Artykuły w czasopismach na temat „Hospital de S. Lázaro (Mexico City, Mexico)”

Xorge Alejandro Dominguez, Mexico s Foremost Organic Chemist, was born in Orizaba, State of Veracruz, Mexico on November 12, 1926, and died of a heart attack in Mexico City on May 26, 1991, only hours after he had been awarded by President Carlos Salinas de Gortari Lázaro Cárdenas Medal for his contributions and dedication to the scientific advancement of Mexico.

Aim: Determine if childhood cancer patients suffer bullying and identify its causes Compare what patients say about bullying, when they are alone versus presence of their parents. Method: We studied 47 childhood cancer patients ages varied between 5 and 17 years old. With previous parental authorization we applied a questionnaire called “That´s how we hang out at school” in two moments, first one in presence of their parents, and the second one without them. Results: Scholar childhood cancer survivors suffer bullying in 89.4%, in contrast with 25.8% of children without cancer suffered bullying according to literature. Secquelae and alopecia were the main causes for bullying, also teacher´s and Student´s lack of knowledge thinking that cancer is contagious. We also observed that children accepted being bullied in presence of the doctor, but not in front of their parents. Conclusion: Childhood cancer patients are more harassed than children without cancer due to secqueale, atipya or consumption that they present, also, fear of contagion enhances harassment and lack of teacher´s intervention. Children deny being bullied in front of their parents, but accept it without them.

Aim: Determine if childhood cancer patients suffer bullying and identify its causes Compare what patients say about bullying, when they are alone versus presence of their parents. Method: We studied 47 childhood cancer patients ages varied between 5 and 17 years old. With previous parental authorization we applied a questionnaire called “That´s how we hang out at school” in two moments, first one in presence of their parents, and the second one without them. Results: Scholar childhood cancer survivors suffer bullying in 89.4%, in contrast with 25.8% of children without cancer suffered bullying according to literature. Secquelae and alopecia were the main causes for bullying, also teacher´s and Student´s lack of knowledge thinking that cancer is contagious. We also observed that children accepted being bullied in presence of the doctor, but not in front of their parents. Conclusion: Childhood cancer patients are more harassed than children without cancer due to secqueale, atipya or consumption that they present, also, fear of contagion enhances harassment and lack of teacher´s intervention. Children deny being bullied in front of their parents, but accept it without them.

Introduction: The increasing resistance to antibiotics is a public health problem and an imminent therapeutic challenge in hospitals. In this report we aimed to analyze the relationship between antimicrobial resistance and antibiotic consumption in a third-level pediatric hospital. Methodology: A cross-sectional analysis was conducted using the information from the microbiology and pharmacy databases of the Pediatric Hospital “Doctor Silvestre Frenk Freund”, during the period 2015-2018. Prevalence of antimicrobial resistance by microorganisms and dispensed grams of selected antibiotics were calculated annually. Antibiotic resistance trend over the time was evaluated using the Chi-square trends test and to assess the correlation between the dispensed grams of antibiotics with their antimicrobial resistance prevalence, we calculated the Pearson's coefficient (r). Results: A total of 4,327 isolated bacterial samples were analyzed (56.5% Gram-positive and 44.5% Gram-negative). Most frequently isolated microorganisms were coagulase-negative staphylococci (CoNS), E. coli, K. pneumoniae, P. aeruginosa and S. aureus. We found a significant increase in resistance to clindamycin and oxacillin for CoNS and significant decrease in nitrofurantoin and amikacin resistance for E. coli and K. pneumoniae. We observed a strong positive and statistically significant correlation between amikacin resistance prevalence and amikacin dispensed grams for P. aeruginosa (r = 0.95, p = 0.05). Conclusions: The antibiotic resistance profile showed by our study highlights the need of an appropriate antibiotic control use in the Hospital setting.

Abstract Background S. aureus is the most common cause of osteomyelitis in children. Panton-Valentine leucocidin (PVL) is an exotoxin produced by certain S. aureus strains, which can be detected in both methicillin-sensitive and -resistant strains of staphylococci. Pediatric osteomyelitis by PVL producing S. aureus constitute a rare, but highly critical event. They are characterized by a rapid course of marked inflammation, worsening under conservative therapy, and a high rate of recurrence. No information is available on osteomyelitis and Panton-Valentine leukocidin producing S. aureus in Mexico. Objective The aim of this study was to determine the molecular characterization of S. aureus strains isolated in pediatric patients with osteomyelitis and their clinical features in a tertiary hospital in Mexico City. Methods We conducted a prospective study of children admitted for osteomyelitis, between December 2018 and November 2019, at Instituto Nacional de Pediatría. We obtained an informed consent in children under 12 years of age and an informed assent in children over 12. The confirmation of the S. aureus isolates was performed by amplification and analysis of 16S rRNA and nuc genes. The mecA and pvl genes were detected by PCR, the clinical features were obtained at the admission. Results Fifty patients were included and 26 cases of osteomyelitis were diagnosed, 13 were due to staphylococcus aureus genus and 6 due to S. aureus; all of them were methicillin susceptible and two were PVL producers. Both patients had a severe initial presentation, with extensive local abscesses, and one required three surgical procedures and developed septic pulmonary embolism. The two patients received double antimicrobial treatment and required a long therapy interval. Conclusions Osteomyelitis with Panton-Valentine Leukocidin producing S. aureus seems to be more severe. In patients with severe osteomyelitis, it is essential to detect the PVL toxin because they require early surgical intervention and prolonged intravenous therapy. Our findings suggest that the severity of the osteomyelitis is linked with PVL production more than with methicillin resistance due to that all our isolates were methicillin susceptible.

10059 Background: Neuroblastoma (NB) is the main extracraneal cancer in children. Progress in survival has not been the same as in other neoplasms despite molecular markers research and new drugs. Our aim was to describe low and high risk patients at Hospital Infantil de México Federico Gómez (HIMFG) and their results. Methods: We included children from 0 to 18 years con NB diagnosed at HIMFG between january, 2002 and december 2011. We perform a retrospective, retrolective and descriptive study analyzing demographic variables and survival with Kaplan Meier. Results: 64 consecutive patients were included. 73.4% had metastasis at diagnosis (bone marrow 23.4%, liver 18.8%, bone 17.2%, 4.7% central nervous system, 9.4% other). 87.5% of patients received neoadyuvant chemotherapy. Patients were treated with POG 8104 y 8441. Global survival of patients with E4 stage was 50% at 120 months, with E3 of 76.5% at 110 months; stage 1, 2 patient´s survival was 4S 100% at120 months. Conclusions: At HIMFG, in Mexico City, 75% of patients with NB arrive with metastatic disease. Clinical prognosis factors are still current in development countries. Our results are similar as in developed countries suggesting that with low resources, we can obtain satisfactory results only with clinical evaluation.

INTRODUCTION: In Mexico, breast cancer (BC) is one of the main causes of cancer deaths in women, with increasing incidence and mortality in recent years. Therefore, the aim of the study is identify possible risk factors related to BC. METHODS: An epidemiological study of hospital cases of BC and controls with cervical uterine cancer (CUCA) was carried out at eight third level concentration hospitals in Mexico City. The total of 353 incident cases of BC and 630 controls with CUCA were identified among women younger than 75 years who had been residents of the metropolitan area of Mexico City for at least one year. Diagnosis was confirmed histologically in both groups. Variables were analyzed according to biological and statistical plausibility criteria. Univariate, bivariate and multivariate analyses were carried out. Cases and controls were stratified according to the menopausal hormonal status (pre and post menopause). RESULTS: The factors associated with BC were: higher socioeconomic level (OR= 2.77; 95%CI = 1.77 - 4.35); early menarche (OR= 1.32; 95%CI= 0.88 - 2.00); old age at first pregnancy (>31 years: OR= 5.49; 95%CI= 2.16 - 13.98) and a family history of BC (OR= 4.76; 95% CI= 2.10 - 10.79). In contrast, an increase in the duration of the breastfeeding period was a protective factor (>25 months: OR= 0.38; 95%CI= 0.20 - 0.70). CONCLUSIONS: This study contributes to the identification of risk factors for BC described in the international literature, in the population of Mexican women. Breastfeeding appears to play an important role in protecting women from BC. Because of changes in women`s lifestyles, lactation is decreasing in Mexico, and young women tend not to breastfeed or to shorten the duration of lactation.

IntroductionThe prevalence of mental disorders (MD) is greater in children; however, they are the population with less help-seeking and access to mental health-care services (MHS).ObjectivesTo explore the characteristics of help-seeking and access to specialized MHS in children with MD.MethodsA cross-sectional study was carried out from 2018 to 2019, in the Children’s Psychiatric Hospital and National Institute of Psychiatry in Mexico City. Sample 397 children and 397 caregivers. The project was approved by the Ethics Committee of both institutions. The patient’s family member was questioned on sociodemographic data and help-seeking to MHS. Sample’s descriptive statistics applying measures of central tendency, Inferential statistics with t-test for differences in means between groups (diagnosis), and one-way ANOVA to variables associated with the help-seeking to MHS.ResultsChildren´s sample: 37% female, average age 12 years (SD± 3.6), 51% had diagnosis of hyperkinetic disorder (HD), 34% depressive disorder (DD). The children´s age at the time of seeking healthcare was different according to the diagnosis: DD 10.1 (SD ± 4.5) and HD 6.95 (SD ± 3.4), (T = -3.18, p = 0.000); and by sex: girls 10.9 (SD ± 4.5), boys 7.85 (SD ± 4.0); (T = -3.07, p = 0.000). The mother was the first person to notice the symptoms.ConclusionsThe search for MHS differs by sex, diagnosis and family history; it is necessary to design mental health interventions considering gender-based differences, namely, to integrate a gender perspective.DisclosureNo significant relationships.

186 Background: Completion of advance directives can help to ensure consistency with people´s preferences at the end of life. However, disparities in access to advance care planning is common among Hispanic population and little is known about their end-of life wishes. Although in Mexico, advance directives were legalized in 2008, only 21% of people know about it. Objective: To describe end-of-life wishes among patients with advanced cancer planning in a third level hospital in Mexico City. Methods: We conducted a cross-sectional analysis of advance directives planning from patients with advanced cancer included in a multidisciplinary patient navigator-led supportive care program in Mexico City (Te Acompañamos). Patients with a life expectancy of 6 months or less were invited to complete advance directives (AD). Life expectancy was calculated using the palliative performance scale (PPS). Descriptive statistics were used for this analysis. Results: From September 2017 to November 2021, a total of 238 patients were invited to complete AD and 55 (23.1%) completed it, 14.5% in 2017, 29% in 2018, 34.5% in 2019, 9% in 2020 and 12.7% in 2021. The mean age among those who completed AD was 65.8 years (range 38-91), 52.7% were women and 61.8% had gastrointestinal cancer. Forty-three (78.1%) patients stated their wish to die at home, 18.1% to have cardiopulmonary reanimation, 9% invasive mechanical ventilation, 24.4% tube feeding, 90.9% pain medications, 10.9% organ donation, 40% cremation, 38.1% a funeral and 50.9% a death ritual. At median follow up of 5 months (0-39), 43 (78.1%) patients have died, and their endo-of-life wishes were respected in 77.5 % of them concerning the place of death and in 96.7% regarding cardiopulmonary reanimation and invasive mechanical ventilation. Conclusions: In our patient navigator-led supportive program approximately a quarter of patients with advanced cancer and a life expectancy of 6 month or less completed AD and end-of-life wishes were respected in a significant proportion of them. Telemedicine methods used to invite patients during COVID-19 pandemic decreased the proportion of AD completion. Although, advanced care planning is associated with improved in quality of care at the end of life, several barriers and disparities exist among Hispanics and strategies to improve their completion are needed.

