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Failure to Rescue as a Quality Metric in Congenital Heart Surgeries in a High-Complexity Service Provider Institution Located in a Middle-Income Country

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Congenital Heart Disease 2024年第2期19卷 207-218页

作者： Gustavo Cruz Santiago Pedroza Juan F.Vélez Jessica Largo Juan F.Tejada Jorge H.Mejía-Mantilla Departamento de Anestesiología Fundación Valle del LiliCali760032Colombia Centro de Investigaciones Clínicas Fundación Valle del LiliCali760032Colombia Departamento de Cardiología pediátrica Fundación Valle del LiliCali760032Colombia Facultad de Medicina Universidad IcesiCali760031Colombia Unidad de Cuidado Intensivo Fundación Valle del LiliCali760032Colombia

Background:Failure to rescue has been an effective quality metric in congenital heart surgery.Conversely,mor-bidity and mortality depend greatly on non-modifiable individual factors and have a weak correlation with better-quality performance.We aim to measure the complications,mortality,and risk factors in pediatric patients undergoing congenital heart surgery in a high-complexity institution located in a middle-income country and compare it with other institutions that have conducted a similar study.Methods:A retrospective observational study was conducted in a high-complexity service provider institution,in Cali,Colombia.All pediatric patients undergoing any congenital heart surgery between 2019 and 2022 were included.The main outcomes evaluated in the study were complication,mortality,and failure to rescue rate.Univariate and multivariate logistic regression analysis was performed with mortality as the outcome variable.Results:We evaluated 308 congenital heart sur-geries.Regarding the outcomes,201(65%)complications occurred,23(7.5%)patients died,and the FTR of the entire cohort was 11.4%.The presence of a postoperative complication(OR 14.88,CI 3.06–268.37,p=0.009),age(OR 0.79,CI 0.57–0.96,p=0.068),and urgent/emergent surgery(OR 8.14,CI 2.97–28.66,p<0.001)were the most significant variables in predicting mortality.Conclusions:Failure to rescue is an effective and comparable quality measure in healthcare institutions and is the major contributor to postoperative mortality in congenital heart surgeries.Despite our higher mortality and complication rate,we obtained a comparable failure to rescue rate to high-income countries’health institutions.

关键词： Congenital heart surgery complication mortality failure to rescue quality metric

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Encephalitis with convulsive status in an immunocompetent pediatric patient caused by Bartonella henselae

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Asian Pacific Journal of Tropical Medicine 2016年第6期9卷 591-594页

作者： Rosario Cerpa Polar Gabriela Orellana Wilmer Silva Caso José Sánchez Carbonel Javier Santisteban Juana del Valle Mendoza Javier Santisteban infectogía pediátrica Servicio de Pediatría Especializada Hospital Edgardo Rebagliati Martins Neurologia pediátrica Hospital Edgardo Rebagliati Martins School of Medicne Faculty of Health Sciences Universidad Peruana de Ciencias Aplicadas Faculty of Health Sciences Research Center of the Faculty of Health Sciences Universidad Peruana de Ciencias Aplicadas Clínica pediatrica Hospital Edgardo Rebagliati Martins

Cat scratch's disease caused by Bartonella henselae, is known to be a self-limited benign process in immunocompetent children. The association with neurologic manifestations is very uncommon especially in patient with no immunologic defects and in cases without specific treatment. A 7 years old male patient, without any immunocromised defect, presented an atypic presentation of the cat scratch disease. The patient came to the hospital in two opportunities in a status epilepticus, in both cases the diagnosis was encephalitis by Bartonella henselae and the evolution with treatment was monitored with PCR(polymerase chain reaction) in cerebrospinal fluid and blood, as well as IFI(IgM, IgG) serology(indirect immunofluorescence). The patient had a favorable clinical and laboratory evolution for 6 months showing no recurrence of the disease.

