Os objetivos do estudo foram avaliar as características clínicas das embolias arteriais sistêmicas no curso da endocardite infecciosa, a distribuição temporal, os fatores de risco de embolia e a influência prognóstica da embolia no curso da doença. Foram estudados 629 episódios de endocardite infecciosa. A idade dos pacientes variou de 2 meses a 83 anos (média 37,9 anos; desvio padrão 17,3). Ocorreram 396 (63%) episódios em homens e 233 (47%) em mulheres. Em 538 (85%) episódios, os pacientes eram portadores de doença cardíaca prévia, 272 (43%) com valvopatia, 224 (36%) portadores de prótese valvar cardíaca, 29 (5%) com doença cardíaca congênita, 13 (2%) com outras cardiopatias e 91 (14%) pacientes não apresentavam evidência de cardiopatia prévia. Os agentes etiológicos foram os estreptococos em 297 (47%) pacientes, os enterococos em 51 (8%), os Staphylococcus aureus em 77 (12,6%), os Staphylococcus epidermidis em 56 (9%), as bactérias gram-negativas em 33 (5%), os fungos em nove (1,4%), e outros microorganismos em 27 (4%). Em 79 (13%) pacientes as hemoculturas foram negativas. Os pacientes receberam tratamento clínico em 376 (60%) episódios e cirúrgico em 253 (40%). Para a análise estatística foram utilizados além da estatística descritiva, o método de Kaplan-Meier para avaliar a sobrevida livre de embolia e o prognóstico, comparadas com os testes de Log-rank e Breslow. Em seguida para a estimativa de riscos, foi ajustado o modelo de riscos proporcionais de Cox. As embolias arteriais ocorreram em 133 (21%) pacientes, cerebrais em 63 (47%), extracerebrais em 57 (43%) e cerebrais a extracerebrais em 13 (10%) pacientes. A distribuição temporal das embolias foi decrescente após o início dos sintomas. O risco de embolia não revelou diferença significativa quanto a idade, a sexo, o estado cardíaco, presença e número de vegetações identificadas no ecocardiograma e a modalidade de tratamento clínico ou cirúrgico. Os pacientes com endocardite causada por Staphylococcus aureus apresentaram risco de ocorrência de embolia 2,9 vezes maior do que os pacientes com endocardite causada por outros agentes etiológicos. Nos pacientes com endocardite infecciosa em prótese mitral e aórtica com vegetação identificada no ecocardiograma, o risco de embolia foi respectivamente 2,4 e 3,3 vezes maior relação aos pacientes com endocardite em valva natural ou em prótese sem vegetação. O risco de embolia foi menor a medida que o tempo decorrido entre o início dos sintomas e o tratamento aumentou. O risco de óbito nos pacientes que sofreram embolia duplicou em relação aos pacientes que não sofreram embolia. / The objectives of the study were to evaluate the clinical characteristics of systemic arterial embolism at infective endocarditis courses, the time related distribution of emboli, risk predictors and prognostic influence of emboli during active disease. So far, we studied 629 episodes of left-sided endocarditis. The patients were aged 37.9 ± 17.3 years; 396 (63%) episodes occurred in men; 233 (47%) in women; 538 (85%) episodes occurred in patients with heart disease: 272 (43%) had valvular heart disease, 224 (36%) had prosthetic heart valves, 29 (5%) had congenital heart disease, 13 (2%) had others cardiac diseases and 91 (14%) had no known heart disease. The causative microorganisms were streptococci in 297 (47%) patients, enterococci in 51 (8%), Staphylococcus aureus in 77 (1 2.6%), Sfaphylococcus epidermidis in 56 (9%), gram-negative bacteria in 33 (5%), fungi in nine (1.4%), and other microorganisms in 27 (4%); 79 (13%) patients had negative blood cultures. The treatment was medical in 376 (60%) and surgical in 253 (40%) episodes. Statistical analysis was pet-formed with descriptive analysis, with Kaplan-Meier methods to evaluate survival free of emboli and prognosis, and Cox proportional hazards model for risk analysis; 133 (21%) patients had an embolic event; 63 (47%) were cerebral emboli and 57 (43%) were extracerebral emboli and 13 (10%) were cerebral and extracerebral. The time-related distribution showed decrease in the incidence after beginning of symptoms. The risk for emboli was not significantly different relative to age, sex, cardiac status, presence or number of vegetations at echocardiogram, and medical or surgical treatment. The risk of emboli was 2.97 times higher in patients with Staphylacoccus aureus endocarditis. The risk of embolism in patients with infective endocarditis in mitral and aortic prosthetic valve with vegetations were 2.4 and 3.3 times higher. The risk of embolism decrease as the time elapsed between beginning of symptoms and treatment increased, suggesting a lower risk in less acute disease. Risk of death was 2.01 times higher in patients with embolism.

