Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.047
Filtrar
1.
S Afr Med J ; 109(8): 592-596, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31456555

RESUMO

BACKGROUND: Little is known about the current clinical profile and outcomes of patients with infective endocarditis (IE) in South Africa (SA). OBJECTIVES: To provide a contemporary and descriptive overview of IE in a representative SA tertiary centre. METHODS: We conducted a retrospective review of the records of patients admitted to Groote Schuur Hospital, Cape Town, between 2009 and 2016 fulfilling universal criteria for definite or possible IE, in search of demographic, clinical, microbiological, echocardiographic, treatment and outcome information. RESULTS: A total of 105 patients fulfilled the modified Duke criteria for IE. The median age of the cohort was 39 years (interquartile range (IQR) 29 - 51), with a male preponderance (61.9%). The majority of the patients (72.4%) had left-sided native valve endocarditis, 14.3% had right-sided disease, and 13.3% had prosthetic valve endocarditis. A third of the cohort had rheumatic heart disease. Although 41.1% of patients with left-sided disease had negative blood cultures, the three most common organisms cultured in this subgroup were Staphylococcus aureus (18.9%), Streptococcus spp. (16.7%) and Enterococcus spp. (6.7%). Participants with right-sided endocarditis were younger (29 years, IQR 27 - 37) and were mainly intravenous drug users (73.3%), and the majority cultured positive for S. aureus (73.3%) with frequent septic pulmonary complications (40.0%). The overall in-hospital mortality was 16.2%, with no deaths in the group with right-sided endocarditis. Predictors of death in our patients were heart failure (odds ratio (OR) 8.16, 95% confidence interval (CI) 1.77 - 37.70; p=0.007) and age >45 years (OR 4.73, 95% CI 1.11 - 20.14; p=0.036). Valve surgery was associated with a reduction in mortality (OR 0.09, 95% CI 0.02 - 0.43; p=0.001). CONCLUSIONS: IE remains an important clinical problem in a typical teaching tertiary care centre in SA. In this setting, it continues to affect mainly young people with post-inflammatory valve disease and congenital heart disease. The in-hospital mortality associated with IE remains high. Intravenous drug-associated endocarditis caused by S. aureus is an important IE subset, comprising ~10% of all cases, which was not reported 15 years ago, and culture-negative endocarditis remains highly prevalent. Heart failure in IE carries a significant risk of death and needs a more intensive level of care in hospital. Finally, cardiac surgery was associated with reduced mortality, with the largest impact in patients with heart failure.


Assuntos
Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Adulto , Fatores Etários , Usuários de Drogas , Endocardite Bacteriana/terapia , Feminino , Insuficiência Cardíaca/mortalidade , Doenças das Valvas Cardíacas/epidemiologia , Próteses Valvulares Cardíacas/efeitos adversos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/terapia , Estudos Retrospectivos , Cardiopatia Reumática/epidemiologia , África do Sul/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia
2.
PLoS Negl Trop Dis ; 13(7): e0007511, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31269021

RESUMO

The prevalence of rheumatic heart disease (RHD) in the Aboriginal population of the Australian Northern Territory is high, and Streptococcus pyogenes skin infections likely contribute to this. A promising candidate S. pyogenes "30mer" vaccine is composed of 30 pharyngitis associated type-specific antigens from the S. pyogenes M protein. Cross opsonisation experiments suggest that 30mer vaccine protection may extend to non-cognate emm types. A new "emm cluster" scheme for classifying M protein is based on the full-length coding sequence, and correlates with functional and immunological properties, and anatomical tropism. Twenty-seven years of research in the Northern Territory has yielded 1810 S. pyogenes isolates with clinical and emm type data. The primary aim was to analyse these data with reference to the emm cluster scheme and cross opsonisation information, to inform estimation of 30mer vaccine efficacy in the Northern Territory. The isolates encompass 101 emm types. Variants of cluster A-C were enriched in throat isolates, and variants of emm cluster D enriched in skin isolates. Throat isolates were enriched for 30mer vaccine cognate emm types in comparison with skin isolates of which only 25% were vaccine emm types. While cross opsonisation data indicates potential for enhancing 30mer vaccine coverage, more than one third of skin isolates were within 38 emm types untested for cross opsonisation. Emm cluster D variants, in particular emm cluster D4, were not only all non-cognate with the vaccine, but were abundant and diverse, and less likely to be cross-opsonisation positive than other emm clusters. Long term persistence of many emm types in the study area was revealed. It was concluded that the 30mer vaccine efficacy in the Northern Territory will likely require both cross protection, and additional measures to elicit immunity against variants of emm cluster D.


