Ponte miocárdica: revisão de literatura

Introdução: A ponte do miocárdio (PM) trata-se de uma patologia congênita coronariana onde um ou mais feixes de músculo cardíaco envolvem um segmento da artéria coronária, sendo a mais comum a artéria anterior esquerda. Objetivo: realizar uma revisão de literatura sobre ponte do miocárdio. Justificativa: A escassez na literatura sobre a PM objetivou a realização desse projeto. Metodologia: A pesquisa realizada neste trabalho é uma revisão integrativa de literatura. Foram realizadas buscas no PubMed, Biblioteca Virtual em Saúde (BVS) e Scielo utilizando os descritores “myocardial bridging” e “ponte miocárdica”, sendo pesquisados apenas artigos de meta-análise e artigos de revisão. Desenvolvimento: Na maioria dos casos, a PM trata-se de uma patologia benigna e por isso bastante subdiagnosticada, mas nos pacientes sintomáticos manifestações da PM se assemelham à angina típica ou atípica e, em alguns casos, o próprio infarto agudo do miocárdio. A Cineangiocoronariografia é o exame padrão ouro para o diagnóstico da PM. Nos pacientes sintomáticos a primeira linha consiste no tratamento farmacológico utilizando betabloqueadores e bloqueadores de canais de cálcio, nos pacientes refratários estão indicados procedimentos invasivos. Considerações finais: Portanto, a PM pode resultar em quadros mais graves e até mesmo morte súbita sendo necessário a investigação desta patologia nos pacientes após a terceira década de vida com quadro clínico sugestivo, sendo recomendado para esses pacientes o início do tratamento farmacológico

Papel da avaliação de fragilidade no pré-operatório de cirurgias vasculares: revisão integrativa da literatura

Cirurgias vasculares são cada vez mais realizadas, especialmente por conta do envelhecimento da população global. Sabe-se que a fragilidade está associada a um maior risco de complicações pós-operatórias e aumento do tempo de permanência hospitalar após cirurgia vascular. Além disso, pacientes frágeis frequentemente apresentam múltiplas comorbidades associadas que aumentam o risco de desfechos indesejados. Dessa forma, o presente estudo objetivou investigar a importância da avaliação de fragilidade sobre os resultados pós-operatórios de pacientes candidatos a cirurgias vasculares. Trata-se de uma revisão integrativa da literatura, realizada pela seleção de artigos científicos originais de bibliografias nacionais e internacionais, que abordem as variáveis envolvidas na aplicação da avaliação de fragilidade no pré-operatório de cirurgias vasculares. Atualmente compreende-se que as medidas de fragilidade têm um efeito maior e um valor discriminativo mais alto para prever eventos adversos do que apenas a idade de forma isolada. A utilização de métodos avaliativos da fragilidade no pré-operatório de pacientes eleitos a cirurgias vasculares é fundamental na predição de morbimortalidade e possíveis complicações advindas desses procedimentos. Diversos métodos de avaliação são utilizados para tal finalidade, como o Índice de Fragilidade (FI) e o Índice de Fragilidade Modificado (mFI). O mFI é a ferramenta de avaliação mais difundida em cirurgia vascular, por ser relativamente conveniente e de fácil aplicação, no entanto, a literatura relata uma ampla variedade de abordagens não padronizadas, permitindo a manutenção de índices de morbimortalidade que ainda poderiam ser reduzidos nos serviços vasculares. Assim sendo, a criação de um método específico e padronizado de avaliação de fragilidade nas cirurgias vasculares é de fundamental importância para a segurança da população de pacientes submetidos a esse tipo de procedimento

PERFIS GENOTÍPICOS DE VIRULÊNCIA RELACIONADOS A INVASIVIDADE DAS CEPAS DE NEISSERIA GONORRHOEAE EM PACIENTES DO HOSPITAL DAS CLÍNICAS DA FACULDADE DE MEDICINA DA UNIVERSIDADE DE SÃO PAULO

