Incidental Diagnosis of Rheumatic Myocarditis during Cardiac Surgery-Impact on Late Prognosis.

Rheumatic fever (RF) and rheumatic heart disease (RHD) are still highly prevalent, particularly in low- and middle-income countries. RHD is a neglected and underdiagnosed disease for which no specific laboratory diagnostic test is completely reliable. This is a retrospective observational study, which included 118 patients with RHD who underwent cardiac surgery from 1985 to 2018. The aim of this investigation was to evaluate the clinical, epidemiological, echocardiographic and pathological characteristics in two cohorts of RHD patients: one cohort with Aschoff bodies present in their pathological results and the other without such histopathological characteristics. No conventional clinical and laboratory tests for RHD myocarditis were able to identify active carditis during the preoperative phase of valve repair or replacement. Patients who had Aschoff bodies in their pathological results were younger (median age of 13 years (11-24 years) vs. 27 years (17-37 years), p = 0.001) and had higher rate of late mortality (22.9% vs. 5.4%, p = 0.043). In conclusion, the presence of Aschoff bodies in pathological findings may predict increased long-term mortality, emphasizing the importance of comprehensive pathology analysis for suspected myocarditis during heart surgery.

Desfechos clínicos intra-hospitalar e em até 1 ano de seguimento da Takotsubo no Brasil: Registro Brasileiro de Takotsubo (Takosubo Br-R) / In-hospital clinical outcomes and up to 1 year of follow-up of Takotsubo in Brazil: Brazilian Takotsubo Registry (Takosubo Br-R)

FUNDAMENTO: A evolução clinica intra-hospitalar e pós alta da Cardiomiopatia por Takotsubo (CT) assim como o perfil clinico dos pacientes de maior risco prognóstico não estão bem caracterizados nos grandes registros assim como no Brasil. OBJETIVO: Determinar a taxa de mortalidade intrahospitalar (MIH), as características dos pacientes que apresentaram relação com uma maior mortalidade, e a taxa de reincidência de CT(RCT)e mortalidade ao fim de 1 ano pós alta no Brasil. Delineamento e MÉTODOS: Este é um estudo retrospectivo, observacional,multicêntrico envolvendo 25 centros dispersos geograficamente pelo Brasil. Os critérios de inclusão foram de acordo com International Takotsubo Diagnostic Criteria (InterTAK Diagnostic Criteria). A características clinicas, biomarcadores, ECG, ecocardiograma (ECO), ressonância magnética cardíaca (RMC), foram avaliados durante a fase IH. Também foram avaliados a taxa de MIH, e a taxa de RCT, readmissão por DCV e mortalidade em 30 dias, 6 meses e 1 ano pós-alta. RESULTADOS: 448 pacientes foram admitidos CT, onde foi observado uma taxa de MIH de 7,5%. Na análise univariada do perfil clinico os pacientes do sexo masculino (p=0,009), com idade menos avançada (67±14 vs 73±11; P=0,0179), com choque cardiogênico (p<0,0001), sepsis (P<0,0001), fibrilação atrial (p=0,01) apresentaram significativamente maior MIH e dor toráxica (p<0,0001) com menor MIH. Na análise do ecocardiograma, ECG, RMC e peptídeos natriuréticos e Troponina não foram observados correlações significativas com a MIH. Quanto a terapêutica utilizada, os pacientes que usaram betabloqueador (P<0,0001), IECA/BRA (p<0,001) e AAS (p=0,04), demonstraram uma menor MIH. Os pacientes que utilizaram Dobutamina (p<0,0001), NE (P<0,0001) e e Vasopressina (P < 0,0001) demonstraram maior MIH. Na regressão logística de todas a variáveis significativas, a presença de sepsis (OR:6,8;IC-95%:2,3- 19,4;p=0,0005), uso de vasopressina(OR:7,5;IC95%:1,8-31;p=0,005) definiram maior MIH, enquanto que Betabloqueador(OR:0,23;IC-95%:0,1- 0,7;p=0,009) edortoráxica (OR:0,28;IC-95%:0,1-0,8;p=0,02) demonstraram uma menor associação com MIH. No seguimento pós-alta observamos uma taxa acumulativa de RCT, readmissão por DCV e mortalidade em 30 dias (0,2%;0,4%;0,2%);6 meses (0,6%; 1,2%;0,8%) e 12meses (0,8%;2,4%;0,8%) respectivamente. CONCLUSÃO: O Registro Brasileiro de Takotsubo demonstrou características clinicas e de exames complementares semelhantes aos dos registros internacionais com predomino de dor toráxica com alteração do segmento ST, assim como nos desfechos clínicos intra-hospitalares. A Takotsubo apresenta um prognostico benigno nos 12 meses pós alta, com uma baixa taxa de recorrência, readmissão hospitalar e mortalidade. Palavras-chave: Takotsubo; cardiomiopatia neuroadrenergica.