关键词： Bartonella henselae Encephalitis Immunocompetent pediatric patient Convulsive status Cat scratch’s disease

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Healthcare staff as promoters of parental presence at anesthetic induction:Net Promoter Score survey

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World Journal of Clinical pediatrics 2021年第6期10卷 159-167页

作者： María Velayos Karla Estefanía María Alvarez María C Sarmiento Lucas Moratilla Pascual Sanabria Francisco Hernández Manuel V López Santamaría Servicio de Cirugía pediátrica Hospital Universitario La PazMadrid 28046Spain Servicio de Anestesia y Reanimación Infantil Hospital Universitario La PazMadrid 28046Spain

BACKGROUND Surgical intervention is usually a traumatic event that causes stress and anxiety in the pediatric patient and the family environment.To reduce the harmful effects of presurgical anxiety,parental presence during induction of anesthesia(PPIA)is one of the more notable interventions used in medical centers.However,data on this measure are difficult to evaluate and often face resistance from healthcare staff.AIM To analyze the perception of the healthcare workers after the implementation of a PPIA program.METHODS A survey was developed and sent by email to all the healthcare staff working in the children’s area of a tertiary hospital.It consisted of 14 items divided into positive aspects of PPIA and negative aspects of PPIA evaluated with the use of a Likert scale(1 to 5).The demographics of the respondents were included in the data collected.The answers to the questions were interpreted through the Net Promoter Score(NPS).The statistical analysis compared the differences in the responses to each question of the survey made by the different groups of health personnel included.RESULTS A total of 141 surveys were sent out,with a response rate of 69%.Of the total number of responses,68%were from women and 32%from men.The average age of the participants was 42.3±10.6 years.As for the positive questions about the PPIA,83%had an NPS>50,and only one had a score between 0 and 50,which means that the quality of the service was rated as excellent or good by 100%of the respondents.On the other hand,100%of the negative questions about the PPIA had a negative NPS.Responses to the question“PPIA increases patient safety”were significantly different(P=0.037),with a lower percentage of pediatric surgeons(70%)thinking that PPIA increased patient safety,compared with anesthesiologists(90%),nursing(92%),and other medical personnel(96%).CONCLUSION The personnel who participated in the PPIA program at our center were in favor of implementation.There were no validated arguments to support worker resistance to the development of

关键词： Parental presence Survey Anesthesia induction Patient-centered care Anxiety Surgery

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Analysis of orthopedic surgical procedures in children with cerebral palsy

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World Journal of Orthopedics 2020年第4期11卷 222-231页

作者： Ignacio Rehbein Viviana Teske Ignacio Pagano Alejandro Cúneo María Elena Pérez Johan von Heideken Clínica de Traumatología y Ortopedia pediátrica Facultad de MedicinaUniversidad de la RepúblicaMontevideo 11200Uruguay Department of Women’s and Children’s Health Karolinska InstitutetKarolinska University HospitalStockholm 17177Sweden

BACKGROUND Orthopedic surgery in children with cerebral palsy(CP)aims to improve function and prevent deformities.Each child’s condition in CP is unique and many covariables influence surgical decision-making including a patient's age and their functional level.Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels,particularly in countries from Latin America.AIM To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP.METHODS This retrospective study included all children with CP(n=245)treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database.Eighteen children(7%)were lost to follow-up due to missing medical charts.Demographics,gross motor function classification(GMFCS),and orthopedic surgeries were obtained from the medical records of 227 children.Chi-squared tests and analysis of variance were used to assess the frequency of surgery,accounting for GMFCS levels.Mean age for soft tissue vs bone surgery was compared with the independent samples t-test.RESULTS A total of 711 surgical procedures were performed between 1998 and 2016.On average,children had 3.1 surgical procedures and the mean age at first surgery was 8.0 years.There were no significant differences in age at first surgery among GMFCS levels(P=0.47).The most common procedures were lower leg soft tissue surgery(n=189,27%),hip tenotomy(n=135,19%),and hamstring tenotomy(n=104,14%).For children with GMFCS level Ⅰ,the mean number of surgeries per child[1.8(range 1-9)]differed significantly at P<0.05 in children with GMFCS levels Ⅱ[3.2(1-12)],Ⅲ[3.2(1-8)],Ⅳ[3.3(1-13)],and Ⅴ[3.6(1-11)].Within Ⅱ,Ⅲ,Ⅳ,and Ⅴ,there was no significant difference in mean number of surgeries per child when comparing across the groups.The proportion of soft tissue surgery vs bone surgery was higher in GMFCS levels Ⅰ-Ⅲ(80%-85%)compared to levels IV(68%)and V(55%)(P<

关键词： Children Cerebral palsy Gross Motor Function Classification System Surgery Epidemiology

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Type 1 diabetes loci display a variety of native American and African ancestries in diseased individuals from Northwest Colombia

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World Journal of Diabetes 2019年第11期10卷 534-545页

作者： Natalia Gomez-Lopera Juan M Alfaro Suzanne M Leal Nicolas Pineda-Trujillo Departamento de pediatría Facultad de MedicinaUniversidad de AntioquiaMedellín 050010470Colombia Sección de Endocrinología pediátrica Departamento de PediatríaFacultad de MedicinaUniversidad de AntioquiaMedellín 050010470Colombia Center for Statistical Genetics Columbia UniversityNew YorkNY 10032United States