Abstract Background Patients with severe SARS-CoV-2 infection are at high risk of complications due to the intensive care unit stay. Hospital-acquired infections (HAI) are one of the most common complication and cause of death in this group of patients, it is important to know the epidemiology and microbiology of this hospital-acquired infections in order to begin to the patients a proper empirical treatment. We describe the epidemiologic and microbiologic characteristics of HAI in patients with COVID-19 hospitalized at intensive care unit (ICU) in a tertiary level private hospital in Mexico City. Methods From April to December 2020, data from all HAIs in patients with severe pneumonia due to SARS-CoV-2 infection with mechanical ventilation at ICU were obtained. The type of infection, microorganisms and antimicrobial susceptibility patterns were determined. Results A total of 61 episodes of HAIs were obtained, the most common was ventilator associated pneumonia (VAP) in 52.4% (n=32) followed by urinary tract infection (UTI) 34.4%(n=21) and bloodstream infection (BSI) 9.84% (n=6). Only two episodes corresponded to C. difficile associated diarrhea. We identified 82 different microorganisms, the most frequent cause of VAP was P. aeruginosa 22% (10/45) followed by K. pneumoniae 20% (9/45); for UTI, E. coli 28.5% (6/21), and S. marcescens 19% (4/21); for BSI the most frequent microorganism was S. aureus 28.5 (2/7). Regarding the antimicrobial susceptibility patters the most common were Extended Spectrum Beta-Lactamase (ESBL) Gram-negative rods followed by Methicillin-resistant Staphylococcus aureus. Conclusion In patients with severe COVID-19 hospitalized in the ICU the most frequent HAIs were VAP and UTI caused by P. aeruginosa and E. coli respectively. ESBL enterobacteriaceae was the most common resistant pattern identifed in the bacterial isolations in our series. Disclosures All Authors: No reported disclosures

The seismic-resistant behaviour and the current structural condition against gravity loads of a hospital-type building is evaluated. The building fell into disuse due to the damages caused by the 1985 Mexico City earthquake. The structural assessment intends to ease the decision-making process regarding either to: 1) demolish the structure (including foundation) in order to build another tower-type structure in the same location; or 2) rehabilitate the structure (increase resistance and stiffness). The building consists in a reinforced concrete structure of the late 1960's, with five levels based on a rigid box foundation with friction piles, which was abandoned after the 1985 earthquake. It is located in a compressible seismic zone (site dominant vibration period, Ts ~ 2 seconds) and was designed according to the RCDF-66 [1] with seismic coefficients of 0.06 and 0.08 for the longitudinal (frames) and transverse (concrete walls of head axes) directions, respectively. Between 1971 and 1972 the foundation was reinforced with control piles. There are no reported damages of the main structural elements resistances but, because of the observed effects in the non-structural components within the building, important lateral movements can be induced, which are not recommended, nor desired, in hospital-type structures. Important deterioration problems can be observed in the non-structural elements and finishes as well as in the main structure (including foundation) after being abandoned for more than 30 years with scarce maintenance. The assessment was performed through spectral modal dynamic analyses, including three-dimensional models of the structure and foundation in conjunction in accordance with the current Code (RCDF-04) [2], as well as with a newer and stricter Regulation proposal of the Mexico City Building Code. Additionally, time-history analyses were performed with both site-representative ground motion records and 1985 earthquake records. The analytical results of the fundamental vibration periods were calibrated against the ambient vibration measured periods. Slump field measurements resulted under 1% with respect to height. In general, it complies with the failure limit state (resistances), but not with the lateral displacements and story drift limit.

514 Background: Gastroenteropancreatic neuroendocrine tumors (GEP NET´s) are infrequent tumors, with a variety of symptoms depending of the kind of peptide they secrete as well as the affected organs. Long acting somatostatin analogues have shown an adequate rate of symptom control in functional tumors, they also have demonstrated antiproliferative effect, which is translated in a significant improvement of progression free and overall survival Methods: In this retrospective analysis of patients with metastatic GEP NET treated with long acting somatostatin analogues as first line, treated between 2005 and 2015, we evaluated clinical and pathological features, symptoms, disease control and survival adjusted with OMS classification Results: Our cohort included 95 patients with a mean age of 53 years. Primary affected sites were midgut (29.4%), followed by pNET (17.%), stomach (14.7%), and primary unknown in 14%. 20% of cases were functional tumors with diarrhea as the most common symptom in 70% and flushing in 50%. Considering the whole cohort the most prevalent symptom was abdominal pain in the 50% of cases. The OMS classification showed low grade tumors in 65% and 35% intermediate grade. Most common metastatic organ sites were; liver only 35%, liver and other 30%, peritoneum 10% and lymph nodes in 6%, non-specified sites in 19%. Somatostatine analogues used in first line were octreotide in 80% and lanreotide in 20%. Survival results demonstrated a progression free survival for the whole cohort of 84months. No differences between lanreotide and octreotide were observed. Conclusions: This study represents the first Mexican cohort of patients with GEP NET’s treated with somatostatin analogues with a long follow up.

Abstract Background Bacterial meningitis (BM) remains a significant global health problem in pediatric care, with substantial morbidity and mortality. The epidemiology of BM has changed over the last 20 years. The ongoing introduction of conjugate vaccines for the most common meningeal pathogens has reduced the global incidence. However, there is limited epidemiologic and microbiologic data of BM in children before and after the widespread use of these vaccines in Mexico. Methods We conducted a retrospective, observational, analytical study. Pediatric patients (from 1 month to 18 years of age) presenting with BM and hospitalized at the Instituto Nacional de Pediatria in Mexico City, from 1990 to 2018, were included. Meningitis from invasive procedures or complicated head trauma were excluded. BM was classified according to the World Health Organization (WHO) criteria. The cases were analyzed in three periods: period A (1990–1999), period B (2000–2008), and period C (2009–2018). Period A corresponds to the time before the conjugate Haemophilus influenzae type b (Hib vaccine) was introduced in Mexico, while periods B and C correspond to the time after the Hib vaccine was routinely applied. Periods A and B correspond to the period before the pneumococcal conjugate vaccine (PCV7) was administrated in Mexico, while period C is after PCV7 and PCV13 were routinely administrated. The proportion of cases between periods was compared with Chi-square or Fisher exact test; P < 0.05 was considered significant. Binomial logistic regression analysis was used to determine the association between potential risk factors and death due to BM. Results A total of 226 cases with BM were included, 180 (79.6%) confirmed cases, and 46 (20.4%) probable cases. The median age at diagnosis was 10 months. There were 126 (55.8%) cases in Period A, 62 (27.4%) cases in Period B, and 38 (16.8%) cases in Period C, with a statistically significant reduction between periods (P = 0.0001). Hib was the most commonly isolated pathogen, found in 38 (50%) cases. However, its proportion declined significantly after the introduction of the Hib conjugate vaccine (P < 0.0001). S. pneumoniae followed as the second most commonly isolated bacterial pathogen. There was a significant reduction in neurological complications after the Hib conjugate vaccine (P = 0.003) and the S. pneumoniae conjugate vaccine (P = 0. 05) were introduced. Independent risk factors associated with mortality were coma (OR 15, P = 0. 0001), intracerebral bleeding (OR 3.5, P = 0.046), and pneumococcal meningitis (OR 9.4, P = 0. 002). Conclusions BM remains a cause of morbidity and mortality in pediatric patients in this hospital, with a dramatic change in the epidemiology since the introduction of the Hib conjugate vaccine to the national immunization schedule. Routine use of childhood conjugate vaccines against the most frequent etiological agents reduced the number of cases globally, mainly those caused by Hib. Additionally, conjugate vaccines reduced neurological complications and sequelae caused by this disease.

There has been very limited investigation regarding the genetic diversity of Mycobacterium tuberculosis (MTb) strains isolated from human immunodeficiency virus (HIV)-infected patients in Mexico. In this study, we isolated 93 MTb strains from pulmonary and extrapulmonary samples of HIV-infected patients treated in a public hospital in Mexico City to evaluate the genetic diversity using spoligotyping and mycobacterial interspersed repetitive unit-variable-number tandem-repeat (MIRU-VNTR) typing (based on 24 loci). The cohort comprised 80 male and 13 female individuals. There was a positive correlation between a high HIV viral load (>100,000 copies) and extrapulmonary tuberculosis (TB) (r = 0.306, p = 0.008). Lineage 4 was the most frequent lineage (79 strains). In this lineage, we found the H clade (n = 24), including the Haarlem, H3, and H1 families; the T clade (n = 22), including T1 and T2; the X clade (n = 15), including X1 and X3; the LAM clade (n = 14), including LAM1, LAM2, LAM3, LAM6, and LAM9; the S clade (n = 2); Uganda (n = 1); and Ghana (n = 1). We also found 12 strains in the EAI clade belonging to lineage 1, including the EAI2-Manila and EAI5 families. Interestingly, we identified one strain belonging to the Beijing family, which is part of lineage 2. One strain could not be identified. This study reports high genetic diversity among MTb strains, highlighting the need for a molecular epidemiological surveillance system that can help to monitor the spread of these strains, leading to more appropriate measures for TB control in HIV-infected patients.

Background: First-line treatments for methicillin-susceptible S. aureus (MSSA) bacteraemia are nafcillin, oxacillin, or cefazolin. Regional shortages of these antibiotics force clinicians to use other options like dicloxacillin and cephalotin. This study aims to describe and compare the safety and efficacy of cephalotin and dicloxacillin for the treatment of MSSA bacteraemia. Methods: This retrospective study was conducted in a referral centre in Mexico City. We identified MSSA isolates in blood cultures from 1 January 2012 to 31 December 2022. Patients ≥ 18 years of age, with a first episode of MSSA bacteraemia, who received cephalotin or dicloxacillin as the definitive antibiotic treatment, were included. The primary outcome was in-hospital all-cause mortality. Results: We included 202 patients, of which 48% (97/202) received cephalotin as the definitive therapy and 52% (105/202) received dicloxacillin. In-hospital all-cause mortality was 20.7% (42/202). There were no differences in all-cause in-hospital mortality between patients receiving cephalotin or dicloxacillin (20% vs. 21%, p = 0.43), nor in 30-day all-cause mortality (14% vs. 18%, p = 0.57) or 90-day all-cause mortality (24% vs. 22%, p = 0.82). No severe adverse reactions were associated with either antibiotic. Conclusions: Cephalotin and dicloxacillin were equally effective for treating MSSA bacteraemia, and both showed an adequate safety profile.

Abstract Background: According to some studies, the metabolic syndrome causes diverse primary cancers; however, there is no evidence about metabolic syndrome impact on second cancers development in women. Aim: To find out the implication of the modified metabolic syndrome in women with second cancers. Materials and Methods: This was a case-control study, at a general hospital in Mexico City, in women with second cancers (cases) and age-matched women with only one neoplasm (controls). The analysis comprised: Tumor (s), anthropometric features, and body mass index (BMI); moreover, presence of diabetes mellitus, hypertension, and fasting serum levels of total cholesterol, triglycerides and glucose. Results: The sample was of nine cases and 27 controls. In cases, the metabolic syndrome (diabetes mellitus or glucose > 99 mg/dL + hypertension or blood pressure ≥ 135/85 mm Hg + triglycerides > 149 mg/dL or BMI ≥ 30 kg/m 2 ) was more frequent (odds ratio 20.8, 95% confidence interval: 1.9-227.1). Conclusion: Our results suggest that in women, the modified metabolic syndrome may be a risk factor for second cancers.

Abstract Background In 2019, the CDC estimated that each year more 2.8 million antibiotic resistant infections ocurr in the United States and more than 35,000 pepole die a a result.Usually in pediatrics, antibiotics are the most prescribed, reviews have demonstrated that 37 to 61% of hospitalized infants and children receive antibiotics and 20 to 50% of these prescriptions are unnecessary either the dosage or duration are incorrect. Antibiotic resistance is an increasing worldwide problem. Effective antimicrobial stewardship programs has been demostrated reduce the inappropriate use and optimizing antimicrobial selection, dosing, route, and duration of terapy, limiting the consequences such adverse drug, resistance and cost.4 The antibiotic time-out consists in reassessment of the continuing need and choise of aantibiotics when the clinical picture is clearer and we have more diagnostic information. Currently, in our institution there is no established stewardship program and the costs attributable to antimicrobial use have been estimated at 1.6 million dollars. The goal of this project was to identify the most common prescription mistakes using the “Time-out” strategy because of its structured applicability and simplified revision that guides antimicrobial use. Methods From May to October 2020, we carried out a time out evaluation for different antimicrobial prescriptions in the five main wards of the INP; it consisted of data collection through a mobile application where the prescriptions were documented and evaluated. We answered three questions: 1) Based on the patient′s clinical course and diagnostic test, is the use of these antibiotics justified? 2)Is the dose, interval and route of administration correct? 3) What is the estimated duration of treatment? An infectious disease specialist evaluated the antimicrobial prescriptions daily and, if necessary, modified or adjusted it during rounds. Our evaluation was carried out between 24 and 72 hours of treatment initiation. Results For a 6 month period, 196 antimicrobial prescriptions were evaluated through the time-out strategy. Of them, 48% were from de group of cephalosporins followed by the glycopeptides (16%) and carbapenems (14.3%). In 23% of cases they were not medically justified and 53% of them required either discontinuation, narrowing of broadening of spectrum. The prevalence of antibiotic prescription errors was 23%. In 30% of cases it was a dose per kg of body weight error, 61% total dose per day and 9% in duration of treatment. Of note, there were 26% of these prescriptions were instances where the antimicrobials were not prescribed by a pediatric infectious disease specialist where 67% was not found to be justified upon evaluation and 72% required discontinuation. Conclusions The implementation of an antimicrobial control program made it possible to identify the most common mistakes in antibiotic prescription in our hospital, confirming the relevance of these programs to reduce the inappropriate use of antimicrobial prescriptions, limiting the consequences such adverse effects drug, antimicrobial resistance and healthcare cost.

Abstract Background and study aims Addition of a reminder program to conventional indications improves colonoscopy. The aim of this study was to evaluate the effectiveness of a short telephone call reminder (STCR) on a patient’s first colonoscopy. Patients and methods One day before colonoscopy, we made a STCR of < 10 minutes to 141 randomly selected patients of 258 recruited. The STCRs informed patients about the procedure date, indications for taking laxatives, and dietetic requirements. Questions were clarified only when patients asked directly. We evaluated bowel preparation, quality indicators, and patient satisfaction. Data were expressed as mean ± SD and percentages. Statistical differences were evaluated by Student’s t and Chi squared tests; alpha = 0.05. All authors had access to the study data and reviewed and approved the final manuscript. Results The STCR group had better bowel preparation which was demonstrated by higher completion frequency (97.16 % vs. 82.05 %), in less time (4.52 ± 3.06 vs. 5.38 ± 3.03 hours) intake of laxative, and higher Boston’s scale (7.66 ± 2.42 vs. 5.2 ± 1.65). Quality indicators of colonoscopy were better in patients that received a STCR [cecal intubation rate: 100.00 % vs. 87.18 %; polyp detection: 42.55 % vs. 9.4 %; and cecal arrival time (min): 12.09 ± 3.62 vs. 15.09 ± 5.02]. STCR patients were more satisfied (97.87 % vs. 55.56 %) and would repeat colonoscopy (21.99 % vs. 11.11 %). Conclusions A simple additional step such as a STCR improves quality of bowel preparation, quality indicators, and satisfaction of patients undergoing their first colonoscopy. Clinical trial registry in Mexico City General Hospital: DI/16/107/3/108.

