Nuevas tendencias de la endocarditis pediátrica
Bibliographic record
Abstract
Evaluar la epidemiología, los agentes etiológicos y la evolución de la endocarditis en una serie de pacientes pediátricos y comparar las principales características a nuestra experiencia anterior. Pacientes menores de 18 años diagnosticados de endocarditis en el CHU Sainte-Justine de Montréal, entre enero de 1986 y diciembre de 2000. La serie reciente se ha comparado con nuestra experiencia anterior de 1960-1985. En la serie actual se incluyeron 56 niños con endocarditis: 35 niños con cardiopatía congénita, 15 con otras enfermedades graves y 6 niños sanos. La edad media fue 7 años y 10 meses. El 54 % de los casos eran varones. La incidencia de endocarditis aumentó de 1,5 a 4 casos/año, en la primera frente a la segunda serie, respectivamente. En la serie actual, 10 pacientes (17,9 %) tenían un catéter. Un total de 16 pacientes (28,6 %) tenían diferentes prótesis vasculares. Los hemocultivos fueron positivos en 50 pacientes (89 %): Streptococcus representaba el 48 % y Staphylococcus el 34 % de los casos. La ecocardiografía fue positiva en 36 de 55 pacientes (65,4 %). Todos los pacientes fueron tratados con antibióticos intravenosos, una media de 43 ± 15 días. No hubo ninguna recurrencia. Se presentaron complicaciones importantes en 26 pacientes (46 %). Se observaron fenómenos embólicos en 11 niños (20 %). Doce pacientes (21 %) necesitaron cirugía. De los 6 niños sanos, cinco presentaron complicaciones. En total, 7 niños (12,5 %) murieron, todos eran mayores de 6 años. Comparando nuestra experiencia de 1960-1985 a 1986-2000, las complicaciones y la mortalidad han disminuido, del 85,7 al 46,4 % y del 27 al 12,5 %, respectivamente. El médico debe conocer que los niños con inmunodeficiencia o con catéteres tienen un riesgo aumentado de endocarditis. Los niños sanos con endocarditis presentan mayor riesgo de complicaciones. Las complicaciones y la mortalidad han disminuido considerablemente en los últimos años. To evaluate the epidemiology, etiology and outcome of endocarditis in a cohort of pediatric patients and to compare the main characteristics with our previous experience. Patients aged less than 18 years of age diagnosed with endocarditis at the Sainte-Justine Hospital, University of Montreal between 1-1986 and 12-2000 were studied. The recent case series was compared with our previous experience from 1960-1985. Fifty-six children with endocarditis were included in the 1986-2000 series: 35 children with congenital heart disease, 15 with serious underlying disease and six healthy children. The mean age was 7 years and 10 months. Fiftyfour percent of the patients were boys. The incidence of endocarditis increased from 1.5 cases/year in the 1986-2000 series to 4 cases/year in the 1986-2000 series. In the 1986-2000 series, 10 (17.9 %) patients had a central catheter. Sixteen (28.6 %) patients had a vascular prosthesis. Blood cultures were positive in 50 patients (89 %): Streptococci were found in 48 % of the patients and Staphylococci in 34 %. Echocardiography was positive in 36 of 55 patients (65.4 %). All children were treated with intravenous antibiotics for a mean of 43 ± 15 days. There were no recurrences. Significant morbidity developed in 26 patients (46 %). Embolic phenomena were seen in 11 children (20 %). Twelve patients (21 %) needed surgery. Of the six healthy children, five developed complications. Overall, seven children (12.5 %) died; all were older than 6 years of age. Comparing our experience from 1960-1985 with that from 1986-2000 revealed that morbidity decreased from 85.7 % to 46.4% and mortality decreased from 27% to 12.5%. Physicians must recognize that children with underlying immunodeficiency and those with central catheters have an increased risk of endocarditis. Healthy children with endocarditis have a greater risk of complications. Morbidity and mortality due to endocarditis has diminished considerably in recent years.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".