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La infección por Salmonella spp. es una importante causa de morbi-mortalidad a nivel mundial. La enteritis aguda es la forma de presentación más frecuente y es generalmente autolimitada. Este estudio tiene como objetivo determinar cuáles son las características sociodemográficas, clínicas y microbiológicas de los pacientes con aislamiento de Salmonella spp. en coprocultivo. Se realizó un estudio observacional descriptivo retrospectivo del 1 de enero de 2016 al 31 de marzo de 2018 en la Fundación Clinica Infantil Club Noel, en pacientes mayores de 1 mes y menores de 18 años con aislamiento de Salmonella spp. en coprocultivo. Se incluyeron 55 casos donde: el aislamiento fue más frecuente en lactantes, el síntoma predominante fue la diarrea y se inició el tratamiento con ampicilina en la mayoría de casos. Los coprocultivos fueron interpretados en un (45.5%) y el tratamiento dirigido más utilizado fue ceftriaxona. Se encontró un predominio de Salmonella spp. con patrón de resistencia Amp C y una alta resistencia específica a ampicilina (76.4%). Los lactantes fueron el grupo más afectado al igual que en textos académicos. Los síntomas fueron claves para definir el diagnóstico y el inicio de antibiótico. Se observó en los perfiles de susceptibilidad un aumento en la resistencia a betalactámicos. Se observó un sobreuso de antibióticos pese a que las recomendaciones se centran en el manejo de soporte. Las tasas de resistencias en el presente estudio fueron altas comparadas con los últimos registros nacionales. Además, se debe considerar Salmonella en el diagnóstico diferencial de EDA asociada a fiebre.

Objectives: Australia9s public health restrictions (9lockdown9) in 2020 successfully contained the spread of COVID-19. These included a national 9initial9 lockdown (March-May), and 9ongoing9 lockdown (July-November) for metropolitan Victorian residents only. Australia9s experience offers an opportunity to assess impacts of lockdown on families with children, in the relative absence of disease morbidity and mortality. This study (1) described the experience of initial lockdown and (2) evaluated the impact of ongoing lockdown, on family finances and mental health. Methods: Data were drawn from the June and September 2020 Royal Children9s Hospital National Child Health Polls. Caregivers of children from the states of Victoria and New South Wales reported on job/income loss; material deprivation (inability to pay for essential items); income-poverty; mental health (Kessler-6); impact on caregiver/child mental health; and caregiver/child coping. Data from N=1207/902 caregivers in June/September were analyzed; Aim (1) with weighted descriptives; Aim (2) with Difference-in-Difference adjusted linear regression models (New South Wales provided the comparator). Results: Following initial lockdown, one-quarter of families reported job/income loss; one-third reported material deprivation. Negative impacts on mental health were reported for half the caregivers and one-third of children. Few caregivers or children had difficulties coping. During Victoria9s ongoing lockdown, job/income loss increased by 11% (95%CI: 3-18%); Kessler-6 poor mental health by 6% (95%CI: 0.3-12%) and negative mental health impacts by 12% for caregivers (95%CI: 6-23%) and 14% for children (95%CI: 4-20%). Female (versus male) caregivers, metropolitan (versus regional/rural) families, and families with elementary school-aged children (versus pre-/high-school) were most affected. Conclusions: Ongoing lockdown had negative impacts on mental health, employment, and income, but not deprivation or poverty, likely because of the government income supplements introduced early in the pandemic. Balancing the benefits and harms of lockdown requires planned responses to outbreaks, and evidence-informed financial and mental health supports.

IntroductionPoverty and deprivation can harm children’s future health, learning, economic productivity and societal participation. The Australian Healthier Wealthier Families project seeks to reduce the childhood inequities caused by poverty and deprivation by creating a systematic referral pathway between two free, community-based services: universal, well-child nursing services, which provide health and development support to families with children from birth to school entry, and financial counselling. By adapting the successful Scottish ‘Healthier Wealthier Children’ model, the objectives of this Australian pilot are to test the (1) feasibility of systematising the referral pathway, and (2) short-term impacts on household finances, caregiver health, parenting efficacy and financial service use.Methods and analysisThis pilot randomised controlled trial will run in three sites across two Australian states (Victoria and New South Wales), recruiting a total of 180 participants. Nurses identify eligible caregivers with a 6-item, study-designed screening survey for financial hardship. Caregivers who report one or more risk factors and consent are randomised. The intervention is financial counselling. The comparator is usual care plus information from a government money advice website. Feasibility will be evaluated using the number/proportion of caregivers who complete screening, consent and research measures, and access financial counselling. Though powered to assess feasibility, impacts will be measured 6 months post-enrolment with qualitative interviews and questionnaires about caregiver-reported income, loans and costs (adapted from national surveys, for example, the Household, Income and Labour Dynamics in Australia Survey); health (General Health Questionnaire 1, EuroQol five-dimensional questionnaire, Depression, Anxiety, Stress Scale short-form); efficacy (from the Longitudinal Study of Australian Children); and financial service use (study-designed) compared between arms.Ethics and disseminationEthics committees of the Royal Children’s Hospital (HREC/57372/RCHM-2019) and South West Sydney Local Health District (2019/ETH13455) have approved the study. Participants and stakeholders will receive results through regular communication channels comprising meetings, presentations and publications.Trial registration numberACTRN12620000154909; prospectively registered. Pre-results.