Photobiomodulation exerts anti-inflammatory effects on the vascular and cellular phases of experimental inflammatory models.

Photobiomodulation therapy (PBMT) is a non-thermal therapeutic procedure widely used in clinical practice. It is considered an effective modality of treatment for the control of various inflammatory conditions with fewer adverse effects as compared to conventional therapy. However, despite the clinical effects, the mechanisms of action and dosimetric parameters of PBMT are not fully understood. This study was performed to describe the effects of two different doses of PBMT on experimental models of inflammation. Male Swiss mice were administered with 0.9% of saline or phlogistic agents (carrageenan, dextran, serotonin, histamine, or bradykinin) by intra-plantar injection and were treated with PBMT at a dose of 1 or 5 J/cm2; right after, the variation of the paw volume was made, and histopathological analysis and myeloperoxidase assay of the carrageenan-induced edematous paw tissues were performed. The action of PBMT on carrageenan-induced vascular permeability was further evaluated. Our results showed that PBMT (1 J/cm2) led to an improvement in paw edema induced by the phlogistic agents and further reduced the histological scores. Inhibition of neutrophil migration was observed following the administration of 1 and 5 J/cm2 of PBMT. However, only 1 J/cm2 of PBMT showed beneficial effects on carrageenan-induced edema. Laser at a dose of 1 J/cm2 showed cellular and vascular effects since it was able to reverse all the inflammatory parameters, and laser at a dose of 5 J/cm2 probably has only cellular effects in the presence of acute inflammation.

3D Echocardiography for Rheumatic Heart Disease Analysis: Ready for Prime Time.

Rheumatic heart disease (RHD) remains to be a very important health issue worldwide, mainly in underdeveloped countries. It continues to be a leading cause of morbidity and mortality throughout developing countries. RHD is a delayed non-suppurative immunologically mediated inflammatory response to the throat infection caused by a hemolytic streptococcus from the A group (Streptococcus pyogenes). RHD keeps position 1 as the most common cardiovascular disease in young people aged <25 years considering all the continents. The disease can lead to valvular cardiac lesions as well as to carditis. Rheumatic fever valvular injuries lead most commonly to the fusion and thickening of the edges of the cusps and to the fusion, thickening, and shortening of the chordae and ultimately to calcification of the valves. Valvular commissures can also be deeply compromised, leading to severe stenosis. Atrial and ventricular remodeling is also common following rheumatic infection. Mixed valvular lesions are more common than isolated valvular disorders. Echocardiography is the most relevant imaging technique not only to provide diagnostic information but also to enable prognostic data. Further, it presents a very important role for the correction of complications after surgical repair of rheumatic heart valvulopathies. Three-dimensional (3D) echocardiography provides additional anatomical and morphofunctional information of utmost importance for patients presenting rheumatic valvopathies. Accordingly, three-dimensional echocardiography is ready for routine use in patients with RHD presenting with valvular abnormalities.

