Preoperative anemia increases the risk of red blood cell transfusion and prolonged hospital length of stay in children undergoing spine arthrodesis surgery.

BACKGROUND: Preoperative anemia is an important modifiable risk factor for red blood cell (RBC) transfusion in a variety of surgical populations. The primary objective of this study was to examine the association between preoperative anemia and i) transfusion of RBCs within 72 hours of surgery and ii) postoperative clinical outcomes in children undergoing spine arthrodesis surgery. STUDY DESIGN AND METHODS: We assembled a retrospective cohort of children included in the American College of Surgeons National Quality Improvement Program Pediatric database who underwent spine arthrodesis surgery from 2012 to 2016. Anemia was defined using age- and sex-specific hematocrit thresholds. Data collected included demographic and surgical characteristics, RBC transfusion within 72 hours, and 30-day postoperative outcomes (postoperative mechanical ventilation, infection, readmission, hospital length of stay, mortality). Multivariable logistic regression analyses were used to identify independent predictors of RBC transfusion and postoperative outcomes. RESULTS: We included 9,095 patients in the analysis. Preoperative anemia was present in 14% (n = 1,233) of the population and 67% (n = 6,135) of patients were transfused. Our multivariable logistic regression showed anemia, surgical time > 350 minutes, > 7 vertebral levels fused, neuromuscular disease, and cerebral palsy were all independent predictors of RBC transfusion. Preoperative anemia was also associated with prolonged hospital LOS (adjusted OR: 1.31, 95%CI: 1.11-1.54, p = 0.002). CONCLUSIONS: In this study of 9,095 children undergoing spine surgery, preoperative anemia was associated with an increased risk of RBC transfusion and prolonged LOS. Further studies are needed to determine if treatment of preoperative anemia can effectively reduce intraoperative RBC transfusion.

Factores pronósticos en las paradas cardiorrespiratorias intrahospitalarias. Revisión de 760 casos / Prognostic factors for in-hospital cardiopulmonary arrests. A review of 760 cases

Fundamento y objetivo: Analizar las paradas cardiorrespiratorias (PCR) intrahospitalarias acontecidas en las salas de hospitalización convencional y evaluar los factores pronósticos de las mismas. Pacientes y método: Revisión retrospectiva de las PCR intrahospitalarias acontecidas en nuestro hospital durante un período de 9 años. Fueron excluidas las PCR en áreas de intensivos, quirófanos y urgencias. Datos recogidos: características demográficas, etiología y ritmo inicial de la PCR, datos de control interno, horario, lugar, métodos y resultados tras la reanimación cardiopulmonar (RCP) (recuperación de la circulación espontánea [RCE] y supervivencia al alta hospitalaria [SAH]) y estado neurológico al alta. Los resultados se analizaron con el paquete estadístico SPSS® v. 20. Resultados: Edad media 66,9 ± 17,5 años; 63,5% hombres. Tiempo medio de llegada del equipo de PCR = 1,75 ± 0,74 min, con una duración media de RCP = 25,8 ± 16,10 min. Ritmo inicial: a) desfibrilable = 22,1%; b) asistolia = 66,2%, y c) actividad eléctrica sin pulso = 11,7%. RCE = 51% y SAH = 24,8%. Factores asociados a un mejor pronóstico (p < 0,05): edad, motivo de ingreso hospitalario, estado previo del paciente, etiología y mecanismo principal de la PCR, número de desfibrilaciones y duración media de la RCP. Conclusiones: A pesar de haber estudiado diversas variables como factores pronósticos de la RCP y haber obtenido significación estadística en alguna de ellas, la predicción precoz de la supervivencia ante una PCR intrahospitalaria sigue siendo incierta. En cualquier caso, nuestro estudio evidencia que mediante una aplicación racional de medidas organizativas, el 25% de las PCR intrahospitalarias podrían llegar a ser dadas de alta en buenas condiciones, por lo que deberían generalizarse planteamientos organizativos y docentes similares en los grandes hospitales (AU)

