Vasopressin as adjunctive therapy in pulmonary hypertension associated with refractory systemic hypotension in term newborns.

OBJECTIVE: The use of vasopressin as an adjunctive therapy in pulmonary hypertension associated with refractory systemic hypotension has increased. The objective of our study is to describe its effects on term infants. STUDY DESIGN: Retrospective observational study. Setting in a referral level IV neonatal intensive care unit from a middle-income region. The patients are term neonates admitted to our NICU who required vasopressin due to severe Pulmonary Hypertension and refractory hypotension during a 49-month period (December 2019 and December 2023). RESULTS: We identified 68 term infants, all in mechanical ventilation, receiving inhaled nitric oxide (iNO), and a phased protocol management for hypotension. Vasopressin was a started at a mean of 2 days with a mean duration of 80 h. Regarding hemodynamic outcome: diastolic, systolic, and median systemic pressure significantly increased during the first 4 h of treatment, as well as arterial pH and urine output. Accordingly, lactate and Vasoactive Inotropic Score (VIS) score decreased after 4 and 8 h, respectively, after vasopressin was started. Regarding oxygenation markers: oxygen requirements and mean airway pressure decreased significantly (and therefore the oxygenation index decreased in concordance) after 4 h of vasopressin. Echocardiographic indices of pulmonary hypertension progressively improved after vasopressin infusion with a significant decrease of tricuspid ingurgitation velocities and the rate of right-to- left ductal shunt through the ductus arteriosus. In the same way, left and right ventricular output increased after the initiation of vasopressin. CONCLUSION: This study showed that the use of vasopressin in neonates with persistent pulmonary hypertension was associated with a rapid and significant improvement in oxygenation and hemodynamic markers of perfusion, including blood pressure. Its effects begin early during the first hours of treatment.

Risk-stratified Results among Congenital Diaphragmatic Hernia Patients in Two Large Extracorporeal Membrane Oxygenation Centers in South America.

INTRODUCTION: Mortality related to CDH is high, but with great variability among centers. There are few studies on patients with this condition born in South America which show poor outcomes. The goal of this study is to present the outcome of CDH in several high-volume quaternary centers in South America, ascertain the factors associated with lower mortality in our population, and compare our outcomes to those of the CDH Study Group (CDHSG). METHODS: The data from two South American centers were retrospectively analyzed and compared with contemporary data from other CDHSG participating centers. Patient demographic and clinical characteristics were also evaluated and compared. RESULTS: Between 2013 and 2018, the two South American centers saw 335 patients with CDH with an overall survival rate of 73.1%. Survival for the high, intermediate, and low-risk groups as determined by the Brindle score was 50%, 70%, and 87%, respectively. In our cohort the strongest predictors of mortality were ECMO use and early PaCO2. There were no significant differences in mortality between the two South American centers and the other CDHSG centers when adjusted by risk score, however, the South American centers had higher use of ECMO in the intermediate-risk group. DISCUSSION: Quaternary South American centers had similar outcomes to CDHSG centers worldwide. The availability and coordination of centralized dedicated care allow more efficient use of scarce technical and professional resources in patients with CDH. LEVEL OF EVIDENCE: III.

Diagnosis of bacteremia in febrile neutropenic episodes in children with cancer: microbiologic and molecular approach.

BACKGROUND: Bacterial isolation using conventional microbiologic techniques rarely surpasses 25% in children with clinical and laboratory findings indicative of an invasive bacterial infection. The aim of this study was to determine the role of real-time polymerase chain reaction (RT-PCR) from whole blood samples compared with automated blood cultures (BC) in detection of relevant microorganisms causing bacteremia in episodes of high-risk febrile neutropenia (HRFN) in children with cancer. METHODS: Children presenting with HRFN at 6 hospitals in Santiago, Chile, were invited to participate. Blood samples were obtained at admission for BC, and at admission and 24 hours for RT-PCR targeting DNA of Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa causing bacteremia in children with HRFN. RESULTS: A total of 177 HRFN episodes were evaluated from May 2009 to August 2010, of which 29 (16.3%) had positive BC, 9 (5%) positive for 1 of the 3 selected bacterial species: 5 for E. coli, 3 for S. aureus, and 1 for P. aeruginosa. RT-PCR detected 39 bacteria in 36 episodes (20%): 14 E. coli, 20 S. aureus, and 5 P. aeruginosa. The sensitivity, specificity, and positive and negative predictive values of RT-PCR compared with BC were 56%, 80%, 13%, and 97%. The final clinical diagnosis was compatible with an invasive bacterial infection in 30/36 (83%) RT-PCR-positive episodes. CONCLUSIONS: In our series, RT-PCR significantly improved detection of the most relevant bacteria associated with HRFN episodes. Large number of patients and close clinical monitoring, in addition to improved RT-PCR techniques will be required to fully recommend RT-PCR-based diagnosis for the routine workup of children with cancer, fever, and neutropenia.

