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Beaton A, Carapetis J. The 2015 revision of the Jones criteria for the diagnosis of acute rheumatic fever: implications for practice in low-income and middle-income countries. HEART ASIA 2015; 7:7-11. [PMID: 27326214 DOI: 10.1136/heartasia-2015-010648] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 12/21/2022]
Abstract
The Jones criteria has longed served as the primary guideline for diagnosing acute rheumatic fever (ARF). However, since the first iteration in 1944, the global epidemiology of ARF and our knowledge regarding the variability of its presentation have changed. In 2015, the American Heart Association took on an ambitious and successful revision, which accounts for these changes. For the first time, the criteria consider the risk within a population and offer two separate diagnostic pathways that prioritise specificity among those at low risk and sensitivity among those at moderate/high risk. Echocardiography is now recommended in all patients with suspected or confirmed ARF, and subclinical carditis can fulfil a major criterion for ARF in all populations. Finally, new and specific criteria are provided for the diagnosis of ARF recurrences. These changes improve the diagnosis of ARF among moderate/high-risk populations and re-establish the Jones criteria as the international gold standard for ARF diagnosis. It is our hope that they will also serve as a catalyst in the global community to increase advocacy, improve case detection, and invest in new research techniques that could ultimately control global ARF in our lifetimes.
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Affiliation(s)
- Andrea Beaton
- Children's National Health System, Cardiology , Washington DC , USA
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, and Princess Margaret Hospital for Children , Subiaco, Western Australia , Australia
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202
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Late Recurrence of Rheumatic Fever. Am J Med Sci 2015; 350:342-3. [PMID: 26270640 DOI: 10.1097/maj.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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203
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Markham R, Tulloh R. Fifteen-minute consultation: rheumatic fever. Arch Dis Child Educ Pract Ed 2015; 100:176-9. [PMID: 25653243 DOI: 10.1136/archdischild-2014-306545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 01/12/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To present a structured approach for an outpatient consultation or inpatient assessment of a child with possible rheumatic fever. METHOD Review of literature and description of diagnostic and therapeutic approach. CONCLUSIONS A focused history and examination is key to establish the cause and draw a management plan for rheumatic fever.
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Affiliation(s)
- Rebecca Markham
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Robert Tulloh
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
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204
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Swain JD, Pugliese DN, Mucumbitsi J, Rusingiza EK, Ruhamya N, Kagame A, Ganza G, Come PC, Breakey S, Greenwood B, Muehlschlegel JD, Patton-Bolman C, Binagwaho A, Morton Bolman R. Partnership for sustainability in cardiac surgery to address critical rheumatic heart disease in sub-Saharan Africa: the experience from Rwanda. World J Surg 2015; 38:2205-11. [PMID: 24728579 DOI: 10.1007/s00268-014-2559-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Rheumatic heart disease (RHD) in the developing world results in critical disability among children, adolescents, and young adults-marginalizing a key population at its peak age of productivity. Few regions in sub-Saharan Africa have independently created an effective strategy to detect and treat streptococcal infection and mitigate its progression to RHD. OBJECTIVE We describe a unique collaboration, where the Rwanda Ministry of Health, the Rwanda Heart Foundation, and an expatriate humanitarian cardiac surgery program have together leveraged an innovative partnership as a means to expand Rwanda's current capacity to address screening and primary prevention, as well as provide life-saving cardiac surgery for patients with critical RHD. EVIDENCE REVIEW Interviews with key personnel and review of administrative records were conducted to obtain qualitative and quantitative data on the recruitment of clinical personnel, procurement of equipment, and program finances. The number of surgical cases completed and the resultant clinical outcomes are reviewed. FINDINGS From 2008 to 2013, six annual visits were completed. A total of 128 prosthetic valves have been implanted in 86 complex patients in New York Heart Association (NYHA) class III or IV heart failure, with excellent clinical outcomes (5 % 30-day mortality). Postoperative complications included a cerebrovascular accident (n = 1) and hemorrhage, requiring reoperation (n = 2). All procedures were performed with participation of local personnel. CONCLUSIONS AND RELEVANCE This strategy provides a reliable and consistent model of sophisticated specialty care delivery; inclusive of patient-centered cardiac surgery, mentorship, didactics, skill transfer, and investment in a sustainable cardiac program to address critical RHD in sub-Saharan Africa.
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Affiliation(s)
- JaBaris D Swain
- Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital-Harvard Medical School, Boston, MA, USA,
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205
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Gapu P, Bwakura-Dangarembizi M, Kandawasvika G, Kao D, Bannerman C, Hakim J, Matenga JA. Rheumatic fever and rheumatic heart disease among children presenting to two referral hospitals in Harare, Zimbabwe. S Afr Med J 2015; 105:384-8. [PMID: 26242684 PMCID: PMC7275821 DOI: 10.7196/samj.7898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant causes of morbidity and mortality in resource-limited settings. In Zimbabwe ARF/RHD characteristics have not been systematically documented. OBJECTIVES To document cases of ARF/RHD among children presenting at referral hospitals in Harare, Zimbabwe, determine their clinical and echocardiographic characteristics, and identify opportunities for improving care. METHODS A cross-sectional survey was carried out in which consecutive children aged 1 - 12 years presenting with ARF/RHD according to the 2002/3 World Health Organization modified Jones criteria were enrolled. RESULTS Out of 2 601 admissions and 1 026 outpatient visits over 10 months, 50 children were recruited, including 31 inpatients with ARF/RHD and 19 outpatients with chronic RHD. Among inpatients, 9 had ARF only, 7 recurrent ARF with RHD, and 15 RHD only. The commonest valve lesions were mitral regurgitation (26/31) and aortic regurgitation (11/31). The commonest reason for admission was cardiac failure (22/31). The proportion of ARF/RHD cases among inpatients aged 1 - 12 years was 11.9/1 000. Of the 22 with RHD, 14 (63.6%) presented de novo and 1 had bacterial endocarditis. Among the outpatients, 15 had cardiac failure while echocardiographic findings included mitral regurgitation (18/19) and aortic regurgitation (5/19). At presentation, 18/26 known cases were on oral penicillin prophylaxis and 7 on injectable penicillin. Of those on secondary prophylaxis, 68.0% reported taking it regularly. CONCLUSION ARF/RHD remains a major problem and cause of hospital admissions in Harare, Zimbabwe. Children often present late with established RHD and cardiac failure. With the majority on oral penicillin, secondary prophylaxis was suboptimal in a resource-limited setting unable to offer valve replacement surgery.
