Pediatric Index of Mortality 2 as a predictor of death risk in children admitted to pediatric intensive care units in Latin America: A prospective, multicenter study.

PURPOSE: The purpose of this study is to asses the performance of the Pediatric Index of Mortality 2 (PIM2) score in pediatric intensive care units (PICUs) in Latin America. MATERIALS AND METHODS: This is a prospective, observational, multicenter study. We included patients aged 1 month to 16 years old admitted consecutively during 1 year to 34 PICUs in 9 Latin American countries. Discrimination and calibration tests were performed to validate the performance of PIM2 in the entire sample and in different subgroups. RESULTS: A total of 7391 patients were analyzed. Pediatric Index of Mortality 2 predicted 573 deaths, whereas the observed deaths were 663 (P < .001). The area under the receiver operating characteristic curve for the entire population was 0.817 (95% confidence interval, 0.808-0.825). The score showed good discrimination. Instead, calibration was inadequate. The difference between observed and predicted deaths for the entire population and across different risk intervals was statistically significant (χ(2) = 121.87; df = 8; P < .001). Pediatric Index of Mortality 2 did not predict mortality correctly in different diagnostic categories (injury, postoperative, and miscellaneous), in children younger than 12 months, adolescents, and patients with chronic complex conditions. CONCLUSIONS: Pediatric Index of Mortality 2 showed good discrimination, but calibration was inadequate. To use PIM2 for monitoring PICU performance in Latin America, it might be necessary to recalibrate the score locally.

Secuencia de hipokinesia fetal (Fenotipo de Pena-shokeir tipo 1). Sobrevida y calidad de vida. Enfoque multidisciplinario / Fetal akinesia deformation sequence (type I Pena Shokeir phenotype). Survival and quality of life

La secuencia de hipoquinesia fetal fue descripta en1974 como un síndrome caracterizado por múltiplesarticulaciones anquilosadas, anomalías facialese hipoplasia pulmonar, secundario a una alteraciónde las neuronas motoras. A través de los añosse vio que el síndrome es una entidad heterogéneaasociada a disminución de la movilidad fetal (miogénica,neurogénica, funcional, isquémica, anóxica).La mayoría de los pacientes mueren intraútero o enel período neonatal por complicaciones de su hipoplasiapulmonar. Se presenta el caso de una niñacon esta patología, que tiene actualmente 4 años y5 meses y vive en su hogar con cuidados especiales.Su supervivencia se logró con cuidados intensivosdurante el primer año, cuando la morbilidad pulmonarfue muy grave. Luego, el trabajo de unequipo multidisciplinario permitió su reinserciónfamiliar y social con adecuada calidad de vida

Transdermal delivery of piroxicam using microemulsions.

To improve the skin permeability of piroxicam, a new oil-in-water microemulsion containing 0.5% piroxicam was developed. Among various oils investigated for their suitability as an oil phase for the microemulsion system, oleic acid showed both excellent solubility and skin permeation enhancing effect for piroxicam. Microemulsion existence ranges were identified through the construction of the pseudo-ternary phase diagram. The effect of the content of oleic acid and the ratio of the surfactant/cosurfactant on skin permeation of piroxicam were evaluated with excised rat skins. The optimum formulation with the highest skin permeation rate (47.14 microg/cm2/h) consisted of 0.5% piroxicam, 10% oleic acid, 60% Labrasol/ethanol (1:5) and water.