Prevalencia de hábitos, conductas e intereses de estudiantes de medicina de 5 escuelas del país / Prevalence of habits, behaviors and interests among medical students from 5 medical school in Chile

Los estudiantes de medicina dedican gran parte del tiempo a estudiar las materias necesarias para su preparación profesional. Así, logran un adecuado desarrollo de conocimientos científicos y competencias médicas. Sin embargo, los médicos necesitan desarrollar habilidades humanísticas.Su objetivo es conocer prevalencias de hábitos, conductas e intereses de alumnos de medicina de distintas escuelas del país, públicas y privadas, en áreas culturales, recreativas, deportivas, actividades comunitarias y de ayuda social, religiosas, políticas, y trabajos remunerados. Se realizó una encuesta anónima a 299 alumnos de medicina de 5 Universidades del país de primero, tercero, y séptimo año; elegidos al azar, en aspectos antes mencionados. Los datos se analizaron con el programa EpiInfo 2002. Fuman: 31,1 por ciento. Bebe alcohol: 73,91 por ciento. Leen periódicos: 75,59 por ciento, priorizan noticias nacionalesy culturales. Actividades recreativas no deportivas y deportivas más de una vez al mes: 51,2 por ciento y 51,51 por ciento. Un 27,09 por ciento realiza actividades comunitarias, considerándolas importante un 79,26 por ciento. Un 61,54 por ciento manifiesta interés por política, sólo un 55,85 por ciento está inscrito en el Servicio Electoral. Un 71,57 por ciento adhiere a alguna religión, un 70 por ciento se declara católico. No trabaja un 77,93 por ciento, la mayoría por no tener tiempo. Los que trabajan, 62,5 por ciento lo hacen para tener dinero extra.Casi la mitad de los estudiantes de medicina dedica parte de su tiempo a actividades culturales, y a pesar de que la mayoría considera importante para su formación la práctica de actividades comunitarias, pocos las realizan. En las escuelas de medicina no hay un claro incentivo para el desarrollo de las artes y letras, por lo que creemos debe impulsarse la integración de las humanidades médicas en la malla curricular de la carrera de medicina.

Most of their time, medical students are engaged in studying the courses needed for their professional training. Thus, they develop an adequate scientific knowledge and acquire medical skills. However, physicians also need to develop humanistic abilities. The purpose of the present work is to assess the prevalence of habits, behaviors and interests among medical students from different public and private medical schools across the country, considering the areas of culture, leisure, sports, community and social care, religion, politics and paid jobs. An anonymous survey was carried out among 299 randomly selected medical students from5 Chilean Universities who were in the first, the third and the seventh year of their career. Data analysis was performed with EpiInfo 2002. The results were as follows: 31,11 percent were smokers; 73.91 percent drank alcohol; 75.59 percent read the newspapers, favoring national and culture news; 51.2 percent and 51.51 percent performed non-sport leisureand sport activities more than once a month; 27.09 percent were involved in community aid, and 79.26 percent considered such activities as important; 61.54 percent expressed interest in politics, and only 55.85 percent were listed on the electoral roll; 71.57 percent adhered to any religion, 70 percent declared themselves Catholics; 77.93 percent did not work, most of them due to lack of time; among those who worked, 62.5 percent did it to obtain extra money. Almost half of medical students spend part of their time in cultural activities, and although most of the students consider community care as an important factor for their training, very few put into practice such activities. Medical schools do not encourage clearly enough the development of arts and letters, therefore the integration of medical humanities to the medical curriculum should be encouraged.