Assuntos
Antígenos de Bactérias/imunologia , Proteínas da Membrana Bacteriana Externa/imunologia , Proteínas de Transporte/imunologia , Cardiopatia Reumática/microbiologia , Infecções Estreptocócicas/prevenção & controle , Vacinas Estreptocócicas/uso terapêutico , Streptococcus pyogenes , Humanos , Northern Territory/epidemiologia , Faringite/epidemiologia , Faringite/microbiologia , Prevalência , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/prevenção & controle , Pele/microbiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/epidemiologia , Vacinas Estreptocócicas/imunologia
7.
Public Health ; 171: 15-23, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31075546

RESUMO

OBJECTIVES: Rheumatic heart disease (RHD) is a preventable disease frequently recognized in urban slums. Disease rates in Brazilian slums are incommensurate with the country's economic status and the existence of its universal healthcare system. Our study aimed to investigate what system issues may allow for disease persistence, focusing on issues surrounding access and utilization of primary and specialized healthcare services. STUDY DESIGN: This was a two-part (formative phase followed by implementation phase) qualitative study based on interviews and focus groups and analyzed via content analysis. METHODS: One focus group and 17 in-depth interviews with community health workers, primary care providers, and cardiologists who serve slum residents in Brazil and six interviews with key informants (community health researchers and cardiologists) were performed. Interviews with community health workers and primary care providers were from a single heath post in the neighborhood of Liberdade, a populous and previously unstudied slum in Salvador. Cardiologists were recruited from tertiary care referral hospitals in Salvador. RESULTS: Our findings revealed six major chronological categories/themes of issues and twenty subthemes that patients must overcome to avoid developing RHD or to have it successfully medically managed. Major themes include the effects of living in a slum (1), barriers to access and utilization of primary healthcare services (2), treatment in primary healthcare services (3), access/utilization of specialized healthcare services (4), treatment in specialized healthcare services (5), and certain systemic issues (6). CONCLUSION: Slums make residents sick in a manner of ways, and various bottlenecks impeding medical access to both primary care and specialty care exist, requiring multifaceted interventions. We detail major themes and finally suggest interventions that can allow for the health system to successfully eliminate RHD as a public health concern for slum residents.


Assuntos
Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Áreas de Pobreza , Cardiopatia Reumática/prevenção & controle , Cobertura Universal do Seguro de Saúde , Brasil/epidemiologia , Cardiologistas/psicologia , Agentes Comunitários de Saúde/psicologia , Grupos Focais , Humanos , Médicos de Atenção Primária/psicologia , Pesquisa Qualitativa , Cardiopatia Reumática/epidemiologia , Determinantes Sociais da Saúde
8.
Pediatr Rheumatol Online J ; 17(1): 12, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940181