Abstract Objectives To examine breastfeeding practices and to identify determinants of breastfeeding duration among Mexican women with high levels of education working in a university. We hypothesized that having a C-section delivery, giving birth at a private hospital, receiving free infant formula at the hospital and/or supplementing breastmilk with other liquids soon after giving birth would be negatively associated with breastfeeding duration. Methods Retrospective, cross-sectional study on mothers 18–50 years of age who worked at a private university in Mexico City (N = 150). We performed descriptive analyses and ran linear regression models to identify determinants of any and exclusive breastfeeding duration for the women's youngest offspring. Results Mean breastfeeding duration was 7.6 months and the mean exclusive breastfeeding duration was 1.81 months. Nearly 60% of the women in the sample had a C-section; almost 70% gave birth at private hospitals; 50% reported to have fed their baby with liquids other than breastmilk within the first three days of their baby´s life; and almost 25% of the women were offered free infant formula at the hospital where their child was born. Findings from the regression models that controlled for sociodemographic characteristics suggest that giving birth at a private vs. a public hospital was significantly associated with 1 month less of exclusive breastfeeding (95% CI: −2.11, 0.10, P &lt; 0.1). Similarly, being offered free infant formula at the hospital was marginally associated with 1.59 months less of exclusive breastfeeding (95% CI: −3.2, 0.02, P &lt; 0.1). Conclusions Breastfeeding outcomes among this group of women are suboptimal. Our findings underscore the need to improve breastfeeding protection, promotion and support in maternity hospitals through adherence to the Ten Steps promoted by the Baby Friendly Hospital Initiative. Funding Sources Universidad Iberoamericana.

Abstract Background Current recommendations for treating obesity in adolescence include a comprehensive approach (nutritional, behavioral, and exercise). Calcarea carbonica ostrearum (CCO) is a homeopathic medicine usually prescribed in obese individuals, but its effects on weight and body fat are not completely known. Objective The aim of this study will be to evaluate the efficacy of homeopathic CCO, in addition to a multidisciplinary intervention (diet, motivational support, and exercise program), on body fat and weight in obese adolescents. Methods/Design A randomized, placebo-controlled, double-blind, parallel-group, superiority trial with 3-month study duration will be undertaken. The study will be conducted in a public research hospital in Mexico City, Hospital Juárez de México, in the outpatient services of homeopathy and sports medicine. Eighty non-diabetic adolescents, 12 to 19 years old, who are overweight or obese, will be included. The primary outcome: change in body fat percentage at week 12. The secondary outcomes: change in mean total weight, total body mass index, fat mass index, waist–hip ratio, lean muscle mass, fasting glucose, insulin, insulin resistance, lipid profile, score of Center for Epidemiologic Studies Depression Scale Revised (CESD-R) and score of Screen for Child Anxiety-Related Emotional Disorders (SCARED) at week 12. Efficacy data will be analyzed in the intention-to-treat sample. To determine the difference in the outcomes between groups at baseline and week 12, data will be analyzed using Student's t-test. Discussion This is the first randomized controlled trial aimed to determine the fat-reducing efficacy in obese adolescents of a homeopathic medicine, CCO, given in addition to a multidisciplinary intervention, compared with placebo plus the same intervention. It is an attempt to support scientific evidence in homeopathy for one of the most common chronic diseases, which causes high mortality due to its complications. ClinicalTrials.gov Identifier: NCT03945396 https://clinicaltrials.gov/ct2/show/NCT03945396?term=homeopathy+for+obesity+in+Mexican+adolescents&rank=1

Abstract Background Approximately one-third of the prosthetic joint infections (PJIs) are polymicrobial. They are difficult to treat and there is an urgent need of clinical evidence that help to guide current protocols. We aimed to define the clinical characteristics and outcomes of patients with polymicrobial PJI. Methods We conducted a retrospective cohort study of patients with polymicrobial PJI treated at a referral hospital in Mexico City. Clinical data was retrieved and analyzed. Time to treatment failure, was evaluated for all cases. Results We identified 166 patients with a polymicrobial PJI from July 2011 to October 2020. The median follow-up period was 3.24 years (IQR, 1.45-6.42). Fistulae (77.7%) and pain (76.5%) were frequent. Patients required a median of 2 (IQR, 1-3) hospitalizations and 3 (IQR, 1-5) surgeries. Relapse, reinfection, and amputation ocurred in 21.1% (35), 10.2% (17), and 7.2% (12) of the cases, respectively. At 1-year follow-up 38.47% (63) patients failed to control the infection. At 2 and 5-year follow-up this rate increased to 50% (83) and 68% (112), respectively. The main infecting microorganisms were Staphylococcus epidermidis (51.8%), Enterococcus faecalis (47.6%), and Staphyloccocus aureus (34.9%). Anaerobes were identified in 38 (22.9%) cases. At 1 and 5-year follow-up, 39.31% (34) and 71.1% (61) of patients with S. epidermidis experienced treatment failure. On the other hand, those with S. aureus showed lower rates (log-rank p-value=0.03): 24.85% (14) and 50% (29), accordingly. Patients affected by anaerobes and E. faecalis exhibited similar trends, between them (log-rank p-value=0.73). Table1. Clinical findings of patients with polymicrobial PJI. Frequency distributions of sociodemographic factors, comorbidities, clinical presentation, outcomes, out-patient treatment, and etiology in patients with polymicrobial PJI. Data is presented as absolute frequency followed by relative frequency enclosed in parenthesis, otherwise specified. Abbreviations: SXT, Trimethoprim/Sulfamethoxazole. Figure 1. Kaplan‒Meier survivorship curve illustrating the time to treatment failure among patients with polymicrobial PJI. The shaded areas surrounding the gross line represent the 95% CI. Figure2. Kaplan‒Meier survivorship curves illustrating the time to treatment failure among patients with polymicrobial PJI, according to the infecting microorganisms.. Patients affected by S. epidermidis, E.faecalis, S. aureus, and anaerobes are represented with red, blue, green, and black lines, respectively. Conclusion Our study showed 61.53% of the patients with polymicrobial PJI controlled the infection at 1-year follow-up. This rate decreased over the years. These patients required a considerable number of hospitalizations and surgeries. Likewise, presenting with fistulae and pain ensured a high suspicion of PJI. S. epidermidis, E. faecalis, and S. aureus were the most frequent infecting microorganisms. The stratification of our cohort suggested the microbiology of polymicrobial PJI could have driven to differences in rates of treatment failure. Disclosures All Authors: No reported disclosures

Abstract Background Since the beginning of the pandemic, the American Academy of Pediatrics and the Children′s Hospital Association have reported over 15.4 million cases of COVID-19 in children in the United States (18% of all cases).1 UNICEF on the other hand, has reported more than 288 million cases all over the world and 4.1 million deaths related to COVID-19 in children.2 Healthcare-Associated Infections (HAI) represent a big burden on the health care system, with a subsequent increase in morbidity, hospital stay, medication/procedures, intensive care unit admissions, mortality, etc. Globally there is not enough data of HAI for SARS-CoV-2 in children, specially from low and lower-middle income countries. Methods Prognosis study through the description and analysis of an ambispective cohort in children at a tertiary care pediatric hospital [Hospital Infantil de Mexico Federico Gomez: (HIMFG)] in Mexico City from April 2020 to December 2022. We identified patients &lt;18 years old with probable and definite healthcare-associated (HA) COVID-19 according to the CDC definition:3 symptom onset (or positive test) on day 8 or on, after admission. Independent variables included socio-demographic information, clinical symptoms, laboratory results, among others. Outcome variables measured included severity (severe and critical), and death.4 Chi square and Wilcoxon tests were performed to identify independent risk factors for severity and death. After the bivariate analysis, logistic regression models were used to identify factors associated with patient severity and mortality. Results 102 patients were included; mean age was 6.4 years (min 0.02, max 17.9) and 57 were male. 32 were asymptomatic, 27 had mild disease, 6 were moderate, 31 severe and 6 critical; of this total, 6 patients died. 98 patients had at least one comorbidity, and 54 had at least 2: 35 with immunosuppression, 28 with cancer, 18 with heart disease, 14 with pulmonary disease and 14 with neurologic disease. 14 patients required admission to a Pediatric Intensive Care Unit. Mean hospital stay at diagnosis was 35.5 days (min 8, max 143): 24 patients were identified with probable HA-COVID-19 (8-14 days after admission) and 78 with definite HA-COVID-19 (&gt;14 days after admission). Conclusions Since the beginning of the COVID-19 pandemic, multiple strategies in infection prevention and control have been implemented at our hospital: universal screening before admission, active surveillance for patients/caretakers/health-care workers with respiratory symptoms and for contacts, universal use of facemasks, isolation of patients with respiratory symptoms, among others. Despite all these measures, a free Hospital from HA-COVID-19 remains a challenge. Our study found that the sudden onset of symptoms, the presence of fever, irritability and polypnea increases significantly the risk for severity in patients that acquired the disease in the hospital. On the other hand, patients with an underlying heart disease have 30 times more risk of dying than those who doesn’t. The presence of O2 desaturation and admission to a PICU increases significantly the mortality in patients with HA-COVID-19. Overall, mortality in children with HA-COVID-19 was 5.9% (up to 8.6% if strictly considering only the symptomatic), much more that the one reported globally (1.4%).2 References 1. Cull B HMBLRG. Children and COVID-19 State Date Report. American Academy of Pediatrics. 2022;V. 10/6/22. 2. UNICEF DATA. UNICEF [cited 2022 Oct] Available from: COVID-19 confirmed cases and deaths - UNICEF DATA. 3. Surveillance definitions for COVID-19. European Centre for Disease Prevention and Control. 2021 Mar 21 https://www.ecdc.europa.eu/en/covid-19/surveillance/surveillance-definitions 4. COVID-19. OMS. Enero 2021: Manejo Clínico de la COVID-19. Orientaciones evolutivas; 25 de Enero de 2021. OMS reference number: WHO/2019-nCoV/clinical/2021.1)

EDITORIAL A scientific evidence: the OBJN has more quantitative and qualitative links. (text in English) Aurora de Afonso Costa School of Nursing - from 1944 to 2004: 60 years preparing nurses to care people´s responses to health and illness and to leader the health system. (text in English) The OBJN upgrade: now it is the official journal of the Professional Master in Nursing Program at the Fluminense Federal University Nursing School. (text in English)ORIGINAL ARTICLESClowns doctors: the child talk. (text in Portuguese) Interfaces of geriatric nursing and dental care.(text in Portuguese)Mortality for Accidents of Traffic in Rio Branco – Acre - Brazil, 2001 to 2003.(text in Portuguese)Nursing diagnosis of patients with myocardial infarction, according to the conceptual model of Florence Nightingale. (text in Portuguese)Nursing process: application to the professional practice. (text in Portuguese)Participation of nursing students in the network for the prevention of occupational accidents - REPAT. (text in Portuguese)The american tegumentary leishmaniasis in the perspective of who lives it. (text in Portuguese)The nurse’s leadership: challenges of the practice. (text in Portuguese)Understanding functional health literacy in experiences with prostate cancer: older men as consumers of health information. (text in English)Vancomycin administration in an universitary hospital at general surgical units inpatients (text in Portuguese)We have needs, too: parental needs during a child’s hospitalisation.(text in English)Work accidents with needles and other sharp medical devices in the nursing team at public hospitals - Rio Branco, Acre - Brazil.(text in Portuguese)REVIEW ARTICL ESGender, health and nursing: The male inclusion in the nursing care. (text in Portuguese)Influence of psychosociais needs in the mental health of the children.(text in Portuguese)Literature review on ineffective thermoregulation – OBNJ Club Journal.(text in Portuguese)Literature review on Neonatal Pain – OBJN Club Journal. (text in Portuguese)Literature review on newbons care – OBJN Club Journal.(text in Portuguese)Literature review on risk for impaired parenting – OBJN Club Journal. (text in Portuguese)Literature review on risk of infection in intravenous catheter related to the dialysis treatment – OBJN Club Journal. (text in Portuguese)Public policies regarding family, institutional requirement from the politics philosophy of Hegel and Marx.(text in Portuguese)Review of research about parish nursing practice (text in English)The civil responsibility of nurse as a public agent. (text in Portuguese)The contribution of philosophy, ethics, and bioethics in the Ribeirão Preto School of Nursing – USP(text in Portuguese)The importance of the insert of the thematic " violence against the woman " in the curriculum of nursing. (text in Portuguese)Work of nursing in the family health program of and its relation with the non-institucionalization.(text in Portuguese)ABSTRACTSConstruction and validation of an instrument of collection of data of the aged one in the Program of Health of the Family.Construction and validation of data collection instrument for children from 0 - 5 years.Interaction among teachers and students in the construction of the nurses professional identityKnowledge and practice of beginner and veteran (men and women) nurses in the hospital scenarioNursing in field from training: “ Natural Lab” a professional learningPsycossocial Necessities of the Client at the Unit of Chest Pain: issues for caring in the Emergency Room.The social representation of family: expectation and meaning of cardiac surgery.(text in English)PROFESSIONAL ISSUES2004 Brazilian Women Year: Visual reflections related to the female sexuality in a feminine (sexy) Brazil focusing the female nurse.(pps in Portuguese) 5th European Conference of ACENDIO: Association for Common European Nursing Diagnoses, Interventions and Outcomes (text in English)NURSES: Working with the Poor; Against Poverty. Message from ICN (text in English)OBJN 2004 thanks to the Editorial and Peer-Review Board (text in English)The Professional Master in Nursing Website (EEAAC/UFF): linking knowledge to nursing practice (text in Portuguese)Thirteen National Brazilian Nursing Research Congress (SENPE) June 2005, São Luiz, Maranhão.World Health Organization: Forum 8 + World Summit on Health Research Mexico City, November 6-10, 2004 (text in English)

