The occurrence of adverse events is associated with increased morbidity and mortality in children admitted to a single pediatric intensive care unit.

Healthcare can cause harm. The goal of this study is to evaluate the association between the occurrence of adverse events (AEs) and morbidity-mortality in critically ill children. A prospective cohort study was designed. All children admitted to the Pediatric Intensive Care Unit (PICU) between August 2016 and July 2017 were followed. An AE was considered any harm associated with a healthcare-related incident. AEs were identified in two steps: first, adverse clinical incidents (ACI) were recognized through direct observation and active surveillance by PICU physicians, and then the patient safety committee evaluated every ACI to define which would be considered an AE. The outcome was hospital morbidity-mortality. There were 467 ACI registered, 249 (53.31%) were considered AEs and the rate was 4.27/100 patient days. From the 842 children included, 142 (16.86%) suffered AEs, 39 (4.63%) experienced morbidity-mortality: 33 (3.92%) died, and 6 (0.71%) had morbidity. Multivariate analysis revealed that the occurrence of AEs was significantly associated with morbidity-mortality, OR 5.70 (CI95% 2.58-12.58, p = 0.001). This association was independent of age and severity of illness score.Conclusion: Experiencing AEs significantly increased the risk of morbidity-mortality in this cohort of PICU children.What is Known:• Many children suffer healthcare-associated harm during pediatric intensive care hospitalization.What is New:• This prospective cohort study shows that experiencing adverse events during pediatric intensive care hospitalization significantly increases the risk of morbidity and mortality independent of age and severity of illness at admission.

Incidence of morbidity and associated factors in a Pediatric Intensive Care Unit. / Incidencia de morbilidad y factores asociados en una Unidad de Cuidados Intensivos Pediátrica.

Introduction: The Functional Status Scale (FSS) was developed to measure acquired morbidity in pediatric patients. Objective: To estimate the incidence of acquired morbidity in the pediatric intensive care unit (PICU) and the presence of associated factors, and describe functional status after hospital discharge. Population and methods: Prospective cohort. All PICU admissions between August 2016 and July 2017. The FSS was used to measure acquired morbidity during hospitalization and up to 1 year after discharge. A univariate analysis was performed to investigate morbidity-associated factors. Results: A total of 842 patients were included. The incidence of morbidity at the PICU was 3.56 % (30/842) and persisted at 0.7 % for the entire cohort at hospital discharge (6/842). Within 1 year after discharge, the functional status of 3/6 patients improved. The univariate analysis showed an association between acquired morbidity at the PICU and the PIM2 score (odds ratio [OR]: 1.04; 95 % confidence interval [CI]: 1.01-1.07; p = 0.007), age younger than 1 year (OR: 2.93; 95 % CI: 1.36-6.15; p = 0.004), the use of assisted mechanical ventilation (AMV) (OR: 7.83; 95 % CI: 3.31-18.49; p = 0.0001) and central venous catheter (CVC) (OR: 38.08; 95 % CI: 5.16-280.95; p = 0.0001), and prolonged hospital stays (OR: 9.65; 95 % CI: 4.33-21.49; p = 0.0001). Conclusions: The incidence of morbidity was 3.56 % and was associated with an age younger than 1 year, patient severity at the time of admission, the use of AMV and CVC, and prolonged hospital stays.

Introducción. La escala de estado funcional (FSS, por su sigla en inglés) fue desarrollada para medir la morbilidad adquirida en los pacientes pediátricos. Objetivo. Estimar la incidencia de morbilidad adquirida en la unidad de cuidados intensivos pediátrica (UCIP), la presencia de factores asociados y describir el estado funcional tras el alta hospitalaria. Población y métodos. Cohorte prospectiva. Todas las admisiones en UCIP entre agosto de 2016 y julio de 2017. Se utilizó FSS para medir la morbilidad adquirida durante la hospitalización y hasta 1 año después del alta. Se realizó un análisis univariado para investigar los factores asociados con morbilidad. Resultados. Se incluyeron 842 pacientes. La incidencia de morbilidad en UCIP fue del 3,56 % (30/842) y persistió en el 0,7 % de toda la cohorte al alta hospitalaria (6/842). Antes del año, 3 de los 6 pacientes mejoraron la condición funcional. El análisis univariado mostró asociación entre la morbilidad adquirida en UCIP y el puntaje PIM2 (odds ratio [OR, por su sigla en inglés]: 1,04; intervalo de confianza del 95 % [IC95 %]: 1,01- 1,07; p = 0,007), la edad menor a 1 año (OR: 2,93; IC95 %: 1,36-6,15; p = 0,004), el uso de asistencia respiratoria mecánica (ARM) (OR: 7,83; IC95 %: 3,31-18,49; p = 0,0001) y de catéteres venosos centrales (CVC) (OR: 38,08; IC95 %: 5,16-280,95; p = 0,0001), y hospitalizaciones prolongadas (OR: 9,65; IC95 %: 4,33-21,49; p = 0,0001). Conclusiones. La incidencia de morbilidad fue del 3,56 % y se asoció con la edad menor a 1 año, la gravedad de los pacientes al momento de la admisión, el uso de ARM y CVC, y las hospitalizaciones prolongadas.