Os objetivos do estudo foram avaliar as características clínicas das embolias arteriais sistêmicas no curso da endocardite infecciosa, a distribuição temporal, os fatores de risco de embolia e a influência prognóstica da embolia no curso da doença. Foram estudados 629 episódios de endocardite infecciosa. A idade dos pacientes variou de 2 meses a 83 anos (média 37,9 anos; desvio padrão 17,3). Ocorreram 396 (63%) episódios em homens e 233 (47%) em mulheres. Em 538 (85%) episódios, os pacientes eram portadores de doença cardíaca prévia, 272 (43%) com valvopatia, 224 (36%) portadores de prótese valvar cardíaca, 29 (5%) com doença cardíaca congênita, 13 (2%) com outras cardiopatias e 91 (14%) pacientes não apresentavam evidência de cardiopatia prévia. Os agentes etiológicos foram os estreptococos em 297 (47%) pacientes, os enterococos em 51 (8%), os Staphylococcus aureus em 77 (12,6%), os Staphylococcus epidermidis em 56 (9%), as bactérias gram-negativas em 33 (5%), os fungos em nove (1,4%), e outros microorganismos em 27 (4%). Em 79 (13%) pacientes as hemoculturas foram negativas. Os pacientes receberam tratamento clínico em 376 (60%) episódios e cirúrgico em 253 (40%). Para a análise estatística foram utilizados além da estatística descritiva, o método de Kaplan-Meier para avaliar a sobrevida livre de embolia e o prognóstico, comparadas com os testes de Log-rank e Breslow. Em seguida para a estimativa de riscos, foi ajustado o modelo de riscos proporcionais de Cox. As embolias arteriais ocorreram em 133 (21%) pacientes, cerebrais em 63 (47%), extracerebrais em 57 (43%) e cerebrais a extracerebrais em 13 (10%) pacientes. A distribuição temporal das embolias foi decrescente após o início dos sintomas. O risco de embolia não revelou diferença significativa quanto a idade, a sexo, o estado cardíaco, presença e número de vegetações identificadas no ecocardiograma e a modalidade de tratamento clínico ou cirúrgico. Os pacientes com endocardite causada por Staphylococcus aureus apresentaram risco de ocorrência de embolia 2,9 vezes maior do que os pacientes com endocardite causada por outros agentes etiológicos. Nos pacientes com endocardite infecciosa em prótese mitral e aórtica com vegetação identificada no ecocardiograma, o risco de embolia foi respectivamente 2,4 e 3,3 vezes maior relação aos pacientes com endocardite em valva natural ou em prótese sem vegetação. O risco de embolia foi menor a medida que o tempo decorrido entre o início dos sintomas e o tratamento aumentou. O risco de óbito nos pacientes que sofreram embolia duplicou em relação aos pacientes que não sofreram embolia. / The objectives of the study were to evaluate the clinical characteristics of systemic arterial embolism at infective endocarditis courses, the time related distribution of emboli, risk predictors and prognostic influence of emboli during active disease. So far, we studied 629 episodes of left-sided endocarditis. The patients were aged 37.9 ± 17.3 years; 396 (63%) episodes occurred in men; 233 (47%) in women; 538 (85%) episodes occurred in patients with heart disease: 272 (43%) had valvular heart disease, 224 (36%) had prosthetic heart valves, 29 (5%) had congenital heart disease, 13 (2%) had others cardiac diseases and 91 (14%) had no known heart disease. The causative microorganisms were streptococci in 297 (47%) patients, enterococci in 51 (8%), Staphylococcus aureus in 77 (1 2.6%), Sfaphylococcus epidermidis in 56 (9%), gram-negative bacteria in 33 (5%), fungi in nine (1.4%), and other microorganisms in 27 (4%); 79 (13%) patients had negative blood cultures. The treatment was medical in 376 (60%) and surgical in 253 (40%) episodes. Statistical analysis was pet-formed with descriptive analysis, with Kaplan-Meier methods to evaluate survival free of emboli and prognosis, and Cox proportional hazards model for risk analysis; 133 (21%) patients had an embolic event; 63 (47%) were cerebral emboli and 57 (43%) were extracerebral emboli and 13 (10%) were cerebral and extracerebral. The time-related distribution showed decrease in the incidence after beginning of symptoms. The risk for emboli was not significantly different relative to age, sex, cardiac status, presence or number of vegetations at echocardiogram, and medical or surgical treatment. The risk of emboli was 2.97 times higher in patients with Staphylacoccus aureus endocarditis. The risk of embolism in patients with infective endocarditis in mitral and aortic prosthetic valve with vegetations were 2.4 and 3.3 times higher. The risk of embolism decrease as the time elapsed between beginning of symptoms and treatment increased, suggesting a lower risk in less acute disease. Risk of death was 2.01 times higher in patients with embolism.

Les macrophages sont fonctionnellement polarisés en macrophages inflammatoires et microbicides (M1) ou immunorégulateurs (M2). Que les monocytes circulants soient polarisables n’est pas démontré. Nous avons étudié la signature transcriptionnelle par microarray et RT-PCR en temps réel de monocytes humains stimulés par l’IFN-γ, un inducteur des macrophages M1 et l’IL-4, un inducteur des macrophages M2. Leur profil de réponse précoce est dépendent de l’agoniste alors que la réponse tardive des monocytes est similaire qu’ils soient stimulés par l’IFN-γ ou l’IL-4. Cette approche dynamique de la réponse monocytaire permet probablement une étude bien plus pertinente des patients atteints d’une fièvre Q que le modèle de polarisation macrophagique. Par ailleurs, la prévalence de la fièvre Q est plus importante chez l’homme que chez la femme. Comme il a été montré que des gènes associés au cycle circadien sont modulés chez les souris infectées par Coxiella burnetii, la bactérie responsable de la fièvre Q, nous avons étudié ces gènes au cours de la fièvre Q. C’est ainsi que le gène Per2 est fortement exprimé chez les hommes atteints d’une fièvre Q aiguë. Ces résultats suggèrent donc que la modulation de gènes circadiens est associée à une maladie infectieuse chez l’homme. L’expression des gènes LNX1 and LNX2, qui codent deux enzymes impliquées dans le catabolisme des protéines, est accrue dans l’endocardite de la fièvre Q mais pas dans la fièvre Q aiguë. / Macrophages are functionally polarized into inflammatory and microbicidal (M1) and immunoregulatory (M2) cells. If circulating monocytes may be polarized is not known. We determined the transcriptional signatures of human monocytes stimulated with IFN-γ and IL-4, known to induce the polarization of macrophages into M1 and M2 cells, respectively, using microarrays and real-time RT-PCR. We found that monocytes exhibited an early pattern of activation specific to IFN-γ or IL-4 and a late pattern of activation common to both agonists. The selected biomarkers of early and late responses were tested in patients with Q fever. We showed that the kinetic model of monocyte activation enables a dynamic approach for the evaluation of patients with acute Q fever or Q fever endocarditis. On the other hand, it is known that the prevalence of Q fever is related to sex and is higher in men than in women. Based on previous studies on an experimental model of infection by Coxiella burnetii, the agent of Q fever, we hypothesized that circadian genes are differently modulated in men and women with Q fever. We showed that the expression of the Per2 gene was significantly increased in males with acute Q fever compared with healthy volunteers but did not differ in females with Q fever and healthy females. These results suggest that that the modulation of circadian genes is associated with a human infectious disease. We also found that the expression of LNX1 and LNX2 genes that encode two enzymes involved in protein degradation is increased in Q fever endocarditis but not in acute Q fever.

