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1.
Nitric Oxide ; 59: 28-41, 2016 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-27387335

RESUMO

Mycobacterium tuberculosis (Mtb) is a facultative intracellular pathogen and the second largest contributor to global mortality caused by an infectious agent after HIV. In infected host cells, Mtb is faced with a harsh intracellular environment including hypoxia and the release of nitric oxide (NO) and carbon monoxide (CO) by immune cells. Hypoxia, NO and CO induce a state of in vitro dormancy where Mtb senses these gases via the DosS and DosT heme sensor kinase proteins, which in turn induce a set of ∼47 genes, known as the Mtb Dos dormancy regulon. On the contrary, both iNOS and HO-1, which produce NO and CO, respectively, have been shown to be important against mycobacterial disease progression. In this review, we discuss the impact of O2, NO and CO on Mtb physiology and in host responses to Mtb infection as well as the potential role of another major endogenous gas, hydrogen sulfide (H2S), in Mtb pathogenesis.


Assuntos
Gasotransmissores/fisiologia , Mycobacterium tuberculosis/fisiologia , Tuberculose Pulmonar/metabolismo , Monóxido de Carbono/fisiologia , Humanos , Sulfeto de Hidrogênio/metabolismo , Mycobacterium tuberculosis/genética , Óxido Nítrico/fisiologia , Oxigênio/fisiologia , Espécies Reativas de Oxigênio/metabolismo , Tuberculose Pulmonar/microbiologia
2.
World J Pediatr Congenit Heart Surg ; 12(3): 394-405, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33942697

RESUMO

The optimal training of the highly specialized congenital heart surgeon is a long and complex process, which is a significant challenge in most parts of the world. The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has established the Global Council on Education for Congenital Heart Surgery as a nonprofit organization with the goal of assessing current training and certification and ultimately establishing standardized criteria for the training, evaluation, and certification of congenital heart surgeons around the world. The Global Council and the WSPCHS have reviewed the present status of training and certification for congenital cardiac surgery around the world. There is currently lack of consensus and standardized criteria for training in congenital heart surgery, with significant disparity between continents and countries. This represents significant obstacles to international job mobility of competent congenital heart surgeons and to the efforts to improve the quality of care for patients with Congenital Heart Disease worldwide. The purpose of this article is to summarize and document the present state of training and certification in congenital heart surgery around the world.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Cirurgia Torácica , Certificação , Criança , Cardiopatias Congênitas/cirurgia , Humanos , Sociedades Médicas
3.
World J Pediatr Congenit Heart Surg ; 10(3): 338-342, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31084309

RESUMO

Surgical palliation has remarkably improved survival of functionally single ventricle (FSV) patients born in developed nations but such outcomes have not occurred in Africa. The poor care coverage for FSV patients in Africa exists within the larger sphere of deficient health care for children born with congenital heart defects (CHDs) in Africa generally. This review takes the position that to improve health-care coverage for CHD patients on the continent, political priority is paramount. This can be attained with cohesive leadership for the CHD agenda, a guiding institution, and the mobilization of civil society to drive advocacy at national and international levels.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Atenção à Saúde/métodos , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/anormalidades , Cuidados Paliativos/organização & administração , África , Criança , Ventrículos do Coração/cirurgia , Humanos
4.
Cardiovasc J Afr ; 27(1): 30-6, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26523459

RESUMO

BACKGROUND: The imaging modalities used to diagnose vascular rings have evolved over time, from basic radiographic studies to advanced cross-sectional imaging. The goal of preoperative imaging is to provide the surgeon with an accurate representation of the ring configuration so that the surgical approach may be planned. METHODS: We conducted a review of all patients with vascular rings who underwent surgery at Inkosi Albert Luthuli Central Hospital, Durban, South Africa from 1 July 2008 to 1 July 2013. RESULTS: Eight patients were diagnosed with vascular rings. Seven patients had an abnormal plain chest radiograph (right aortic arch, tracheal narrowing, or abnormal mediastinal silhouette), while in six patients the contrast oesophagogram demonstrated a fixed extrinsic oesophageal indentation. Computed tomography angiography confirmed the pathology in all cases, with six double aortic arches and two right aortic arches with aberrant left subclavian artery and left ligamentum arteriosum. CONCLUSIONS: We advocate a diagnostic imaging algorithm consisting of plain chest radiography, contrast oesophagogram and computed tomography angiography prior to surgery. Magnetic resonance imaging may provide an alternative axial imaging modality depending on institutional preference.


