Pediatric Hospital of Sinaloa

Introduction: Children with cancer frequently experience clinical deterioration events (CDEs), with high mortality and resource utilization, yet limitations of life-sustaining interventions (LLI) remain poorly characterized. Understanding these practices can guide resource allocation and promote goal-concordant care. We hypothesized limited LLI among critically ill children with cancer in Latin America. Methods: Proyecto EVAT is a collaborative to improve early identification of CDEs in children with cancer. Participating hospitals registered CDE characteristics, outcomes, and LLI. Patients with pre-existing LLI were excluded. Treatment-related mortality (TRM) was defined as death from any cause other than cancer progression or relapse. Registry data from April 1, 2017 through December 31, 2024 were included, with each hospitalization used as the unit of analysis. Chi-squared tests evaluated associations between LLI and mortality, TRM, and oncologic diagnoses. Univariate logistic regression estimated the odds of LLI by cancer type. Results: A total of 4490 CDEs occurred during 3993 hospitalizations among 3592 patients at 73 hospitals in 18 countries. LLI were used in 7.6% of hospitalizations, with wide variability across hospitals (range 0 -100%), mainly due to cancer progression (70%). Overall, 32% of hospitalizations resulted in death with 91% during the CDE. Among deaths, 41% occurred within 48 hours of CDE start and 82% were due to TRM. LLI were more common among non-survivors (14% vs 5% survivors, p< 0.0001), in deaths due to cancer progression (37% vs 9% in TRM, p< 0.0001), and in deaths occurring >48 hours after CDE start (21% vs 4% in deaths < 48 hrs since CDE start, p< 0.0001). Compared to patients with hematologic malignancies, those with CNS (OR=3.6, 95% CI [2.5, 5.2], p< 0.0001) and solid tumors (OR=1.8, 95% CI [1.4, 2.4], p< 0.0001) had higher odds of using LLI. Conclusions: LLI use is infrequent among children with cancer experiencing CDEs, even among those who died, suggesting missed opportunities for goal-concordant care. When used, LLI were more often due to cancer progression, suggesting perceived prognosis, rather than severity of acute illness, drives LLI decisions. Despite higher mortality, palliative care principles are underutilized in cancer treatment-related critical illness.

Coccidioidomycosis, caused by Coccidioides infection, is typically subclinical and self-limited in immunocompetent patients. Occupational soil exposure, age ≥55 years, pregnancy, comorbidities, or immunosuppression states are common contributors to disease progression and potential mortality. This report describes a 34-year-old woman from Northwest Mexico, without evident risk factors, who presented chest pain and odynophagia as initial clinical symptoms and died at the 19th day of progressive clinical evolution consequence of pulmonary coccidioidomycosis. Findings in this report, along with those reviewed from the literature, highlight potential disparities that may be helpful in limited clinical settings, so eventual mortality-related coccidioidomycosis can be prevented.

BackgroundPediatric Early Warning Systems (PEWS) are evidence-based interventions that monitor hospitalized pediatric patients to improve outcomes and prevent complications, particularly in children with cancer. However, there is limited data on how clinicians perceive the impact of PEWS on patient care across healthcare centers in resource-variable settings. Understanding clinicians’ perceptions of PEWS is crucial, as their recognition of its benefits can enhance adoption and sustainability across various healthcare settings.ObjectiveTo assess clinician perceptions of impacts following PEWS implementation across pediatric oncology centers in Latin America and Spain.MethodsWe conducted a secondary analysis of a study assessing capacity for PEWS sustainability and adaptations at resource-variable hospitals participating in a collaborative to implement PEWS. Anonymous surveys in Spanish and Portuguese were distributed to nurses, physicians, ward, and ICU clinicians using PEWS at 58 hospitals across 19 countries. The survey included one free-text question about adaptations made to PEWS. A qualitative analysis of these responses was conducted using codes developed during a previous study to describe clinician perceptions on PEWS impact. Content analysis focused on clinician perspectives on the multilevel impact of PEWS.ResultsOf 1,909 free-text responses, PEWS impact was mentioned in 48% (n=913) by clinicians at 58 participating hospitals. Participants described impacts at the level of the patient, clinician, team, and institution, and emphasized the positive impact of PEWS at their centers. PEWS was perceived as vital in facilitating timely patient care interventions, mitigating progression of critical illness, and reducing mortality for pediatric oncology patients. Clinicians also reported that PEWS made patient care easier and empowered them in their roles. Finally, PEWS was perceived to improve communication and team dynamics among multidisciplinary clinicians.ConclusionThis study adds to existing literature by describing clinician perceptions of the multilevel impacts of PEWS on hospital care for children with cancer across hospitals of diverse resource-levels, providing further evidence of how this intervention might benefit patients, clinicians, and clinical teams. These findings emphasize that understanding perspectives of clinicians who use evidence-based interventions, like PEWS is crucial to promote adoption and guide sustainability strategies to improve outcomes for children with cancer globally.