Submitted by Maykon Nascimento (maykon.albani@hotmail.com) on 2016-05-09T19:10:21Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertacao Grasiele Bonadiman.pdf: 3637833 bytes, checksum: 9c919dca44b71050b2c6cbe78d9a59a6 (MD5) / Approved for entry into archive by Patricia Barros (patricia.barros@ufes.br) on 2016-06-06T12:34:39Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertacao Grasiele Bonadiman.pdf: 3637833 bytes, checksum: 9c919dca44b71050b2c6cbe78d9a59a6 (MD5) / Made available in DSpace on 2016-06-06T12:34:39Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertacao Grasiele Bonadiman.pdf: 3637833 bytes, checksum: 9c919dca44b71050b2c6cbe78d9a59a6 (MD5) / Possíveis associações entre doença periodontal (DP) e alterações cardiovasculares em cães, como a endocardite infecciosa (EI), são relatadas na literatura, apesar de ainda não comprovadas. Fármacos anestésicos, utilizados para a tratamento periodontal (TP), podem levar à hipotensão, redução do fluxo sanguíneo coronariano e isquemia miocárdica. A determinação de biomarcadores, especialmente a troponina I cardíaca (TnIc), pode ser utilizada para a detecção de lesão miocárdica tanto em casos de EI, quanto por efeitos de fármacos anestésicos. Objetivou-se avaliar os níveis séricos de TnIc em cães com DP, como um indicador de EI, anestesiados para TP, com e sem o uso de antibióticos. Utilizou-se 24 cães com DP, sem evidências de outras doenças sistêmicas, selecionados por meio de avaliação física, laboratorial e cardiovascular. Formou-se três grupos de 8 cães cada: grupo I (controle) – cães anestesiados; grupo II - cães anestesiados submetidos a TP, não tratados com antibióticos; grupo III - cães anestesiados submetidos a TP, tratados com antibióticos. Os cães foram sedados com meperidina e acepromazina, induzidos com propofol e mantidos com isoflurano em oxigênio. Dosagens de TnIc foram realizadas imediatamente antes e 24 horas após o TP, com kit comercial pelo método de ELISA. A análise estatística foi realizada por meio do teste de "D'Agostino & Pearson", teste t para comparação de duas médias e teste post hoc de comparação múltipla de Tukey, após a análise de variância. Não houve diferença significativa nas dosagens de TnIc entre os grupos, nem entre os momentos avaliados (p>0,05). Conclui-se que não há aumento de TnIc em cães com DP após o TP, submetidos ou não a antibioticoterapia, podendo sugerir que não houve o desenvolvimento de EI; e não há aumento de TnIc em cães saudáveis submetidos ao protocolo anestésico estipulado. / Associations between periodontal disease (PD) and cardiovascular changes in dogs, such as infeccious endocarditis (IE), are reported by literature, although no evidences between them are verified. Anesthetic drugs, used for periodontal treatment (PT), can lead to hypotension, reduction of coronary blood flow and myocardial ischemia. Determination of biomarkers, especially cardiac troponin I (cTnI) can be used for the detection of myocardial injury in both cases: endocarditis and the effects of anesthetic drugs. This study aimed to evaluate canine cTnI in dogs with PD, as an indicator of IE, after PT, with and without using antibiotics. It was used 24 dogs with PD, with no evidence of any other systemic diseases. They were selected by physical examination, laboratory and cardiovascular evaluation and were divided into three groups: group I (n=8; control) - anesthetized dogs, group II (n=8) - anesthetized dogs submited to PT, not treated with antibiotics, group III (n=8) - anesthetized dogs submited to PT, treated with antibiotics. The dogs were sedated with acepromazine and meperidine, induced with propofol and maintained with isoflurane in oxygen. Canine cTnI dosages were taken immediately before and 24 hours after PT, using commercial kit (ELISA). Statistical analysis were performed by using "D'Agostino & Pearson" normality test, unpaired t test to compare two samples and Tukey´s post hoc test for multiple comparisons. All tests were performed at a level of significance of 0.05 No significant differences were found between groups or in different moments (p>0.05). It was concluded that there is no increased cTnI in dogs with PD after PT, treated or not with antibiotics, suggesting that there was no development of IE, and there is no increase in canine cTnI in healthy dogs anesthetized using this protocol.

Orientador: Renata de Oliveira Mattos-Graner / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-19T14:43:07Z (GMT). No. of bitstreams: 1 Moraes_JuliannaJoannadeCarvalho_D.pdf: 2742487 bytes, checksum: fd22472bad0fcb9906c477e4e103b797 (MD5) Previous issue date: 2011 / Resumo: Streptococcus sanguinis são colonizadores primários dos dentes reconhecidos como microrganismos comensais benéficos da cavidade bucal, pois são capazes de inibir o crescimento de espécies patogênicas, como Streptococcus mutans. S. sanguinis são comumente envolvidos em endocardite bacteriana, embora por mecanismos de patogenicidade ainda não conhecidos. Para colonizar os dentes ou tecidos cardíacos, S. sanguinis devem ser capazes de se estabelecer em biofilmes e de se adaptar às diversas condições de estresse ambiental decorridas da ação de microrganismos competidores e/ou das defesas do hospedeiro. A resposta bacteriana a condições de estresse ambiental é regulada por sistemas reguladores globais de transcrição de dois componentes (SDC), os quais são essenciais para modular o transcriptoma bacteriano durante os processos de colonização e infecção do hospedeiro. O genoma de S. sanguinis SK36 apresenta 14 desses sistemas. Através de análises de BLAST, identificou-se um SDC com alta similaridade ao sistema VicRK (vic de virulence control), o qual regula fatores de virulência e é conservado em diversas espécies de bactérias Gram-positivas, como S. mutans e Streptococcus pneumoniae. O objetivo deste trabalho foi caracterizar a função do sistema VicRK na biologia de S. sanguinis, através da análise dos efeitos da inativação de vicK em diversas características bacterianas possivelmente associadas à virulência e à formação de biofilmes. Para isto, foi construído um mutante knock-out do gene vicK a partir da cepa SK36, o qual foi designado SKvicK. SKvicK foi comparado à cepa selvagem quanto à capacidade de formação de biofilmes e quanto às características que influenciam na capacidade de colonização (hidrofobicidade, atividade autolítica e sensibilidade ao estresse oxidativo) em diferentes condições atmosféricas. Também foram comparados, entre as cepas, os padrões de expressão de genes com possível função de virulência, cujos ortólogos são regulados por VicRK nas espécies S. mutans e/ou S. pneumoniae. Estes incluem genes relacionados à formação de biofilmes e biogênese da parede celular (ssapcsB, lysM, gtfP), à resposta ao estresse oxidativo e produção de peróxido de hidrogênio (sodA, spxB, ccpA). A inativação de vicK inibiu claramente a formação inicial de biofilmes. Além disto, SKvicK demonstrou maior sensibilidade ao estresse oxidativo e maior hidrofobicidade celular. A inativação de vicK