OBJECTIVE: The study aims to describe factors that contribute to the Length of Stay (LOS) in the Emergency Department (ED) patients of a Tertiary Private Hospital in Philippines.

METHODS: This is a retrospective descriptive study from September 1, 2015 to March 31, 2016 on the factors of ED consultations specifically on demographics (age and sex), payment schemes (Out of Pocket (OOP) and third party payer), shift times (morning, afternoon and night) and triage-levels were associated with LOS.

RESULTS: Our ED consultations with age (mean 40.75 years, SD 16.8, N 20,687, range 95) were dominated by females (56%), two age-range, 21-30 (28.4%) & 31-40 and third party payer (57%). LOS (mean of 4,40 hours, SD 3,89, N 18540, range 68) was significantly higher (p<0.001) on OOP patients, older age-range; 71-80, (3.5%) and 81-90, (2.3%). Emergent cases had higher incidence (X2= 30.2, p<0.001) on morning shift, urgent cases on afternoon shift and trauma cases on evening shift. Non-urgent cases were consistent on all time frames. LOS was significantly higher (X2=p<0.001) on urgent and emergent cases and on morning and afternoon shifts and significantly lowest, (p<0.001) on night shifts.

CONCLUSION: Higher LOS was associated on the following: urgent and emergent triage- levels, older age range, OOP, and morning and afternoon shifts.

In the 80’s, in Spain, there was a very significant increase in the population addicted to heroin use. The behaviour patterns of use and abuse of this substance also caused many drug addicts to be linked to the associated consumption of multiple toxic substances, favouring the appearance of politoxicomania. The origin of the change of model in drug use began in mid- 1987 and in the following years, ecstasy and the so-called designer drugs began to spread throughout the festival scene in the United Kingdom, Western Europe and the Iberian Peninsul. In the 90’s, new substances were introduced into society that had little to do with heroin use, shifting the link to toxic substances to these better accepted and less questioned substances, avoiding the possible problems associated with consumption in marginal environments. The normalization of the consumption of substances of abuse began to have a greater social tolerance, breaking the stigma that led to the alarm raised by heroin consumption in the 80’s. In this sense, drugs were no longer associated with marginalization, and were seen in environments considered festive and, therefore, “normal”. ASEAN Journal of Psychiatry, Vol. 22(5): July 2021: 1-4.

OBJECTIVES: Early initiation of breastfeeding (EIBF) is one of the most cost-effective strategies to reduce neonatal mortality. We sought to determine the prevalence and determinants of EIBF in Peru. METHODS: We performed a cross-sectional analytical study of the 2018 Peruvian Demographic and Family Health Survey as a secondary data source. In total, 19,595 children born during the 5 years prior to the survey were included in the study. The dependent variable (EIBF status), socio-demographic variables, and pregnancy-related variables were analyzed using a multivariate logistic regression model to identify the determinants of EIBF. RESULTS: The prevalence of EIBF in the study population was 49.7%. Cesarean deliveries were associated with a lower likelihood of EIBF (adjusted odds ratio [aOR], 0.06; 95% confidence interval [CI], 0.05 to 0.07) than were vaginal deliveries. Newborns born at public health centers (aOR, 1.37; 95% CI, 1.15 to 1.65) had a higher rate of EIBF than those not born at public or private health centers. Women from the jungle region (aOR, 2.51; 95% CI, 2.17 to 2.89) had higher odds of providing EIBF than those from the coast. Mothers with more than a secondary education (aOR, 0.65; 95% CI, 0.55 to 0.76) were less likely to breastfeed during the first hour of the newborn's life than women with primary or no education. CONCLUSIONS More than half of Peruvian children do not breastfeed during the first hour after birth. The major determinants of EIBF status were the delivery mode and the region of maternal residence. Strategies are needed to promote early breastfeeding practices.