BACKGROUND Type 1 diabetes(T1D)is a complex disease with a higher incidence in Europeans than other populations.The Colombians Living in Medellin(CLM)is admixed with ancestry contributions from Europeans,Native Americans(NAT)and Africans(AFR).AIM Our aim was to analyze the genetic admixture component at candidate T1D loci in Colombian individuals with the disease.METHODS Seventy-four ancestry informative markers(AIMs),which tagged 41 T1D candidate loci/genes,were tested by studying a cohort of 200 Northwest Colombia diseased individuals.T1D status was classified by testing for glutamic acid decarboxylase(GAD-65 kDa)and protein tyrosine-like antigen-2 autoantibodies in serum samples.Candidate loci/genes included HLA,INS,PTPN22,CTLA4,IL2RA,SUMO4,CLEC16A,IFIH1,EFR3B,IL7R,NRP1 and RNASEH1,amongst others.The 1,000 genome database was used to analyze data from 94 individuals corresponding to the reference CLM.As the data did not comply with a normal distribution,medians were compared between groups using the Mann-Whitney U-test.RESULTS Both T1D patients and individuals from CLM displayed mainly European ancestry(61.58 vs 62.06)followed by Native American(27.34 vs 27.46)and to a lesser extent the AFR ancestry(10.28 vs 10.65)components.However,compared to CLM,ancestry of T1D patients displayed a decrease of NAT ancestry at gene EFR3B(24.30 vs 37.10)and an increase at genes IFIH1(32.07 vs 14.99)and IL7R(52.18 vs 39.18).Also,for gene NRP1(36.67 vs 0.003),we observed a non-AFR contribution(attributed to NAT).Autoimmune patients(positive for any of two auto-antibodies)displayed lower NAT ancestry than idiopathic patients at the MHC region(20.36 vs 31.88).Also,late onset patients presented with greater AFR ancestry than early onset patients at gene IL7R(19.96 vs 6.17).An association analysis showed that,even after adjusting for admixture,an association exists for at least seven such AIMs,with the strongest findings on chromosomes 5 and 10(gene IL7R,P=5.56×10-6 and gene NRP1,P=8.70×10-19,respectively).CONCLUSION Although Colom

关键词： Type 1 diabetes Genetic admixture Native American Idiopathic Colombia

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Hepatocyte cryopreservation:Is it time to change the strategy?

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World Journal of Gastroenterology 2010年第1期16卷 1-14页

作者： Xavier Stéphenne Mustapha Najimi Etienne M Sokal Catholic University of Louvain and St Luc Clinics Paediatric Department(HPED)PEDI unitLaboratory of Paediatric Hepatology and Cell Therapy

Liver cell transplantation presents clinical benefit in patients with inborn errors of metabolism as an alternative,or at least as a bridge,to orthotopic liver transplantation.The success of such a therapeutic approach remains limited by the quality of the transplanted cells.Cryopreservation remains the best option for long-term storage of hepatocytes,providing a permanent and sufficient cell supply.However, isolated adult hepatocytes are poorly resistant to such a process,with a significant alteration both at the morphological and functional levels.Hence,the aim of the current review is to discuss the state of the art regarding widely-used hepatocyte cryopreservation protocols,as well as the assays performed to analyse the post-thawing cell quality both in vitro and in vivo. The majority of studies agree upon the poor quality and efficiency of cryopreserved/thawed hepatocytes as compared to freshly isolated hepatocytes.Intracellular ice formation or exposure to hyperosmotic solutionsremains the main phenomenon of cryopreservation process,and its effects on cell quality and cell death induction will be discussed.The increased knowledge and understanding of the cryopreservation process will lead to research strategies to improve the viability and the quality of the cell suspensions after thawing.Such strategies,such as vitrification,will be discussed with respect to their potential to significantly improve the quality of cell suspensions dedicated to liver cell-based therapies.