também inibiu, de forma significativa, a transcrição dos genes pcsB, lysM, spxB e comE. Estes dados indicam que VicRK regula diversas funções biológicas de S. sanguinis importantes para a colonização de humanos / Abstract: Streptococcus sanguinis are primary colonizers of the teeth and recognized as beneficial commensal microorganisms of the oral cavity because they are able to inhibit the growth of pathogenic species such as Streptococcus mutans. S. sanguinis are commonly involved in the infective endocarditis, although pathogenic mechanisms are still unknown. S. sanguinis are able to establish in biofilms and to adapt among various environmental stress conditions from competing microorganisms and/or from host defenses during colonization of enamel or endothelial tissues. Bacterial responses from environmental stress conditions are regulated by two-component global regulatory systems (TCS), which are essential to modulate the bacterial transcriptome during colonization and infection of the host. S. sanguinis SK36 genome contains at least 14 TCS. Through BLAST analyses, we identified a TCS with high similarity to VicRK system (vic from virulence control), which regulates virulence factors and is conserved in several species of gram-positive bacteria such as S. mutans and Streptococcus pneumoniae. The aim of this study was to characterize the role of VicRK system in S. sanguinis biology, by analyzing the effects of vicK inativation on several characteristics potentially associated with bacterial virulence and biofilm formation. For this purpose, vicK mutant gene knock-out was obtained from strain SK36 and it was designated SKvicK. SKvicK was compared to the wild-type strain about the ability to form biofilms and cellular traits which influence in the ability of host colonization (hydrophobicity, autolytic activity and sensitivity to oxidative stress) under diverse atmospheric conditions. Gene expression was also compared in the strains because these genes are potencially involved in virulence, whose orthologs are regulated by VicRK system in S. mutans and S. pneumoniae species. These include genes involved in biofilm formation and cell wall biogenesis (ssapcsB, lysM, gtfP), oxidative stress response and production of hydrogen peroxide (sodA, spxB, ccpA). The inactivation of vicK inhibited the initial formation of biofilms. Moreover, SKvicK showed increased sensitivity to oxidative stress and cell hydrophobicity. vicK gene inativation also signicantly down-regulated transcription of pcsB, lysM, spxB and comE. These data indicate that VicRK regulates several biological functions relevant for S. sanguinis colonization / Doutorado / Estomatologia / Doutor em Estomatopatologia

Made available in DSpace on 2011-11-09T14:45:44Z (GMT). No. of bitstreams: 2 license.txt: 1648 bytes, checksum: e095249ac7cacefbfe39684dfe45e706 (MD5) 000239.pdf: 1746615 bytes, checksum: b1538d716409c5efb4a08da0bc08f73d (MD5) Previous issue date: 2008 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / Objetivo: avaliar a evolução clínica, morbidade e mortalidade de crianças e adolescentes portadores de cardiopatia reumática em acompanhamento ambulatorial num centro terciário. Material e Métodos: estudo descritivo observacional longitudinal de base hospitalar. Foi realizada análise de prontuários de pacientes com 3-18 anos, acompanhados por no mínimo 2 anos no ambulatório do Instituto Nacional de Cardiologia no Rio de Janeiro. O diagnóstico foi confirmado pelos critérios de Jones e/ou exame ecocardiográfico com lesão reumática típica mitral e/ou aórtica. Banco de dados foi elaborado com o programa ACCESS 2000, e a análise estatística realizada com o programa EPI-INFO 2000. Foi considerado significativo o valor de α- 0,05. Resultados:139 prontuários foram incluídos no estudo. A mediana da idade no início do seguimento foi de 11 anos, 52,6% eram do sexo feminino. Quanto à forma de apresentação clínica 45,3% estavam no primeiro surto, 14,4% em recidiva e 40,3% na fase crônica. A mediana de idade dos pacientes crônicos e em recidiva era superior aos pacientes do primeiro surto de febre reumática (p-0,0001). O tempo médio de seguimento foi de 9,9 anos (2-21 anos). A lesão valvar predominante foi a insuficiência mitral (82,7%), seguida da insuficiência aórtica (55,9%) e da insuficiência mitro-aórtica em 45,3% dos casos. Houve redução importante dos percentuais de lesões valvares graves - tanto mitrais como aórticas - ao final do seguimento.Recidivas foram evidenciadas em 32,3%. Pacientes com profilaxia irregular ou sem profilaxia apresentaram a média do número total de surtos (2,4 surtos por paciente) superior a do grupo em profilaxia regular (1,4 surtos por paciente), com diferença entre os grupos estatisticamente significante (p-0,0009).A mortalidade foi de 4,3% (n=6) Todos os pacientes que evoluíram para óbito eram portadores de próteses valvares. O abandono de tratamento foi de 10,8%, sendo que 1,4% desses pacienteseram portadores de próteses mecânicas (n-=2). Procedimentos intervencionistas foram realizados em 45,3% dos pacientes - valvuloplastia por cateter balão em 2,9% e cirurgia cardíaca valvar em 42,4%. Reoperação foi necessária em 8,6% (2ª cirurgia) e 2,8% (3ª cirurgia). O procedimento mais realizado foi o implante de prótese mecânica mitral (31,3%), seguido por prótese mecânica aórtica (20,9%) e plastia mitral (18,6%). A endocardite infecciosa foi evidenciada em 8,6%, sendo a endocardite de prótese em 3,6%, responsável por 50% da mortalidade desta amostra, com letalidade de 25%. Outrascausas de mortalidade incluíram estenose grave de prótese biológica (n=1), estenose grave de prótese mecânica (n=1) e trombose de prótese biológica (n=1). / Objective: to investigate the outcome, mortality and morbidity of children and adolescents with rheumatic heart disease followed up in an outpatient care unit of a terciarie center. Methods– descriptive longitudinal observational study of an hospitalar based population. Medical file of patients – 3 to18 years old - with rheumatic heart disease, followed-up for at least 2 years from in the outpatient care unit of the National Cardiology Institute (InstitutoNacional de Cardiologia) in Rio de Janeiro were reviewed. Diagnosis were confirmed through medical file register of the revised Jones criteria for rheumatic fever and/or Doppler echocardiographic report of typical chronic mitral or aortic lesions. Database program ACCESS 2000, statistical analysis was performed using EPI-INFO 2000 software, with significant αvalue 0,05. Results–139 medical files were reviewed. Median age at the first visit to the service was 11 years, 52,5% were female. At the first exam, 45,3% presented with acute rheumatic fever- first attack, 14,4% recurrence; while 40,3% had chronic valvular lesions. Median age of the chronic and recurrent group was greater than median age of the first attack group (p-0,0001). Mean follow-up time was 9,9 years (2 to 21 years). Mitral regurgitation was the most common valvular lesion (82,7%), followed by aortic regurgitation (55,9%) and combined mitral and aortic regurgitation (45,3%). There was a significant percent decrease in severe valvular lesions - both mitral and aortic – at the end of follow-up period. Recurrences were present in 32,3% of cases. There was a significant difference (p-0,0009) between the mean rate of the total number of attacks of patients under irregular or no prophylaxis (2,4 attacks / patient) compared with patients under regular prophylaxis (1,4 attacks / patient). Mortality rate were 4,3% (n=6). All these patients that died had prosthesis. 