Avaliação da atuação do núcleo de apoio à saúde da família / Evaluation of the performance of the Family Health Support Center / Evaluación de la actuación del Núcleo de Apoyo a la Salud de la Familia

Avaliar a atuação do Núcleo de Apoio à Saúde da Família (NASF) através do conhecimento e da avaliação de serviços pelos profissionais da Estratégia de Saúde da Família (ESF). Métodos: Estudo descritivo quantitativo realizado em 2012 junto às 10 ESF vinculadas ao NASF, distrito 1, de Parnaíba/PI - Brasil, no qual entrevistaram-se 76 profissionais por meio de um questionário composto por caracterização do profissional, investigação do seu conhecimento com relação às atividades do NASF e avaliação dos serviços prestados pela equipe do NASF. Os dados foram divididos em categorias, agrupados e analisados pelo SPSS (versão 19.0). Resultados: Na avaliação da atuação do NASF pelos membros das ESF, 42% (n=32) apontaram o serviço como muito importante, 59,0% (n=45) dos membros encontravam-se satisfeitos, 54,0% (n=41) classificavam o serviço como acessível para a população e 90% (n=68) dos entrevistados reconheceram quais os profissionais que compõem a equipe do NASF, destacando o fisioterapeuta e o educador físico. Conclusão: Concluiu-se que as ESF possuem informação com relação à estrutura do NASF, apontando o serviço como muito importante, estando satisfeitos com as atividades realizadas, classificando o serviço como acessível para a população, sendo esta informada pelo NASF acerca de seus direitos na saúde pública...

To evaluate the performance of the Family Health Support Center (NASF) through the knowledge and evaluation of services by professionals of the Family HealthStrategy (FHS). Methods: Quantitative descriptive study conducted in 2012 with 10 FHS linked to NASF, District 1, Parnaíba - PI - Brazil, where 76 professionals were interviewed using a questionnaire on the characterization of the professional, their knowledge regarding the NASF activities and the evaluation of services provided by the NASF team. The data were divided into categories, grouped and analyzed using SPSS 19.0. Results: In the evaluation of the NASF performance by the members of the FHS, 42% (n=32) considered the service very important, 59.0% (n= 5) of the members were satisfied, 54.0% (n=41) rated the service as accessible to the population, and 90% (n=68) of interviewees recognized which professionals make up the NASF team, highlighting the physiotherapist and the physical educator. Conclusion: It is concluded that the FHS have information regarding the structure of the NASF, pointing the service as very important. Additionally, they are satisfied with the activities performed and rate the service as accessible to the population, which is informed by NASF about their rights in public health...

Evaluar la actuación del Núcleo de Apoyo a la Salud de la Familia (NASF) a través del conocimiento y de la evaluación de servicios por los profesionales de la Estrategia de Salud Familiar (ESF). Métodos: Estudio descriptivo cuantitativo realizado em 2012 junto a las 10 ESF vinculadas al NASF, distrito 1 de Parnaíba/ PI - Brasil, en el cual se entrevistaron 76 profesionales con um cuestionario constituido de la caracterización del profesional, investigación de su conocimiento respecto las actividades Del NASF y evaluación de los servicios ofrecidos por el equipo Del NASF. Los datos fueron divididos en categorías, agrupados y analizados por el SPSS (versión 19.0). Resultados: En La evaluación de la actuación del NASF por los miembros de lãs ESF, el 42% (n=32) relataron el servicio como muy importante, el 59,0% (n=45) de los miembros estaban satisfechos, el 54,0% (n=41) clasificaron el servicio accesible para la población y El 90% (n=68) de los entrevistados reconocieron los profesionales que constituyen el equipo del NASF, destacando el fisioterapeuta y el educador físico. Conclusión: Se concluye que las ESF poseen información respecto la estructura del NASF considerando El servicio muy importante y encontrándose satisfechos con lãs actividades realizadas, clasificando el servicio como accesible para la población siendo la misma informada por el NASF sobre sus derechos de la salud pública...