Endocardite infecciosa em cirurgias valvares: avaliação ecocardiográfica e clínica como preditores de mortalidade em uma série de casos / Infectious endocarditis in valve surgeries - ecocardiographic and clinical evaluation as mortality predictors in a series of cases

OBJETIVO: Analisar uma série de casos cirúrgicos com diagnóstico de endocardite infecciosa, comparando fatores clínicos, ecocardiográficos e cirúrgicos. MÉTODOS: Estudo retrospectivo de caráter observacional, com análise de prontuários dos pacientes operados com diagnóstico prévio de endocardite infecciosa, no período entre janeiro de 2015 a outubro de 2016 em um hospital terciário. RESULTADOS: Dentre as cirurgias cardíacas valvares realizadas nesse período, 14% possuíam diagnóstico de endocardite infecciosa. Houve prevalência do sexo masculino, sendo a valva aórtica a mais acometida (62,5%). Febre e dispneia foram os sintomas mais comuns (37,5%). Ao ecocardiograma, a maioria dos pacientes apresentava vegetações maiores que 10mm e disfunção valvar importante. Todos os casos utilizaram associação de antibióticos, e a gentamicina esteve presente em metade deles. A mortalidade intra-hospitalar na amostra ocorreu em 37,5%. CONCLUSÃO: Foi encontrada alta incidência de endocardite, com elevada mortalidade não relacionada ao procedimento cirúrgico. Ressalta-se a necessidade de intervenção precoce com a intenção de reduzir complicações como dilatação e disfunção ventricular e embolias.(AU)

OBJECTIVE: To analyze a series of surgical cases with diagnosis of infective endocarditis, and to compare clinical, echocardiographic and surgical factors. METHODS: A retrospective observational study was carried out, with an analysis of medical records of patients operated with previous diagnosis of infective endocarditis between January 2015 and October 2016 in a tertiary hospital. RESULTS: Among the heart valve surgeries performed in this period, 14% had a diagnosis of infective endocarditis. There was a prevalence of males, with the aortic valve being the most affected (62.5%). Fever and dyspnea were the most common symptoms (37.5%). On echocardiogram, most patients presented vegetations larger than 10mm, and important valve dysfunction. All cases used an antibiotic combination, and gentamicin was present in half of them. In-hospital mortality in the sample occurred in 37.5%. CONCLUSIONS: High incidence of endocarditis was found, with high mortality that was not related to the surgical procedure. The need for early intervention with the intention of reducing complications such as dilation and ventricular dysfunction and embolisms is emphasized.(AU)

Uso de los antibióticos y antisépticos en la prevención de endocarditis infecciosa durante el tratamiento periodontal / Use of antibiotics and antiseptics for prevention of infective endocarditis during periodontal treatment

Las bacterias dentro de las bolsas periodontales deben ser eliminadas mecánicamente a través de procedimientos quirúrgicos y no quirúrgicos. Antes de realizar procedimientos invasivos en pacientes con compromiso sistémico, se deben conocer los fundamentos para la prevención de complicaciones por bacteriemias, como la endocarditis infecciosa. Objetivo: indagar el uso de los antibióticos y antisépticos en la profilaxis de la endocarditis infecciosa durante la terapia periodontal. Método: se realizó una búsqueda de estudios de casos y controles, de cohorte transversal y metaanálisis en las bases de datos Medline-Pubmed, LILACS y Dialnet, acerca de la profilaxis de la endocarditis infecciosa. Resultados: los estudios reportan que antes de iniciar un tratamiento periodontal debe considerarse el riesgo local, el tipo de procedimiento dental y las condiciones sistémicas del paciente que ameriten profilaxis antibiótica. Conclusión: la clorhexidina y la amoxicilina pueden emplearse antes de cualquier procedimiento invasivo que provoque sangrado, para prevenir endocarditis infecciosa

Conhecimento sobre endocardite infecciosa entreestudantes de odontologia / Knowledge about infective endocarditis among dentistry students

Objetivo: Avaliar o conhecimento sobre Endocardite Infecciosa(EI) entre estudantes do 9.º e 10.º períodos do curso de Odontologiado Centro Universitário de João Pessoa – UNIPÊ.Método: Foi realizada uma pesquisa de campo, com abordagemquantitativa dos dados. A amostra foi composta por 59 estudantes,que responderam um questionário composto de 6 quesitos (4 objetivose 2 subjetivos) específicos sobre o assunto. Os dados foramregistrados na forma de banco de dados do programa de informáticaSPSS (StatisticalPackage for the Social Sciences) para Windows®,versão 20.0, e analisados por meio de estatística descritiva e inferencialbivariada.Resultados: A maioria dos estudantes (83,1%)definiu corretamentea EI. O fator de risco para desenvolvimento da EI mais citado foia endocardite infecciosa prévia (86,4%). A maioria dos estudantes(91,5%) destacou a extração dentária como um dos procedimentosem que a profilaxia antibiótica é necessária para a prevenção da EI.Apenas 13,6% dos estudantes acertaram o protocolo de prevençãoda EI. A maioria (74,6%) julgou insuficiente os conhecimentos adquiridossobre a EI durante a graduação.