10,8% were lost of follow-up - 1,4% of these patients had mechanical prostheses (n=2). 45,4% underwent valve procedures: 2,9% balloon dilatation and 42,4% valve surgery. Reoperation wererequired by 8,6% (2 nd surgery) and rereoperation by 2,8% (3 rd surgery). The most common surgical procedure was mitral valve replacement with mechanical prosthesesimplantation (31,3%), followed by aortic valve replacement with mechanical prostheses implantation (20,9%) and mitral valve repair (18,6%). A total of 8,6% presented with endocarditis - 3,6% had prosthetic valve endocarditis, that accounted for 50% mortality of this group, and for a letality rate of 25%.Another causes of death included severe bioprosthesis stenosis (n=1), severe mechanical prosthesis stenosis (n=1) and bioprosthesis valve trombosis (n=1).

Submitted by Anderson Silva (avargas@icict.fiocruz.br) on 2012-09-27T17:08:04Z No. of bitstreams: 1 debora_h_g_paula_ipec_pesquisaclinicadi_0007_2010.pdf: 1005728 bytes, checksum: b98fa20a9a16f91bb1e9a163dcd87107 (MD5) / Made available in DSpace on 2012-09-27T17:08:04Z (GMT). No. of bitstreams: 1 debora_h_g_paula_ipec_pesquisaclinicadi_0007_2010.pdf: 1005728 bytes, checksum: b98fa20a9a16f91bb1e9a163dcd87107 (MD5) Previous issue date: 2010 / Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil / Eventos Adversos (EAs) são complicações indesejadas que podem decorrer durante os cuidados prestados ao paciente, não atribuídas à evolução natural da doença de base, podendo resultar em seqüela, prolongando a permanência no hospital ou mesmo levar ao óbito. A utilização do acesso intravenoso no tratamento medicamentoso da endocardite infecciosa (EI) pode trazer EAs ao paciente, com riscos de desfechos desfavoráveis. O objetivo deste estudo é identificar os EAs infecciosos e não infecciosos relacionados à utilização do acesso intravenoso no tratamento da EI no Instituto Nacional de Cardiologia (INC) nos anos de 2009 e 2010. Trata-se de estudo observacional, analítico, e prospectivo, a partir do diagnóstico possível e definitivo para EI, pelos critérios de Duke modificados, através do preenchimento de instrumentos de coleta de dados adaptados de outros estudos primários [International Collaboration on Endocarditis (ICE) e de um estudo piloto de terapia intravenosa (INC)] dos acessos intravenosos [periférico, profundo, hemodiálise, e catéter central de inserção periférica (PICC)]. Foram incluídos 37 episódios de EI, que ocorreram em 35 pacientes. A idade média foi 44,32 ± 15,32 anos; sendo 22 (63%) pacientes do sexo masculino e 13 (37%) do sexo feminino. A amostra estudada totalizou 253 acessos intravenosos sendo 148 acessos periféricos, 85 acessos intravenosos (21 de hemodiálise) profundos de curta permanência não tunelizado (CVP), e 20 cateteres centrais de inserção periférica (PICC). “Hiperemia” e “infiltração” foram os eventos mais frequentes nos acessos periféricos; “febre” foi o evento mais frequente nos acessos profundos; “obstrução” e “exteriorização” mais frequente no PICC. A análise estatística relacionando os EAs com cada tipo de acesso intravenoso mostrou significância estatística para febre (p<0,005), bacteremia (p<0,05), saída acidental e exteriorização (p<0,001), e obstrução (p<0,001). Com relação ao tempo de permanência dos cateteres, o número de cateteres-dia foi 360 para periféricos, 1156 para CVP e 420 para PICC. A construção de curvas de Kaplan Meyer para CVP e PICC mostrou diferença estatística para obstrução (p<0,001) e manuseio (saída acidental, mais exteriorização mais obstrução, p<0,001), sendo estes eventos mais comuns na PICC. Houve mais bacteremias no CVP, mas sem diferença estatística (p=0,23). Observa-se que os eventos descritos decorrem do manuseio inadequado e de possíveis falhas nas técnicas assépticas. Deste modo, é necessário implementação mais rigorosa de medidas efetivas de controle de infecções relacionadas a acessos e ações educativas para evitar complicações mecânicas. / Adverse events (AEs) are undesirable complications that may occur during patient care that cannot be attributed to the natural history of the underlying disease. They may result in incapacity, lengthening of hospital stay or even death. The use of intravenous access in the medical treatment of infective Endocarditis (IE) may result in AE to the patient, with unfavorable outcomes. The goal of the present study was to identify the infectious and non-infectious AEs related to the use of intravenous access sites for IE treatment at national Institute of Cardiology (INC) in the years from 2009 to 2010. This is an observational, analytic and prospective study based on cases of IE diagnosed as possible or definite by the modified Duke criteria. A case report form was created for data collection on intravenous lines (peripheral, central vascular, haemodyalisis and peripherally inserted central catheter/ PICC), based on data collection forms from other primary studies[International Collaboration on Endocarditis (ICE), and a pilot study on intravenous therapy (INC)].Thirty-seven episodes of IE in 35 patients were studied. Patients’ mean age was 44.32 ± 15.2 years; 22 patients (63%) were male, and 13 (37%) female. A total of 253 vascular catheters were studied, 148 were peripheral catheters, 85 were short term, non tunneled central venous catheters (21 of which were for haemodyalisis) and 20 were PICC. “Erythema” and “infiltration” were the most frequently observed AEs in the peripheral catheters, while “fever” was the most frequent AEs for CVPs, and “obstruction”, and “externalization” were more frequent in PICCs. Statistical analysis relating AEs with venous catheters type showed significance for fever (p<0.005), bacteraemia (p<0.05), accidental extrusion and externalization (p<0.001), and obstruction (p<0.001). As to the time catheters remained, the number of catheter-days was 360 for peripheral catheters, 1,156 for CVP and 420 for PICC. Kaplan Meyer curves for CVP and PICC showed statistical difference for obstruction (p<0.001) and “manipulation” (accidental extrusion, externalization, and obstruction, p<0.001), and these events were more common in PICC. More bacteraemia occurred in CVP, but this was of no statistical significance (p=0.23). The described adverse events resulted from inadequate handling and breakdown in aseptic techniques. Therefore, it is important that stricter implementation of infection control measures to prevent catheter related infections and educational measures to minimize mechanical complications are implemented.