关键词： Hepatocyte Cryopreservation Quality Mitochondria Intracellular ice formation

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<i>Streptococcus pneumoniae</i>Upper Respiratory Carriage in Costa Rican Children with Otitis Media before the Introduction of the Heptavalent Conjugated Vaccine in the National Immunization Program

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World Journal of Vaccines 2013年第2期3卷 39-45页

作者： Catalina Ulloa Alfonso Pereira Carolina Soley Nurith Porat Arturo Abdelnour Ron Dagan Adriano Arguedas Instituto de Atención pediátrica San José Costa Rica Instituto de Atención pediátrica San José Costa Rica Universidad de Ciencias Médicas San José Costa Rica pediatric Infectious Disease Unit Soroka University Medical Center and the Faculty of Health Sciences Ben-Gurion University of the Negev Beer-Sheva Israel

Objective: The aim of this study was to analyze the NP/OP S. pneumoniae serotype distribution and potential vaccine coverage in Costa Rican children with Otitis Media (OM) before the introduction of PCV-7 in the National Immunization Program (NIP). Methods: Between 2002 and 2006, NP and OP samples were obtained from 641 children from 6 to 79 months of age, at the time of OM diagnosis. S. pneumoniae serotyping and antimicrobial susceptibility were performed. Results: 386 S. pneumoniae isolates were recovered. The most common S. pneumoniae serotypes (ST) were: ST 6B, ST 14, ST 19F. Penicillin non-susceptibility was observed among 57% of the isolates obtained from children 24 months of age. Antibiotic non-susceptibility and MDR were significantly higher in children <24 months of age. This study demonstrates that PCV-13 offers the highest potential vaccine coverage and serves to assess the impact of introduction of one of the conjugated vaccines in the NIP in Costa Rica.

关键词： Streptococcus pneumoniae Serotypes Nasopharynx Oropharynx Pneumococcal Conjugated Vaccine

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Investigation of possible relationship between atopic dermatitis and salivary biomarkers,stress,and sleep disorders

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World Journal of Clinical Cases 2023年第17期11卷 3958-3966页

作者： Juliany Estefan Dennis de Carvalho Ferreira Fernanda Sampaio Cavalcante Kátia Regina Netto dos Santos Marcia Ribeiro Dermatologia pediátrica Universidade Federal do Rio de JaneiroRio de Janeiro 21941630Brazil Faculdade de Enfermagem Departamento de Fundamentos de EnfermagemUniversidade do Estado do Rio de JaneiroRio de Janeiro 20551030Brazil Departamento de Clínica Médica Instituto de Ciências MédicasUniversidade Federal do Rio de JaneiroCampus MacaéRio de Janeiro 27930-560Brazil Departamento de Microbiologia Médica Instituto de Microbiologia Paulo de GóesUniversidade Federal do Rio de JaneiroRio de Janeiro 21941630Brazil Genética médica Instituto de Puericultura e Pediatria Martagão Gesteira/Universidade Federal do Rio de JaneiroRio de Janeiro 21941630Brazil

Atopic dermatitis(AD)is a chronic,relapsing,multifactorial inflammatory disease with genetic,environmental,and immunological characteristics.The quality of life and sleep of patients and their families are affected by AD,which triggers stress,described as one of the factors that worsens AD.Salivary biomarkers such as cortisol,alpha-amylase,chromogranin A,and melatonin have been associated with stress and sleep disturbances.Therefore,the evaluation of stress and sleep disorders using salivary biomarkers in AD patients is important.This review aims to describe the possible relationship between atopic dermatitis and stress,sleep disorders,and salivary biomarkers,seeking to contribute to better understanding and clinical management of AD.This descriptive study is characterized as a narrative literature review.A literature search was conducted of studies published in English and Portuguese between January 2012 and October 2022 that are available in electronic media from various databases,such as Scientific Electronic Library Online,Latin American and Caribbean Literature on Health Sciences,and PubMed.AD is associated with different degrees of impact on the lives of individuals who present with the disease.Psychological stress may induce changes in saliva composition and worsen AD;at the same time,the severity of the disease may be associated with emotional impact.Further studies are needed to assess and correlate AD severity,stress,and sleep disturbances with salivary biomarkers in order to better understand this association.

关键词： Atopic dermatitis Sleep Psychological stress Chromogranin A Melatonin Cortisol

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Long-Term Impact in the Quality of Life of Patients with Drug-Resistant Epilepsy That Use Cannabidiol

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Neuroscience & Medicine 2021年第4期12卷 103-113页

作者： Gabriela Pesántez Ríos Ignacio Pascual Pascual Ximena Pesántez Ríos Luciana Armijos Estefanía Chediak Hugo Navarrete Zambrano Ruth Jimbo Galo Pesantez Cuesta Servicio de Neurología pediátrica Centro Nacional de Epilepsia Quito Ecuador Universidad Autónoma de Madrid Madrid Espa&#241 a Servicio de Neurología pediátrica Hospital Universitario La Paz Madrid Espa&#241 a Centro de Investigación para la Salud en América Latina (CISeAL) Quito Ecuador Facultad de Medicina Pontificia Universidad Católica del Ecuador Quito Ecuador