Introdução: As infecções causadas por Neisseria gonorrhoeae (Ng) ainda representam um desafio no enfrentamento das infecções sexualmente transmissíveis (ISTs) no mundo. Dentro do espectro de doenças causadas pela Ng, a doença gonocócica invasiva (DGI) representa a apresentação mais grave da infecção. O objetivo do presente estudo foi avaliar fatores genéticos bacterianos associados a ocorrência de DGI. Metodologia: Nesta coorte retrospectiva, 25 amostras de Ng obtidas de pacientes do Hospital das Clínicas da FMUSP foram submetidas a sequenciamento completo do genoma. Dados clínicos foram obtidos dos prontuários médicos. O sequenciamento foi realizado utilizando as plataformas Ion Torrent ou MiSeq Illumina. As sequências genéticas encontradas foram analisadas utilizando as ferramentas MLSTfinder 2.0, ResFinder 4.0, Comprehensive Antibiotic Resistance Database Card, Virulence Factor Database e Basic Local Alignment Search Tool. Variáveis categóricas foram comparadas pelo teste exato de Fisher ou qui-quadrado, quando apropriado. Resultados: A caracterização da origem do material de isolamento das cepas de Ng evidenciou que 28% eram anogenitais, 28% articulares, 32% oftálmicas e 12% de hemoculturas. Logo, 40% (n = 10) dos casos foram classificados como DGI por conta do isolamento bacteriano de sítios não estéreis. Não houve diferença entre os dados clínicos dos pacientes com ou sem DGI. Na avaliação filogenética, houve agrupamento de cepas de DGI em um cluster diferente das cepas não DGI. Também identificamos que dois elementos genéticos móveis foram mais frequentemente encontrados em amostras DGI comparado a amostras não DGI, os plasmídeos pEP5289 (80% vs. 13%, p = 0,002) e pJD4 (50% vs. 7%, p = 0,023). Conclusão: Identificamos a presença de dois elementos genéticos móveis presentes no genoma da Ng possivelmente associados a invasividade da doença causada por este agente. Esse achado reforça a hipótese que fatores genéticos relacionados ao patógeno podem influenciar a ocorrência de DGI

Impact of Discontinuing Levofloxacin Prophylaxis on Bloodstream Infections in Neutropenic Hematopoietic Stem Cell Transplantation Patients

Multidrug-resistant pathogens have emerged worldwide. We have driven the hypothesis that the non-use of fluoroquinolone prophylaxis during neutropenia could reduce antibiotic resistance in Gram-negative bacteria that cause bloodstream infections (BSIs) in hematopoietic stem cell transplantation (HSCT) patients and that this change in resistance pattern could lead to an impact on BSI mortality. This is a quasi-experimental study comparing BSI incidence, resistance patterns of bacteria that cause BSI, and BSI mortality when levofloxacin prophylaxis was routine for neutropenic HSCT patients (2016–2018) to when fluoroquinolone prophylaxis was discontinued in our center (2019). Bivariate comparisons and multivariate logistic regression models were used for analyses. A total of 310 HSCTs (66 (21%) allogeneic and 244 (79%) autologous) were performed during the study period. Sixty (19%) patients had BSIs, 30 in each evaluated period. The discontinuation of levofloxacin prophylaxis was associated with an increase in BSI incidence and a decrease in the resistance rates of causative BSI bacteria and in BSI 30-day mortality. The increase in the rate of resistant bacteria causing BSI and in BSI mortality might outweigh the benefits of a decrease in BSI incidence caused by fluoroquinolone prophylaxis in neutropenic HSCT patients. We suggest that the routine use of fluoroquinolone in this context be revisited

Serological diagnosis of pneumococcal infection in children with pneumonia using protein antigens: A study of cut-offs with positive and negative controls