Le brossage des dents, la mastication des aliments et toutes autres activités orales quotidiennes peuvent provoquer une bactériémie transitoire. Cette bactériémie transitoire a le potentiel de causer une endocardite infectieuse en présence de certains facteurs de risque. Les cardiopathies congénitales chez les enfants font partie de ces facteurs de risque. Le contrôle de la plaque dentaire et une bonne santé buccodentaire permettent de réduire le risque d’endocardite infectieuse. Les objectifs du présent projet de recherche visent à évaluer les connaissances des parents d’enfants atteints de cardiopathies congénitales sur l’endocardite infectieuse et son lien avec la santé buccodentaire et de connaître les habitudes d’hygiène orale personnelles et professionnelles adoptées par les enfants atteints de cardiopathies congénitales. Le projet de recherche vise également à évaluer l’efficacité de deux méthodes d’enseignement d’hygiène orale chez les enfants atteints de cardiopathies congénitales. La procédure expérimentale implique que tous les parents ou gardiens légaux d’enfants atteints de cardiopathies congénitales, âgés entre 6 et 12 ans qui visitent le service de cardiologie du CHU Sainte-Justine sont sollicités à participer au projet de recherche. Un formulaire d’information et de consentement ainsi qu’un questionnaire sont remis aux parents. Le questionnaire vise à évaluer la connaissance des parents d’enfants atteints de cardiopathies congénitales sur ce qu’est l’endocardite infectieuse et son lien avec la santé buccodentaire ainsi que de connaître les habitudes d’hygiène orale personnelles et professionnelles des enfants atteints de cardiopathies congénitales. L’examen clinique nécessaire au projet de recherche implique le prélèvement d’un indice de plaque Quigley & Hein, Turesky modifié avant et après que l’enfant participant au projet de recherche ait appliqué les instructions d’hygiène orale reçues. L’enfant est assigné à l’une des deux méthodes d’instructions d’hygiène orale avec l’aide d’une table de randomisation. La méthode d’instructions d’hygiène orale du groupe 1 correspond à des instructions transmises par le cardiologue tandis que la méthode d’instructions d’hygiène orale du groupe 2 correspond aux instructions transmises par l’intermédiaire d’un document audio visuel. Des analyses chi-carré et des tests de T pairé ainsi que des analyses de variance univariée (one-way ANOVA) et des analyses de corrélation de Pearson entre le questionnaire et les données cliniques ont été effectuées pour analyser les données recueillies. Les résultats démontrent que les parents d’enfants « à risque élevé » d’effet adverse d’une endocardite infectieuse ne connaissent pas davantage le risque d’endocardite infectieuse d’origine buccodentaire que les parents d’enfants « de moindre risque » (p=0,104). Les résultats démontrent toutefois que les parents d’enfants atteints de cardiopathies congénitales qui connaissent le risque d’endocardite infectieuse et son lien avec la santé buccodentaire adhèrent à des comportements dans le but de maintenir une bonne santé buccodentaire chez leur enfant. Les résultats qui proviennent de l’examen clinique démontrent que l’application des instructions d’hygiène orale faites par le cardiologue et par l’intermédiaire d’un document audio visuel permettent d’observer une différence statistiquement significative (p=0,000) au niveau du contrôle de la plaque dans chacun de ces groupes. Toutefois, aucune différence statistiquement significative (p=0,668) n’a pu être démontrée entre les deux méthodes d’instructions d’hygiène orale. Les parents qui connaissent le lien entre la santé buccodentaire et le risque d’endocardite infectieuse pour leur enfant atteint de cardiopathie congénitale adoptent un comportement pour optimiser la santé buccodentaire de leur enfant. Les instructions d’hygiène orale par l’intermédiaire d’un document audio visuel sont équivalentes aux instructions d’hygiène orale prodiguées par le cardiologue. / Tooth brushing and food chewing are among the oral activities that can cause transient bacteremia. A transient bacteremia can initiate infective endocarditis in patients at risk. Risk factors for infective endocarditis in children include most congenital heart diseases and it has been shown that effective plaque control and good oral hygiene can reduce the risk for infective endocarditis initiated by bacteria of oral origin. The present research objectives were drawn up to evaluate the level of knowledge of parents of children with congenital heart disease on infective endocarditis and its relation to oral health. Our other research objective was to probe the oral hygiene habits of children with congenital heart disease. The efficacy of two oral hygiene instructional methods in children with congenital heart disease was also evaluated. The experimental procedure meant the involvement of all the parents of children with congenital heart disease, between 6 and 12 years old who were visiting the department of cardiology at the CHU Sainte-Justine. They were solicited to participate in the research project and were given an information and consent form. All parents who agreed to participate were given the questionnaire that was used to evaluate the knowledge of parents of children with congenital heart disease on infective endocarditis and its association with oral health. The questionnaire also aimed to know the personal and professional oral hygiene habits of children with congenital heart disease. A clinical exam performed on each child cited the Quigley & Hein, Turesky modified plaque index before and after the utilization of the assigned oral hygiene instructions. Each child was assigned to one of the two oral hygiene instruction groups through a randomization table. The method of oral hygiene instructions of group 1 corresponded to the instructions given by the cardiologist and the method of oral hygiene instructions of group 2 corresponded the to instructions given by an audio visual presentation. Paired T-test and Chi-square analyses, as well as one-way ANOVA analysis and Pearson’s correlation analysis were produced to evaluate the data. The results demonstrated that the knowledge of the association between oral health and infective endocarditis was not superior in parents of children with higher risk of adverse effect from infective endocarditis than in parents of children with a lesser risk (p=0,104). Interestingly enough, parents of children with a congenital heart disease that are knowledgeable about the association will adopt preventive behaviors in order to promote their child’s oral heath and reduce their risk for infective endocarditis. The clinical exam also demonstrated that both oral hygiene instructions methods were effective for plaque control (p=0,000) but no significant statistical difference was found between the two methods (p=0,668). The parents of children with congenital heart disease that are aware of the association between oral health and infective endocarditis demonstrated preventive oral health behaviors to promote oral health in comparison with the parents who lacked the knowledge. The oral hygiene instructions methods given by way of the audio visual presentation was not superior to those given by the cardiologist.

