysis showed differences between our results and those from previous studies (24.6 % vs. 15.2 %, P < 0.001). Conclusions The actual ADR in Mexico is higher than previously reported. Previous low ADR values could be explained by poorly performed colonoscopies rather than by low adenoma and CRC incidence in our country.

The WHO methodology for point prevalence surveys on antibiotics use in hospitals should be improved: Lessons from pilot studies in four Mexican hospitals

Point prevalence surveys (PPSs) are a useful option for collecting antimicrobial prescription data in hospitals where regular monitoring is not feasible. The methodology recommended by the World Health Organization (WHO) for conducting PPSs (WPPS), which targets low- and middle-income countries (LMICs), attempts to respond to the lag in these regions to generate estimates for antimicrobial use. However, based on our experience in four third-level public hospitals in Mexico, we identified substantial gaps in the WPPS guide with regards to addressing common challenges for the implementation of PPSs. While the oversimplified narrative of WPPS could facilitate the adoption of this methodology and extend its use, it underestimates the efforts and potential pitfalls for survey preparation, coordination, and reliable implementation. Conducting rigorous pilot studies could reduce the WPPS deficiencies and strengthen the reliability and comparability of the estimates for antimicrobial use.

Evaluation of a novel Cardiac Peri-Operative Transfusion Trigger Scoring system in patients with coronary artery disease

BackgroundA simple and accurate scoring system to guide perioperative blood transfusion in patients with coronary artery disease (CAD) undergoing cardiac surgery is lacking. The trigger point for blood transfusions for these patients may be different from existing transfusion guidelines. This study aimed to evaluate the safety and efficacy of a new scoring strategy for use in guiding transfusion decisions in patients with CAD.MethodsA multicenter randomized controlled trial was conducted at three third-level grade-A hospitals from January 2015 to May 2018. Data of 254 patients in a Cardiac Peri-Operative Transfusion Trigger Score (cPOTTS) group and 246 patients in a group receiving conventional evaluation of the need for transfusion (conventional group) were analysed. The requirements for transfusion and the per capita consumption of red blood cells (RBCs) were compared between groups.ResultsBaseline characteristics of the two groups were comparable. Logistic regression analyses revealed no significant differences between the two groups in primary outcomes (1-year mortality and perioperative ischemic cardiac events), secondary outcomes (shock, infections, and renal impairment), ICU admission, and ICU stay duration. However, patients in the cPOTTS group had significantly shorter hospital stays, lower hospital costs, lower utilization rate and lower per capita consumption of transfused RBCs than controls. Stratified analyses revealed no significant differences between groups in associations between baseline characteristics and perioperative ischemic cardiac events, except for hemofiltration or dialysis and NYHA class in I.ConclusionsThis novel scoring system offered a practical and straightforward guideline of perioperative blood transfusion in patients with CAD.Trial registration chiCTR1800016561(2017/7/19).

Investigation and Analysis of the Status Quo of Prevention and Control Practices of Catheter-Line Associated Bloodstream Infections (CLABSI) in Guangxi, China

The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI.

An Analysis of Recently Retracted Articles by Authors Affiliated with Hospitals in Mainland China

The aim of this study was to analyze the features of retracted articles by authors affiliated with hospitals in mainland China. We searched the PubMed, Web of Science, and Retraction Watch databases for retractions and identified the following characteristics of each retracted article: publisher, open access status, impact factor of the journal that retracted the article, any PubPeer comments recorded before the retraction, status of the hospital where the authors worked, and any response to the retraction from the authors. We found 521 retractions, primarily by authors at grade A, third-level hospitals located in a limited number of regions of mainland China, and found that the journals that had published and later retracted the articles tended to have a medium to high impact factor. The main reasons for retraction were data manipulation, fabrication, or fraud; errors made by the authors; or plagiarism. Few of the retracted publications had PubPeer comments before their retraction. This is the first report to focus on retracted research coming out of hospitals in mainland China. The large number of retractions for Chinese hospitals is worrying. The results suggest that some retractions were related to third parties that provided editorial and other services.

New public health policy intervention for diabetic foot management in Mexico

Abstract Problem In Mexico, an estimated 12 million people have diabetes, with complications of diabetes contributing to 25-90% of non-traumatic amputations. Description of the Problem We conducted a review through the literature of available studies in English-language databases and libraries, including PubMed and UNAM digital Library to determine the role of teaching first contact health workers and the creation of limb salvage teams in the prevention of amputations. Through this review, we present the basis of our proposal about implementing these strategies to improve a care coordination system for diabetic foot management in Mexico. Results There were 25 publications from different countries, 12 eligible for this review. The review emphasizes that the creation of Specialized Diabetic Foot Teams to treat patients and teach first contact medical workers could help to achieve the following objectives which result in the reduction of amputations and improved patient outcomes: Standardize and simplify the diabetic foot clinical examination. Timely reference of patients with DM with a moderate and high risk of diabetic foot complications. Timely reference of patients with diabetic foot and peripheral arterial disease to third-level hospitals. Periodic first-contact health workers training on risk detection and stratification of diabetic foot. Lessons Implementing the policy of creation of Specialized Diabetic Foot Teams to treat patients and teach first contact medical workers will contribute to reducing major amputations due to diabetes in our country. We aim to implement a successful policy in Mexico to strengthen the health system and improve outcomes and therefore the quality of life of patients with diabetic foot complications. We aim to serve as a legislative voice for all patients in Mexico facing major amputations and other diabetes complications. Key messages New public health policy implementation for diabetic foot management in Mexico. Prevention of major amputations.