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2016-05-04T17:52:36Z No. of bitstreams: 1 Andrade DC Serological....pdf: 358091 bytes, checksum: 43cf3e94df4116a058f4af4f7702c84a (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2016-05-04T18:04:58Z (GMT) No. of bitstreams: 1 Andrade DC Serological....pdf: 358091 bytes, checksum: 43cf3e94df4116a058f4af4f7702c84a (MD5)Made available in DSpace on 2016-05-04T18:04:58Z (GMT). No. of bitstreams: 1 Andrade DC Serological....pdf: 358091 bytes, checksum: 43cf3e94df4116a058f4af4f7702c84a (MD5) Previous issue date: 2016Federal University of Bahia. School of Medicine. Salvador, BA, BrasilFederal University of Bahia. School of Medicine. Salvador, BA, BrasilTurku University Hospital and University of Turku. Department of Pediatrics and Adolescent Medicine. Turku, FinlandTurku University Hospital and University of Turku. Department of Pediatrics and Adolescent Medicine. Turku, FinlandValneva Austria GmbH. Campus Vienna Biocenter, Vienna, AustriaFederal University of Bahia. School of Medicine. Salvador, BA, Brasil / Federal University of Bahia School of Medicine. Department of Pathology. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilNational Institute for Health and Welfare. Helsinki, FinlandTurku University Hospital and University of Turku. Department of Pediatrics and Adolescent Medicine. Turku, FinlandFederal University of Bahia. School of Medicine. Salvador, BA, Brasil / Federal University of Bahia School of Medicine. Department of Pediatrics. Salvador, BA, BrasilThe etiological diagnosis of infection by Streptococcus pneumoniae in children is difficult, and the use of indirect techniques is frequently warranted.We aimed to study the use of pneumococcal proteins for the serological diagnosis of pneumococcal infection in children with pneumonia. We analyzed paired serum samples from 13 Brazilian children with invasive pneumococcal pneumonia (positive control group) and 23 Finnish children with viral pharyngitis (negative control group), all aged b5 years-old. Children with pharyngitis were evaluated for oropharyngeal colonization, and none of them carried S. pneumoniae.We used a multiplex bead-based assay with eight proteins: Ply, CbpA, PspA1 and 2, PcpA, PhtD, StkP and PcsB. The optimal cut-off for increase in antibody level for the diagnosis of pneumococcal infection was determined for each antigen by ROC curve analysis. The positive control group had a significantly higher rate of ≥2-fold rise in antibody levels against all pneumococcal proteins, except Ply, compared to the negative controls. The cut-off of ≥2-fold increase in antibody levelswas accurate for pneumococcal infection diagnosis for all investigated antigens. However, there was a substantial increase in the accuracy of the test with a cut-off of ≥1.52-fold rise in antibody levels for PcpA. When using the investigated protein antigens for the diagnosis of pneumococcal infection, the detection of response against at least one antigen was highly sensitive (92.31%) and specific (91.30%). The use of serology with pneumococcal proteins is a promising method for the diagnosis of pneumococcal infection in children with pneumonia. The use of a ≥2-fold increase cut-off is adequate for most pneumococcal proteins

Effect of Pneumococcal Conjugate Vaccine on the Natural Antibodies and Antibody Responses Against Protein Antigens From Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in Children With Community-acquired Pneumonia

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2016-10-14T14:14:56Z No. of bitstreams: 1 Andrade DC Effect of pneumococcal....pdf: 692474 bytes, checksum: 5f617f020e01ab00b9d972a72feb2734 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2016-10-14T16:08:18Z (GMT) No. of bitstreams: 1 Andrade DC Effect of pneumococcal....pdf: 692474 bytes, checksum: 5f617f020e01ab00b9d972a72feb2734 (MD5)Made available in DSpace on 2016-10-14T16:08:18Z (GMT). No. of bitstreams: 1 Andrade DC Effect of pneumococcal....pdf: 692474 bytes, checksum: 5f617f020e01ab00b9d972a72feb2734 (MD5) Previous issue date: 2016-06Postgraduate Program in Health Sciences. Salvador, BA, BrasilPostgraduate Program in Health Sciences. Salvador, BA, BrasilUniversity of the Witwatersrand. DST/NRF Vaccine Preventable Diseases, Respiratory and Meningeal Pathogens Research Unit. Johannesburg, South AfricaValneva Austria GmbH. Vienna, AustriaPostgraduate Program in Health Sciences. Salvador, BA, Brasil / Postgraduate Program in Human Pathology. Salvador, BA, Brasil / Fundação Gonçalo Moniz, Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilTurku University and University Hospital. Department of Paediatrics. Turku, FinlandNational Institute for Health and Welfare. Helsinki. FinlandPostgraduate Program in Health Sciences. Federal University of Bahia. School of Medicine. Department of Paediatrics. Salvador, BA, BrasilStreptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are common causative agents of respiratory infections. Pneumococcal conjugate vaccines have been introduced recently, but their effect on the natural immunity against protein antigens from these pathogens has not been elucidated

Seasonal patterns and association of meteorological factors with infection caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in childhood community-acquired pneumonia in a tropical region

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-06-29T17:19:07Z No. of bitstreams: 1 Borges IC Seasonal patterns and association....pdf: 785349 bytes, checksum: b27b1566b22b0d2d84f82e9b411fb4c5 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-06-29T17:44:07Z (GMT) No. of bitstreams: 1 Borges IC Seasonal patterns and association....pdf: 785349 bytes, checksum: b27b1566b22b0d2d84f82e9b411fb4c5 (MD5)Made available in DSpace on 2017-06-29T17:44:07Z (GMT). No. of bitstreams: 1 Borges IC Seasonal patterns and association....pdf: 785349 bytes, checksum: b27b1566b22b0d2d84f82e9b411fb4c5 (MD5) Previous issue date: 2016Bahia State Agency for Research Funding (FAPESB), Brazil; Brazilian Council for Scientific and Technological Development (CNPq), Brazil; and in part by National Institute for HealthFederal University of Bahia. School of Medicine. Postgraduate Program in Health Sciences. Salvador, BA, BrazilFederal University of Bahia. School of Medicine. Postgraduate Program in Health Sciences. Salvador, BA, BrazilUniversity of São Paulo. School of Public Health. Department of Epidemiology. São Paulo, SP, BrasilValneva Austria GmbH. Campus Vienna Biocenter 3. Vienna, AustriaFederal University of Bahia. School of Medicine. Postgraduate Program in Health Sciences. Salvador, BA, Brazil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil Federal University of Bahia. School of Bahia. Department of Pathology. Salvador, BA, BrasilNational Institute for Health and Welfare. Helsinki, FinlandTurku University and University Hospital. Department of Paediatrics. Turku, FinlandFederal University of Bahia. School of Medicine. Postgraduate Program in Health Sciences. Salvador, BA, Brazil / Federal University of Bahia. School of Medicine. Department of Paediatrics. Salvador, BA, Brazi