Made available in DSpace on 2016-04-28T20:18:35Z (GMT). No. of bitstreams: 1 Anselmo Silva Ramos.pdf: 9452970 bytes, checksum: 54edbfe5612f83c527cf96b62151498d (MD5) Previous issue date: 2011-01-25 / Based on the premisse that the oral trauma might cause the introduction of bacteria in the bloodstream, this study was developed aiming at investigating the frequency of transitory bacteremia in different dental procedures and the usual in dogs and the risk of infectious endocarditis in these animals. 36 dogs were were evaluated and classified as to the degree of the periodontal disease in six treatments: T1 (n=5) healthy gum/ negative control;T2(n=6) mild gingivitis; T3 (n=6) moderate or severe gingivitis/feeding;T4(n=6)moderate or severe gingivitis / toothbrushing t5(n=6)moerate or severe periodontitis/ removal of subgum plaque ;T5(n=7) severe periodonctis / exodontia. Blood samples for hemogram and hemoculture were obtained before the procedures, and two for hemoculture with thirty-minute breaks after the procedures. The hemoculture was performed in triphasic hemobac and the hemograms in electronic counter. After that, the animals were sumitted to cardiac assessment by ultrasound tests. A great accumulation of plaque was observed in animals of different ages especially in the upper molar and premolar teeth. The hemogram revealed values indicative of ANN, normal leucometria and trombocitopenia in all groups. There were 22 % of positive hemocultures beforem, 32,2% immediately after and 30 minutes after the procedures with mostly Staphylococcus sp and Streptococcus sp .In the ultrasound tests there were no alterations indicative of proliferative vegetative lesions. The diameters of the atria and ventricles were smaller in the animals with periodontitis. The cardiac debt was also smaller in these animals. The thickness of the walls of the ventricles were smaller in the healthy animals. The average mitral thickness did not significantly vary in the healthy animals and the ones with PD. The average values were compatible with endocardiosis (3,39 +_ 0,71) in 31 animals. The two represent the measurement of the diameter of the root of the Aorta out of the limits and the relation LV/AO made cardiopathy evident in at least 15 animals. The cardiac debt was smaller in the animals with PD within the group of weight associated with other parameters of the ventricular function suggest a PD effect on the cardiocirculatory activity. / Com base na premissa de que o trauma oral pode provocar a introdu??o de bact?rias na corrente sangu?nea, este estudo foi desenvolvido com a finalidade de investigar a freq??ncia de bacteremia transit?ria em diferentes procedimentos odontol?gicos e usuais em c?es e o risco de endocardite infecciosa nesses animais. Foram avaliados 36 c?es classificados quanto ao grau da doen?a periodontal em seis tratamentos: T1 (n=5) gengivas saud?veis / Controle negativo; T2 (n=6) - gengivite leve; T 3 (n= 6) gengivite moderada ou grave / alimenta??o; T 4 (n= 6) gengivite moderada ou grave / escova??o; T 5 (n=6) - periodontite moderada ou grave / remo??o da placa subgengival; T6 (n=7) periodontite grave / exodontia. Amostras de sangue para hemograma e hemocultura foram obtidas antes dos procedimentos, e duas para hemocultura com intervalos de 30 minutos ap?s os procedimentos. A hemocultura foi realizada em Hemobac trif?sico e os hemogramas em contador eletr?nico. Ap?s, os animais foram submetidos ? avalia??o card?aca pela ecocardiografia. Em animais de diferentes idades foi observado grande ac?mulo de placa, sobretudo nos pr?-molares e molares superiores. O hemograma revelou valores indicativos de ANN, leucometria normal e trombocitopenia em todos os grupos. Obteve-se 22% de hemoculturas positivas antes, 32,2% imediatamente e 30 minutos ap?s os procedimentos com predom?nio de Staphylococcus sp e Streptococos sp. Na avalia??o ultrassonogr?fica n?o foram evidenciadas altera??es indicativas de les?es proliferativas vegetativas. Os di?metros dos ?trios e ventr?culos foram menores nos animais com periodontite. Tamb?m o d?bito card?aco foi menor nesses animais. A espessura da parede do ventr?culo foi menor nos animais sadios. A espessura m?dia da mitral n?o variou significativamente entre animais sadios e com DP. Os valores m?dios foram compat?veis com endocardiose (3,39 ? 0,71) em 31 animais. Dois apresentaram a mensura??o do di?metro da raiz da aorta fora dos limites e a rela??o VE/AO evidenciou cardiopatia em pelo menos 15 animais. O d?bito card?aco menor em animais com DP na mesma faixa de peso em associa??o com outros par?metros da fun??o ventricular sugere um efeito da DP sobre a atividade cardiocirculat?ria.