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Affiliation(s)
- P Gapu
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
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206
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Herath VCK, Carapetis J. Sore throat: Is it such a big deal anymore? J Infect 2015; 71 Suppl 1:S101-5. [PMID: 25917806 DOI: 10.1016/j.jinf.2015.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 01/27/2023]
Abstract
Sore throat remains a common disease of childhood, and a major cost and cause for antibiotic prescriptions. The management of sore throat remains controversial in affluent countries with various guidelines available and overall poor adherence to those guidelines. Group A streptococcus is the commonest bacterial cause with important sequelae including acute rheumatic fever (ARF). The driver for diagnosis and treatment is still questionable. In most affluent populations it is difficult to justify antibiotic treatment on the basis of preventing ARF, whereas this remains the major driver for sore throat management in populations at higher risk of ARF. Reduction in severity and duration of symptoms may be a reasonable basis to consider antibiotic treatment, and thus accurate diagnosis of GAS pharyngitis, particularly in those with more severe symptoms. The potential role of rapid tests in diagnosis appears to be increasing.
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Affiliation(s)
- Verangi C K Herath
- Department of Paediatrics, Royal Darwin Hospital, 105 Rockland Drive, Tiwi, Northern Territory 0810, Australia.
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, West Perth, Western Australia 6872, Australia; Princess Margaret Hospital for Children, Subiaco, Perth, Western Australia 6008, Australia.
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207
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Gewitz MH, Baltimore RS, Tani LY, Sable CA, Shulman ST, Carapetis J, Remenyi B, Taubert KA, Bolger AF, Beerman L, Mayosi BM, Beaton A, Pandian NG, Kaplan EL. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation 2015; 131:1806-18. [PMID: 25908771 DOI: 10.1161/cir.0000000000000205] [Citation(s) in RCA: 366] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute rheumatic fever remains a serious healthcare concern for the majority of the world's population despite its decline in incidence in Europe and North America. The goal of this statement was to review the historic Jones criteria used to diagnose acute rheumatic fever in the context of the current epidemiology of the disease and to update those criteria to also take into account recent evidence supporting the use of Doppler echocardiography in the diagnosis of carditis as a major manifestation of acute rheumatic fever. METHODS AND RESULTS To achieve this goal, the American Heart Association's Council on Cardiovascular Disease in the Young and its Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee organized a writing group to comprehensively review and evaluate the impact of population-specific differences in acute rheumatic fever presentation and changes in presentation that can result from the now worldwide availability of nonsteroidal anti-inflammatory drugs. In addition, a methodological assessment of the numerous published studies that support the use of Doppler echocardiography as a means to diagnose cardiac involvement in acute rheumatic fever, even when overt clinical findings are not apparent, was undertaken to determine the evidence basis for defining subclinical carditis and including it as a major criterion of the Jones criteria. This effort has resulted in the first substantial revision to the Jones criteria by the American Heart Association since 1992 and the first application of the Classification of Recommendations and Levels of Evidence categories developed by the American College of Cardiology/American Heart Association to the Jones criteria. CONCLUSIONS This revision of the Jones criteria now brings them into closer alignment with other international guidelines for the diagnosis of acute rheumatic fever by defining high-risk populations, recognizing variability in clinical presentation in these high-risk populations, and including Doppler echocardiography as a tool to diagnose cardiac involvement.
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208
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Affiliation(s)
- Mohammed R Essop
- From the Division of Cardiology, CH-Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa.
| | - Ferande Peters
- From the Division of Cardiology, CH-Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
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209
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Gender differences in outcomes following cardiac surgery: implications for managing patients with mitral valve disease. Curr Opin Cardiol 2015; 30:151-154. [PMID: 25574891 DOI: 10.1097/hco.0000000000000150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the differences in clinical outcomes following cardiac surgery according to gender. RECENT FINDINGS Women comprise a large proportion of patients presenting with coronary artery or valvular heart disease. Although it is well known that women have poorer survival following bypass surgery compared with men, more recent data confirm that women also have poorer outcomes after heart valve surgery. Women are also more likely to receive mitral valve replacement instead of repair, when compared with men. These divergent outcomes are because of many factors, including valve disease and clinical presentation, which may result in delayed surgical referral in women. SUMMARY Factors that result in poorer outcomes following heart valve surgery, including mitral valve surgery, between men and women remain incompletely understood. These may relate to differences in clinical presentation, valve morphology, and physiology. Further research is needed to clarify differences in heart valve outcomes according to gender.
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210
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Watt G, Lacroix A, Pachirat O, Baggett HC, Raoult D, Fournier PE, Tattevin P. Prospective comparison of infective endocarditis in Khon Kaen, Thailand and Rennes, France. Am J Trop Med Hyg 2015; 92:871-4. [PMID: 25646262 DOI: 10.4269/ajtmh.14-0689] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/13/2014] [Indexed: 12/13/2022] Open
Abstract
Prospectively collected, contemporary data are lacking on how the features of infective endocarditis (IE) vary according to region. We, therefore, compared IE in Rennes, France and Khon Kaen, Thailand. Fifty-eight patients with confirmed IE were enrolled at each site during 2011 and 2012 using a common protocol. Compared with French patients, Thais had a lower median age (47 versus 70 years old; P < 0.001) and reported more animal contact (86% versus 21%; P < 0.001). There were more zoonotic infections among Thai than France patients (6 and 1 cases; P = 0.017) and fewer staphylococcal infections (4 versus 15 cases; P = 0.011). Underlying rheumatic heart disease was more prevalent in Thai than in French patients (31% and 4%; P = 0.001), whereas prosthetic heart valves were less prevalent (9% and 35%; P = 0.001). Our data strengthen previous observations that IE in the tropics has distinctive demographic characteristics, risk factors, and etiologies and underscore the need for improved prevention and control strategies.
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Affiliation(s)
- George Watt
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Adele Lacroix
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Orathai Pachirat
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Henry C Baggett
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Didier Raoult
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Pierre-Edouard Fournier
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Pierre Tattevin
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
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211
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Azevedo PM, Pereira RMR. Acute rheumatic fever. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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212
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Phillips DIW, Osmond C. Is susceptibility to chronic rheumatic heart disease determined in early infancy? An analysis of mortality in Britain during the 20th century. Glob Cardiol Sci Pract 2014; 2014:464-72. [PMID: 25780799 PMCID: PMC4355519 DOI: 10.5339/gcsp.2014.59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/11/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The reason why some individuals but not others are susceptible to rheumatic fever and chronic rheumatic heart disease is not understood. Because of the substantial evidence that poverty is an important determinant of the disease and must operate in early life, we have investigated the role of the early environment in an ecological study using 20(th) century mortality as an index of disease prevalence. METHODS We analysed 37,321 deaths from rheumatic heart disease in England and Wales during 1968-78. We compared the geographical distribution of deaths with previous infant mortality records from 1911 onwards. These records included details of mortality at different ages and from different causes. They also included data on housing and population density. RESULTS Mortality from rheumatic heart disease showed a strong correlation with past infant mortality that was consistently stronger with postneonatal mortality (deaths from one month to one year) than with neonatal mortality (deaths during the first month of life). Areas with high infant mortality from diarrhoea or bronchitis had the highest subsequent mortality from rheumatic heart disease. Although rheumatic heart disease was linked with early overcrowding, regression analyses suggested that overcrowding could not per se explain the infant mortality associations. CONCLUSIONS Chronic rheumatic heart disease may have its origins in early infancy. Our findings raise the possibility that susceptibility to rheumatic fever and rheumatic heart disease may be linked with infection in the postneonatal period. Alternatively, they may be explained by the operation of environmental factors that both predispose to infection in infancy and the subsequent liability to heart disease.