Poor household water supply and sanitation can affect maternal and newborn health outcomes through several pathways, including the quality of drinking water consumed by pregnant woman and exposure to harmful fecal pathogens in the environment due to poor quality sanitation. Using data on 14,098 pregnancies across four rounds of the Indonesian Family Life Survey (IFLS), we investigate the relationship between water and sanitation and outcomes along the course of a pregnancy - health and complications during pregnancy, probability of a miscarriage, complications during child birth, probability of live birth, and neonatal outcomes including birth weight and newborn survival rates. After controlling for confounding factors, we find that access to at least basic household sanitation is strongly associated with substantially decreased overall risk during pregnancy and birth. Whether or not a household has access to at least basic sanitation is strongly significantly associated with a lower probability of miscarriage and is a strong predictor of high fever during labor (an indicator of infection). We find no systematic association between household access to basic water and maternal and newborn outcomes. We also find no evidence of herd protection resulting from high levels of sanitation within the community.

Objective Since its emergence in late 2019, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the novel coronavirus that causes novel coronavirus disease 2019 (COVID-19), has spread globally. Within the United States, some of the most affected regions have been New York, and Northern New Jersey. Our objective is to describe the impact of COVID-19 in a large delivery service in Northern New Jersey, including its effects on labor and delivery (L&D), the newborn nursery, and the neonatal intensive care unit (NICU). Materials and Methods Between April 21, 2020 and May 5, 2020, a total of 78 mothers (3.6% of deliveries) were identified by screening history or examination to either be COVID-19 positive or possible positives (persons under investigation). Of the mothers who were tested after admission to L&D, 28% tested positive for SARS-CoV-2. Discussion Isolation between mother and infant was recommended in 62 cases, either because the mother was positive for SARS-CoV-2 or because the test was still pending. Fifty-four families (87%) agreed to isolation and separation. The majority of infants, 51 (94%), were initially isolated on the newborn nursery. Six needed NICU admission. No infants had clinical evidence of symptomatic COVID-19 infection. Fourteen infants whose mothers were positive for SARS-CoV-2, and who had been separated from the mother at birth were tested for SARS-CoV-2 postnatally. All were negative. Results COVID-19 posed a significant burden to mothers, infants, and staff over the 5-week study period. The yield from screening mothers for COVID-19 on L&D was high. Most families accepted the need for postnatal isolation and separation of mother and newborn. Conclusion Our study suggests that the transmission of SARS-CoV-2 from mother to her fetus/newborn seems to be uncommon if appropriate separation measures are performed at birth. Key Points The yield of targeted testing for SARS-CoV-2, on mothers on Labor and Delivery is high. Agreement to separation of mothers and infants to reduce transmission of SARS-CoV-2 was high. The incidence of symptomatic COVID-19 in newborns is low, if appropriate separation occurs at birth.