RESUMO

BACKGROUND: Rheumatic heart disease (RHD) is a chronic condition responsible of congestive heart failure, stroke and arrhythmia. Almost eradicated in high-income countries (HIC), it persists in low- and middle-income countries. The purpose of the study was to assess the feasibility and meaningfulness of ultrasound-based RHD screening among the population of unaccompanied foreign minors in Italy and determine the burden of asymptomatic RHD among this discrete population. METHODS: From February 2016 to January 2018, Médecins Sans Frontières conducted a weekly mobile screening by echocardiography in reception centers and family houses for unaccompanied foreign minors in Rome, followed by fix echocardiographic retesting for those resulting positive at screening. 'Definite' and 'borderline' cases were defined according to the World Hearth Federation criteria. RESULTS: Six hundred fifty-three individuals (13-26 years old) were screened; 95.6% were below 18 years old (624/653). Six 'definite RHD' were identified at screening, yielding a detection rate of 9.2‰ (95% CI 4.1-20.3‰), while 285 (436.4‰) were defined as 'borderline' (95% CI 398.8-474.9‰). Out of 172 "non-negative borderline" cases available for being retested (113 "non-negative borderline" lost in follow-up), additional 11 were categorized as 'definite RHD', for a total of 17 'definite RHD', yielding a final prevalence of 26.0‰ (95% CI 16.2-41.5‰) (17/653), and 122 (122/653) were confirmed as 'borderline' (final prevalence of 186.8‰, 95% CI 158.7-218.7). In multivariate logistic regression analysis the presence of systolic murmur was a strong predictor for both 'borderline' (OR 4.3 [2.8-6.5]) and 'definite RHD' (OR 5.2 [1.7-15.2]), while no specific country/geographic area of origin was statistically associated with an increased risk of latent, asymptomatic RHD. CONCLUSIONS: Screening for RHD among the unaccompanied migrant minors in Italy proved to be feasible. The burden of 'definite RHD' was similar to that identified in resource-poor settings, while the prevalence of 'borderline' cases was higher than reported in other studies. In view of these findings, the health system of high-income countries, hosting migrants and asylum seekers, are urged to adopt screening for RHD in particular among the silent and marginalized population of refugee and migrant children.


Assuntos
Ecocardiografia/métodos , Programas de Rastreamento/métodos , Refugiados/estatística & dados numéricos , Cardiopatia Reumática/diagnóstico , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Criança , Estudos de Viabilidade , Feminino , Humanos , Itália/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Cardiopatia Reumática/epidemiologia , Fatores de Risco , Adulto Jovem
9.
Indian Heart J ; 71(1): 85-90, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31000189

RESUMO

The rheumatic heart disease continues to be an important cause of disease burden in India, affecting the population in their prime and productive phase of the life. The prevalence of rheumatic heart disease is varied in different Indian studies, because of the inclusion of different populations at different point of times and using different screening methods for the diagnosis. The data on incidence and prevalence on a nationally represented sample are lacking. There is a need for establishing a population-based surveillance system in the country for monitoring trends, management practices, and outcomes to formulate informed guidelines for initiating contextual interventions for prevention and control of rheumatic heart disease.


Assuntos
Vigilância da População , Cardiopatia Reumática/epidemiologia , Medição de Risco/métodos , Humanos , Incidência , Índia/epidemiologia , Prevalência
11.
Intern Med J ; 49(3): 400-403, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30897668

RESUMO

International Classification of Diseases, 10th Revision codes for rheumatic heart disease (RHD) include valvular heart disease of unspecified origin, limiting their usefulness for estimating RHD burden. A cross-disciplinary national consultation developed an algorithm to improve RHD identification in hospital data. The algorithm has been operationalised and piloted. The algorithm developed categorised 32% of RHD-coded patients as probable/possible RHD. We outline a series of research initiatives to improve identification of RHD in administrative data thereby contributing to monitoring the RHD burden globally.


Assuntos
Monitoramento Epidemiológico , Classificação Internacional de Doenças , Cardiopatia Reumática/classificação , Cardiopatia Reumática/diagnóstico , Algoritmos , Saúde Global , Humanos , Valor Preditivo dos Testes , Cardiopatia Reumática/epidemiologia
12.
Congenit Heart Dis ; 14(4): 614-618, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30706669

RESUMO

BACKGROUND: In asymptomatic children, screening echocardiography has been used to attempt to diagnose rheumatic heart disease (RHD) at an early stage (latent RHD). World Heart Federation guidelines have standardized categorization of "definite," "borderline," or no RHD by echo findings. The progression of RHD diagnosed through echo screening is not known. In 2014, we screened 1450 schoolchildren in Malawi. OBJECTIVE: Our objective was to evaluate 2-year RHD evolution among those diagnosed through screening. METHODS: Two-year follow-up echocardiograms of those diagnosed with latent RHD were read by a primary, secondary, then third reader if there was disagreement. Progression or regression of both definite and borderline groups were tabulated. Penicillin adherence, age, gender, number in home, and household income were compared between those with definite RHD who regressed to borderline and those that stayed definite. We utilized the local system used to track HIV defaulters in order to bring participants back into care. Comparisons were made using Fisher's exact and Wilcoxon rank-sum tests. RESULTS: Of the 39 with borderline RHD, 1 was lost to follow-up (2.6%), 1 progressed to definite (2.6%), 19 remained borderline (48.7%), 17 (43.6%) regressed to normal, and 1 was reclassified as mitral valve prolapse (2.6%). Of the 11 with definite RHD, 6 (54.5%) remained definite, 4 regressed to borderline (36.4%), and 1 regressed to normal (9.1%). Two of 11 with definite RHD had penicillin adherence above 80% for the 2-year follow-up period. There were no differences in adherence, gender, age, household income, or number in household between those with definite RHD that regressed to borderline and those who did not (P > .19). CONCLUSIONS: Borderlines had a very low progression rate to definite RHD. A strength of our study was a high retention rate (98%). Longer follow-up is needed to determine expected disease evolution.