Objective: The study aims to describe factors that contribute to the Length of Stay (LOS) in the Emergency Department (ED) patients of a Tertiary Private Hospital in Philippines. Methods: This is a retrospective descriptive study from September 1, 2015 to March 31, 2016 on the factors of ED consultations specifically on demographics (age and sex), payment schemes (Out of Pocket (OOP) and third party payer), shift times (morning, afternoon and night) and triage-levels were associated with LOS. Results: Our ED consultations with age (mean 40.75 years, SD 16.8, N 20,687, range 95) were dominated by females (56%), two age-range, 21-30 (28.4%) & 31-40 and third party payer (57%). LOS (mean of 4,40 hours, SD 3,89, N 18540, range 68) was significantly higher (p<0.001) on OOP patients, older age-range; 71-80, (3.5%) and 81-90, (2.3%). Emergent cases had higher incidence (X2= 30.2, p<0.001) on morning shift, urgent cases on afternoon shift and trauma cases on evening shift. Non-urgent cases were consistent on all time frames. LOS was significantly higher (X2=p<0.001) on urgent and emergent cases and on morning and afternoon shifts and significantly lowest, (p<0.001) on night shifts. Conclusion Higher LOS was associated on the following: urgent and emergent triage- levels, older age range, OOP, and morning and afternoon shifts.
Emergency Service, Hospital ; Length of Stay ; Triage

COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has produced a serious emergency for global public health, placing enormous stress on national health systems in many countries. Several studies suggest that cytokine storms (interleukins) may play an important role in severe cases of COVID-19. Neutralizing key inflammatory factors in cytokine release syndrome (CRS) could therefore be of great value in reducing the mortality rate. Tocilizumab (TCZ) in its intravenous (IV) form of administration-RoActemra? 20 mg/mL (Roche)-is indicated for treatment of severe CRS patients. Preliminary in-vestigations have concluded that inhibition of IL-6 with TCZ appears to be efficacious and safe, with several ongoing clinical trials. This has led to a huge increase in demand for IV TCZ for treating severe COVID-19 patients in hospitals, which has resulted in drug shortages. Here, we present a comparability study assessing the main critical physicochemical attributes of TCZ solutions used for infusion, at 6 mg/mL and 4 mg/mL, prepared from RoActemra? 20 mg/mL (IV form) and from RoActemra? 162 mg (0.9 mL solution pre-filled syringe, subcutaneous(SC) form), to evaluate the use of the latter for preparing clinical solutions required for IV administration, so that in a situation of shortage of the IV medicine, the SC form could be used to prepare the solutions for IV delivery of TCZ. It is important to remember that during the current pandemic all the medicines are used off-label, since none of them has yet been approved for the treatment of COVID-19.

The main objective was to determine the immune response of Blackbelly lambs infected with Haemonchus contortus, Trichostrongylus colubriformis, or both species. In the first stage, an experimental challenge was performed with 200 infective larvae (L3)/kg body weight (BW) of H. contortus (Hct, n = 8). Additionally, eight animals were infected with 500 L3/kg BW of T. colubriformis (Tcl), eight lambs with the mixed infection at the same dose (HctTcl), and lambs without infection were the control group. In the second infection, the same lambs were reinfected with high doses: 400 L3/kg BW of Hct and 900 L3/kg BW of Tcl. The third stage consisted of a natural reinfection in grazing. Faecal samples were taken to determine the faecal egg count (FEC) of gastrointestinal nematodes (GINs). IgA was determined in serum and saliva by an indirect Enzyme-Linked Immuno Sorbent Assay (ELISA). The haematological parameters were recorded. With the first challenge, it was not possible to promote an immune response, whereas in the second infection, FEC were higher than 1000 eggs per gram of faeces (EPG) in infected animals. During the third stage, FECs were higher in lambs infected with Tcl. Eosinophils (EOS) did not show differences in the first and second stages, but during grazing the infected lambs had higher counts than the control group (P < 0.05). IgA activity values showed the same trend, and lambs infected with HctTcl had a higher response (33% of the positive standard) than groups mono-infected (16.5% and 22.6%, respectively).

Malaria and dengue fever are among the most common mosquito-borne diseases worldwide; however, reports of coinfection are rare. We present a case of severe malaria and dengue coinfection in a 16-yearold female patient presenting with fever, thrombocytopenia, pleural effusion, myopericarditis, and acute respiratory distress syndrome. Dengue infection was confirmed by the presence of immunoglobin M antibodies and nonstructural protein 1, while malaria was confirmed by the presence of Plasmodium vivax in thick and thin blood smears. This is the first report of a dengue/malaria coinfection in Mexico.