Objective: To evaluate knowledge about infective endocarditis(IE) among students from the 9th and 10th terms of the Dentistrycourse at Centro Universitário deJoão Pessoa – UNIPÊ.Method: A field research with quantitative approach of data wascarried out. The sample was composed of 59 students who answeredto a questionnaire containing six specific questions (four objectiveand two subjective ones) about the subject. Data were registered asdatabase of the SPSS (Statistical Package for the Social Sciences) computingprogram for Windows®, version 20.0, and they were analyzedby means of descriptive and bivariate inferential statistics.Results: Most of the students (83,1%) defined IE correctly. Themostly mentioned risk factor for the development of IE was theprevious infective endocarditis (86,4%). The majority of the students(91,5%) highlighted tooth extraction as one of the proceduresin which the antibiotic prophylaxis is necessary for preventing IE.Only 13,6% of the students correctly defined the IE prevention protocol.The majority of them (74,6%) judged the acquired knowledgeas insufficient regarding the IE during the undergraduate course.Conclusion: In spite of the students showed to be aware in relationto risk factors for the IE development as well as about the dentalprocedures, in which the antibiotic prophylaxis is necessary, thereduced number of those who know the prevention protocol of thisinfection is of great concern.

Influencia de una charla sobre el conocimiento de la profilaxis de endocarditis infecciosa en padres y/o tutores de niños con cardiopatias congénitas en el INSN 2012 / Influence of a chat on the knowledge of the prevention of endocarditis infectious in parents and / or tutors of children with congenital cardiopathies in the INSN 2012

A pesar de estudios y recientes avances en el diagnóstico y tratamiento, la endocarditis infecciosa sigue siendo una enfermedad con alta morbilidad y mortalidad. En los últimos diez años, estudios han reportado tasas de incidencia de Endocarditis infecciosa que varían de 2 a 6 casos por 100 000 personas al año .El conocimiento de los padres sobre profilaxis de endocarditis infecciosa se incrementará significativamente luego de recibir una charla educativa sobre la profilaxis de endocarditis infecciosa. Material y métodos: Se realizó un estudio de intervención educativa para determinar los conocimientos sobre profilaxis de endocarditis infecciosa, en padres y/o tutores de niños portadores de cardiopatías congénitas, hospitalizados y/o atendidos por consultorio externo en los servicios de Cardiología y Medicina del INSN antes y después de dicha intervención Integraron el universo 350 padres y/o tutores de niños que se encontraron en el INSN (Dato aproximado del mes de marzo del año 2012, proporcionado por la oficina de estadística e informática del INSN) y la muestra de tipo no probabilística se constituyó por 75 padres y/o tutores que de forma voluntaria participaron en el estudio...

Knowledge of parents and status of dental health in children at risk of infective endocarditis

Congenital heart disease is the most common disposing factor to bacterial endocarditis. Since the people with cardiac disease are in high risk of caries and some microorganisms of endocarditis are due to streptococci [caries initiation], good dental and oral health in these people are very important. The purpose of this study was to determine the parent's knowledge about antibiotic prophylaxis before dental procedure and dental health [dmft/DMFT] of the children at risk of endocarditis. This is a cross-sectional descriptive analytical study performed on 84 people subjects [38 M, 46 F] being 2-17 years old and at risk of endocarditis in Amirkola and Shahid Beheshti Hospital in Babol. After clinical examination of the patients and completing of the questionnaires, findings were analyzed according to SPSS program and Chi-Square test. The percentage of parents who understood the meaning of 'heart infection' was 42.9% those, who knew the possibility of endocarditis occurrence to be caused by a dental procedure was 57.1%, those who understood the requirement for antibiotic cover before dental treatment was 16.7%, and those who understood the importance of a good oral health to prevent infective endocarditis was 60.7%. Regarding oral health behaviour, 51.2% of children brushed their teeth at least once a day and 48.8% did not brush their teeth or brushed irregularly. Only 2.4% of children referred a dentist every six months and 44% had never visited a dentist before. 26.1% of subjects were free of caries and the mean of dmft was 1.86 +/- 2.47 and for DMFT was 2.23 +/- 2.97. The parents' knowledge about the importance of dental health and its role in prevention of endocarditis was low. Absence of caries in these children was low making them susceptible to bacterial endocarditis

Escaso conocimiento del paciente con prótesis valvular cardiaca / Scant knowledge of heart valvular protheses patients recarding their disease

Dentro de las cirugías cardiacas la valvular es una de las más frecuente en el adulto; para obtener buenos resultados se requiere de medidas especiales y educación del paciente. Por esta razón se diseño un estudio prospectivo y observacional que consta de un cuestionario de 11 preguntas sobre el conocimiento de la enfermedad vascular, que se aplicó a 126 pacientes con prótesis vascular cardiaca. En promedio respondieron cinco preguntas, ninguno contesto las 11. Este estudio demuestra el poco conocimiento de los pacientes acerca de su enfermedad, el cual los médicos también deben intervenir

Endocardite infecciosa: como evitar procedimentos odontológicos / Infectious endocarditis: how to avoid dental procedures

Discorre-se uma revisäo da literatura abrangendo a etiologia da Endocardite Infecciosa, classificaçäo dos pacientes de risco, procedimentos odontológicos que requerem profilaxia antimicrobiana, e antibióticos sugeridos para controle de bacteremia de acordo com as diretrizes da Sociedade Britânica de Quimioterapia Antimicrobiana e da Associaçäo Americana de Cardiologia

Endocarditis / Endocarditis

Los autores hacen una revisión de Endocarditis infecciosa en niños, en cuanto a etiología, patogenia, manifestaciones clínicas, bases del tratamiento y prevención