Assuntos
Cardiopatia Reumática/epidemiologia , Adolescente , Doenças Assintomáticas , Criança , Progressão da Doença , Ecocardiografia/métodos , Feminino , Seguimentos , Humanos , Incidência , Malaui/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico , Fatores de Tempo
13.
Heart ; 105(1): 60-66, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30068532

RESUMO

OBJECTIVE: Estimates of the prevalence of rheumatic heart disease (RHD) in many endemic countries are limited to samples of children attending schools, which generate an incomplete picture of disease burden in communities. The present study conducted household-based RHD screening in a representative community in Gulu district, Uganda. METHODS: Members of households identified through a two-stage cluster-sampling approach between the ages of 5 years and 50 years were invited to undergo limited cardiac testing with a handheld echocardiogram to assess for the presence of RHD. Suspicious cases underwent confirmatory echocardiogram with a fully functional machine. RESULTS: Of the 2453 community members screened, 2.45% (95% CI 1.87% to 3.14%) showed echocardiographic evidence of RHD with 1.26% (95% CI 0.860% to 1.79%) having definite RHD. The overall prevalence of RHD among participants <20 years was 2.52% (95% CI 1.78% to 3.45%), with a borderline prevalence of 1.97% (95% CI 1.33% to 2.82%) and a definite prevalence of 0.544% (95% CI 0.235% to 1.07%). Prevalence rates among youth increased with age and peaked in the age group of 16-20 years. The overall adult prevalence (>20 years) of RHD was 2.34% (95% CI 1.49% to 3.49%). The majority of definite cases were mild (81%) and marked by mitral regurgitation and associated morphological valve changes (71%). CONCLUSION: Our data reveal a high prevalence of undiagnosed RHD within an endemic community and fill a critical gap in RHD epidemiology in African adults.


Assuntos
Insuficiência da Valva Mitral , Cardiopatia Reumática , Adolescente , Adulto , Criança , Análise por Conglomerados , Pesquisa Participativa Baseada na Comunidade , Ecocardiografia/métodos , Características da Família , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/etiologia , Prevalência , Cardiopatia Reumática/complicações , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/epidemiologia , Uganda/epidemiologia
14.
Heart Lung Circ ; 28(7): 1102-1111, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30139596

RESUMO

BACKGROUND: Rheumatic heart disease often leads to valve surgery at a young age in our Indigenous population. Anticoagulation can be problematic and therefore repeat surgery to replace degenerated bioprosthetic valves is common. We sought to examine outcomes following redo valve surgery in this population. METHODS: Data from our institutional database was reviewed from 1992 to 2017. During this period, 82 redo valve surgeries were performed in 73 patients identifying as Aboriginal and Torres Strait Islander. We compared this study group to Indigenous patients undergoing primary valve surgery (n=389) and non-Indigenous patients undergoing redo valve surgery (n=154). RESULTS: Redo patients had a median age of 29.5 years (IQR 24, 44), 59% were female, and they had significant comorbidities. The 30-day mortality in this cohort was 6% (EuroSCORE II 3.57), and they had significant morbidity. The median time to repeat surgery in those who had previous mitral valve surgery was 6.3 years, with no difference between mitral valve repair or replacement at the index procedure. Compared to non-Indigenous patients undergoing redo valve surgery, the Indigenous patients were significantly younger with higher left ventricular function but a greater proportion of pulmonary hypertension. There were no significant differences in short-term outcomes. Compared to Indigenous patients undergoing primary valve surgery, the Indigenous redo patients were significantly younger with more co-morbidities. There was no difference in 30-day mortality, but the redo patients did have significantly greater resource utilisation (increased hospital and intensive care unit (ICU) lengths of stay, ventilation and blood transfusion) and poorer long-term survival. CONCLUSIONS: Indigenous patients presenting for redo valve surgery represent a complex and comorbid group of patients, with outcomes worse than expected in a young population, albeit comparable within study groups. Time from original surgery was short at 6 years, and thus a strategy must be in place in terms of planning future surgeries in this cohort of predominantly young rheumatic heart disease patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Grupo com Ancestrais Oceânicos , Reoperação , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/cirurgia , Adulto , Idoso , Austrália/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Indian Heart J ; 70(6): 907-910, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30580864