Incidencia de morbilidad y factores asociados en una Unidad de Cuidados Intensivos Pediátrica / Incidence of morbidity and associated factors in a Pediatric Intensive Care Unit

Introducción. La escala de estado funcional (FSS, por su sigla en inglés) fue desarrollada para medir la morbilidad adquirida en los pacientes pediátricos. Objetivo. Estimar la incidencia de morbilidad adquirida en la unidad de cuidados intensivos pediátrica (UCIP), la presencia de factores asociados y describir el estado funcional tras el alta hospitalaria. Población y métodos. Cohorte prospectiva. Todas las admisiones en UCIP entre agosto de 2016 y julio de 2017. Se utilizó FSS para medir la morbilidad adquirida durante la hospitalización y hasta 1 año después del alta. Se realizó un análisis univariado para investigar los factores asociados con morbilidad. Resultados. Se incluyeron 842 pacientes. La incidencia de morbilidad en UCIP fue del 3,56 % (30/842) y persistió en el 0,7 % de toda la cohorte al alta hospitalaria (6/842). Antes del año, 3 de los 6 pacientes mejoraron la condición funcional. El análisis univariado mostró asociación entre la morbilidad adquirida en UCIP y el puntaje PIM2 (odds ratio [OR, por su sigla en inglés]: 1,04; intervalo de confianza del 95 % [IC95 %]: 1,01-1,07; p = 0,007), la edad menor a 1 año (OR: 2,93; IC95 %: 1,36-6,15; p = 0,004), el uso de asistencia respiratoria mecánica (ARM) (OR: 7,83; IC95 %: 3,31-18,49; p = 0,0001) y de catéteres venosos centrales (CVC) (OR: 38,08; IC95 %: ,16-280,95; p = 0,0001), y hospitalizaciones prolongadas (OR: 9,65; IC95 %: 4,33-21,49; p = 0,0001). Conclusiones. La incidencia de morbilidad fue del 3,56 % y se asoció con la edad menor a 1 año, la gravedad de los pacientes al momento de la admisión, el uso de ARM y CVC, y las hospitalizaciones prolongadas

Introduction. The Functional Status Scale (FSS) was developed to measure acquired morbidity in pediatric patients. Objective. To estimate the incidence of acquired morbidity in the pediatric intensive care unit (PICU) and the presence of associated factors, and describe functional status after hospital discharge. Population and methods. Prospective cohort. All PICU admissions between August 2016 and July 2017. The FSS was used to measure acquired morbidity during hospitalization and up to 1 year after discharge. A univariate analysis was performed to investigate morbidity-associated factors. Results. A total of 842 patients were included. The incidence of morbidity at the PICU was 3.56 % (30/842) and persisted at 0.7 % for the entire cohort at hospital discharge (6/842). Within 1 year after discharge, the functional status of 3/6 patients improved. The univariate analysis showed an association between acquired morbidity at the PICU and the PIM2 score (odds ratio [OR]: 1.04; 95 % confidence interval [CI]: 1.01-1.07; p = 0.007), age younger than 1 year (OR: 2.93; 95 % CI: 1.36-6.15; p = 0.004), the use of assisted mechanical ventilation (AMV) (OR: 7.83; 95 % CI: 3.31-18.49; p = 0.0001) and central venous catheter (CVC) (OR: 38.08; 95 % CI: 5.16-280.95; p = 0.0001), and prolonged hospital stays (OR: 9.65; 95 % CI: 4.33-21.49; p = 0.0001). Conclusions. The incidence of morbidity was 3.56 % and was associated with an age younger than 1 year, patient severity at the time of admission, the use of AMV and CVC, and prolonged hospital stays

Cumulus Cell Mitochondrial Resistance to Stress In Vitro Predicts Oocyte Development During Assisted Reproduction.

CONTEXT: Complex cumulus cell-oocyte interactions govern energy utilization during oocyte development. OBJECTIVE: This study investigates the relationship of cumulus cell mitochondria with oocyte development during ovarian stimulation for in vitro fertilization (IVF). DESIGN: This is a prospective cohort study. SETTING: The setting was an academic center. PATIENTS: Thirty women underwent ovarian stimulation for IVF. INTERVENTION(S): Pooled cumulus cells were collected; numbers of total and mature oocytes and two-pronuclear (day 1), six- to eight-cell cleavage (day 3), and blastocyst (day 5) embryos were recorded. MAIN OUTCOME MEASURE(S): A mitochondrial bioassay was developed with Jurkat cells and used with cumulus cells from IVF patients to correlate mitochondrial membrane potential resistance to carbonyl cyanide 3-chlorophenylhydrazone (CCCP) stress with oocyte development and embryogenesis. RESULTS: Adjusting for FSH administered and maternal age, cumulus cell mitochondrial membrane potential resistance to CCCP positively correlated with numbers of total (P < .025) and mature (P < .025) oocytes retrieved. The highest oocyte numbers that correlated with cumulus cell mitochondrial membrane potential occurred in women with the greatest ovarian response to FSH (mitochondrial membrane potential resistance to CCCP-log FSH interactions: total oocytes P < .025; mature oocytes P < .05). Multiple regression modeling of mature oocyte numbers, age, and cumulus cell mitochondrial membrane potential resistance to CCCP showed that numbers of mature oocytes best correlated with numbers of embryos at all stages (P < .0001). CONCLUSION: During ovarian stimulation for IVF, cumulus cell mitochondrial membrane potential resistance to stress correlates with numbers of total and mature oocytes retrieved, suggesting that cumulus cell-oocyte interactions involving energy facilitate oocyte development.