Background:Nailfold capillaroscopy is a relatively easy-to-access, low-cost clinical tool that could help identify early coagulopathy in subjects with SARS-CoV-2, but specific findings vs. controls and its possible prognostic role has not been studied.Objectives:To describe capillaroscopic findings and their usefulness in patients with COVID-19 compared to healthy controls.Methods:We designed a cross-sectional study, carried out in a single care center for critical patients with SARS-CoV-2 pneumonia at the ABC Medical Center, Mexico City, which included patients from an intensive care unit (ICU) and internal medicine ward from March to April 2020. Demographic, biochemical and clinical features were collected. All patients signed the informed consent and the study was approved by the hospital ethics committee. All patients underwent nail capillary imaging of the 3 central fingers of each hand with a portable microscope with 60-100x magnification coupled to a smartphone with 7 megapixel images in an immersion medium. Capillaroscopy was performed in patients who did not have fever or hypothermia, or need vasopressors at the time of evaluation. Control subjects are healthy subjects matched on age and sex from a database of healthy controls without rheumatic diseases. Image evaluation of COVID-19 patients was performed in a blinded way for their characteristics. Prior to the analysis of the images, a pilot test was obtained with 4 rheumatologists in random cases, obtaining an acceptable global agreement in the visualization of capillaries and specific alterations of the nail bed. (Kappa = 0.58, p = 0.0019). Obtained data from capillaroscopies were used to be compared between severe and moderate cases of SARS-CoV-2 pneumonia. Additionally, we compared the findings against a healthy population in order to establish a reference.Results:We included data from 27 patients and 32 controls with similar demographic features. Patients with COVID-19 patients had a mean age of 43 +/- 13.8 years, 63% female. Comorbidities were present in 44.4% with: type II Diabetes Mellitus 18.5%, systemic arterial hypertension 18.5%, and rheumatoid arthritis 3.7%. The mean length of stay time was 13 +/- 7.1 days, 48.1% were admitted to the ICU, and 40.7% required invasive mechanical ventilation. In the capillaroscopic review remarkable findings of patients vs. controls were hemosiderin deposits (33 vs 12.5%, p=0.05), less frequently observable capillaries (77 vs 100%, p=0.005), any abnormality in capillaries (25.9 vs. 6.3%, p=0.03). Of notice, specific findings in COVID-19 patients were capillary tortuosities in 19%, dilatation in 9.5%, serpentine pattern in 4.8%, bush pattern in 9.5% and decreased density in only 4.8% of the cases. No avascular areas or capillaries of neoformation were observed. Finally, the presence of hemosiderin was associated with worse presentation and risk factors for severe COVID-19: Male sex 66.7 vs. 27.8%, (p = 0.024); Admission to ICU 77% vs 33% (p = 0.029); BMI > 30 kg/m2 66.7 vs. 27.8% (p = 0.053). And risk for ICU admission OR = 7.0 (95% CI 1.098 - 44.6). No significant associations were found for abnormalities in capillary morphology.Conclusion:We present one of the first reports of nailfold capillaroscopic findings in patients with COVID-19 and the first to compare to healthy controls. Previous data on this regard suggests the presence of endothelial dysfunction and microvascular complications such as micro hemorrhage or micro thrombosis. Further studies may confirm these findings and prognostic value for worse outcomes in COVID-19 patients.References:[1]Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–13.[2]Cutolo M, Cortes S. capillaroscopic patterns in rheumatic diseases. Acta Reumatol Port. 2007 Jan-Mar;32(1):29-36.[3]Natalello G, De Luca G, Gigante L, et al. Nailfold capillaroscopy findings in patients with coronavirus disease 2019: Broadening the spectrum of COVID-19 microvascular involvement. Microvasc Res. 2021;133:104071.Disclosure of Interests:None declared

BackgroundLung ultrasound (LUS) has proven useful to detect interstitial lung disease (ILD) among patients with systemic sclerosis (SSc) when compared to high-resolution computerized tomography (HRCT) as the gold standard; owing to its accessibility and innocuity it confers several advantages over the latter, which turns it into a potential valuable tool in clinical practice. Nevertheless, a key drawback is the lack of a standardized methodology to perform LUS.ObjectivesTo evaluate diagnostic accuracy of LUS for ILD by comparing the systematic evaluation of 14 intercostal spaces (ICS) against 12 postero-basal ICS.MethodsPatients with SSc were included according to the 2013 ACR/EULAR classification criteria of the Rheumatology clinic of the National Institute of Medical Sciences and Nutrition, reference hospital in Mexico City. Demographic, clinical, serological, and imaging variables were collected, followed by LUS assessment with the simultaneous scanning of 14 predetermined ICS and 12 postero-basal ICS. “B” lines (BL) and pleural abnormalities (PA) were documented for each ICS. HRCT was performed with a maximum 3 month-interval from the time of recruitment (before or after).Descriptive statistics for categorical and continuous variables was used. A bivariate analysis was undertaken to discriminate factors associated with the presence of ILD. A Pearson correlation test was carried out to compare findings between LUS and HRCT. Diagnostic accuracy was assessed through elaboration of ROC curves.ResultsWe included 73 patients, with a median age of 54.5±15.1 years and 96.1% were women. Prevalence of ILD was 43.6%. Relevant baseline characteristics are shown in Table 1. Acknowledged risk factors for ILD were pulmonary hypertension (OR 6.27, CI 95% 1.75-22.4, p=0.005) and diffuse SSc (OR 6.17, CI 95% 1.92-19.76, p=0.002).The AUC were 0.87 (95% CI, 0.78-0.96), 0.94 (95% CI, 0.88-1.00) and 0.84 (95% CI, 0.74-0.94) for the evaluation of the number of BL in 14 ICS, in 12 ICS and the number of ICS with PA (22 EIC), respectively. ROC curves are represented in Image 1.ConclusionOur study confirms the robustness of LUS as a tool for the detection of ILD through the quantification of BL and PA when using any of two different scanning protocols (14 and 12 ICS). However, more studies are required to elucidate the added value of pleural abnormalities identification for the diagnosis of ILD by LUS.References[1]Vicente-Rabaneda EF, Bong DA, Castañeda S. Use of ultrasound to diagnose and monitor interstitial lung disease in rheumatic diseases. Clin Rheumatol [Internet]. 2021;40(9):3547–64.[2]Ruaro B, Baratella E, Confalonieri P, et al. High-resolution computed tomography and lung ultrasound in patients with systemic sclerosis: Which one to choose? Diagnostics. 2021;11(12):1–12.Table 1.Characteristics of patients according to presence or absence of ILDVariablew/o ILD (n= 40)ILD (n= 31)pAge50.3 ± 13.0556 ± 12.20.66Gender (female)40 (56.3)28 (39.4)0.079Body Mass Index23.3 ± 3.423.8 ± 4.70.601SSc variant (n= 71):LimitedDiffuse33 (46.5)7 (9.9)14 (19.7)17 (23.9)0.003Anti-Scl-70 (n= 64)Anti-centromere (n= 68)22 (34.3)30 (44.1)23 (35.9)23 (33.8)0.1791.000Time from RP (years) (n= 64)12 (7-20)12 (7-17)0.849Time from first non-RP symptom (years) (n= 67)11 (6-20)11 (6.3-13.7)0.620mRSS (n= 69)3 (1-8)9 (2-12.5)0.015Pulmonary Hypertension (n= 71)5 (7.0)14 (19.7)0.003Medsger global score (n= 69)2 (1-2)2 (1-3)0.048Warrick score13.5 (9-20.8)4 (0-9.5)<0.001Kazerooni score1.1 (1-1.5)1.2 (0.8-1.6)0.5 (0-0.9)0.3 (0-0.6)<0.001 <0.001Immunosuppresants, no. (n= 71)1 (0-1)1 (0-2)0.177MethotrexateMycophenolate mophetilAzathioprinePrednisone6 (8.4)7 (9.8)4 (5.6)5 (7.0)6 (8.4)13 (18.3)2 (2.8)6 (8.4)0.7530.0330.6900.516Continuous variables: Mean ± DE, Median (25-75), Categorical variables: Frequency (%)ILD: Interstitial Lung Disease, SSc: Systemic Sclerosis, RP: Raynaud’s Phenomenon, mRSS: modified Rodnan Skin ScoreImage 1.ROC curves for the diagnosis of ILD by LUSAcknowledgements:NIL.Disclosure of InterestsNone Declared.

Introduction: Stenotrophomonas maltophilia is a non-fermentative gram-negative bacillus with increasing importance as a multidrug-resistant nosocomial agent. Despite reports of mortality rates between 14 and 69% in patients with bacteremia, the information documented in our environment is minimal. Methods: Descriptive, observational, retrospective and longitudinal study. Outpatients and hospitalized patients were sampled between January 1 and December 31, 2019, from the Centro Médico Nacional siglo XXI. Bacterial growth was evaluated to identify the presence of S. maltophilia. In a total of 7,019 cultures, we observed a frequency of 94 cases of Results: S. maltophilia and in these we identied that 54.5% were resistant to trimethoprim-sulfamethoxazole. Women were the most affected by this entity with a median age of 54.5 years. Fifty percent of the samples came from intensive therapy and the most frequent site of extraction was the trachea. We identied a higher resistance to trimethoprim-sulfamethoxazole than that repor Discussion: ted in the literature (5%), in an organism capable of developing both nosocomial and community-acquired infections, forcing us to suspect its existence as well as a second treatment option in the face of multidrug resistance.

Staphylococcus aureus is the main aetiologic agent of osteoarticular infections (OAIs) in paediatric patients. The aim of this prospective unicenter study was to describe the phenotypic and genotypic characteristics of S. aureus isolates obtained from OAIs in paediatric patients admitted to tertiary care hospital. Through a surveillance program called OsteoCode, a multidisciplinary team was created and we identified 27 patients with OAIs caused by S. aureus from 2019 to 2021. The susceptibility profile, virulence factors, biofilm formation, pulsed-field gel electrophoresis (PFGE), clonal complex (CC) and sequence type (ST) were determined. In addition, the clinical characteristics and evolution of the patients presented six months after the diagnosis of OAIs were described. Ninety-two percent of the isolates were methicillin-sensitive S. aureus (MSSA). In methicillin-resistant S. aureus (MRSA), SCCmec-II and SCCmec-V were detected. The pvl gene was only observed in MSSA (18.5%) and was associated with highest fever (p=0.015), multiple localization (p=0.017), and soft tissue sites of infection beyond the bone (pyomyositis, pulmonary abscess) (p=0.017). Biofilm formation was detected in 55.6% of isolates. The most common CC were CC5 and CC30 which represent the most common linages for bone and joint infections worldwide. The isolates were distributed in different STs, and ST672 was predominant. MRSA were associated with a longer duration of intravenous treatment and a prolonged hospital stay (p=0.023). Recurrent infection occurred in five children and orthopaedic complications in 33.3% of patients. This is the first study that reflects the epidemiology of S. aureus in OAIs in paediatric patients in Mexico; a clear predominance of MSSA distributed in different STs was observed. Our findings highlight that a multidisciplinary team is required for the diagnosis and treatment of OAIs.

AbstractEarly extubation (EE) in pediatric cardiac surgery has demonstrated important benefits. However, ventilating them for 24 hours or more (delayed decannulation, DD) is an enduring practice. The objectives of this study were to describe the clinical profiles of EE in our setting and analyze its impact and the factors that prolong mechanical ventilation. Children operated on for cardiac surgery from 2016 to 2017 were included. The information was obtained from an electronic database. Comparisons were performed with Pearson's chi-square test, Student's t-test, or Mann–Whitney U test. Multivariate logistic regression was used to evaluate factors associated with DD. Of 649 cases, 530 were extubated on one occasion. EE was performed in 305 children (57.5%): 97 (31.8%) in the operating room and 208 (68.2%) in the intensive care unit (ICU). Reintubation (RI) occurred in 7.5% with EE and 16.9% with DD (p = 0.001). Fewer complications and ventilation time and decreased ICU and hospital length of stay resulted with EE. Age, presurgical ventilation, emergency surgery, pump time, attempts to weaning from cardiopulmonary bypass, bleeding greater than usual, and CPR in surgery were associated with DD. EE in the National Institute of Cardiology (INC; Spanish acronym) is in the middle category and has shown benefits without compromising the patient; the fear of further complications, RI, or death is unfounded. Although not all children at the INC can be decannulated early, if there are no or minimal risk factors, it should be a priority.