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Affiliation(s)
- D I W Phillips
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - C Osmond
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
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213
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4448] [Impact Index Per Article: 444.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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214
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Prevalence of rheumatic heart disease in young adults from New Caledonia. Arch Cardiovasc Dis 2014; 108:16-22. [PMID: 25511373 DOI: 10.1016/j.acvd.2014.07.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 06/25/2014] [Accepted: 07/04/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is an important public health issue, particularly in the Pacific region, but its true burden is unknown. OBJECTIVES To evaluate the prevalence of rheumatic heart disease (RHD) in young adults from New Caledonia, based on echocardiography, and to evaluate the accuracy of dynamic criteria, focusing on mitral valve (MV) leaflet motion. METHODS Blind analysis of echocardiography by three cardiologists; diagnosis of RHD required at least one dynamic criterion (exaggerated or restricted MV leaflet motion); subjects with morphological criteria (MV leaflet thickening), but without dynamic criteria, were considered as borderline. RESULTS There were 834 subjects from three socioeconomic groups, aged 18-22 years: 699 had normal echocardiography; 93 (11.5%) had physiological regurgitation; nine (0.9%) had borderline RHD; and five (0.59%) had RHD. The prevalence of RHD in New Caledonia was thus estimated at 5.9 per 1000 (95% confidence interval 2.6-12.2). The RHD cases were of Pacific ethnicity. Physiological regurgitation was more frequent in Pacific subjects (13.7%) than in non-Pacific subjects (6.9%; P<0.0001). RHD was more prevalent in the lowest socioeconomic group. No disagreement occurred between the three reviewers concerning analysis of dynamic criteria; all disagreements were related to morphological criteria. CONCLUSIONS The prevalence of echocardiographically diagnosed RHD in adults in New Caledonia is estimated at 5.9 per 1000; it occurs most frequently in Pacific subjects and those with low incomes. Dynamic criteria were more accurate and reproducible than standard morphological criteria.
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215
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Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents. LANCET GLOBAL HEALTH 2014; 2:e717-26. [DOI: 10.1016/s2214-109x(14)70310-9] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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216
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Abstract
In this review, we discuss right-sided heart valve disease, namely tricuspid regurgitation (TR), tricuspid stenosis, pulmonary regurgitation, pulmonary stenosis and right-sided endocarditis. These are frequently seen in conjunction with other diseases, making assessment of their significance more difficult, but it has become increasingly clear that moderate or severe right-sided heart valve disease, in particular TR, is associated with worse prognosis. There remain large gaps in our knowledge of medical and interventional treatment, but in this article we outline what is known about the causes, presentation and management of these commonly seen conditions.
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Affiliation(s)
- S Coffey
- Cardiology Research Group, Department of Medicine, University of Otago, Dunedin, New Zealand; Department of Cardiology, Oxford University Hospitals NHS Trust, Oxford, UK
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217
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Infective endocarditis epidemiology and consequences of prophylaxis guidelines modifications: the dialectical evolution. Curr Infect Dis Rep 2014; 16:440. [PMID: 25233804 DOI: 10.1007/s11908-014-0440-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Historically, infective endocarditis (IE) affected patients with predisposing cardiac conditions and community-acquired bacteremia. Over the past 30 years, significant changes have occurred, regarding microorganisms, underlying valvular heart diseases, portals of entry, and patients' comorbidities. Given these epidemiological changes and unproven prophylaxis efficacy, experts in most countries currently limit antibiotic indications to patients with high-risk cardiac conditions having oral procedures and, in the UK, recommend discontinuing their use altogether. To date, no epidemiological impact on streptococcal IE incidence has been observed. Policy must now address these epidemiological modifications, focus on community-acquired and health care-associated staphylococcal bacteremia prevention, and prompt the adoption of broader and nonexclusively antibiotic-based strategies.
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218
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Teng CL. Antibiotic prescribing for upper respiratory tract infections in the Asia-Pacific region: A brief review. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2014; 9:18-25. [PMID: 25893067 PMCID: PMC4399404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This review highlights the high prevalence of antibiotic use for upper respiratory tract infections (URTIs) in a larger part of the Asia-Pacific region. Since URTIs are one of the common reasons for primary care consultations in this region, inappropriate use of antibiotic in both quantity and drug choice has greatly influenced the development of antibiotic resistance. Notwithstanding the paucity of Asia-Pacific data on the above issues, the available information suggests urgent actions needed to be taken to promote judicious antibiotic use at the point-of-care through a multi-pronged approach targeting the patients/consumers (or parents), healthcare providers and health care systems.
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Affiliation(s)
- CL Teng
- Department of Family Medicine, International Medical University
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219
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Merlini AB, Stocco CS, Schafranski MD, Arruda P, Bail L, Borges CL, Dornelles CF. Prevalence of group a Beta-hemolytic streptococcus oropharyngeal colonization in children and therapeutic regimen based on antistreptolysin levels: data from a city from southern Brazil. Open Rheumatol J 2014; 8:13-7. [PMID: 25136388 PMCID: PMC4136371 DOI: 10.2174/1874312901408010013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/24/2014] [Accepted: 07/02/2014] [Indexed: 11/30/2022] Open
Abstract
The aim of this study is to determinate the prevalence of oropharyngeal colonization by group A beta-hemolytic Streptococcus (GABHS) in pediatric population of Ponta Grossa, a midsize city of southern Brazil; estimate the effectiveness of antistreptolysin-O (ASO), compared to culture, in presence of infection; and design an unpublished investigative algorithm of rheumatic fever's suspicion, based on needs identified in worldwide consensus. It is an epidemiologic, observational and transversal study, involving 180 children younger than 12 years. Secretion of posterior oropharynx was collected for culture; and peripheral blood for determination of ASO. Student-t and chi-square tests, with Yates correction, were performed for statistical analysis. The ASO cutoff was determined by Receiver Operating Characteristic (ROC) curve. The prevalence encountered was 3.9%, and 25.5% of the children showed reagent ASO. This serological test demonstrated quantitatively and qualitatively significant associations to the GABHS presence (p=0.0001 for both associations) throughout the ROC curve, 200 U Todd was the value that resulted in the best accuracy, demonstrating 100% of sensibility and 80% of specificity in the GAS infection documentation. Also, it was found that the value of 1.200 U represents a specificity of 100%. The results emphasize the need for similar studies in other populations, to provide better targeting of the diagnosis and treatment of oropharyngitis by GABHS, which in turn can prevent up to 80% the cases of rheumatic fever, and consequently, the chronic rheumatic heart disease.