Determination of avidity of IgG against protein antigens from Streptococcus pneumoniae: assay development and preliminary application in clinical settings

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-02-05T13:37:15Z No. of bitstreams: 1 Andrade DC Determination of a vidity....pdf: 616257 bytes, checksum: e4039ee328b9171190615bc1efe09fa7 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-02-05T14:06:18Z (GMT) No. of bitstreams: 1 Andrade DC Determination of a vidity....pdf: 616257 bytes, checksum: e4039ee328b9171190615bc1efe09fa7 (MD5)Made available in DSpace on 2018-02-05T14:06:18Z (GMT). No. of bitstreams: 1 Andrade DC Determination of a vidity....pdf: 616257 bytes, checksum: e4039ee328b9171190615bc1efe09fa7 (MD5) Previous issue date: 2018Bahia State Agency for Research Funding (FAPESB), Brazil; Brazilian Council for Scientific and Technological Development (CNPq), Brazil; Turku University Hospital Research Foundation, Finland; Rauno and Anne Puolimatka Foundation, Finland; Sohlberg Foundation, Finland.Federal University of Bahia. School of Medicine. Postgraduate Programme in Health Sciences. Salvador, BA, BrazilFederal University of Bahia. School of Medicine. Postgraduate Programme in Health Sciences. Salvador, BA, BrazilNational Institute for Health and Welfare. Helsinki, FinlandUniversity of Turku and Turku University Hospital. Department of Paediatrics. Turku, FinlandUniversity of Turku and Turku University Hospital. Department of Paediatrics. Turku, Finland / Satakunta Central Hospital. Department of Otorhinolaryngology. Pori, FinlandFederal University of Bahia. School of Medicine. Pathology Department and Postgraduate Programme in Health Sciences. Salvador, BA, Brazil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilUniversity of Turku and Turku University Hospital. Department of Paediatrics. Turku, FinlandUniversity of Turku and Turku University Hospital. Department of Paediatrics. Turku, Finland / Satakunta Central Hospital. Department of Otorhinolaryngology. Pori, FinlandFederal University of Bahia. School of Medicine. Pathology Department and Postgraduate Programme in Health Sciences. Salvador, BA, BrazilThe measurement of antibody levels is a common test for the diagnosis of Streptococcus pneumoniae infection in research. However, the quality of antibody response, reflected by avidity, has not been adequately evaluated. We aimed to evaluate the role of avidity of IgG against eight pneumococcal proteins in etiologic diagnosis. Eight pneumococcal proteins (Ply, CbpA, PspA1 and 2, PcpA, PhtD, StkP-C, and PcsB-N) were used to develop a multiplex bead-based avidity immunoassay. The assay was tested for effects of the chaotropic agent, multiplexing, and repeatability. The developed assay was applied to paired samples from children with or without pneumococcal disease (n = 38 for each group), determined by either serology, polymerase chain reaction (PCR), or blood culture. We found a good correlation between singleplex and multiplex assays, with r ≥ 0.94.The assay was reproducible, with mean inter-assay variation ≤ 9% and intra-assay variation < 6%. Children with pneumococcal disease had lower median avidity indexes in the acute phase of disease for PspA1 and 2 (p = 0.042), PcpA (p = 0.002), PhtD (p = 0.014), and StkP-C (p < 0.001). When the use of IgG avidity as a diagnostic tool for pneumococcal infection was evaluated, the highest discriminative power was found for StkP-C, followed by PcpA (area under the curve [95% confidence interval, CI]: 0.868 [0.759-0.977] and 0.743 [0.607-879], respectively). The developed assay was robust and had no deleterious influence from multiplexing. Children with pneumococcal disease had lower median avidity against five pneumococcal proteins in the acute phase of disease compared to children without disease