Relapses, recurrences, valve replacements, and mortality during the long-term follow-up after infective endocarditis.

BACKGROUND: Late prognosis after infective endocarditis has not been systematically studied in large series of patients with different underlying heart conditions in recent years. METHODS: We studied an inception cohort study of 420 patients discharged after treatment of endocarditis from a university tertiary care hospital. The patients were aged 34.2+/-17.2 years (mean +/- SD), ranging from 2 months to 83 years; 270 (64.3%) were men and 150 (35.7%) were women. Mean follow-up was 6.1+/-4.3 years for survivors and 3.7+/-3.7 years for the patients who died during the follow-up. We studied the frequency and risk factors for relapses and recurrences of endocarditis, cardiac valve replacements, and deaths during the follow-up. Statistical analysis was performed through comparison of groups, of event-free survival, and risk ratios. RESULTS: Relapses were observed in 14 (3.3%) patients. There was one recurrence of endocarditis in 48 (11.4%) patients, two (0.5%) in 2 patients, three in 1 patient (0.2%), and five (0.2%) in 1 patient. Valve replacement was performed in 83 (19.7%) patients. Ninety-eight (12.3%) patients died. Risk factors for recurrent endocarditis were increasing age (risk ratio 1.02) and male sex (risk ratio 1.61). Risk factors for valve replacement were recurrent endocarditis (risk ratio 1.62) and prosthetic valve endocarditis (risk ratio 1.61). Risk factors for death were increasing age (risk ratio 1.03) and recurrent endocarditis (risk ratio 2.06). CONCLUSIONS: The long-term event-free survival for patients who survived their first episode of endocarditis was low. Recurrent endocarditis, prosthetic valve endocarditis, and increasing age contributed to the high rate of events during the follow-up.

Occupational exposure to lead, kidney function tests, and blood pressure.

In the present study we examined sensitive biochemical markers of kidney function and damage in 166 workers exposed to lead and in 60 control workers. The objective was to investigate the chronic renal toxicity of lead and its possible correlation with arterial pressure. Diastolic arterial pressure was higher in the exposed group (p < 0.05), but the two groups did not differ in systolic pressure. Median activity of urinary N-acetyl-beta-D-glucosaminidase was higher in the exposed group (p < 0.001), and correlated with blood lead levels (p < 0.001) and duration of exposure (p < 0.001), but not with arterial pressure. The other indicators studied, gamma-glutamyl-transpeptidase and alanine-aminopeptidase activity, urine albumin, and total urine protein, were not higher than in the control group and were not correlated with blood lead, duration of exposure, or arterial pressure.

Comparison of the effects of lab chow and casein diets based on body and brain development of rats.

1. In order to study the effects of protein quantity and quality on development, Wistar rats were submitted to four different diets during lactation and post-lactation periods. Three isocaloric diets were utilized with 6% (M), 16% (W16) and 20% (W20) of protein (casein), and the fourth diet (C) consisted of a commercial lab chow containing 22% protein. 2. During the lactation and post-lactation periods the body weights of dams and pups were recorded weekly. On the 49th day of age (21 days of suckling and 28 days of ad libitum chow), all animals were sacrificed and the brains removed and weighed. 3. Dams from all groups increased food intake during the lactation period, but dams of the M group consumed a lower amount of diet as compared with other groups. Only the body weight of M dams was affected by diet during the lactation period, but the body weight of pups from the M and C groups was lower than in the other two groups. At 49 days of age C and M pups showed a significantly lower brain weight compared with W16 and W20 pups. 4. Thus, a commercial lab chow diet does not promote normal body and brain development as compared with balanced diets containing 16 or 20% protein. These results emphasize the need for further studies in order to evaluate other biological and behavioral parameters that might be altered by a lab chow diet.

Comparison of the effects of lab chow and casein diets based on body and brain development of rats

1. In order to study the effects of protein quantity and quality on development, Wistar rats were submitted to four different diets during lactation and post-lactation periods. Three isocaloric diets were utilized with 6 per cent (M), 16 per cent (W16) and 20 per cent (W20) of protein (casein), and the fourth diet (C) consisted of a commercial lab chow containing 22 per cent protein. 2. During the lactation and post-lactation periods the body weights of dams and pups were recorded weekly. On the 49th day of age (21 days of suckling and 28 days of ad libitum chow), all animals were sacrificed and the brains removed and weighed. 3. Dams from all groups increased food intake during the lactation period, but dams of the M group consumed a lower amount of diet as compared with other groups. Only the body weight of M dams was affected by diet during the lactation period, but the body weight of pups from the M and C groups was lower than in the other two groups. At 49 days of age C and M pups showed a significantly lower brain weight compared with W16 and W20 pups. 4. Thus, a commercial lab chow diet does not promote normal body and brain development as compared with balanced diets containing 16 or 20 per cent protein. These results emphasize the need for further studies in order to evaluate other biological and behavioral parameters that might be altered by a lab chow diet

[Correlation between maternal age, social class and smoking, and birth weight]. / Associação entre idade, classe social e hábito de fumar maternos com peso ao nascer.

An epidemiological survey was carried out in Ribeirão Preto, Brazil, from June 1978 to May 1979. Interviews were held with mother of singleton live borne children, delivered in hospitals, which accounted for 98% of all births in the area. The higher percentages of low birthweight children related to the offspring of smokers, young mother and women belonging to the working class. The majority of young women were found in the working class and the prevalence of smoking was higher in the group of women below 20 years of age. There was no statistical difference in the smoking habit as between different social classes. A larger number of low birthweight children were observed in nonsmoking women of the working class than among women smokers of the middle class. A log model was adjusted to the data in order to study the possible multiple association of smoking, maternal age and social class with birthweight. The results indicated that maternal smoking, maternal age and social class had independent effects on birthweight. The was no interaction between them. These findings suggest that the higher prevalence of low birthweight in nonsmoking mothers of the working class in relation to smoking mothers of the middle class probably reflects clustering of other risk factors-such as poor education inadequate prenatal care, high parity and differences in reproductive behavior in women of the working class.

[Perinatal health: low birth weight and social class]. / Saúde perinatal: baixo peso e classe social.

A survey was carried out in Ribeirão Preto, S. Paulo State, Brazil, between June 1978 and May 1979 with a view to studying the prevalence of low birth weight and its occurrence among different social classes. Data were collected from 8,878 singleton live births in eight maternity hospitals, accounting for 98% of all births in the area. Social classes were determinated by the use of a model proposed by Singer and modified for epidemiological purposes by Barros. Out of the 8,878 births, 660 (7.5%) were of low birth weight. The prevalence of deficient weight at birth (between 2,500 and 2,999 grams) was of 21.1%. Analysis indicated that 50.6% of children with low birth weight were at term and the majority of them suffered form intrauterine growth retardation. The prevalence of low birth weight according to social class was seen to be lower in the bourgeoisie classes (ranging from 2.8% to 3.9%) and higher in working classes (from 7% up to 9.5%). Low birth weight (defined as less than or equal to 2,500 grams) was used for purposes of comparison with other previous surveys. The percentage was lower in this study (8.3%) than that found in the Interamerican Investigation of Mortality in Childhood (8.7%), carried out in 1968-70. No statistically significant differences in the percentage of low birth weight were found in the case of Ribeirão Preto when these two surveys were compared.