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Affiliation(s)
| | - Carolina S Stocco
- Department of Medicine, State University of Ponta Grossa, Paraná, Brazil
| | | | - Polliane Arruda
- Department of Medicine, State University of Ponta Grossa, Paraná, Brazil
| | - Larissa Bail
- Department of Microbiology, State University of Ponta Grossa, Paraná, Brazil
| | - Celso L Borges
- Department of Immunology, State University of Ponta Grossa, Paraná, Brazil
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Zafindraibe NJ, Randriamanantany ZA, Rajaonatahina DH, Andriamahenina R, Rasamindrakotroka A. Current practice about the evaluation of antibody to streptolysin O (ASO) levels by physicians working in Antananarivo, Madagascar. Afr Health Sci 2014; 14:384-9. [PMID: 25320588 DOI: 10.4314/ahs.v14i2.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The diagnosis of post streptococcal diseases is usually confirmed by immunological tests. Only the antistreptolysin O is usually prescribed by physician. This study aimed to describe the current practice of these requests in Antananarivo. METHODS It was a retrospective and descriptive study conducted at the Para clinic Unit of Immunology at the University Center Hospital of Antananarivo. We analyzed all requests during seven years, from January 2003 to December 2009. We looked at age, gender, and clinical symptoms which led to the request and the result for each request. RESULTS We retained 4143 requests for antistreptolysin O titration in our study. The mean age of the study participants was 32.9 years with 18.3% of participants being less than 15 years old. The main symptoms leading to the request of this analysis were rheumatologic (41%), followed by neurological (13.9%) and cardiologic symptoms (8.5%) and 19.4% were prescribed for various symptoms. Only 15% of all requests had a value more than 200 U/ml. CONCLUSION Our study found that in most of requests, ASO titre levels were not significant.
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Affiliation(s)
- Norosoa Julie Zafindraibe
- University center hospital of Antananarivo, Para clinic unit of immunology, Antananarivo, Madagascar
| | | | | | | | - Andry Rasamindrakotroka
- University center hospital of Antananarivo, Para clinic unit of immunology, Antananarivo, Madagascar
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Zheng RL, Zhang H, Jiang WL. Tumor necrosis factor-alpha 308G>A polymorphism and risk of rheumatic heart disease: a meta-analysis. Sci Rep 2014; 4:4731. [PMID: 24751687 PMCID: PMC3994435 DOI: 10.1038/srep04731] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/31/2014] [Indexed: 12/29/2022] Open
Abstract
Rheumatic heart disease (RHD) remains a serious cardiovascular disorder across the world. Tumor necrosis factor alpha (TNF-α) codifies a potent immunomodulator and pro-inflammatory cytokine that mediates diverse pathological processes. A promoter 308G>A polymorphism in TNF-α has been implicated in RHD risk. However, the results remain controversial. Therefore, to evaluate more precise estimations of the relationship, a meta-analysis was performed. A total of 7 studies including 735 RHD cases and 926 controls were involved in this meta-analysis. Overall, our results revealed that there was a significant association with RHD risk in three genetic models (homozygous model: OR = 3.06, 95%CI = 1.22–10.60, P = 0.020; dominant model, OR = 2.03, 95%CI = 1.01–4.07, P = 0.048; and recessive model, OR = 4.26, 95%CI = 2.41–7.55, P < 0.001). Further ethnic population analysis found a significantly increased risk of RHD among Asians and Europeans. Interestingly, similar results were found among hospital-based studies. Begg's funnel plot and Egger's test did not reveal any publication bias. Taken together, this meta-analysis demonstrates that the TNF-α 308G>A polymorphism is associated with RHD susceptibility, and it contributes to the increased risk of RHD. However, additional well-designed studies with larger samples are warranted to confirm these findings.
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Affiliation(s)
- Ruo-Long Zheng
- Department of Cardiology, The Affiliated Jiangyin hospital of Medical College of Southeast University, Wuxi 214400, China
| | - Hua Zhang
- Department of Cardiology, The Affiliated Jiangyin hospital of Medical College of Southeast University, Wuxi 214400, China
| | - Wen-Long Jiang
- Department of Cardiology, The Affiliated Jiangyin hospital of Medical College of Southeast University, Wuxi 214400, China
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Cardiac surgery for advanced rheumatic heart disease in Rwanda. LANCET GLOBAL HEALTH 2014; 2:e141-2. [DOI: 10.1016/s2214-109x(14)70022-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129:e28-e292. [PMID: 24352519 PMCID: PMC5408159 DOI: 10.1161/01.cir.0000441139.02102.80] [Citation(s) in RCA: 3511] [Impact Index Per Article: 351.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Choudhury SA, Exil V. Rheumatic heart disease in Tennessee: An overlooked diagnosis. SAGE Open Med Case Rep 2014; 2:2050313X14527589. [PMID: 27489643 PMCID: PMC4857350 DOI: 10.1177/2050313x14527589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/12/2014] [Indexed: 11/15/2022] Open
Abstract
Rheumatic heart disease, already a major burden in low- and middle-income countries, is becoming an emerging problem in high-income countries. Although acute rheumatic fever and rheumatic heart disease have almost been eradicated in areas with established economies, the emergence of this problem may be attributable to the migration from low-income to high-income settings. Between 2010 and 2012, we diagnosed a cluster of rheumatic heart disease cases in children from the Middle Tennessee area. The goal of this report is to increase awareness among clinicians as the incidence and prevalence of acute rheumatic fever remain relatively significant in large US metropolitan areas. Although acute rheumatic fever is seasonal, a high suspicion index may lead to the early diagnosis and prevention of its cardiac complications. Furthermore, screening procedures may be recommended for populations at risk for rheumatic heart disease in endemic areas, and active surveillance with echocardiography-based screening might become very important.