Introduction: Epilepsy is considered a chronic neurological condition that manifests itself with seizures, where 30% - 40% of patients do not achieve control of their seizures despite proper management. Seizures represent a significant limitation in the patient’s daily activities and are often accompanied by emotional and relational difficulties that have a great impact on the quality of life of the patient and their families. Cannabidiol (CBD) has been found to be effective in controlling seizures and may also improve cognitive and behavioral abilities. Material and Methods: The Quality of Life of the Patient with Epilepsy (CAVE) scale was applied to patients with refractory epilepsies who use Cannabidiol (CBD) added to their base therapy, before the use of CBD and after 12 months of follow-up. The presentation of collateral effects was also evaluated. Results: Out of 34 patients, 26 (76.5%) increased their CAVE value at the end of the study and only 1 (2.9%) decreased. 19 (55.9%) improved in learning and behavior, 55.8% in the frequency of seizures and 79.4% reported a decrease in the intensity of seizures. There were other positive side effects such as improvement in alertness, language, sleep and behavior. The main side effects were mild and transitory, including drowsiness, and constipation. There was a correlation between the global perception of improvement and seizure control. Conclusions: This study shows that in the long term CBD improves the quality of life of patients with refractory epilepsies, through the control of seizures and the improvement of cognitive and behavioral functions.

关键词： Quality of Life Refractory Epilepsy Cannabidiol

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A functional variant in the CD209 promoter is associated with DQ2-negative celiac disease in the Spanish population

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World Journal of Gastroenterology 2006年第27期12卷 4397-4400页

作者： C Nú■ez B Rueda A Martínez C Maluenda I Polanco MA López-Nevot E Ortega E Sierra E Gómez de la Concha E Urcelay J Martín Servicio de Inmunología Clínica Hospital Clínico San CarlosMadridSpain Instituto de Parasitología y Biomedicina "López Neyra" CSICGranadaSpain Servicio de pediatría Hospital Clínico San CarlosMadrid Spain Servicio de Gastroenterología y Nutrición pediátrica Hospital La PazMadridSpain Servicio de Inmunología Hospital Virgen de las NievesGranadaSpain Servicio de pediatría Hospital Virgen de las NievesGranadaSpain Centro de Investigaciones Biológicas CISCMadridSpain

瞄准：在乳糜泻(CD ) 探讨 CD209 的角色病人。非人类的白血球抗原(HLA ) 在 CD 倾向的基因因素糟糕被理解，并且象传染病原体一样的环境因素可以起一个作用。CD209 是一树枝状并且涉及病原体识别和有免疫力的激活的巨噬细胞表面分子。... 详细信息

瞄准：在乳糜泻(CD ) 探讨 CD209 的角色病人。非人类的白血球抗原(HLA ) 在 CD 倾向的基因因素糟糕被理解，并且象传染病原体一样的环境因素可以起一个作用。CD209 是一树枝状并且涉及病原体识别和有免疫力的激活的巨噬细胞表面分子。最近，在 CD209 基因的倡导者的功能的变体(-336A/G) 被显示了影响 transcriptional CD209 活动在试管内，它与感染的更高的危险性 to/or 严厉被联系了。方法：学习人口由 103 和 386 个 CD 病人和 312 y 的二个盒子控制队组成象 257 个腹的家庭的一块面板一样的 419 健康控制。为 -336A/G CD209 倡导者多型性的 Genotyping 用 TaqMan 5' 被执行突变而产生之遗传的辨别试金。HLA-DQ 被杂交与等位基因 specific 探针决定。结果：开始，盒子控制和家庭研究没与 CD 危险性发现 -336 A/G CD209 基因变体的任何协会。然而，由 HLA-DQ2 的层化确实在 HLA-DQ2 (-) 组揭示了 CD209 倡导者多型性的一个重要协会(在 DQ2 (-) 对 DQ2 (+) 病人的搬运人 A 对 GG (P = 0.026，或 = 3.71 ) 。结论：-336G CD209 等位基因似乎在 HLA-DQ2 (-) 病人涉及 CD 危险性。我们的结果可能在 CD 病人的一个次要的组的发作建议病原体的一个可能的角色。

关键词：腹腔疾病西班牙流行疾病临床

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