Endocarditis tardía en un portador de un Amplatzer. Manejo conservador en un paciente pediátrico.

Since their introduction, percutaneous techniques have been replacing conventional surgery as a first-line treatment for septal defects. Amplatzer devices were the first to be approved by the Food and Drug Administration, and their placement has become a standard procedure in pediatric cardiology. Bacterial endocarditis of intracardiac devices such as the Amplatzer septal occluder is very infrequent. We report a case of bacterial endocarditis in a pediatric patient with an Amplatzer device, who developed an infectious endocarditis six years after its placement and received conservative management with intravenous antibiotics, with satisfactory evolution

Epinephrine Improves the Efficacy of Nebulized Hypertonic Saline in Moderate Bronchiolitis: A Randomised Clinical Trial

<div><p>Background and Aims</p><p>There is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline.</p><p>Patients and Methods</p><p>We performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours. The primary outcome measure was the length of hospital stay.</p><p>Results</p><p>A total of 185 infants were analyzed: 94 in the epinephrine plus 3% hypertonic saline group and 91 in the placebo plus 3% hypertonic saline group. Baseline demographic and clinical characteristics were similar in both groups. Length of hospital stay was significantly reduced in the epinephrine group as compared with the placebo group (3.94 ±1.88 days vs. 4.82 ±2.30 days, P = 0.011). Disease severity also decreased significantly earlier in the epinephrine group (P = 0.029 and P = 0.036 on days 3 and 5, respectively).</p><p>Conclusions</p><p>In our setting, nebulized epinephrine in 3% hypertonic saline significantly shortens hospital stay in hospitalized infants with acute moderate bronchiolitis compared to 3% hypertonic saline alone, and improves the clinical scores of severity from the third day of treatment, but not before.</p><p>Trial Registration</p><p><a href="https://eudract.ema.europa.eu/" target="_blank">EudraCT 2009-016042-57</a></p></div

Mean secondary efficacy outcome values in both groups during hospitalization.

<p>WDF denotes Wood-Downes clinical score modified by Ferres.</p

Wood-Downes Clinical Scoring System Modified by Ferres.

<p>Wood-Downes Clinical Scoring System Modified by Ferres.</p

Baseline Characteristics of Study Patients.

<p>Baseline Characteristics of Study Patients.</p

Randomization of the Study Patients.

<p>Randomization of the Study Patients.</p