Assuntos
Aneurisma/diagnóstico , Aorta Torácica/patologia , Anormalidades Cardiovasculares/diagnóstico , Transtornos de Deglutição/diagnóstico , Artéria Subclávia/anormalidades , Algoritmos , Aneurisma/patologia , Anormalidades Cardiovasculares/patologia , Transtornos de Deglutição/patologia , Humanos , Imageamento por Ressonância Magnética , Radiografia/métodos , África do Sul , Artéria Subclávia/patologia
5.
Interact Cardiovasc Thorac Surg ; 19(1): 56-63, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24659550

RESUMO

OBJECTIVES: The extraordinarily high rate of penetrating heart injuries in South Africa provides a substantial denominator from which we derive a subset of patients with intracardiac lesions as a result of these injuries. The surgical literature, which consists largely of case reports and case series, describing various patterns of injury is dated and a review of management in the era of modern imaging and surgical techniques is warranted. METHODS: A retrospective observational chart review of all patients with intracardiac injuries following penetrating trauma who were referred to the Department of Cardiothoracic Surgery at Inkosi Albert Luthuli Central Hospital in Durban, South Africa, during the 10-year period between July 2003 and July 2013 was performed. The spectrum of pathology encountered included ventricular septal defects, valve apparatus lacerations, intracardiac fistulae, ventricular aneurysms and retained intracardiac missiles. RESULTS: Of the 17 patients, 10 required operative repair of the intracardiac lesions using cardiopulmonary bypass, with no early mortality noted. Seven patients were treated non-operatively, for reasons that varied from insignificant haemodynamic shunts to advanced human immunodeficiency virus (HIV) infection. The in-hospital mortality in this group consisted of 1 patient, who was moribund at presentation. CONCLUSIONS: The referral of patients for the repair of intracardiac injuries following penetrating cardiac trauma is often delayed. Symptoms of cardiac failure should be optimized medically prior to undertaking definitive surgical repair, thereby also allowing for detailed preoperative imaging to guide appropriate intervention. Utilizing standard principles of intracardiac shunt repair, as well as contemporary valve repair techniques, favourable surgical outcomes may be reproduced. Percutaneous catheter device techniques may prove useful in patients deemed unsuitable for surgical repair, such as patients with sternal wound sepsis.


Assuntos
Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/terapia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/terapia , Adolescente , Adulto , Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Angiografia Coronária/métodos , Feminino , Traumatismos Cardíacos/mortalidade , Traumatismos Cardíacos/fisiopatologia , Hemodinâmica , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , África do Sul , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/fisiopatologia , Adulto Jovem
7.
Ann Thorac Surg ; 94(2): 381-6, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22633500

RESUMO

BACKGROUND: Extensively drug resistant tuberculosis (XDR-TB) has been reported in 58 countries around the world and has emerged as a major public health challenge. Our objective was to determine the impact of pulmonary resection on XDR-TB treatment outcomes in a resource-constrained setting. METHODS: We conducted a retrospective case review of 11 patients with XDR-TB who were referred for pulmonary resection between January 2007 and June 2010 at a tertiary care referral hospital in South Africa. Two pneumonectomies and three upper lobectomies were performed. Occurrence of surgical complications and TB treatment outcome were assessed. RESULTS: No perioperative mortality or major morbidity was noted. All patients achieved sputum conversion, with 4 regarded as "cured." One patient defaulted on treatment, but subsequently returned and is regarded as a probable cure. CONCLUSIONS: We describe pulmonary resection for XDR-TB management in Africa. Although the initial cohort of XDR-TB patients from Tugela Ferry demonstrated nearly complete mortality, our results demonstrate the potential of adjuvant surgical methods in XDR-TB treatment. With appropriate chemotherapy and timely adjuvant surgery, patients with XDR-TB localized to lobe or lung may achieve a "cure" with low morbidity and mortality. Consequently, this approach may be the most cost effective treatment for patients suitable for lung resection.


Assuntos
Tuberculose Extensivamente Resistente a Medicamentos/cirurgia , Pneumonectomia , Tuberculose Pulmonar/cirurgia , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , África do Sul , Adulto Jovem
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