BackgroundFor countries to contribute to Sustainable Development Goal 3.1 of reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030, identifying the drivers of maternal mortality is critically important. The ability of countries to identify the key drivers is however hampered by the lack of data sources with sufficient observations of maternal death to allow a rigorous analysis of its determinants. This paper overcomes this problem by utilising census data. In the context of Indonesia, we merge individual-level data on pregnancy-related deaths and households' socio-economic status from the 2010 Indonesian population census with detailed data on the availability and quality of local health services from the Village Census. We use these data to test the hypothesis that health service access and quality are important determinants of maternal death and explain the differences between high maternal mortality and low maternal mortality provinces.MethodsThe 2010 Indonesian Population Census identifies 8075 pregnancy-related deaths and 5,866,791 live births. Multilevel logistic regression is used to analyse the impacts of demographic characteristics and the existence of, distance to and quality of health services on the likelihood of maternal death. Decomposition analysis quantifies the extent to which the difference in maternal mortality ratios between high and low performing provinces can be explained by demographic and health service characteristics.FindingsHealth service access and characteristics account for 23% (CI: 17.2% to 28.5%) of the difference in maternal mortality ratios between high and low-performing provinces. The most important contributors are the number of doctors working at the community health centre (8.6%), the number of doctors in the village (6.9%) and distance to the nearest hospital (5.9%). Distance to health clinics and the number of midwives at community health centres and village health posts are not significant contributors, nor is socio-economic status. If the same level of access to doctors and hospitals in lower maternal mortality Java-Bali was provided to the higher maternal mortality Outer Islands of Indonesia, our model predicts 44 deaths would be averted per 100,000 pregnancies.ConclusionIndonesia has employed a strategy over the past several decades of increasing the supply of midwives as a way of decreasing maternal mortality. While there is evidence of reductions in maternal mortality continuing to accrue from the provision of midwife services at village health posts, our findings suggest that further reductions in maternal mortality in Indonesia may require a change of focus to increasing the supply of doctors and access to hospitals. If data on maternal death is collected in a subsequent census, future research using two waves of census data would prove a useful validation of the results found here. Similar research using census data from other countries is also likely to be fruitful.

Mucinous adenocarcinoma of the fallopian tube is exceptionally rare and the detailed clinicopathologic features of these tumors have not yet been reported in English literature. Here we report a moderately differentiated mucinous adenocarcinoma arising in the tubal fimbria in a 70-year-old woman. Patient had a history of cholecystectomy for gallstones and gastric banding who presented with gastrointestinal discomfort and was found to have a large adnexal mass on imaging studies. Serum CA-125 was moderately elevated. Recent mammography, upper endoscopy and colonoscopy were completely normal. She underwent surgical staging for the adnexal mass. Frozen section and final pathology diagnosis revealed moderately differentiated adenocarcinoma arising in the left fimbria. Carcinoma had spread to the ipsilateral ovary and pelvic soft tissue at the time of her presentation. Tumor was strongly immunoreactive to CK7 and CEA, and was negative for CK20, CDX-2, PAX-8, WT-1, p16, ER, and vimentin. TP53 showed wild-type phenotype by immunohistochemistry. Molecular studies showed no mutation in codon 12 and 13 of the k-ras gene, and no mutation was detected in the BRAF and EGFR genes. In addition, the non-tumorous fimbria epithelium showed a spectrum of mucinous alterations with variable nuclear atypia: cytologically bland areas that were reminiscent of mucinous metaplasia were positive for p53 and showed minimal proliferation as assessed by Ki-67, and cytologically atypical stratified mucinous epithelium that was positive for p53 and Ki-67. The patient received 3 cycles of Folfox and was regularly followed at a 3–6 month interval. Her carcinoma recurred in abdomen at 32 months post surgery. After excluding the possibility of an extra-gynecologic tract primary through extensive clinical investigations and post-surgical follow-up, we concluded that this tumor most likely represented a mucinous adenocarcinoma of tubal origin.

e16546 Background: Carboplatin sensitivity in drug resistance assays has been shown to be an independent predictor of longer progression free interval with conflicting results in overall survival. We evaluated in vitro drug resistance for carboplatin and paclitaxel combination and its correlation with progression free survival (PFS) and overall survival (OS). Methods: From April 1, 2006 to December 12, 2011, in vitro drug resistance assays were sent after cytoreductive surgery for primary epithelial ovarian cancer. Patients were analyzed according to drug resistance scoring system of low drug resistance (S), intermediate drug resistance (I), and extreme drug resistance (R). Retrospective chart review was performed to evaluate PFS and OS. The Kaplan Meier product limit method was used to estimate OS and PFS. Survival curves were compared between groups using the log rank test. Results: From a total of 142 patients: 57 were S, 52 I, and 33 R; 77% were responsive (S+I) to carboplatin and paclitaxel combination. At median follow-up of 18 months, PFS and OS rates were 58.1 and 91.3% respectively for S, 66.1 and 78.7% for I, and 43.2% and 84.3% for R. At 36 months, the PFS and OS rates were 52.3 and 61.1% for S, 51.3 and 55.3% for I and 39.3% and 48.7% for R. There was OS advantage between the S and I compared to R. There were no significant differences in PFS curves (p