In February 2024, rocoto pepper (Capsicum pubescens) plants exhibiting symptoms of yellowing, stunting, and root-knot were observed in a field in Culiacán, Sinaloa, Mexico. Disease incidence was approximately 70% (200 plants evaluated). Five samples, each consisting of 1 kg of rhizospheric soil and galled roots from five rocoto pepper plants, were collected and analyzed. Second-stage juveniles (J2s) were extracted from 100 g of soil using the Baermann funnel and Cobb's sieving methods (Christie and Perry 1951). For the observation of females, roots were washed with tap water and dissected. Nematodes of the genus Meloidogyne were found in all samples, with populations ranging from 125 to 242 nematodes per 100 g of soil and 85 to 146 nematodes per 1 g of root. Microscopic examination of the perineal pattern of mature females (n= 20) showed a high, square dorsal arch, and lacking an evident lateral line. Females were pear-shaped, body length ranged from 528 to 682 µm, and body width ranged from 310 to 484 µm. Second-stage juveniles were vermiform with stylets featuring rounded basal knobs, and the tail had a transparent area with an obtuse tip. J2 body length (n= 30) averaged 419.6 µm, stylet length measured 13.8 µm, the distance from the dorsal esophageal gland orifice (DGO) to the stylet knobs was 4.3 µm, and the tail length was 27.9 µm. These morphological characteristics corresponded to those reported for Meloidogyne incognita (Eisenback and Hirschmann 1981). For molecular identification, total DNA was extracted from individual females following the extraction protocol described by Hu et al. (2011). An 835-bp DNA fragment was obtained using the specific SCAR primers Mi-F/Mi-R for Meloidogyne incognita (Meng et al. 2004). Additionally, a fragment of the mitochondrial cytochrome oxidase subunit I (coxI) gene was amplified by PCR using the primer pair JB3/JB5 (Bowles et al. 1992), and sequenced. The sequence was deposited in GenBank under the accession number PV076867. BLASTn searches showed 100% identity with available coxI sequences of M. incognita from the Philippines (PP325802), China (MH743220, MH743221), and Vietnam (MH332669). The pathogenicity and reproduction of the M. incognita population were evaluated on 30-day-old rocoto pepper plants. Eight plants were transplanted into 8 L pots filled with sterile soil and inoculated with 2,000 nematodes J2, while three uninoculated plants were used as control. Plants were maintained at 15 to 30°C in a greenhouse. Forty days post-inoculation, foliar yellowing symptoms were observed along with the presence of females and egg masses on the roots. The root galling index was 4, according to the Taylor and Sasser scale (1978), and the reproduction factor (final population density/initial population density) was 8.2. Nematodes extracted from inoculated roots were morphologically identical to those observed in the originally infected roots, fulfilling Koch's postulates. The pathogenicity test was carried out twice with similar results. The presence of M. incognita parasitizing pepper (C. annuum) and tomato (Solanum lycopersicum) plants has been previously reported in Sinaloa, Mexico (Carrillo-Fasio et al., 2019; Carrillo-Fasio et al., 2021). In other countries, such as Spain, M. incognita has been reported affecting rocoto pepper plants (Gisbert et al., 2013). However, to our knowledge, this is the first report of M. incognita parasitizing rocoto pepper plants in Mexico. This study serves as a reference for future research on distribution and management strategies for this plant-parasitic nematode.