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Affiliation(s)
| | - Vernat Exil
- Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Children's Hospital At Vanderbilt University, Nashville TN, USA
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Leão SC, Lima MRM, do Nascimento HM, Octacilio-Silva S, Rodrigues TMDA. IL-10 and ET-1 as biomarkers of rheumatic valve disease. Braz J Cardiovasc Surg 2014; 29:25-30. [PMID: 24896159 PMCID: PMC4389480 DOI: 10.5935/1678-9741.20140007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 01/06/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the immunological profile and gene expression of endothelin-1 (ET-1) in mitral valves of patients with rheumatic fever originated from a reference service in cardiovascular surgery. METHODS This was a quantitative, observational and cross-sectional study. Thirty-five subjects (divided into four groups) participated in the study, 25 patients with chronic rheumatic heart disease and ten control subjects. The mean age of the sample studied was 34.5 years. Seventeen of them (48.58%) were male and 18 (51.42%) were female. Inflammatory cytokines (TNF-α, IL-4 and IL-10) were measured and ten mitral valves of patients who underwent first valve replacement were collected for determination of gene expression of endothelin-1 by real time PCR. RESULTS Among the groups studied (patients vs. controls), there was a statistically significant difference in IL-10 levels (P=0.002), and no differences in other cytokines. Expression of endothelin-1 was observed in 70% of samples. Quantitatively, average of ET-1 expression was 62.85±25.63%. CONCLUSION Inflammatory cytokine IL-10 participates in the maintenance of chronicity of rheumatic fever in patients who underwent valve replacement and those who are undergoing medical treatment. The expression of endothelin-1 in heart valve lesions in patients undergoing mitral valve replacement confirms its association with inflammatory activity in rheumatic fever.
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Le Huu A, Shum-Tim D. Tissue engineering of autologous heart valves: a focused update. Future Cardiol 2013; 10:93-104. [PMID: 24344666 DOI: 10.2217/fca.13.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The prevalence of valvular heart disease is expected to increase in the coming decades, with an associated rise in valve-related surgeries. Current options for valve prostheses remain limited, essentially confined to mechanical or biological valves. Neither selection provides an optimal balance between structural integrity and associated morbidity. Mechanical valves offer exceptional durability coupled with a considerable risk of thrombogenesis. Conversely, a biological prosthesis affords freedom from anticoagulation, but with a truncated valve lifespan. Tissue-engineered heart valves have been touted as a solution to this dilemma, by offering an immunopriviledged prosthesis combined with resistance from degeneration and the potential to grow. Although the reality of commercially available tissue-engineered heart valves remains distant, this article will highlight the cellular and clinical advancements in recent years.
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Affiliation(s)
- Alice Le Huu
- Division of Cardiac Surgery & Surgical Research, Department of Surgery, The Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, Suite S8.73b, Montreal, Quebec, H3A 1A1, Canada
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Ralph AP, Fittock M, Schultz R, Thompson D, Dowden M, Clemens T, Parnaby MG, Clark M, McDonald MI, Edwards KN, Carapetis JR, Bailie RS. Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach. BMC Health Serv Res 2013; 13:525. [PMID: 24350582 PMCID: PMC3878366 DOI: 10.1186/1472-6963-13-525] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 11/29/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve quality of RHD care through development and implementation of a continuous quality improvement (CQI) strategy. METHODS We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008-2010. Participatory action research methods were employed to identify system barriers to delivery of high quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (≥80% of scheduled 4-weekly penicillin injections) and quality of documentation. RESULTS Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ≥40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p = 0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p = 0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p = 0.001). However, the proportion receiving ≥80% of scheduled BPG did not change. Documentation in medical files improved: ARF episode documentation increased from 31/55 (56%) to 50/62 (81%) (p = 0.004), and RHD risk category documentation from 87/154 (56%) to 103/145 (76%) (p < 0.001). Large differences in performance were noted between health centres, reflected to some extent in SAT scores. CONCLUSIONS A CQI process using a systems approach and participatory action research methodology can significantly improve delivery of ARF/RHD care.
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Affiliation(s)
- Anna P Ralph
- Menzies School of Health Research, Darwin, Northern Territory (NT), Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Marea Fittock
- Menzies School of Health Research, Darwin, Northern Territory (NT), Australia
| | - Rosalie Schultz
- Nyangirru Piliyi-ngara Kurantta, Anyinginyi Health Aboriginal Corporation, Tennant Creek, NT, Australia
| | - Dale Thompson
- Menzies School of Health Research, Darwin, Northern Territory (NT), Australia
| | | | - Tom Clemens
- Northern Territory Department of Health and Community Services, Townsville, Australia
| | - Matthew G Parnaby
- Northern Territory Department of Health and Community Services, Townsville, Australia
| | - Michele Clark
- Queensland Health, Queensland Government, Townsville, Queensland, Australia
| | - Malcolm I McDonald
- School of Medicine and Dentistry, Cairns Campus, James Cook University, Townsville, QLD, Australia
| | - Keith N Edwards
- Northern Territory Department of Health and Community Services, Townsville, Australia
| | - Jonathan R Carapetis
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Ross S Bailie
- Menzies School of Health Research, Darwin, Northern Territory (NT), Australia
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Vogel T, Kitcharoensakkul M, Fotis L, Baszis K. The heart and pediatric rheumatology. Rheum Dis Clin North Am 2013; 40:61-85. [PMID: 24268010 DOI: 10.1016/j.rdc.2013.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recent advances in Kawasaki disease have included attempts to define genes involved in its pathogenesis. There have been recent advances in the studies of rheumatic carditis, leading to a better understanding of the mechanism of the disease. Histologic evaluation of patients with neonatal lupus erythematosus has revealed fibrosis with collagen deposition and calcification of the atrioventricular node. Therapy for cardiac involvement in systemic juvenile idiopathic arthritis should involve treatment of the underlying disease and systemic inflammatory state, and typically includes nonsteroidal antiinflammatory drugs, corticosteroids, disease-modifying drugs, and biologic therapies targeting tumor necrosis factor-alpha, interleukin-1, and interleukin-6.