Background: Breast reconstruction can have a significant impact on the physical, emotional and psychological well-being of patients undergoing mastectomy. The type and timing of breast reconstruction influence the satisfaction index of reconstructed patients. Methods: A retrospective examination was carried out on patient records from 2016 to 2024 at general hospital of Mexico. The analysis encompassed 210 patients who underwent breast reconstruction during this frame time. The BREAST-Q questionnaire was administered in March 2024 and at various intervals during each patient´s post-operative care. Patients were stratified according to multiple variables such as: oncological therapy, timing of reconstruction, type of reconstruction and educational attainment. Results: The average age of the participants was 50.3 years. In terms of reconstruction timing, 25.24% underwent immediate reconstruction, while 74.76% opted for delayed reconstruction. When it came to BMI, the average was 26.99 kg/m². Regarding the type of flap used for reconstruction, the majority (82.86%) had a latissimus dorsi flap. The overall demonstrated a mean psychosocial well-being scale score of 76±6.6. Conclusions: Breast reconstruction goes beyond physical restoration; it can profoundly impact a patient's emotional recovery, self-image, and quality of life. By addressing not only the physical changes but also the emotional and psychological aspects of breast cancer treatment, reconstruction plays a vital role in helping patients move forward with confidence, resilience, and a sense of empowerment. Regardless of when we first contact the patient, it is always worthwhile to provide her with information and the option of reconstruction.

Objective: It was to evaluate the diagnostic tools and treatments of low-income Covid19 pregnant patients managed in a general hospital of the metropolitan area of Mexico City; Methods. The study was a retrospective clinical trial performed by means of the revision of patient´s files. Diagnosis of covid-19 was made by means of different strategies. They were clinical symptomatology, rapid antigen test, RT-PCR, X ray evaluation and chest tomography. Were used statistical descriptive tests. Results: Mean age of patients was 24.9 ± 3.3 years. In 9.3% of the patients were detected comorbidities. The most common diagnostic tool was the rapid antigen test. Treatment was essentially symptomatic. The most frequent drug employed in the treatment was enoxaparin. Mortality rate 1.3%. Conclusion: In this trial, the registered common diagnostic and therapeutic strategies utilized in pregnant patients in a typical hospital of a developing country can be employed as a clinical experience for other health facilities of similar nations.

Abstract Background The current paradigm in the treatment of acute coronary syndromes classifies patients according to the presence of persistent ST-segment elevation as a potential marker of total coronary thrombosis, in whom immediate fibrinolysis or primary PCI is appropriate. However, patients with NSTEMI may present with a total acute thrombotic coronary occlusion and may not be detected by this approach, therefore precluding the benefits of early reperfusion strategies. Purpose To identify the prevalence of total thrombotic occlusion elicited by coronary angiography in patients with NSTEMI, and to analyze their baseline characteristics and in-hospital mortality. Methods Retrospective cohort study including consecutive patients admitted with NSTEMI in a single center over a 15-year period. Patients with coronary angiography were further classified in three groups: patients with a total angiographic coronary thrombotic occlusion (TIMI thrombus V), patients with subtotal coronary thrombus (TIMI thrombus I–IV) and patients without angiographic thrombus. Baseline characteristics and in-hospital outcomes were compared among the three groups. Results A total of 4216 of NSTEMI patients were admitted within the study period, of whom 3191 underwent coronary angiography and constituted in the final analytic sample. In 211 patients (6.6%) a TIMI thrombus V was found. Table 1 summarizes the main characteristics among the three groups. In the group of patients with total thrombotic occlussion, a higher proportion were male, were more prone to be current smokers, had a lower prevalence of major cardiovascular risk factors and had suffered less cardiovascular events at enrollment. During hospital follow-up, 15 (7.1%) patients within the total thrombus group, 14 (4.3%) patients within the subtotal thrombus group and 112 (4.2%) patients within the no-thrombus group died. No statistically significant differences in hospital mortality were noted when comparing total thrombotic occlusion vs. no thrombus (HR 1.69, 95% CI 0.94–3.01, p=0.07) (Figure 1). Conclusions In our study, 6.6% of the patients with NSTEMI presented an acute total thrombotic occlusion in coronary angiography. Patients with total thrombotic occlusion showed a different risk-factor profile and a similar in-hospital mortality when compared with non-total thrombus or no thrombus. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Ignacio Chavez National Heart Institute, Mexico City, Mexico Table 1. Baseline characteristicsFigure 1. In-hospital mortality

Real de Zimapán was a focus of attention for the Mexico´s City Protomedicato in late 1793 and early 1794 due to an epidemic outbreak with no clear diagnosis. After several attempts to find a doctor to assist the sick, José Mustelier accepted the task and went to the Real. His medications and the installation of a temporary hospital worked, erradicating the disease in less than three months, benefiting above all the indigenous people of the area who were the most affected due to the conditions of poverty and hard work in the mines. Social and medical Histories are tied in this research showing the difficulties and benefits obtained in an alarm situation and in a specific region. El Real de Zimapán fue un foco de atención para el Protomedicato de la ciudad de México a finales de 1793 e inicios de 1794 por un brote epidémico que no tenía diagnóstico claro. Tras varios intentos por buscar un facultativo que asistiera la enfermedad, José Mustelier aceptó la tarea y acudió al Real. Sus medicamentos y la instalación de un hospital provisional dieron resultado, erradicando la enfermedad en menos de tres meses, beneficiando sobre todo a los indígenas de la zona quienes fueron los más afectados debido a las condiciones de pobreza y trabajo pesado en las minas. La historia social y la historia de la medicina se empatan en esta investigación mostrando las dificultades y beneficios obtenidos en una situación de alarma y en una región específica.

AbstractBackgroundThe Everyday Cognition (ECog) scale was created to assess the functional abilities of older adults across a wide range of abilities between normal aging and dementia. The original ECog was shown to have convergent and divergent external validity. Developed in 2008 by Farias et al and updated in 2021. This scale screens early cognitive alterations such as Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI) and Alzheimer’s dementia (AD) through the decline of basic activities and instruments of daily life (DLA)To establish validity, reliability, and cross‐cultural adaptation of the ECog in Spanish (M‐ECog) to identify: SCD, MCI, and Alzheimer’s‐type dementia in older Mexican adults.Method200 patients and 200 informants in a memory clinic of a third level hospital in Mexico City. Four groups were formed: 50 cognitively healthy (CH), 50 SQD, 50 MCI and 50 AD. The clinical evaluation included: sociodemographic aspects, cognitive status by the Mini‐Mental State Evaluation (MMSE) and Montreal Cognitive Evaluation Spanish version (MoCA‐E). The informants rated the functional status measured through the KATZ and Lawton & Brody scales, as well as the ECog Spanish version (M‐ECog).ResultThe internal consistency of the overall function of the M‐ECog (Cronbach’s alpha) was 0.881. The intraclass correlation coefficient was 0.877 (95% CI, 0.850‐0.902; p<0.001). M‐ECog was significantly correlated with DLA 0.40 (95% CI, 0.320‐0.471; p<0.001), MMSE 0.68; (95% CI, 0.650‐0.710; p<0.001) and MoCA‐E 0.70 (95% CI, 0.620‐0.892; p<0.001). And it differentiated patients with SCD, MCI and AD from CH (p < 0.002). The area under the curve (AUC) for SQD was 0.70 (95% CI, 0.58‐0.82), p < 0.005 with a cut‐off value of 46 points, (Sensitivity (S) 99%, and Specificity (E) of 96%; the AUC for MCI was 0.94 (95% CI, 0.89‐0.99), p < 0.001 with a cut‐off point of 52 points, (S: 97%, E: 27%); and for the dementia group, the AUC was 0.86 (95% CI, 0.79‐0.92), p <0.001 with a cut‐off value of 85 points, with (S: 97%, E: 51%).ConclusionM‐ECog is a valid, reliable, useful instrument that measures daily skills mediated by cognition in older Mexican adults, self‐applicable (patients and informants) with SCD, MCI and Alzheimer’s Dementia

Background: Intravenous immunoglobulin (IVIG) and aspirin is the standard initial therapy in the treatment of Kawasaki disease (KD), which is proven to decrease the incidence of coronary artery aneurysms from 25% to less than 5%. There is increasing evidence for steroid therapy as adjunctive primary therapy with IVIG especially in those patients who are at increased risk of coronary artery aneurysms and in patients with risk of IVIG resistance. However, clinical trials evaluating the use of corticosteroids plus IVIG have produced confusing results. Objective: To evaluate the clinical efficacy and safety of steroids plus intravenous immunoglobulin (IVIG) combination therapy (IVIG+S) for the initial treatment of patients with KD to prevent coronary artery aneurysms (CAA) compared with the standard treatment with intravenous immunoglobulin plus aspirin (IVIG+A) in a Children’s Hospital in Mexico City. Material and Methods: An observational, comparative, retrospective and case-control study of all patients treated with IVIG for KD in our Institution from August 1995 to May 2014. The clinical presentation, laboratory results and coronary artery abnormalities in the IVIG+S and the IVIG+A groups were analyzed and compared. Results: We studied 295 patients with KD treated with IVIG, 136 (46.1%) received IVIG+A treatment and 159 (53.9%) received IVIG+S treatment. We didn’t found adverse reactions in the patients treated with steroids. The IVIG+S group were older 43.25 ± 43.04 than the non-steroid group 32.07 ± 24.51 (p < 0.008). Steroids were commonly use in incomplete cases (p < 0.059) and in patients with cardiac complications at diagnosis: pericardial effusion (p < 0.056) and pericarditis (p < 0.013). The steroid group has slightly more days of fever after the IVIG treatment 1.27 ± 1.51 days vs. 0.93 ± 0.924 days (p < 0.028). We found no difference in the development of CAA in both groups. (p = 0.221) Conclusions: There were no differences in the development of CAA with the use of steroids in the initial treatment of KD. Nevertheless steroids were used more commonly in incomplete forms of KD and in more severely affected patients, which could reflect the lack of difference in the development of CAA in both groups.

Background: Actigraphy has advanced the measurement of sleep for cardiometabolic research in childhood. However, actigraphy methods lack standardization, limiting rigor and reproducibility. GGIR, an open-source R package, facilitates raw accelerometer data processing to generate sleep data in a standardized manner. This tool has been validated and applied to adult data, but less is known about the suitability of this tool for generating sleep estimates among children. We aimed to (1) determine the validity of multiple sleep scoring settings available within GGIR in children, and (2) evaluate how this tool automatically generates sleep data in community-based pediatric studies. Method: The validation study included 30 children (14 female, 8-16y) referred for in-lab overnight polysomnography at Children’s Hospital of Philadelphia. Participants wore a GENEActiv during polysomnography that captured data at 50 Hz, which were aligned into 30-second epochs against the sleep stages from polysomnography scored by a sleep medicine physician. Balanced accuracy was the primary validation metric, which is the average of sensitivity and specificity. For community-based testing, three pediatric cohorts were used: Study 1 (Philadelphia; 12-16y; GENEActiv, N=251), Study 2 (Mexico City, 9-18y; ActiGraph GT3X-BT; N=543), and Study 3 (Houston; 5-8y; ActiGraph GT3X+, N=226). We processed raw accelerometry data with the Cole-Kripke (CK), Sadeh (S), and Van Hees (VH) algorithm settings. Result: For in-lab validation, 271.5 hours of polysomnography data were collected with 80% of the epochs scored as sleep; sleep duration averaged 7.3 hours (SD = 1.3). In rank order, average balanced accuracies were 0.81 (SD = 0.08) for GGIR-CK, 0.77 (SD = 0.09) for GGIR-VH, and 0.68 (SD = 0.11) for GGIR-S. The GGIR-S algorithm had the poorest detection of night awakenings (specificity: 0.38 [SD = 0.21]). For community-based data, without manually altering the data, the average sleep duration was highest when using the Sadeh algorithm in each study (8.3 [SD = 1.6], 8.0 [SD = 1.9], and 5.2 [SD = 4.4] hours for studies 1-3) and lower when using the GGIR-CK algorithm (7.1 [SD = 1.4], 6.9 [SD = 1.7], 4.3 [SD = 3.7] hours for studies 1-3). Approximately 2% of the data were affected by obvious errors (e.g., negative wake after sleep onset), with almost all such errors detected with the Sadeh algorithm. Conclusion: In a controlled setting, GGIR-CK had the optimal balanced accuracy performance for estimating sleep duration in children. In keeping with the lab-based finding of poorer detection of night awakenings, sleep duration was highest in the community samples when using GGIR-S. When applied to community-based data the automated GGIR approach generated sleep data that included errors, necessitating additional data cleaning. Incorporating standardized data cleaning steps within GGIR would improve rigor and reproducibility.

