Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
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Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
Rheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2and its chronic sequel, rheumatic heart disease (RHD) result from an autoimmune disease that starts with an infection caused by Streptococcus pyogenes (Group A streptococci—GAS) and remain the most common cause of preventable childhood heart disease worldwide. It follows a nontreated throat infectio Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2n in susceptible children and teenagers (3- to 19-years old): and strongly relates to socioeconomic and environmental determinants, such as overcrowdiEbook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
ng. poor standard of living, poor access to medical care and inadequate expertise of health-care teams 11, 2].EpidemiologyDespite being considered todRheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2edical and public health problem, especially in low and middleincome countries and in indigenous populations, where it causes disability andM. de Melo Barbosa. M.D.. Ph D. (0)ECO Center. Hospital Socor. Belo Horizonte. BrazilInteramerican Society of Cardiologye-mail: marciambarbosa@terra.com.brM. do Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2 Carino Pereira Nunes. M.D.School of Medicine. Federal University of Minas Gerais, Belo Horizonte. Brazile-mail: mcarmo @ way mai I .com.brR. Muller.Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
M.D.. Ph.D.Working Group on Rheumatic Fever from the World Heart Federation. Geneva. SwitzerlandNational Heart Institute of Rio de Janeiro, Rio de JanRheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2lar Diseases. nni in inm/ntc Í -5 10144M. de Melo Barbosa el al.premature death in children and young adults in their most productive years [I], As stated recently. RHD does not get the same attention as cancer as a chronic non-communicable disease (NCD) “because it is a disease of the bottom billio Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2n of the poorest people in the world—one of the most neglected of the neglected diseases” [2].In 2005. the World Health Organization (WHO) estimated aEbook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
prevalence of al least 15.6 million cases of RHD worldwide, with 282,000 new cases (ARF) and 233.000 deaths related to RHD each year. The burden of sRheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2ns, and future incoming-data will show these figures to be dramatically underestimated [5].In Brazil, estimates based on WHO epidemiological model and data from the last Census in 2010, appointed to around 30.000 new cases of ARF each year, of which around 12.800 can develop RHD [1.6). Brazilian off Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2icial figures have shown a significant reduction in the number of hospitalizations due to ARF and RHD in the last 10 years, however, in 2012. 2713 ARFEbook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
and 4268 RHD hospital admissions were still reported [7], since, similar to other countries, Brazil has not yet implemented a national register systeRheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2e very common.In a recent linkage study with 53.210 Brazilian in-hospital children and adolescents admitted for heart failure (HF) from 2001 to 2007 the survival analysis for the ARF/RHD patients showed only 61 %, 55 % and 36 % survival rate at 1.2 and 7 years, respectively, with a hazard ratio obse Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2rved for RHD patients’ death of 15.5. These poor results were strongly related to social conditions measured by human development index (HDI) of the pEbook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
atients' residence [8].Another Brazilian study with 100 RHD low-income patients in Sao Paulo analyzing the entire course of the disease concluded thatRheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2te of 22 (7c. 23 % parents' work absenteeism, about 5 % lost jobs, and the intangible costs associated w ith RHD. resulting from premature disability and death, and loss of intellectual opportunities, with its adverse effects on the socioeconomic family and society development. The estimated annual Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2cost of RF for society in Brazil was estimated in 2001 as USS 51.144.347.00 [9].More recently, advocacy groups, including the World Heart Federation (Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
WHF), have put greater efforts into rectifying this neglect disease [2]. In April 2013. the WHF issued a statement of commitment to the strategic objeRheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2ing RHD and eliminating ARF. five strategic targets have been identified: (I) Comprehensive register-based control programs: (2) Cdobal access to Benzathine penicillin G: (3) Identification and development of public figures as "RHD champions”: (4) Expansion of RHD training hubs: and (5) Support for Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2vaccine development [ 10],A recent editorial about RHD discussed that the challenge regarding RHD does not relate to knowledge of the disease, but toEbook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
the implementation of measures to control the disease globally [5], which depends on the political will of the governments and inclusion of ARF in pubRheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 25PathogenesisThe pathogenesis of ARF/RHD is complex and both environmental and genetic factors contribute to its etiology, but still remains incompletely understood 111]. Streptococcus, in the appropriate condition, triggers the pathogenic sequence that starts with pharyngitis, leading, in a small p Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2ercentage of cases (1 to 5 % of susceptible children), to ARF which, in about 60 % of the cases, will develop life-threatening valve lesions characterEbook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
istic of RHD [2].Several genes associated with RHD have been described, related to both the innate and adaptive immune responses. The susceptibility oRheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2which are all located on human chromosome 6. HLA alleles are involved in antigen recognition by T lymphocytes through the T cell receptor (TCR). TNF-a gene encodes the inflammatory TNF alpha protein, w hich is involved in the inflammatory process mediating hearttissue lesions in RHD. Several other a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2ssociations have been established through single nucleotide polymorphisms (SNPs) for genes code for other proteins also involved with the immune respoEbook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
nse (innate and adaptive pathways) [11],Molecular mimicry between streptococcal antigens and human proteins is central to RHD pathogenesis, and mainlyRheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2 and proliferate in the valves in response to stimulation with specific cytokines. High TNF alpha, interferon gamma, and low IL4 are found in the rheumatic valve. 1L-4+ cells are found in the myocardium: however, these cells are very scarce in the valve lesions of RHD patients. IL-4 is a Th2-type cy Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2tokine and plays a regulatory role in the inflammatory response mediated by Th 1 cytokines. These findings indicate that the Thl/Th2 cytokine balanceEbook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
has a role in healing myocarditis, while the low numbers of IL-4-producing cells in the valves probably induce progressive and permanent valve damage Rheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2 inflammatory process and the streptococcal infection. Clinical diagnosis of carditis is usually made by the auscultation of a pathological mitral regurgitation (MR) murmur. Jones criteria [12] created in 1944, are characterized in major and minor, and represent the gold standard for the diagnosis o Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2f the first attack. They are an epidemiological and not clinical tool for the initial attack and have been revised, modified and updated by the AmericEbook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2
an Heart Association [13. 14] and by the WHO [I] (Tables 1 and 2).For the initial attack, the presence of two major manifestations or of one major andRheumatic Heart Disease: A Neglected Heart DiseaseMarcia de Melo Barbosa, Maria do Carmo Pereira Nunes, and Regina MullerAcute Rheumatic fever (ARF) a Ebook Prevention of cardiovascular diseases from current evidence to clinical practice: Part 2 aGọi ngay
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