Relación entre la duración de la enfermedad y características clínicas de pacientes con Artritis Reumatoide en dos centros de referencia

Introduction: There are differences between patients with early and established rheumatoid arthritis (RA) that can condition quality of life and prognosis of the disease. Material and methods: Descriptive, cross-sectional study in a cohort of RA patients with regular follow-up visits in two third-level hospitals. A questionnaire with epidemiological, clinical, laboratory and radiographic variables was completed, in addition to physical examination. Patients were divided into 3 groups: 0 to 12 months, 13 to 60 months and more than 60 months of disease duration. Results: 330 patients were included, with mean disease duration of 108.19±91.17 months. Patients with less than 12 months of disease duration have a BMI of less than 25 more frequently (50% vs. 24.9%, p 0.037), they also have a higher average SJC (3.20±3.6 vs. 1.64±2.7, p 0.034), TJC (3.53±4.13 vs. 1.7±2.77, p 0.015) and pain VAS (28.93±30.14 vs. 15.09 ± 19.79, p 0.011). Meanwhile, patients with more than 60 months disease duration are older (53.08±12 vs. 48.23±14, p 0.002), have a higher incidence of erosions (39% vs. 21%, p 0.004) and osteoporosis (23.5% vs. 12.9%, p 0.023) and a lower average TJC (1.49±2.5 vs. 2.28±3.3, p 0.018). Conclusion: Patients with shorter disease duration have higher average activity indexes. Patients with longer disease duration have a higher frequency of erosive disease and osteoporosis but lower average tender joint counts.

The Family Attitudes of Patients With End-Stage Renal Disease Toward Living Kidney Donation in China

BackgroundOrgan shortages limit the progress of organ transplantation. The family attitudes of patients with end-stage renal disease (ESRD) play an important role in advocating organ transplantation and donation. The purpose of this study was to analyze the family attitudes of patients with ESRD toward living kidney donation in China. Ethical approval was obtained from the ethics committee of Linyi People’s Hospital. This study was performed in compliance with the Declaration of Helsinki. Materials and methodsThis research was performed at 5 third-level hospitals with hemodialysis and nephrology departments, and a small section comes from urology departments. The participants were surveyed from January to November 2018. Attitudes were evaluated using a validated questionnaire concerning the psychosocial aspects of organ donation. The self-administered questionnaire was completed anonymously. Statistical analyses employed t tests and the χ2 test. ResultsRegarding living kidney donation, 69.1% (n = 428) of patient families favored it; however, only 30.9% (n = 192) did not support it. A favorable attitude toward living donation was mainly associated with the following variables: 1. the recipient is not more than 50 years old; 2. the recipient is a member of the immediate family; 3. the living donation is from the recipient’s family member; 4. the family has previous personal experience with organ transplantation and donation; and 5. the family has a concern about the possibility of needing a transplant within the family unit (P < .05). ConclusionsEconomic burden and mental stress from long-term dialysis influenced the attitudes and behavioral intentions of the families of patients with ESRD on advocating organ donation. Repeated education and constant advocacy are advised to increase the participation of families of patients with ESRD in organ donation. The results showed favorable attitudes toward living kidney donation among the families of patients with ESRD.

Availability of ENT Surgical Procedures and Medication in Low-Income Nation Hospitals: Cause for Concern in Zambia.

Background Ear, nose, and throat (ENT) diseases are an oft overlooked global health concern. Despite their high prevalence and associated morbidity and mortality, ENT diseases have remained neglected in health care delivery. In Zambia and many other low-income countries, ENT services are characterized by poor funding, unavailable surgical procedures, and erratic supply of essential drugs. Objective To investigate ENT service provision in Zambia with regard to availability of surgical procedures and supply of essential drugs. Methods A descriptive cross-sectional survey was conducted using a piloted structured questionnaire between 17 January 2017 and 2 January 2018. Included in the study were the 109 hospitals registered with the Ministry of Health (MoH) across the 10 provinces of Zambia. Results Of the participating hospitals, only 5.9% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (Conclusion ENT service delivery in Zambia is limited with regard to performed surgical procedures and availability of essential drugs, necessitating urgent intervention. The findings from this study may be used to direct national policy on the improvement of provision of ENT services in Zambia.

Effectiveness and safety of leflunomide compared with cyclophosphamide as induction therapy in Takayasu's arteritis: an observational study.

Aims:The objective of this study was to investigate the outcomes of leflunomide (LEF) compared with those of cyclophosphamide (CYC) as induction against active Takayasu’s arteritis (TA) in Chinese patients.Methods:This was an observational study based on a prospective cohort that included TA patients diagnosed in large third-level first-class general hospitals in East China from January 2009 to September 2018. LEF- or CYC-induced active patients were enrolled for comparative effectiveness analysis. One-to-more paired cohorts of LEF versus CYC were derived by propensity-score matching (PSM). The primary outcome was complete remission (CR) at 9-month follow up, and secondary endpoints included partial remission (PR) and effectiveness rate (ER). Multivariable logistic regression was used to identify statistical significance.Results:A total of 131 enrolled patients with at least 3-months treatment included 53 receiving a regimen of glucocorticoid (GC) and LEF and 78 receiving GC and CYC. Compared with the CYC group, the LEF group showed higher CR rate {LEF versus CYC: 84.6% [95% confidence interval (CI) 74.5–94.8%] versus 59.0% (47.8–70.1%); relative risk (RR) = 0.3 (0.1–0.6), p = 0.002} and lower daily GC dose [10.0 (5.0–12.5) versus 12.5 (10.0–15.0) mg, p = 0.043] at the end of the 9-month induction. In the matched analysis, the LEF group (n = 23) still indicated a higher CR rate than the CYC group (n = 54) after PSM [RR = 0.1 (0.0–0.6), p = 0.003]. Four LEF-treated patients had mild side effects, and one died unrelated to LEF.Conclusion:LEF could be an alternative induction therapy against TA, showing good effectiveness and tolerance compared with CYC.