Background and objective: The aim of this study is to analyse in-hospital cardiopulmonary arrests (CA) that took place in conventional wards and evaluate their prognostic factors. Patients and method: Retrospective review of in-hospital CA which occurred in our hospital over a 9-year period. CA that took place in intensive care areas, emergency rooms and operating theatres were excluded from the study. The following data were collected: demographic data, cause and initial rhythm of CA, internal control data, time, place, methods and results after cardiopulmonary resuscitation (CPR) (recovery of spontaneous circulation, [ROSC], and survival at discharge [SAD]) and neurologic performance at discharge. Results were analysed with SPSS® v. 20 predictive analytics software. Results: Average age was 66.9 ± 17.5 years; 63.5% male. CA team arrived in 1.75 ± 0.74 min on average, and the average length of CPR was 25.8 ± 16.10 min. First rhythm: a) shockable rhythms = 22.1%; b) asystole = 66.2%, and c) pulseless electrical activity = 11.7%. ROSC = 51% and SAD = 24.8%. Factors associated with a better prognostic (P < .05): age, reason for hospital admission, patient's previous physical condition, principal cause of CA, number of defibrillations and average length of CPR. Conclusions: Despite having studied several variables as prognostic factors for CA and some of them being statistically significant, early prediction for survival for an in-hospital CA remains uncertain. Our study suggests that applying rational organisational measures, 25% of in-hospital CA could be discharged from hospital in good condition, and therefore, these organisational and educational measures should be extended to large hospitals (AU)

[Prognostic factors for in-hospital cardiopulmonary arrests. A review of 760 cases]. / Factores pronósticos en las paradas cardiorrespiratorias intrahospitalarias. Revisión de 760 casos.

BACKGROUND AND OBJECTIVE: The aim of this study is to analyse in-hospital cardiopulmonary arrests (CA) that took place in conventional wards and evaluate their prognostic factors. PATIENTS AND METHOD: Retrospective review of in-hospital CA which occurred in our hospital over a 9-year period. CA that took place in intensive care areas, emergency rooms and operating theatres were excluded from the study. The following data were collected: demographic data, cause and initial rhythm of CA, internal control data, time, place, methods and results after cardiopulmonary resuscitation (CPR) (recovery of spontaneous circulation, [ROSC], and survival at discharge [SAD]) and neurologic performance at discharge. Results were analysed with SPSS(®) v. 20 predictive analytics software. RESULTS: Average age was 66.9±17.5 years; 63.5% male. CA team arrived in 1.75±0.74min on average, and the average length of CPR was 25.8±16.10min. First rhythm: a) shockable rhythms=22.1%; b) asystole=66.2%, and c) pulseless electrical activity=11.7%. ROSC=51% and SAD=24.8%. Factors associated with a better prognostic (P<.05): age, reason for hospital admission, patient's previous physical condition, principal cause of CA, number of defibrillations and average length of CPR. CONCLUSIONS: Despite having studied several variables as prognostic factors for CA and some of them being statistically significant, early prediction for survival for an in-hospital CA remains uncertain. Our study suggests that applying rational organisational measures, 25% of in-hospital CA could be discharged from hospital in good condition, and therefore, these organisational and educational measures should be extended to large hospitals.

Comparative chromosome painting in Aotus reveals a highly derived evolution.

The genus Aotus represents a highly diverse group with an especially intricate taxonomy. No standard cytogenetic nomenclature for the genus has yet been established. So far, cytogenetic studies have characterized 18 different karyotypes with diploid numbers ranging from 46 to 58 chromosomes. By combining G-banding comparisons and molecular cytogenetic techniques, we were able to describe the most likely pattern of chromosome evolution and phylogenetic position of two Aotus karyomorphs (KMs) from Venezuela: Aotus nancymai (KM3, 2n=54) and Aotus sp. (KM9, 2n=50). All of the proposed Platyrrhini ancestral associations (2/16, 3/21, 5/7, 8/18, 10/16, 14/15) were found in the Aotus KMs studied, except 2/16 and 10/16. In addition, some derived chromosomal associations were also detected in both KMs (1/3, 1/16, 2/12, 2/20, 3/14, 4/15, 5/15, 7/11, 9/15, 9/17, 10/11, and 10/22). Although some of these associations have been found in other New World monkeys, our results suggest that Aotus species have undergone a highly derived chromosomal evolution. The homologies between these two Aotus KMs and human chromosomes were established, indicating that KM3 has a more derived karyotype than KM9 with respect to the ancestral Platyrrhini karyotype.