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Affiliation(s)
- Tiphanie Vogel
- Division of Rheumatology, Department of Pediatrics, Washington University School of Medicine, Box 8116, One Children's Place, St Louis, MO 63110, USA; Division of Rheumatology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
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Wunderlich NC, Beigel R, Siegel RJ. Management of Mitral Stenosis Using 2D and 3D Echo-Doppler Imaging. JACC Cardiovasc Imaging 2013; 6:1191-205. [DOI: 10.1016/j.jcmg.2013.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/03/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
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Affiliation(s)
- David J Hunter
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
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Commensal microbiota contributes to chronic endocarditis in TAX1BP1 deficient mice. PLoS One 2013; 8:e73205. [PMID: 24086273 PMCID: PMC3785488 DOI: 10.1371/journal.pone.0073205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/17/2013] [Indexed: 12/12/2022] Open
Abstract
Tax1-binding protein 1 (Tax1bp1) negatively regulates NF-κB by editing the ubiquitylation of target molecules by its catalytic partner A20. Genetically engineered TAX1BP1-deficient (KO) mice develop age-dependent inflammatory constitutions in multiple organs manifested as valvulitis or dermatitis and succumb to premature death. Laser capture dissection and gene expression microarray analysis on the mitral valves of TAX1BP1-KO mice (8 and 16 week old) revealed 588 gene transcription alterations from the wild type. SAA3 (serum amyloid A3), CHI3L1, HP, IL1B and SPP1/OPN were induced 1,180-, 361-, 187-, 122- and 101-fold respectively. WIF1 (Wnt inhibitory factor 1) exhibited 11-fold reduction. Intense Saa3 staining and significant I-κBα reduction were reconfirmed and massive infiltration of inflammatory lymphocytes and edema formation were seen in the area. Antibiotics-induced ‘germ free’ status or the additional MyD88 deficiency significantly ameliorated TAX1BP1-KO mice's inflammatory lesions. These pathological conditions, as we named ‘pseudo-infective endocarditis’ were boosted by the commensal microbiota who are usually harmless by their nature. This experimental outcome raises a novel mechanistic linkage between endothelial inflammation caused by the ubiquitin remodeling immune regulators and fatal cardiac dysfunction.
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233
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Zühlke LJ, Karthikeyan G. Primary Prevention for Rheumatic Fever: Progress, Obstacles, and Opportunities. Glob Heart 2013; 8:221-6. [DOI: 10.1016/j.gheart.2013.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 08/01/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022] Open
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Zühlke LJ, Steer AC. Estimates of the Global Burden of Rheumatic Heart Disease. Glob Heart 2013; 8:189-95. [DOI: 10.1016/j.gheart.2013.08.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022] Open
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Ramsey LS, Watkins L, Engel ME. Health education interventions to raise awareness of rheumatic fever: a systematic review protocol. Syst Rev 2013; 2:58. [PMID: 23866796 PMCID: PMC3720575 DOI: 10.1186/2046-4053-2-58] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/02/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is a significant global health burden associated with acute rheumatic fever (ARF) and rheumatic heart disease (RHD), especially in developing countries. ARF and RHD most often strike children and young adults living in impoverished settings, where unhygienic conditions and lack of awareness and knowledge of streptococcal infection progression are common. Secondary prophylactic measures have been recommended in the past, but primary prevention measures have been gaining more attention from researchers frustrated by the perpetual prevalence of ARF and RHD in developing countries. Health education aims to empower people to take responsibility for their own well-being by gaining control over the underlying factors that influence health. We therefore conducted a review of the current best evidence for the use of health education interventions to increase awareness and knowledge of streptococcal pharyngitis and ARF. METHODS AND DESIGN This article describes the protocol for a systematic review of the effectiveness of health education interventions aimed at increasing awareness and knowledge of the symptoms, causes and consequences of streptococcal pharyngitis, rheumatic fever and/or rheumatic heart disease. Studies will be selected in which the effect of an intervention is compared with either a pre-intervention or a control, targeting all possible audience types. Primary and secondary outcomes of interest are pre-specified. Randomized controlled trials, quasi-randomized trials, controlled before-after studies and controlled clinical trials will be considered. We will search several bibliographic databases (for example, PubMed, EMBASE, World Health Organization Library databases, Google Scholar) and search sources for gray literature. We will meta-analyze included studies. We will conduct subgroup analyses according to intervention subtypes: printed versus audiovisual and mass media versus training workshops. DISCUSSION This review will provide evidence for the effectiveness of educational components in health promotion interventions in raising public awareness in regard to the symptoms, causes and consequences of streptococcal pharyngitis, ARF and/or RHD. Our results may provide guidance in the development of future intervention studies and programs.
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Affiliation(s)
- Laura Susan Ramsey
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
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Casey JD, Solomon DH, Gaziano TA, Miller AL, Loscalzo J. Clinical problem-solving. A patient with migrating polyarthralgias. N Engl J Med 2013; 369:75-80. [PMID: 23822780 DOI: 10.1056/nejmcps1208808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jonathan D Casey
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
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Anzouan-Kacou JB, Siransy E, Nchoh-Mottoh MP, Ekou A, Bamba-Kamagaté D, Kadio EM. [Transthoracic echocardiography in a heart institute in Abidjan (Ivory Coast): Indications and evaluation of the request appropriateness]. Ann Cardiol Angeiol (Paris) 2013; 63:1-6. [PMID: 23806860 DOI: 10.1016/j.ancard.2013.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 04/27/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to clarify the clinical situations motivating indications of transthoracic echocardiography (TTE) in a cardiology institute in Côte d'Ivoire and to assess the appropriateness of indications. PATIENTS AND METHODS This is a prospective and observational study conducted over a period of 6 months. The 1733 enrolled were classified according to the indications and their relevance defined by the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Echocardiography and the American Heart Association (ACCF/ASE/AHA). RESULTS In five cases (0.3%), indications were not listed in the document ACCF/ASE/AHA. The most common indication was the initial evaluation of hypertension (HTA) and suspicion of hypertensive heart disease (47.3%). All indications, the assessment in the context of hypertension represented 853 examinations (49.2%). Heart failure accounted for 5.3% of indications, but consisted of 302 applications (17.4%) when was associated hypertension with signs suggestive of heart failure. Requests were considered as appropriate in 95.3%, inappropriate in 3.2% and uncertain in 1.6%. In the group of inappropriate indications patients were significantly younger, and were examinations more often normal and less often absolutely abnormal. CONCLUSION The profile of cardiovascular morbidity in our institution is dominated by the spectrum of hypertension and heart failure. Each indication must be balanced for the profitability of the ETT.
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Affiliation(s)
- J B Anzouan-Kacou
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire.