Abstract Background Cardiogenic shock (CS) mortality is about 50–60%; acute myocardial infarction (AMI) remains the most common cause, representing the 81%. There are related risk factors for the occurrence of CS in this vulnerable population, yet, data in these patients is scarce and compels us to identify specific risk factors and treatments to improve their prognosis. Purpose To identify the differences in clinical and laboratory characteristics, management strategies and outcomes, by evaluating etiology and risk factors, in order to predict mortality in this setting. Methods 255 women were included, CS was defined by: systolic blood pressure &lt;90 mmHg, need of vasopressors, cardiac index &lt;2.2 L/min/m2, or blood lactate ≥2 mmol/L. Categorical variables were analyzed using X2; continuum data with U-Mann-Whitney; logistic regression for in-hospital mortality was constructed and KM curves were performed against SCAI and CARDSHOCK scores. Results In the current cohort, we found that classic risk factors are associated with AMI-CS such as age (68 vs 60, p&lt;0.001), BMI (26 vs 24, p=0.007), diabetes (65.58 vs 25%, p&lt;0.001), smoking (20.78 vs 2%, p=0.015), dyslipidemia (29 vs 10.89%, p=0.001), hypertension (66.88 vs 41.58%, p&lt;0.001) and previous stroke (3.9 vs 11.8, p&lt;0.001). Interestingly, AF occurred more frequently in non-AMI-CS (48.51 vs 3.25, p&lt;0.001). Initial SBP, DBP, and MAP were lower in this group (p&lt;0.001), and LVEF was higher (45 vs 35%, p=0.015). At lab data, AMI-CS had higher glucose, leukocytes, sodium, AST, ALT, and eGFR and lower creatinine. Regarding the management strategy, AMI-CS was associated with the simultaneous use of more vasoactive agents (p&lt;0.001), norepinephrine (p=0.001), dobutamine (p&lt;0.001) and levosimendan (p=0.019), as well as IABP (31.17. vs 1.98, p&lt;0.001). No difference among groups was seen in global mortality (74.68 vs 73.27, p=0.802). When analyzed by logistic regression, SCAI stages D and E had higher odds ratio (OR) of mortality compared to C stage. CARDSHOCK had significant differences along the tertiles, these 2 scores had substantial differences in the Kaplan-Meier curves with the 30-day mortality (p&lt;0.001, Fig. 1A, B, and C). The number of vasoactive agents had an incremental risk when using 2 (OR=2.66) or ≥3 (OR=2.32) drugs. Mechanical ventilation was associated with an increased mortality (OR=1.86). Gasometrical derived data had significant differences in lactate (OR=1.1), pH decrease (OR=1.33), and base excess (BE, OR=1.07) (Fig. 1A) Conclusions Herein, we identified specific risk factors related to mortality in women, AMI-CS patients had similar risk factors than the ones seen in men populations. But some specifics factors in women management differ compared to historical mixed cohorts. In conclusion, women-derived data must be specifically analyzed focusing in the involved risk factors and management strategies, which differ from those reported in mixed cohorts. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology in Mexico City

Photo by Chris Carzoli on Unsplash INTRODUCTION l. The Need for a Children’s Hospital El Paso, Texas did not receive a children’s hospital until 2012, much later than would be expected given its demographics and geographic isolation. By that time, there were already nearly 250 children’s hospitals spread across the United States, some in areas far smaller, far older, and in far closer proximity to other urban centers.[1] Without accounting for its substantial population of undocumented immigrants,[2] El Paso is the country’s 22nd largest city (and situated in its 70th most populous county).[3] The nearest American city of comparable size is Phoenix, AZ, located about 350 miles away. Moreover, El Paso has a decidedly young demographic skew: more than 28 percent of the population is under the age of 18, compared to 26.5 percent of the population in Texas and 23.1 percent of the population nationally.[4] This gap is expected to widen in the coming years.[5] El Paso children also have less access to care than children in cities with comparable populations and population structures. Though the situation has improved in the last decade, El Paso contains several Health Professional Shortage Areas (HPSAs) for primary care, dental health, and mental health. This is in addition to many Medically Underserved Areas (MUAs) for primary care, specialty care, dental health, and mental health.[6] This means that El Paso children wait longer for their appointments and are often seen by tired and overworked providers. Before the El Paso Children’s Hospital (EPCH) opened its doors if these children needed advanced care, they had to leave the city, and many simply did not have the resources to do so. It is more difficult to assess the quality of the care that they were able to receive locally, as few systematic reviews of pediatric outcomes in the region were conducted during that period. Nevertheless, several El Paso physicians look back and describe an “unacceptably low” standard of care.[7] Regardless, access and quality are interrelated, and children’s hospitals tend to promote both.[8] ll. Why Did It Take So Long? There are several reasons why El Paso did not receive a children’s hospital until years after the need for it became apparent to forward-thinking physicians and other interested parties, including select parent groups. a. There were no wealthy benefactors willing to establish a children’s hospital endowment, forcing the hospital’s proponents to ask the taxpayers to issue $120 million in bonds for the project.[9] However, El Paso is fairly poor. The median annual household income is approximately $42,000, more than $17,000 below the state average and $25,000 below the national average.[10] Property values are low, and Texas does not do much to redistribute funds from wealthier to poorer parts of the state, so resources for community development are limited and spending priorities must be chosen carefully. b. The wealthier, less-Hispanic parts of El Paso were reluctant to fund a project that was billed primarily as a means of assisting poor, Hispanic children. c. Two previous children’s hospital projects had fallen through after their for-profit sponsors pulled out, and some El Pasoans were hesitant to try again. d. Tenet Healthcare, the owners of El Paso’s largest for-profit hospital network, opposed the project. They feared competition for the basic services they provided in their “children’s wing,” and perhaps knew that they might no longer get away with providing substandard pediatric care. When, over their objections, the project appeared on the ballot they launched a vigorous advertisement campaign against it. Some physicians joined them. e. Low levels of education and civic engagement in El Paso, coupled with an underdeveloped sense of entitlement, led to complacency. There was a lack of political will for a big project like the children’s hospital because many El Pasoans did not think that they deserved better than what they were getting. They were accustomed to a certain quality of care and a certain level of access to care. If they were not content with the status quo, they were at least tolerant of it. This last point is worth elaborating upon. Fewer than 24 percent of El Pasoans complete a bachelor’s degree, compared to nearly 32 percent of Texans and nearly 35 percent of Americans.[11] The city’s high school graduation rate is just above 75 percent, nearly 10 percent below the corresponding national and state rates.[12] Additionally, the majority of available jobs are low-paying and physically demanding, so many well-educated El Pasoans choose to make their lives elsewhere (“brain drain”).[13] Poverty and limited English proficiency compound upon low levels of education to lower access to the instruments of democracy and erode democratic culture, and they make the population more susceptible to manipulation by powerful interests – on any side. Tenet Healthcare’s advertising campaign was better funded than the campaign for the children’s hospital, and physicians and experts lined up on both sides which created confusion. In addition, and perhaps counterintuitively, given El Paso’s poor and largely Hispanic population (>80 percent),[14], [15] trust in the healthcare system is high.[16] One possible explanation is exceptional quality of care, though all the facts suggest this is not the case. Other explanations include a high degree of physician-patient ethnic concordance, a cultural deference to authority, and underentitelment, that is, the belief that one deserves less than what dispassionate others conclude s/he deserves. Any population can grow accustomed to the status quo and poverty, lack of education, and membership in an otherwise vulnerable group can prevent information filtering in from outside the city – nationwide trends – from really “taking hold.” However, in El Paso, the situation is still more complicated. Many El Pasoans have family in Mexico and cross the border regularly for shopping or recreation. In many ways, El Paso and Ciudad Juárez form a single community, and even El Pasoans who have been in the country their entire lives tend to maintain a strong connection to Mexico. This is relevant because the quality of medical care in Mexico (though improving) is low,[17] and expectations for what the government (or any large entity) will do for the common man lower still.[18] El Paso voters ultimately made the decision to fund the construction of a children’s hospital, though by a margin of less than 2 percent and with fewer than 12 percent of eligible voters weighing in.[19] The El Paso Children’s Hospital has more than delivered on its community health improvement promises. It has reduced pediatric outmigration for subspecialty and surgical care by more than 80 percent, substantially increased the county’s physician workforce, and launched several successful preventive health and health education programs. In addition, it has promoted cutting-edge research on a slew of pediatric conditions and helped to increase the city’s physician retention rate.[20] But there have been some serious hiccoughs along the way, including a bankruptcy crisis in 2015 that caused almost half of the hospital’s board to resign,[21] and there is still a lot of work to be done.[22] lll. A Better Approach to Building Children’s Hospitals The difficulty in opening a children’s hospital in El Paso serves as an important starting point for a discussion on the principles of ethical governance. Most agree that when the private sector fails to address an important community need, it is the responsibility of the government to intervene. However, people differ on what they consider an “important community need” and the precise role of government in filling needs. They may also prefer that government intervention occur at the local, state or federal level, or some combination of the three, depending on the issue before them. Five separate feasibility studies were conducted in the lead-up to the 2007 vote. All agreed that El Paso needed a children’s hospital.[23] ,But none discussed how much it needed a children’s hospital, i.e., what trade-offs would be appropriate for the community to make in order to build one. Nor could they. People will always prioritize differently. Perhaps a delay in funding a children’s hospital would allow for a restructuring of the school system. Americans usually prefer to decide such issues at the ballot box, either directly or through their representatives. However, for projects like a children’s hospital, where not all community members are informed enough on the pertinent issues to perform a cost/benefit analysis, and the risks of not acting can be severe, some other mechanism, or some supplementary mechanism, of deciding on the issue is more appropriate. In determining whether and what types of state intervention are justified, ethicists weigh several competing concerns: beneficence (the good that is likely to come to the community, folding in the harm to certain stakeholders), justice (in this case, for children, in terms of access to and quality of care) and autonomy (of the voters). However, in many communities across the country, after the need for a children’s hospital is demonstrated[24] if local voters and their representatives weigh in at all, it need only be to decide on zoning and other logistical issues because wealthy benefactors are willing to foot the bill.[25] In communities like El Paso, where no such benefactors make themselves known, voters or their representatives are asked to make a much more difficult decision: whether to fund a children’s hospital by raising taxes on themselves. That may not be fair to them, especially if their community is already poor, and it is certainly not fair to the children whose health and quality of life are at stake. Though El Paso did eventually vote to fund a children’s hospital, similarly situated communities may vote differently, and their children could suffer as a result, just as El Paso children suffered during the delay. Communities like El Paso may also be in a poor position to make truly autonomous decisions on this issue. Poverty and lack of education can lead to confusion or ambivalence owing to lack of information or access to the tools necessary to become informed. For-profit hospital chains unwilling to establish their own children’s hospitals, and others who stand to lose out, can use their considerable power to unduly influence the debate, which can also be inaccurately cast as one about redistributing resources from wealthy white households to poor, “undeserving” ethnic minorities. But one need not accept an argument about diminished community autonomy to conclude that some form of state or federal intervention to tip the scales on specific children’s hospital projects is ethically permissible. This is partially because the autonomy concern, with respect to the children’s hospital issue, is a red herring. As noted above, voters and local officials in most communities barely weigh in on children’s hospital projects at all. Projects which, it is important to stress, concern the welfare of a non-voting vulnerable group and so maybe should not be subject to majoritarianism to begin with! Moreover, if a state or the federal government were to establish a uniform process for determining whether a community needs a children’s hospital, e.g. delegating authority to a health planning agency that performs regular and transparent health infrastructure assessments and proactively issues “certificates of need” (as opposed to issuing them only after an application by interested parties), the democratic process is respected more than if a children’s hospital were simply foisted upon a community by wealthy benefactors. If the state or federal government were also to help qualifying local communities obtain their children’s hospitals, much local hesitancy about the hospital would shrink. One may wonder whether this is just “kicking the problem up to another level of government.” There is, after all, no assurance that political will for building children’s hospitals in needy communities will be higher at the state or federal level than at the local level. It may even be lower, as state and federal officials are more emotionally removed from the conditions on the ground. However, a key difference is that the reliance on a single governmental agency – one that has the resources to perform thorough, less biased assessments – removes a lot of the extraneous variables with bearing on the success of a children’s hospital project. Such an agency focuses only on the first part of the project, establishing that the hospital is necessary. This is a lower hurdle to clear, and it provides momentum for the next parts of the process, which may include varying degrees of state or federal government intervention, all of which could also be managed by a different agency. This system also makes capture by powerful interests difficult. Not only do these interests often appear less powerful at the state or federal level than locally, but a health planning agency applies objective criteria in making its determinations, and the next steps occur “in a different house.” Finally, state or federal involvement leads to parity across communities and sounder resource management because children’s hospitals generally serve areas outside the communities in which they are situated. Once a certificate of need has been issued to a community indicating that it needs a children’s hospital, the state[26] may (1) build the hospital using its own funds or funds appropriated to it for that purpose by the federal government or (2) let the local community take the lead, providing subsidies on a sliding scale to ensure that the communities which struggle to afford a children’s hospital still get one. For a variety of political and budgetary reasons, this latter route is more realistic, and it has the advantage of building local community buy-in, which could be important if the children’s hospital is to successfully recruit personnel, receive referrals from local physicians and actively participate in the local medical education/research enterprises. A certificate of need issued by an impartial government agency as part of its mandate might itself be enough to persuade a local community to take action. It could spur proponents to organize, if they had not done so earlier, and could be used as ammunition in their advertisement campaigns. But if the community is still apathetic or hesitant, the state can launch educational initiatives, including those aimed at changing underentitlement, and help it negotiate with for-profit hospital chains to see if they can be incentivized to take a children’s hospital project on. The state may also consider issuing different types of certificates of need and, for the highest level, require that the community build a children’s hospital, in the same way, that it (often) requires it to have police or fire protection. Subsidies would almost certainly have to be offered for this to be politically viable (and ethically acceptable). CONCLUSION There are several issues with this framework, including precisely how a financially infeasible but necessary children’s hospital can be made feasible. Details will have to be filled in. Nevertheless, it is something worth investigating. It could significantly improve the current situation, in which communities like El Paso are essentially left to fend for themselves. Disclaimer: The author has family associated with the El Paso Children’s Hospital. Chetan Moorthy and Sadhana Chheda are his parents. Chheda served as Board Secretary and works at Children’s as a neonatologist. Moorthy contracts with Children’s to provide radiology services. Both have practiced in El Paso for decades, and their experience is drawn upon to support some of the article’s claims, particularly those for which no hard data has been collected. [1] Casimir, Georges. 2019. “Why Children’s Hospitals Are Unique and So Essential.” Frontiers in Pediatrics 7 (July). https://doi.org/10.3389/fped.2019.00305. [2] Pew Research Center’s Hispanic Trends Project. 2019. “Metro Area U.S. Unauthorized Immigrant Population Estimates, 2016 and 2007.” Pew Research. March 11, 2019. https://www.pewresearch.org/hispanic/interactives/unauthorized-immigrants-by-metro-area-table/. [3] “City and Town Population Totals: 2010-2019.” 2020. United States Census Bureau. https://www.census.gov/data/tables/time-series/demo/popest/2010s-total-cities-and-towns.html. [4] “El Paso, Texas: Demographic Profile.” 2017. EPTX. 2017. https://www.elpasotexas.gov/economic-development/business-services/data-and-statistics/population. [5] “Community Health Needs Assessment 2014.” 2014. El Paso Children’s Hospital. https://elpasochildrens.org/wp-content/uploads/2019/08/epch-chna-report-final-9-29-14-v3.pdf. [6] Ibid. [7] Moorthy, Chetan, and Sadhana Chheda. 2020. Conditions in El Paso, Texas: Physician Services and Patient Perceptions. Interview by Gyan Moorthy. In-Person. [8] “All Children Need Children’s Hospitals.” n.d. National Association of Children’s Hospitals and Related Institutions. Accessed November 29, 2020. https://www.upstate.edu/gch/pdf/academics/allchildren.pdf. [9] Schalden, Mary. 2015. “Children’s Hospital Timeline.” El Paso Times, October 5, 2015. https://www.elpasotimes.com/story/news/2015/10/05/childrens-hospital-timeline/73394588/. [10] “El Paso, Texas: Demographic Profile.” 2017. [11] Ibid. [12] “High School Graduation Rate Data for El Paso, TX.” 2018. Open Data Network. 2018. https://www.opendatanetwork.com/entity/1600000US4824000/El_Paso_TX/education.graduation_rates.percent_high_school_graduate_or_higher?year=2018. [13] Anderson, Lindsey. 2015. “More People Leave El Paso for Elsewhere than Other Major Cities.” El Paso Times, July 22, 2015. https://www.elpasotimes.com/story/news/local/2015/07/22/more-people-leave-el-paso-elsewhere-than-other/71987220/. [14] “El Paso, Texas: Demographic Profile.” 2017. [15] Armstrong, Katrina, Karima L. Ravenell, Suzanne McMurphy, and Mary Putt. 2007. “Racial/Ethnic Differences in Physician Distrust in the United States.” American Journal of Public Health 97 (7): 1283–89. https://doi.org/10.2105/AJPH.2005.080762. [16] Moorthy, Chetan, and Sadhana Chheda. 2020. [17] Barber, Ryan M., Nancy Fullman, Reed J. D. Sorensen, Thomas Bollyky, Martin McKee, Ellen Nolte, Amanuel Alemu Abajobir, et al. 2017. “Healthcare Access and Quality Index Based on Mortality from Causes Amenable to Personal Health Care in 195 Countries and Territories, 1990–2015: A Novel Analysis from the Global Burden of Disease Study 2015.” The Lancet 390 (10091): 231–66. https://doi.org/10.1016/S0140-6736(17)30818-8. [18] Lagos, Lorenzo Felipe. 2012. “Institutional Trust: The Case Study of Mexican State Institutions.” Student Perspectives on Institutions, Choices, and Ethics 7 (4): 39. [19] “Final Election Results (2007).” 2007. El Paso County Elections Department. https://el-paso-county-elections.s3.amazonaws.com/documents/files/000/000/300/original/ELECTION_RESULTS_FINAL.pdf?1450312070. [20] “2018 Annual Community Benefit Report.” 2018. El Paso Children’s Hospital. https://elpasochildrens.org/wp-content/uploads/2018/11/epch_communityreport_2018_small.pdf. [21] Flores, Aileen B. 2015. “Taxpayers Still Owe $116M for Construction of El Paso Children’s Hospital.” El Paso Times, May 27, 2015. https://www.elpasotimes.com/story/news/local/2015/05/27/taxpayers-still-owe-116m-construction-childrens-hospital/31261601/. [22] Moorthy, Chetan, and Sadhana Chheda. 2020. [23] “History of El Paso Children’s Hospital.” 2020. El Paso Children’s Hospital. 2020. https://elpasochildrens.org/about-us/. [24] In many states, a “certificate of need” must be obtained before new healthcare facilities can be created. See Mercatus Center. 2015. “How State Certificate-of-Need (CON) Laws Affect Access to Health Care.” Medium. December 23, 2015. https://medium.com/concentrated-benefits/how-state-certificate-of-need-con-laws-impact-access-to-health-care-b8d3ec84242f for more. Certificates of need may slow the founding of hospitals in some areas, but they could also spur it when political will is low or absent. [25] Moorthy, Chetan, and Sadhana Chheda. 2020. [26] Given federal/state separation of powers, it is very unlikely that the federal government would be directly involved at this step.