RESUMO

A significant socioeconomic inequality is the main barrier to achieve primordial prevention of rheumatic heart disease (RHD) in the developing countries. An effective vaccine with affordable cost against Streptococcus yet to be identified. The subclinical nature of rheumatic fever (RF) is the main hurdle for effective primary prevention of RHD. When RF and RHD are recognized at the earliest, treated adequately and SP with penicillin is strictly followed, then this disease can be kept under control though cannot be eradicated.


Assuntos
Países em Desenvolvimento , Cardiopatia Reumática/prevenção & controle , Prevenção Secundária/organização & administração , Saúde Global , Humanos , Incidência , Cardiopatia Reumática/epidemiologia , Fatores Socioeconômicos , Taxa de Sobrevida/tendências
19.
Congenit Heart Dis ; 13(6): 1069-1071, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30280492

RESUMO

In the 2017, "Cairo Accord on Rheumatic Heart Disease-From Molecules to The Global Community" experts from endemic areas enumerated an approach to reduce the population burden of rheumatic heart disease. The 10 key recommendations include immediate logistical objectives as well as domains for further study. Echocardiographic population screening programs were relegated to research alone. Given the large body of supporting data, relegating echo screening to an investigational modality is an opportunity lost.


Assuntos
Ecocardiografia/métodos , Programas de Rastreamento/métodos , Vigilância da População , Cardiopatia Reumática/diagnóstico , Brasil/epidemiologia , Humanos , Incidência , Cardiopatia Reumática/epidemiologia
20.
J Card Fail ; 24(12): 849-853, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30312764

RESUMO

BACKGROUND: Heart failure is a significant cause of morbidity and mortality in sub-Saharan Africa. Our understanding of the heart failure burden in this region has been limited mainly to registries from urban referral centers. Starting in 2006, a nurse-driven strategy was initiated to provide echocardiography and decentralized heart failure care within noncommunicable disease (NCD) clinics in rural district hospitals in Rwanda. METHODS AND RESULTS: We conducted a retrospective review of patients with cardiologist-confirmed heart failure treated at 3 district hospital NCD clinics in Rwanda from 2006 to 2017 to determine patient clinical characteristics and disease distribution. Over 10 years, 719 patients with confirmed heart failure were identified. Median age was 27 years overall, and 42 years in adults. Thirty-six percent were children (age <18 years), 68% were female, and 78% of adults were farmers. At entry, 39% were in New York Heart Association functional class III-IV. Among children, congenital heart disease (52%) and rheumatic heart disease (36%) were most common. In adults, cardiomyopathy (40%), rheumatic heart disease (27%), and hypertensive heart disease (13%) were most common. No patients were diagnosed with ischemic cardiomyopathy. CONCLUSIONS: The results of the largest single-country heart failure cohort from rural sub-Saharan Africa demonstrate a persistent burden of rheumatic disease and nonischemic cardiomyopathies.


Assuntos
Cardiomiopatias/complicações , Previsões , Insuficiência Cardíaca/etiologia , Hospitais de Distrito , Hipertensão/complicações , Cardiopatia Reumática/complicações , População Rural , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/epidemiologia , Lactente , Masculino , Pessoa de Meia-Idade , Pobreza , Estudos Retrospectivos , Cardiopatia Reumática/epidemiologia , Ruanda/epidemiologia , Fatores Socioeconômicos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA