Twenty-six patients with hematological or solid tumors who developed bacteremia caused by Stenotrophomonas maltophilia (n = 10), Pseudomonas putida (n = 6), Sphingomonas paucimobilis complex (n = 4) or Alcaligenes xylosoxidans (n = 6) in the period between 1993 and 1995 were studied. Seventeen patients were neutropenic during the infection, and 13 were undergoing bone marrow or peripheral blood stem cell transplantation. Twenty-three patients had catheter-related infections; only 3 of the 26 patients developed septic complications (all due to Stenotrophomonas maltophilia). Twenty patients were cured following catheter removal, either as primary measure (n = 8) or salvage measure (n = 12). Four responded to antibiotic therapy only, and two died of septic complications. Such infections in hematological and oncological patients have increased in this hospital from no cases in 1975 to 11 cases in 1995.
Emerging adults are attempting to navigate a rapidly shifting and immensely complicated landscape of modern love, often without meaningful sex and relationship education. Although individually oriented relationship education programs for emerging adults make a difference in the knowledge, attitudes, and beliefs of the recipients (Simpson et al., Journal of Youth and Adolescence, 2018, 47, 477) and most emerging adults report they yearn for relationship education (Weissbourd et al., The talk: How adults can promote young people’s healthy relationships and prevent misogyny and sexual harassment, 2017), these programs are not widely available. Educators who are working with emerging adults in a classroom or psychoeducational setting are well‐positioned to help emerging adults identify and enact healthy and purposeful relational and sexual choices. The first part of the paper orients readers to the “topography” of the modern love landscape by describing four macro cultural themes that impact the intimate lives of emerging adults. The second part of the paper introduces relationship educators to Relational Self‐Awareness (Solomon, Loving Bravely: 20 lessons of self‐discovery to help you get the love you want, New Harbinger, 2017), an integrative approach to helping emerging adults understand the self‐in‐relationship. Each of the five pillars of Relational Self‐Awareness is defined and operationalized, and specific recommendations are provided for how educators can integrate these pillars into their existing curricula. Clinical implications and future directions are offered.
Los linfomas no Hodgkin se originan a partir de linfocitos B, T y natural killer (NK) maduros, dentro de estos existe un subtipo poco frecuente de linfoma que se desarrolla a partir de células NK y en menor porción por células T citotóxicas denominado “Linfoma extra ganglionar de linfocitos NK/T de tipo nasal.” Este tipo se suele presentar en sujetos masculinos, entre 40-50 años y en zonas de Latinoamérica y el Sureste Asiático. Se caracteriza por tener una rápida progresión y causar destrucción de las estructuras de la línea media facial, los síntomas B son poco frecuentes(1-5). El diagnóstico se basa en anatomía patológica e inmunohistoquímica positiva para marcadores de células natural killer o linfocitos T, así como la presencia del virus Epstein Barr(7,8). El tratamiento requiere un abordaje interdisciplinario entre los servicios de hematología y otorrinolaringología. El pronóstico depende del estadiaje del tumor al momento del diagnóstico y de los factores de riesgo que presente el paciente(5).
La endocarditis infecciosa afecta principalmente las válvulas cardiacas, produciendo una lesión primaria que se conoce como vegetación. El 50% de los pacientes con esta enfermedad, no poseen factores de riesgo asociados. Las manifestaciones clínicas son variables, entre ellas las más frecuentes son fiebre, anemia y el desarrollo de un nuevo soplo cardiaco o el agravamiento de uno antiguo. La evolución clínica de la endocarditis depende del microorganismo causal; usualmente la produce un Streptococcus spp. o Staphylococcus aureus. En la población adulta mayor e inmunodeficiente, el agente patógeno más común es el Streptococcus gallolyticus. Las complicaciones neurológicas, son las más comunes y graves de la endocarditis infecciosa; dentro de estas, el aneurisma micótico es una complicación que presenta una alta mortalidad del 60-80%. En el presente artículo, se discute el caso de un paciente joven y sin factores de riesgo asociados, que presentó una endocarditis infecciosa por Streptococcus gallolyticus y desarrolló un aneurisma micótico como complicación neurológica de esta.
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