Domeier, Norman / Christian Mühling (Hrsg.), Homosexualität am Hof. Praktiken und Diskurse vom Mittelalter bis heute (Geschichte und Geschlechter, 74), Frankfurt a. M. / New York 2020, Campus, 401 S. / Abb., € 39,95. (Martin Dinges, Stuttgart) Hengerer, Mark / Nadir Weber (Hrsg.), Animals and Courts. Europe, c. 1200 – 1800, Berlin / Boston 2020, de Gruyter Oldenbourg, VII u. 434 S. / Abb., € 89,95. (Stefano Saracino, Jena / München) Baumann, Anette / Alexander Jendorff / Frank Theisen (Hrsg.), Religion – Migration – Integration. Studien zu Wechselwirkungen religiös motivierter Mobilität im vormodernen Europa, Tübingen 2019, Mohr Siebeck, VIII u. 312 S. / € 54,00. (Bettina Braun, Mainz) Dirmeier, Artur / Mark Spoerer (Hrsg.), Spital und Wirtschaft in der Vormoderne. Sozial-karitative Institutionen und ihre Rechnungslegung als Quelle für die Sozial- und Wirtschaftsgeschichte (Studien zur Geschichte des Spital-‍, Wohlfahrts- und Gesundheitswesens, 14), Regensburg 2020, Pustet, 308 S. / Abb., € 34,95. (Peter Rauscher, Wien) Raffa, Guy P., Dante’s Bones. How a Poet Invented Italy, Cambridge / London 2020, The Belknap Press of Harvard University Press, VIII u. 370 S. / Abb., $ 28,95. (Arne Karsten, Wuppertal) Backes, Martina / Jürgen Dendorf (Hrsg.), Nationales Interesse und ideologischer Missbrauch. Mittelalterforschung in der ersten Hälfte des 20. Jahrhunderts. Vorträge zum 75jährigen Bestehen der Abteilung Landesgeschichte am Historischen Seminar der Albert-Ludwigs-Universität Freiburg (Freiburger Beiträge zur Geschichte des Mittelalters, 1), Ostfildern 2019, Thorbecke, 268 S. / Abb., € 28,00. (Bernd Schneidmüller, Heidelberg) Page, Sophie / Catherine Rider (Hrsg.), The Routledge History of Medieval Magic (Routledge Histories), London / New York 2019, Routledge, XVII u. 550 S. / Abb., £ 175,00. (Rita Voltmer, Trier) Ziegler, Tiffany A., Medieval Healthcare and the Rise of Charitable Institutions. The History of the Municipal Hospital (The New Middle Ages), Cham 2018, Palgrave Macmillan, VI u. 155 S., € 58,84. (Artur Dirmeier, Regensburg) Speich, Heinrich, Burgrecht. Von der Einbürgerung zum politischen Bündnis im Spätmittelalter (Vorträge und Forschungen, Sonderband 59), Ostfildern 2019, Thorbecke, 419 S. / Abb., € 52,00. (Gabriel Zeilinger, Rostock) Harry, David, Constructing a Civic Community in Late Medieval London. The Common Profit, Charity and Commemoration, Woodbridge 2019, The Boydell Press, XI u. 216 S., £ 75,00. (Jens Röhrkasten, Dresden) Carr, Mike, Merchant Crusaders in the Aegean, 1201 – 1352 (Warfare in History), Woodbridge 2019, The Boydell Press, XII u. 196 S. / Abb., £ 19,99. (Kristjan Toomaspoeg, Lecce) Dokumente zur Geschichte des Deutschen Reiches und seiner Verfassung 1340 – 1343, Bd. 7, Teil 2, bearb. v. Michael Menzel (Monumenta Germaniae Historica. Constitutiones et acta publica imperatorum et regum, 7.2), Wiesbaden 2019, Harrassowitz, XLIV und 404 S., € 120,00. (Andrea Stieldorf, Bonn) Flemmig, Stephan, Zwischen dem Reich und Ostmitteleuropa. Die Beziehungen von Jagiellonen, Wettinern und Deutschem Orden (1386 – 1526) (Quellen und Forschungen zur sächsischen und mitteldeutschen Geschichte, 44), Stuttgart 2019, Steiner, 706 S., € 116,00. (Julia Burkhardt, München) Hagemann, Manuel, Herrschaft und Dienst. Territoriale Amtsträger unter Adolf II. von Kleve (1394 – 1448) (Schriften der Heresbach-Stiftung Kalkar, 17), Bielefeld 2020, Verlag für Regionalgeschichte, 912 S., € 49,00. (Benjamin Müsegades, Heidelberg) Traxler, Christina, Firmiter velitis resistere. Die Auseinandersetzung der Wiener Universität mit dem Hussitismus vom Konstanzer Konzil (1414 – 1418) bis zum Beginn des Basler Konzils (1431 – 1449) (Schriften des Archivs der Universität Wien, 27), Göttingen 2019, V&amp;R unipress / Vienna University Press, 547 S., € 70,00. (Blanka Zilynská, Prag) Chronik des Konstanzer Konzils 1414 – 1418 von Ulrich Richental. Historisch-kritische Edition, 3 Bde., Bd. 1: A-Version; Bd. 2: K-Version; Bd. 3: G-Version, eingel., komm. u. hrsg. v. Thomas M. Buck (Konstanzer Geschichts- und Rechtsquellen, 49.1 – 3), Ostfildern 2020, Thorbecke, 461 S.; 415 S.; 433 S., € 145,00. (Christof Rolker, Bamberg) Šmahel, František, Die Basler Kompaktaten mit den Hussiten (1436). Untersuchung und Edition (Monumenta Germaniae Historica. Studien und Texte, 65), Wiesbaden 2019, Harrassowitz, XXII u. 226 S., € 45,00. (Dušan Coufal, Prag) Decembrio, Pier Candido, Lives of the Milanese Tyrants, hrsg. v. Massimo Zaggia, ins Englische übers. u. mit einer Einleitung versehen v. Gary Ianziti (The I Tatti Renaissance Library, 88), Cambridge / London 2019, Harvard University Press, LIII u. 339 S., £ 19,95. (Tobias Daniels, Zürich) Thomas von Kempen, Dialogus noviciorum / Novizengespräche, hrsg. v. Nikolaus Staubach / Stefan Sudmann, Münster 2020, Aschendorff, 472 S., € 69,00. (Julia Becker, Heidelberg) Kempf, Charlotte K., Materialität und Präsenz von Inkunabeln. Die deutschen Erstdrucker im französischsprachigen Raum bis 1500 (Forum historische Forschung. Mittelalter, 1), Stuttgart 2020, Kohlhammer, 583 S. / Abb., € 89,00. (Christoph Reske, Mainz) Gammerl, Benno / Philipp Nielsen / Margrit Pernau (Hrsg.), Encounters with Emotions. Negotiating Cultural Differences since Early Modernity, New York / Oxford 2019, Berghahn, VI u. 308 S. / Abb., £ 92,00. (Kim Siebenhüner, Jena) Dierksmeier, Laura, Charity for and by the Poor. Franciscan-Indigenous Confraternities in Mexico, 1527 – 1700, Norman / San Diego 2020, University of Oklahoma Press / The Academy of American Franciscan History, XVI u. 222 S. / Abb., $ 55,00. (Tobias Winnerling, Düsseldorf) Strunck, Christina (Hrsg.), Faith, Politics and the Arts. Early Modern Cultural Transfer between Catholics and Protestants (Wolfenbütteler Forschungen, 158), Wiesbaden 2019, Harrassowitz in Kommission, 391 S., € 88,00. (Bernd Roeck, Zürich) Glück, Helmut / Mark Häberlein / Andreas Flurschütz da Cruz (Hrsg.), Adel und Mehrsprachigkeit in der Frühen Neuzeit. Ziele, Formen und Praktiken des Erwerbs und Gebrauchs von Fremdsprachen (Wolfenbütteler Forschungen, 155), Wiesbaden 2019, Harrassowitz in Kommission, 259 S. / Abb., € 58,00. (Martin Wrede, Grenoble) Scholz, Luca, Borders and Freedom of Movement in the Holy Roman Empire (Studies in German History), Oxford 2020, Oxford University Press, VI u. 266 S., £ 60,00. (Tobias Schenk, Wien) Füssel, Marian (Hrsg.), Wissensgeschichte (Basistexte Frühe Neuzeit, 5), Göttingen 2019, Steiner, 300 S. / Abb., € 28,00. (Kristina Hartfiel, Düsseldorf) Friedrich, Markus / Jacob Schilling (Hrsg.), Praktiken frühneuzeitlicher Historiographie (Cultures and Practices of Knowledge in History / Wissenskulturen und ihre Praktiken, 2), Berlin / Bosten 2019, de Gruyter Oldenbourg, VIII u. 445 S. / Abb., € 79,95. (Helmut Zedelmaier, München) Stockhorst, Stefanie, Ars Equitandi. Eine Kulturgeschichte der Reitlehre in der Frühen Neuzeit, Hannover 2020, Wehrhahn, 359 S. / Abb., € 34,00. (Jürgen Overhoff, Münster) Frohnapfel-Leis, Monika, Jenseits der Norm. Zauberei und fingierte Heiligkeit im frühneuzeitlichen Spanien (Hexenforschung, 18), Bielefeld 2019, Verlag für Regionalgeschichte, 263 S. / Abb., € 29,00. (Sarah Masiak, Detmold) Kamp, Jeannette, Crime, Gender and Social Control in Early Modern Frankfurt am Main (Crime and City in History, 3), Leiden / Boston 2020, Brill, XII u. 335 S. / Abb., € 121,00. (Matthias Schnettger, Mainz) Liapi, Lena, Roguery in Print. Crime and Culture in Early Modern London (Studies in Early Modern Cultural, Political and Social History, 33), Woodbridge 2019, The Boydell Press, IX u. 194 S. / Abb., £ 65,00. (Birgit Näther, Berlin) Ritsema van Eck, Marianne P., The Holy Land in Observant Franciscan Texts (c. 1480 – 1650). Theology, Travel, and Territoriality (The Medieval Franciscans, 17), Leiden / Boston 2019, Brill, XI u. 260 S. / Abb., € 132,00. (Mirko