Le brossage des dents, la mastication des aliments et toutes autres activités orales quotidiennes peuvent provoquer une bactériémie transitoire. Cette bactériémie transitoire a le potentiel de causer une endocardite infectieuse en présence de certains facteurs de risque. Les cardiopathies congénitales chez les enfants font partie de ces facteurs de risque. Le contrôle de la plaque dentaire et une bonne santé buccodentaire permettent de réduire le risque d’endocardite infectieuse. Les objectifs du présent projet de recherche visent à évaluer les connaissances des parents d’enfants atteints de cardiopathies congénitales sur l’endocardite infectieuse et son lien avec la santé buccodentaire et de connaître les habitudes d’hygiène orale personnelles et professionnelles adoptées par les enfants atteints de cardiopathies congénitales. Le projet de recherche vise également à évaluer l’efficacité de deux méthodes d’enseignement d’hygiène orale chez les enfants atteints de cardiopathies congénitales. La procédure expérimentale implique que tous les parents ou gardiens légaux d’enfants atteints de cardiopathies congénitales, âgés entre 6 et 12 ans qui visitent le service de cardiologie du CHU Sainte-Justine sont sollicités à participer au projet de recherche. Un formulaire d’information et de consentement ainsi qu’un questionnaire sont remis aux parents. Le questionnaire vise à évaluer la connaissance des parents d’enfants atteints de cardiopathies congénitales sur ce qu’est l’endocardite infectieuse et son lien avec la santé buccodentaire ainsi que de connaître les habitudes d’hygiène orale personnelles et professionnelles des enfants atteints de cardiopathies congénitales. L’examen clinique nécessaire au projet de recherche implique le prélèvement d’un indice de plaque Quigley & Hein, Turesky modifié avant et après que l’enfant participant au projet de recherche ait appliqué les instructions d’hygiène orale reçues. L’enfant est assigné à l’une des deux méthodes d’instructions d’hygiène orale avec l’aide d’une table de randomisation. La méthode d’instructions d’hygiène orale du groupe 1 correspond à des instructions transmises par le cardiologue tandis que la méthode d’instructions d’hygiène orale du groupe 2 correspond aux instructions transmises par l’intermédiaire d’un document audio visuel. Des analyses chi-carré et des tests de T pairé ainsi que des analyses de variance univariée (one-way ANOVA) et des analyses de corrélation de Pearson entre le questionnaire et les données cliniques ont été effectuées pour analyser les données recueillies. Les résultats démontrent que les parents d’enfants « à risque élevé » d’effet adverse d’une endocardite infectieuse ne connaissent pas davantage le risque d’endocardite infectieuse d’origine buccodentaire que les parents d’enfants « de moindre risque » (p=0,104). Les résultats démontrent toutefois que les parents d’enfants atteints de cardiopathies congénitales qui connaissent le risque d’endocardite infectieuse et son lien avec la santé buccodentaire adhèrent à des comportements dans le but de maintenir une bonne santé buccodentaire chez leur enfant. Les résultats qui proviennent de l’examen clinique démontrent que l’application des instructions d’hygiène orale faites par le cardiologue et par l’intermédiaire d’un document audio visuel permettent d’observer une différence statistiquement significative (p=0,000) au niveau du contrôle de la plaque dans chacun de ces groupes. Toutefois, aucune différence statistiquement significative (p=0,668) n’a pu être démontrée entre les deux méthodes d’instructions d’hygiène orale. Les parents qui connaissent le lien entre la santé buccodentaire et le risque d’endocardite infectieuse pour leur enfant atteint de cardiopathie congénitale adoptent un comportement pour optimiser la santé buccodentaire de leur enfant. Les instructions d’hygiène orale par l’intermédiaire d’un document audio visuel sont équivalentes aux instructions d’hygiène orale prodiguées par le cardiologue. / Tooth brushing and food chewing are among the oral activities that can cause transient bacteremia. A transient bacteremia can initiate infective endocarditis in patients at risk. Risk factors for infective endocarditis in children include most congenital heart diseases and it has been shown that effective plaque control and good oral hygiene can reduce the risk for infective endocarditis initiated by bacteria of oral origin. The present research objectives were drawn up to evaluate the level of knowledge of parents of children with congenital heart disease on infective endocarditis and its relation to oral health. Our other research objective was to probe the oral hygiene habits of children with congenital heart disease. The efficacy of two oral hygiene instructional methods in children with congenital heart disease was also evaluated. The experimental procedure meant the involvement of all the parents of children with congenital heart disease, between 6 and 12 years old who were visiting the department of cardiology at the CHU Sainte-Justine. They were solicited to participate in the research project and were given an information and consent form. All parents who agreed to participate were given the questionnaire that was used to evaluate the knowledge of parents of children with congenital heart disease on infective endocarditis and its association with oral health. The questionnaire also aimed to know the personal and professional oral hygiene habits of children with congenital heart disease. A clinical exam performed on each child cited the Quigley & Hein, Turesky modified plaque index before and after the utilization of the assigned oral hygiene instructions. Each child was assigned to one of the two oral hygiene instruction groups through a randomization table. The method of oral hygiene instructions of group 1 corresponded to the instructions given by the cardiologist and the method of oral hygiene instructions of group 2 corresponded the to instructions given by an audio visual presentation. Paired T-test and Chi-square analyses, as well as one-way ANOVA analysis and Pearson’s correlation analysis were produced to evaluate the data. The results demonstrated that the knowledge of the association between oral health and infective endocarditis was not superior in parents of children with higher risk of adverse effect from infective endocarditis than in parents of children with a lesser risk (p=0,104). Interestingly enough, parents of children with a congenital heart disease that are knowledgeable about the association will adopt preventive behaviors in order to promote their child’s oral heath and reduce their risk for infective endocarditis. The clinical exam also demonstrated that both oral hygiene instructions methods were effective for plaque control (p=0,000) but no significant statistical difference was found between the two methods (p=0,668). The parents of children with congenital heart disease that are aware of the association between oral health and infective endocarditis demonstrated preventive oral health behaviors to promote oral health in comparison with the parents who lacked the knowledge. The oral hygiene instructions methods given by way of the audio visual presentation was not superior to those given by the cardiologist.