ABSTRACT
La endocarditis infecciosa es una grave y poco frecuente afección del endocardio. La etiología micótica representa menos del 10% de dichos casos. Cada vez son más frecuentes, como grupos de riesgo, los niños con tratamiento antibiótico endovenoso, alimentación parenteral y catéteres venosos centrales por tiempo prolongado, aún sin cardiopatías previas. Se revisaron retrospectivamente las historias clínicas de 6 niños con endocarditis por Cándida y se describen los factores predisponentes, la evolución clínica y la terapéutica empleada. Los antimicóticos empleados fueron anfotericin B, 5-fluorocitocina y fluconazol. Se realizó exéresis quirúrgica de las vegetaciones, 5 plastias valvulares tricuspídeas y una sustitución valvular mitral. Sobrevivieron todos los pacientes y uno necesitó nueva plastia valvular tricuspídea después de un año de operado. Con un seguimiento medio de 5 años, todos mantienen buena función valvular sin recidivas infecciosas. Se recomienda una combinación de tratamiento antimicótico sinérgico y prolongado con la intervención quirúrgica precoz(AU)
Infective endocarditis is a serious and uncommon condition affecting the endocardium. Less than 10% of these cases are of fungal origin. A growing number of individuals are at high risk, due to insertion of central venous catheters, total parenteral nutrition and prolonged exposure to broad-spectrum antibiotics, even without previous heart diseases. We retrospectively analysed the records of six children with Candida endocarditis, reviewing the comorbidities, clinical outcome, and treatment. The antifungal agents used were amphotericin B, 5-fluorocytosine and fluconazole. Patients underwent surgical excision of vegetation, five tricuspid valve repairs and one mitral valve replacement. There were no hospital deaths, and one child needed a new valvuloplasty one year later. The mean follow up was five years, and all have good valvular function without recurrent endocarditis. A combination of synergistic long-term antifungal treatment and early surgical intervention is recommended(AU)
Subject(s)
Humans , Male , Female , Child , Endocarditis/complications , Endocarditis/drug therapy , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/drug therapy , Candida/isolation & purification , Candida albicans/isolation & purification , Amphotericin B/therapeutic use , Fluconazole/therapeutic use , Cytokines/therapeutic use , Receptors, Cytokine/therapeutic use , Candidiasis/complications , Endocarditis, Bacterial/diagnosis , Endocardium/microbiology , Endocarditis/diagnosis , Endocardium/pathology , Echocardiography/methods , EchocardiographyABSTRACT
Infective endocarditis is a serious and uncommon condition affecting the endocardium. Less than 10% of these cases are of fungal origin. A growing number of individuals are at high risk, due to insertion of central venous catheters, total parenteral nutrition and prolonged exposure to broad-spectrum antibiotics, even without previous heart diseases. We retrospectively analysed the records of six children with Candida endocarditis, reviewing the comorbidities, clinical outcome, and treatment. The antifungal agents used were amphotericin B, 5-ï¬uorocytosine and fluconazole. Patients underwent surgical excision of vegetation, five tricuspid valve repairs and one mitral valve replacement. There were no hospital deaths, and one child needed a new valvuloplasty one year later. The mean follow up was five years, and all have good valvular function without recurrent endocarditis. A combination of synergistic long-term antifungal treatment and early surgical intervention is recommended.
Subject(s)
Candidiasis , Endocarditis , Candidiasis/diagnosis , Candidiasis/therapy , Child, Preschool , Endocarditis/diagnosis , Endocarditis/therapy , Female , Humans , Infant , Male , Retrospective StudiesABSTRACT
The purpose of this article is to review the somatic disorders, drugs and toxics more often related to psychopathology. It is also exposed the conceptual framework chosen for this task, based in the nonlinear dynamical systems theory and in a recently proposed subdivision of central nervous system. We intuitively suggest that most psychopathological syndromes could be correlated with the cerebral dysfunction conditioned by the self-organization of dissipative structures formed by hierarchical and diffuse subsystems interrelated neurons groups. Any perturbation which affect these subsystems in a brain region, and change enough their activation level and interaction pattern to make any of these interactions functionally insufficient, could begin the process.