Breitenstein, Dresden) Bowd, Stephen D., Renaissance Mass Murder. Civilians and Soldiers during the Italian Wars, Oxford / New York 2018, Oxford University Press, X u. 288 S., £ 65,00. (Christian Jaser, Klagenfurt) Schulte, Daniela, Die zerstörte Stadt. Katastrophen in den schweizerischen Bilderchroniken des 15. und 16. Jahrhunderts (Medienwandel – Medienwechsel – Medienwissen, 41), Zürich 2020, Chronos, 246 S. / Abb., € 48,00. (Stephanie Armer, Eichstätt) Deiters, Maria / Ruth Slenczka (Hrsg.), Häuslich – persönlich – innerlich. Bild und Frömmigkeitspraxis im Umfeld der Reformation, Berlin / Boston 2020, de Gruyter, XIV u. 423 S. / Abb., € 99,95. (Gregor Rohmann, Frankfurt a. M.) Christ-von Wedel, Christine, Die Äbtissin, der Söldnerführer und ihre Töchter. Katharina von Zimmern im politischen Spannungsfeld der Reformationszeit, unter Mitarbeit v. Irene Gysel / Jeanne Pestalozzi / Marlis Stähli, Zürich 2019, Theologischer Verlag Zürich, 356 S. / Abb., € 33,90. (Bettina Braun, Mainz) Grochowina, Nicole, Reformation (Seminar Geschichte), Berlin / Boston 2020, de Gruyter Oldenbourg, X u. 220 S. / Abb., € 24,95. (Tobias Jammerthal, Neuendettelsau) Behringer, Wolfgang / Wolfgang Kraus / Roland Marti (Hrsg.), Die Reformation zwischen Revolution und Renaissance. Reflexionen zum Reformationsjubiläum (Kulturelle Grundlagen Europas, 6), Berlin 2019, Lit, 350 S. / Abb., € 39,90. (Martina Fuchs, Wien) Greiling, Werner / Thomas T. Müller / Uwe Schirmer (Hrsg.), Reformation und Bauernkrieg (Quellen und Forschungen zu Thüringen im Zeitalter der Reformation, 12), Wien / Köln / Weimar 2019, Böhlau, 474 S. / Abb., € 55,00. (Ulrich Bubenheimer, Reutlingen) Werz, Joachim, Predigtmodi im frühneuzeitlichen Katholizismus. Die volkssprachliche Verkündigung von Leonhard Haller und Georg Scherer in Zeiten von Bedrohungen (1500 – 1605) (Reformationsgeschichtliche Studien und Texte, 175), Münster 2020, Aschendorff, X u. 606 S. / graph. Darst., € 77,00. (Kai Bremer, Osnabrück) Freitag, Werner / Wilfried Reininghaus (Hrsg.), Beiträge zur Geschichte der Reformation in Westfalen, Bd. 2: Langzeitreformation, Konfessionskultur und Ambiguität in der zweiten Hälfte des 16. Jahrhunderts. Beiträge der Tagung am 27. und 28. Oktober 2017 in Lemgo (Veröffentlichungen der Historischen Kommission für Westfalen. Neue Folge, 47), Münster 2019, Aschendorff, 391 S. / Abb. / CD-ROM, € 44,00. (Andreas Rutz, Dresden) Cordes, Jan-Christian, Politik und Glaube. Die Reformation in der Hansestadt Lüneburg (Veröffentlichungen der Historischen Kommission für Niedersachsen und Bremen, 304), Göttingen 2020, Wallstein, 758 S., € 49,00. (Olaf Mörke, Kiel) Hough, Adam G., The Peace of Augsburg and the Meckhart Confession. Moderate Religion in an Age of Militancy (Routledge Research in Early Modern History), New York / London 2019, Routledge, X u. 341 S. / Abb., £ 115,00. (Marion Bechtold-Mayer, Darmstadt) Francisco de Vitoria, De iustitia / Über die Gerechtigkeit, Teil 3, hrsg., eingel. u. ins Deutsche übers. v. Joachim Stüben, mit einer Einleitung v. Tilman Repgen (Politische Philosophie und Rechtstheorie des Mittelalters und der Neuzeit. Reihe I: Texte, 5), Stuttgart-Bad Cannstatt 2020, Frommann-Holzboog, LI u. 242 S., € 168,00. (Nils Jansen, Münster) Overell, M. Anne, Nicodemites: Faith and Concealment between Italy and Tudor England (St Andrews Studies in Reformation History), Leiden / Boston 2019, Brill, XII u. 218 S., € 125,00. (Andreas Pietsch, Münster) Schultz, Jenna M., National Identity and the Anglo-Scottish Borderlands, 1552 – 1652 (Studies in Early Modern Cultural, Political and Social History, 32), Woodbridge 2019, The Boydell Press, XVII u. 326 S. / Karten, £ 70,00. (Iris Fleßenkämper, Münster) Heinemann, Julia, Verwandtsein und Herrschen. Die Königinmutter Catherine de Médicis und ihre Kinder in Briefen 1560 – 1589 (Pariser Historische Studien, 118), Heidelberg 2020, Heidelberg University Publishing, 517 S. / Abb., € 49,90. (Katrin Keller, Wien) Malettke, Klaus, Katharina von Medici. Frankreichs verkannte Königin, Paderborn 2020, Schöningh, VIII u. 403 S. / Abb., € 78,00. (Katrin Keller, Wien) Haar, Christoph Ph., Natural and Political Conceptions of Community. The Role of the Household Society in Early Modern Jesuit Thought, c. 1590 – 1650 (Jesuit Studies, 17), Leiden / Boston 2019, Brill, VI u. 314 S., € 132,00. (Nils Jansen, Münster) Senning, Calvin F., Spain, Rumor, and Anti-Catholicism in Mid-Jacobean England. The Palatine Match, Cleves, and the Armada Scares of 1612 – 1613 and 1614 (Routledge Research in Early Modern History), New York / London 2019, Routledge, XI u. 254 S. / Abb., £ 120,00. (Alexander Schunka, Berlin) Saito, Keita, Das Kriegskommissariat der bayerisch-ligistischen Armee während des Dreißigjährigen Krieges (Herrschaft und soziale Systeme in der Frühen Neuzeit, 24), Göttingen 2020, V&amp;R unipress, 346 S. / graph. Darst., € 50,00. (Michael Kaiser, Bonn) Hämmerle, Tobias E., Flugblatt-Propaganda zu Gustav Adolf von Schweden. Eine Auswertung zeitgenössischer Flugblätter der Königlichen Bibliothek zu Stockholm, Marburg 2019, Büchner-Verlag, 577 S. / Abb., € 45,00. (Michael Kaiser, Bonn) Hennings, Jan, Russia and Courtly Europe. Ritual and the Culture of Diplomacy, 1648 – 1725 (New Studies in European History), Cambridge [u. a.] 2016, Cambridge University Press, XII u. 297 S. / Abb., £ 70,99. (Martina Winkler, Kiel) Bell, David A. / Yair Mintzker (Hrsg.), Rethinking the Age of Revolutions. France and the Birth of the Modern World, New York 2018, Oxford University Press, XXIX u. 287 S. / Abb., £ 64,00. (Volker Depkat, Regensburg) Vallance, Edward (Hrsg.), Remembering Early Modern Revolutions. England, North America, France and Haiti (Remembering the Medieval and Early Modern Worlds), London / New York 2019, Routledge, XI u. 222 S., £ 90,00. (Volker Depkat, Regensburg) Mokhberi, Susan, The Persian Mirror. French Reflections of the Safavid Empire in Early Modern France, New York 2019, Oxford University Press, XI u. 223 S. / Abb., £ 47,99. (Markus Friedrich, Hamburg) Fulda, Daniel (Hrsg.), Aufklärung fürs Auge. Ein anderer Blick auf das 18. Jahrhundert, Halle 2020, Mitteldeutscher Verlag, 247 S. / Abb., € 38,00. (Denise Schlichting, Osnabrück) Müller, Miriam, Der sammelnde Professor. Wissensdinge an Universitäten des Alten Reichs im 18. Jahrhundert (Wissenschaftskulturen. Reihe I: Wissensgeschichte, 1), Stuttgart 2020, Steiner, 268 S. / Abb., € 44,00 (Bernhard Homa, Hannover) Schläwe, Elisabeth, Ins Gedächtnis geschrieben. Leben und Schreiben der Eleonora Wolff Metternich zur Gracht (1679 – 1755) (Transgressionen, 1), Stuttgart 2020, Steiner, 218 S. / Abb., € 52,00. (Melanie Greinert, Kiel) Fingerhut-Säck, Mareike, Das Gottesreich auf Erden erweitern. Einführung und Festigung des Pietismus durch das Grafenpaar Sophie Charlotte und Christian Ernst zu Stolberg-Wernigerode in seiner Grafschaft (1710 – 1771) (Studien zur Geschichte und Kultur Mitteldeutschlands, 5), Halle a. d. S. 2019, Mitteldeutscher Verlag, 410 S. / Abb., € 54,00. (Thomas Dorfner, Aachen / Erfurt) Ihle, Stefan, Die Entführung des Johann Wilhelm Pfau in Halle 1734. Eine Studie zur Rivalität zweier anhaltischer Landesfürsten (Forschungen zur hallischen Stadtgeschichte, 28), Halle 2021, Mitteldeutscher Verlag, 214 S. / Abb., € 24,00. (Barbara Stollberg-Rilinger, Berlin) Klesmann, Bernd, Die Notabelnversammlung 1787 in Versailles. Rahmenbedingungen und Gestaltungsoptionen eines nationalen Reformprojekts (Beihefte der Francia, 83), Ostfildern 2019, Thorbecke, 569 S., € 67,00. (Martin Wrede, Grenoble) Quaasdorf, Friedrich, Kursachsen und das Ende des Alten Reichs. Die Politik Dresdens auf dem Immerwährenden Reichstag zu Regensburg 1802 bis 1806 (Schriften zur sächsischen Geschichte und Volkskunde, 63), Leipzig 2020, Leipziger Universitätsverlag, 449 S., € 55,00. (Dorothée Goetze, Bonn)