| | - E Siransy
- Laboratoire de physiologie et d'explorations fonctionnelles, UFR sciences médicales d'Abidjan, Abidjan, Côte d'Ivoire
| | - M P Nchoh-Mottoh
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - A Ekou
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - D Bamba-Kamagaté
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - E M Kadio
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
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Barash J. Rheumatic Fever and Post-Group A Streptococcal Arthritis in Children. Curr Infect Dis Rep 2013; 15:263-8. [DOI: 10.1007/s11908-013-0335-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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240
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Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease. Nat Rev Cardiol 2013; 10:284-92. [DOI: 10.1038/nrcardio.2013.34] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rémond MGW, Severin KL, Hodder Y, Martin J, Nelson C, Atkinson D, Maguire GP. Variability in disease burden and management of rheumatic fever and rheumatic heart disease in two regions of tropical Australia. Intern Med J 2013; 43:386-93. [DOI: 10.1111/j.1445-5994.2012.02838.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 05/20/2012] [Indexed: 11/27/2022]
Affiliation(s)
- M. G. W. Rémond
- Cairns Clinical School; School of Medicine and Dentistry; Faculty of Medicine; Health and Molecular Sciences; James Cook University; Cairns; Queensland
| | - K. L. Severin
- Western Australia Country Health Service Kimberley; University of Western Australia; Broome; Western Australia
| | - Y. Hodder
- Cairns Clinical School; School of Medicine and Dentistry; Faculty of Medicine; Health and Molecular Sciences; James Cook University; Cairns; Queensland
| | - J. Martin
- Western Australia Country Health Service Kimberley; University of Western Australia; Broome; Western Australia
| | - C. Nelson
- Kimberley Aboriginal Medical Services Council; University of Western Australia; Broome; Western Australia
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242
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Baroux N, Rouchon B, Huon B, Germain A, Meunier JM, D'Ortenzio E. High prevalence of rheumatic heart disease in schoolchildren detected by echocardiography screening in New Caledonia. J Paediatr Child Health 2013; 49:109-14. [PMID: 23347199 DOI: 10.1111/jpc.12087] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2012] [Indexed: 11/28/2022]
Abstract
AIM Despite the well-documented burden of rheumatic heart disease (RHD) in several Pacific countries, the disease is poorly understood in New Caledonia. The aim of this study was to assess the prevalence of RHD detected by echocardiographic screening in school children. METHODS An annual RHD screening programme is conducted by the Health and Social Agency of New Caledonia for school-aged children in their fourth year of primary school. For the purpose of this study, we used data collected during this echocardiographic screening between 2008 and 2010. RESULTS Of 12,728 children screened, 50.2% were male and the mean age was 9.6 ± 0.6 years. Between 2008 and 2010, 114 children had RHD, corresponding to a prevalence of 8.9 cases per 1000 (95% confidence interval (CI) (7.3-10.6)). Prevalence of RHD was higher on the main island outside Greater Noumea (13.7 per 1000; 95% CI (9.8-17.5)) and in the outlying island groups (14.6 per 1000; 95% CI (8.4-20.9)) than in Greater Noumea (5.8 per 1000; 95% CI (4.1-7.5)). RHD was more prevalent in Melanesian children (13.5 per 1000; 95% CI (10.9-16.1)) than in European (1.8 per 1000; 95% CI (0.4-3.1)). CONCLUSION This study documented a high prevalence of RHD in New Caledonia, particularly in districts located outside Noumea and in children of Melanesian heritage. These results uncover a hitherto unknown burden of disease in New Caledonia and underline the importance of delivering secondary prophylaxis to reduce the prevalence of RHD.
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Affiliation(s)
- Noémie Baroux
- Infectious Diseases Epidemiology Unit, Institut Pasteur of New Caledonia, Institut Pasteur International Network, Noumea, New Caledonia.
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243
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013; 127:e6-e245. [PMID: 23239837 PMCID: PMC5408511 DOI: 10.1161/cir.0b013e31828124ad] [Citation(s) in RCA: 3335] [Impact Index Per Article: 303.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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244
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Palla AH, Khan RA, Gilani AH, Marra F. Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulm Med 2012; 12:70. [PMID: 23176084 PMCID: PMC3517306 DOI: 10.1186/1471-2466-12-70] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 10/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although Group A beta hemolytic streptococcus (GABHS) can cause bacterial pharyngitis, the most common etiology is viral; despite this viral etiology, antibiotics are commonly prescribed for this infection in industrialized countries. We investigated the prevalence of GABHS in adult pharyngitis patients from lower socioeconomic settings in Karachi, Pakistan, how often antibiotics are prescribed for pharyngitis and if appropriate agents were used in a developing world setting. Finally, we wanted to see the usefulness of modified McIsaac scores in predicting positive cultures. METHODS Adult patients were recruited from three local hospital outpatient dispensaries (OPDs). All patients aged 14-65 years who were suspected of having bacterial pharyngitis had throat swabs taken. Laboratory results for GABHS pharyngitis were then compared with their prescriptions. Appropriateness (using the World Health Organization's definition) and type of antibiotic prescribed were assessed. RESULTS Of 137 patients, 30 patients each were studied for scores of 0, 1, 2 and 3; 17 patients were studied for score 4. Although 6 (4.4%) patients were GABHS+, for a prevalence of 43.8 per 1000 population, antibiotics were prescribed to 135 patients (98.5%). Of these, only 11.1% received appropriate antibiotics while 88.9% received inappropriate antibiotics. Penicillins were prescribed most (34.1%), especially amoxicillin/clavulanate; followed by macrolides (31.1%), especially the second-generation agents, and fluoroquinolones (14.8%). McIsaac scores were found to be 100% sensitive and 68.7% specific, giving a positive predictive value (PPV) of 12.7% and a negative predictive value (NPV) of 100%. CONCLUSIONS Antibiotics were prescribed irrationally to adult pharyngitis patients, as most cultures were negative for bacterial infection. McIsaac modification of Centor scores related directly to culture results. We would therefore highly recommend its use to help family physicians make treatment decisions for adult pharyngitis patients.
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Affiliation(s)
- Amber Hanif Palla
- Department of Pharmacology, University of Karachi, Karachi, Pakistan
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245
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Gomes WJ. EACTS in the future: second strategic conference. The view from the BRICS countries†. Eur J Cardiothorac Surg 2012; 43:238-40. [DOI: 10.1093/ejcts/ezs417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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246
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Shrestha NR, Pilgrim T, Karki P, Bhandari R, Basnet S, Tiwari S, Dhakal SS, Urban P. Rheumatic heart disease revisited. J Cardiovasc Med (Hagerstown) 2012; 13:755-9. [DOI: 10.2459/jcm.0b013e32835854b6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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247
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Imperato PJ, Imperato AC, Imperato GH. The management of subacute bacterial endocarditis superimposed on rheumatic heart disease in the immediate pre-penicillin era: the case of Pasquale Imperato. J Community Health 2012; 37:1301-60. [PMID: 23085897 DOI: 10.1007/s10900-012-9623-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Subacute bacterial endocarditis (SBE) was invariably a fatal disease in the pre-penicillin era. The availability of sulfonamide antibiotics beginning in the mid-1930s raised hopes that they would be effective in SBE. Unfortunately, except in rare instances, they were not. This paper reviews the clinical experience with sulfonamides in the pre-penicillin period in treating patients with SBE. It presents in detail the case of Pasquale Imperato, who died from the disease at the age of 72 years on 30 November 1942. In so doing, it focuses on the medical management measures then available to treat patients with SBE and on the inevitable course of the illness once it began. Also discussed is the relationship of acute rheumatic fever and its sequela, rheumatic heart disease, to predisposing people to SBE and possible genetic factors. The well-known case of Alfred S. Reinhart, a Harvard Medical School student who died from SBE in 1931 and who kept a detailed chronicle of his disease, is also discussed and contrasted with Pasquale Imperato's case.