Psychosocial adaptation and cellular immunity in breast cancer patients in the weeks after surgery: An exploratory study.

BACKGROUND: The period just after surgery for breast cancer requires psychosocial adaptation and is associated with elevated distress. Distress states have been associated with decreased cellular immune functioning in this population, which could have negative effects on physical recovery. However, little is known about relations between psychological status [negative and positive mood states and overall quality of life (QOL)] and cellular signaling cytokines that could account for these associations in women undergoing treatment for breast cancer. METHODS: The present study examined associations between psychological adaptation indicators (mood, QOL) and T-helper cell type 1 (Th1) cytokine production from stimulated peripheral mononuclear cells in women who had recently undergone surgery for early-stage breast cancer but had not yet begun adjuvant therapy. These associations were evaluated while controlling for relevant disease/treatment, sociodemographic, and health behavior covariates. RESULTS: Lower anxiety related to greater production of the Th1 cytokine interleukin-2 (IL-2), while greater positive mood (affection) related to greater production of the Th1 cytokines IL-12 and interferon-gamma (IFN-gamma). Better QOL related to greater production of the Th1 cytokine, tumor necrosis factor-alpha (TNF-alpha). CONCLUSION: Individual differences in psychosocial adaptation in women with breast cancer during the period after surgery relate to biological parameters that may be relevant for health and well-being as they move through treatment.

Tristetraprolin, a negative regulator of mRNA stability, is increased in old B cells and is involved in the degradation of E47 mRNA.

We have previously shown that the E2A-encoded transcription factor E47, which regulates class switch in splenic B cells, is down-regulated in old B cells, due to increased E47 mRNA decay. At least part of the decreased stability of E47 mRNA seen in aged B cells is mediated by proteins. We have herein looked at the specific proteins responsible for the degradation of the E47 mRNA and found that tristetraprolin (TTP), a physiological regulator of mRNA expression and stability, is involved in the degradation of the E47 mRNA. Although many studies have characterized TTP expression and function in macrophages, monocytes, mast cells, and T cells, little is known about the expression and function of TTP in primary B cells. We show herein that TTP mRNA and protein expression are induced by LPS in B cells from young and old mice, the levels of TTP in old B cells always being higher than those in young B cells. Although TTP mRNA is degraded at a significantly higher rate in old B cells, TTP mRNA expression is higher in old than in young, likely due to its increased transcription. Like in macrophages, TTP protein expression and function in B cells are dependent upon p38 MAPK. We found that there is less phospho-TTP (inactive form), as well as phospho-p38, in old than in young splenic-activated B cells. This is the first report showing that TTP is involved in the degradation of the E47 mRNA and is up-regulated in old B cells.

Síndrome de Poland-Moebius: presentación de un caso clínico / Syndrome Poland-Moebius: presentation of a clinical case

El síndrome de Poland es infrecuente, más aun cuando esta asociado al síndrome de Moebius (15 por ciento), pertenece al grupo de enfermedades raras, una incidencia de 1/7000 a 1/100000 nacidos vivos. La etiopatogenia es desconocida, se plantea una disrupción vascular con disminución de aporte sanguíneo durante la morfogénesis. Se caracteriza por presentar hipoplasia o agenesia del músculo pectoral mayor, simbraquidactilia ipsilateral y afectación de los pares craneales VI y VII, pueden afectarse otros pares craneales. Se trata de un escolar de 9 años, sin antecedentes patológicos; quien desde su nacimiento presenta hipoplasia de pectoral mayor con hipoplasia y ubicación elevada del pezón del lado izquierdo, y simbraquidactilía de mano ipsilateral. También se evidencia parálisis facial y estrabismo convergente derecho; afectación del nervio hipogloso. Las características de presentación difieren en algunos aspectos con lo descrito en la literatura, se presenta del lado izquierdo, cuando en la afectación de Poland un 70 por ciento es del lado derecho. El desarrollo psicomotor no es adecuado; no esta descrito retraso ni alteraciones mentales. Se encontró que en la literatura no relacionan la arteria vertebral con la posible explicación de la asociación Poland-Moebius. En conclusión la mayoría de médicos no conocen sobre este tipo de patología y frecuentemente tardan meses o incluso años en averiguarlo. Un diagnóstico precoz proporcionaría como mínimo unos tratamientos paliativos o acceso a servicios y beneficios necesarios para mejorar la calidad de vida. El manejo debe ser multidisciplinario.