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248
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Araújo FDDR, Goulart EMA, Meira ZMA. Prognostic value of clinical and Doppler echocardiographic findings in children and adolescents with significant rheumatic valvular disease. Ann Pediatr Cardiol 2012; 5:120-6. [PMID: 23129897 PMCID: PMC3487196 DOI: 10.4103/0974-2069.99610] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The diagnosis of acute rheumatic fever (RF) is based on clinical findings. However, during the chronic phase of the disease, the clinical approach is not sufficient for the follow-up of the patients and the Doppler echocardiography is a tool for the diagnosis of cardiac involvement. Prognostic variables that influence long-term outcomes are not well known. METHODS 462 patients with RF according to Jones criteria were studied, and followed-up from the initial attack to 13.6 ± 4.6 years. All patients underwent clinical assessment and Doppler echocardiography for the detection of heart valve involvement in the acute and chronic phases. Multivariate logistic regression analysis was used to identify the factors influencing long-term heart valve disease. RESULTS Carditis occurred in 55.8% and subclinical valvulitis in 35.3% patients. In the chronic phase, 33% of the patients had significant valvular heart disease. No normal Doppler echocardiography exam was observed on patients who had severe valvulitis, although heart auscultation had become normal in 13% of these. In the multivariate analysis, only the severity of carditis and the mitral and/or aortic valvulitis were associated with significant valvular heart disease. Chorea or arthritis were protective factors for significant valvular heart disease, odds ratio 0.41 (95% C.I. 0.22 - 0.77) and 0.43 (95% C.I. 0.23 - 0.82), respectively. CONCLUSIONS Our study suggests that the use of Doppler echocardiography during RF helps to identify prognostic factors regarding the development of significant valvular heart disease. Initial severe carditis is an important factor in the long-term prognosis of chronic RHD, whereas arthritis and chore during the initial episode of RF appears to be protective. Strict secondary prophylaxis should be mandatory in high risk patients.
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249
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Beaton A, Okello E, Lwabi P, Mondo C, McCarter R, Sable C. Echocardiography screening for rheumatic heart disease in Ugandan schoolchildren. Circulation 2012; 125:3127-32. [PMID: 22626741 DOI: 10.1161/circulationaha.112.092312] [Citation(s) in RCA: 180] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Historically, sub-Saharan Africa has had the highest prevalence rates of clinically detected rheumatic heart disease (RHD). Echocardiography-based screening improves detection of RHD in endemic regions. The newest screening guidelines (2006 World Health Organization/National Institutes of Health) have been tested across India and the Pacific Islands, but application in sub-Saharan Africa has, thus far, been limited to Mozambique. We used these guidelines to determine RHD prevalence in a large cohort of Ugandan school children, to identify risk factors for occult disease, and to assess the value of laboratory testing. METHODS AND RESULTS Auscultation and portable echocardiography were used to screen randomly selected schoolchildren, 5 to 16 years of age, in Kampala, Uganda. Disease likelihood was defined as definite, probable, or possible in accordance with the 2006 National Institutes of Health/World Health Organization guidelines. Ninety-seven percent of eligible students received screening (4869 of 5006). Among them, 130 children (2.7%) had abnormal screening echocardiograms. Of those 130, secondary evaluation showed 72 (55.4%) with possible, probable, or definite RHD; 18 (13.8%) with congenital heart disease; and 40 (30.8%) with no disease. Echocardiography detected 3 times as many cases of RHD as auscultation: 72 (1.5%) versus 23 (0.5%; P<0.001). Children with RHD were older (10.1 versus 9.3 years; P=0.002). Most cases (98%) involved only the mitral valve. Lower socioeconomic groups had more RHD (2.7% versus 1.4%; P=0.036) and more advanced disease (64% versus 26%; P<0.001). Antistreptolysin O titers were elevated in children with definite RHD. CONCLUSIONS This is one of the largest single-country childhood RHD prevalence studies and the first to be conducted in sub-Saharan Africa. Our data support inclusion of echocardiography in screening protocols, even in the most resource-constrained settings, and identify lower socioeconomic groups as most vulnerable. Longitudinal follow-up of children with echocardiographically diagnosed subclinical RHD is needed.
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Affiliation(s)
- Andrea Beaton
- Children's National Medical Center, Department of Cardiology, 111 Michigan Ave, Washington, DC 20010, USA.
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250
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Pavani A, Naushad SM, Mishra RC, Malempati AR, Pinjala R, Kumar TR, Kutala VK. Retrospective evidence for clinical validity of expanded genetic model in warfarin dose optimization in a South Indian population. Pharmacogenomics 2012; 13:869-78. [DOI: 10.2217/pgs.12.62] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To optimize warfarin dose in patients at risk for thrombotic events, we have recently developed a pharmacogenomic algorithm, which explained 44.9% of the variability in warfarin dose requirements using age, gender, BMI, vitamin K intake, CYP2C9 (*2 and *3) and VKORC1 (*3, *4 and -1639 G>A) as predictors. The aim of the current study is to develop an expanded genetic model that can explain greater percentage of warfarin variability and that has clinical validity. Patients & methods: CYP2C9*8, CYP4F2 V433M, GGCX G8016A and thyroid status were added to an expanded genetic model (n = 243). Results: The expanded genetic model explained 61% of the variability in warfarin dose requirements, has a prediction accuracy of ±11 mg/week and can differentiate warfarin sensitive and warfarin resistant groups efficiently (areas under receiver operating characteristic curves: 0.93 and 0.998, respectively; p < 0.0001). Higher percentage of International Normalized Ratios in therapeutic range (52.68 ± 4.21 vs 43.80 ± 2.27; p = 0.04) and prolonged time in therapeutic range (61.74 ± 3.18 vs 47.75 ± 5.77; p = 0.03) were observed in subjects with a prediction accuracy of <1 mg/day compared with subjects with prediction accuracy >1 mg/day. In the warfarin-resistant group, primary hypothyroidism was found to induce more resistance while in the warfarin-sensitive group, hyperthyroidism was found to increase sensitivity. Conclusion: The expanded genetic model explains greater variability in warfarin dose requirements and it prolongs time in therapeutic range and minimizes out-of-range International Normalized Ratios. Thyroid status also influences warfarin dose adjustments. Original submitted 21 March 2012; Revision submitted 16 April 2012
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Affiliation(s)
- Addepalli Pavani
- Departments of Clinical Pharmacology & Therapeutics, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Shaik Mohammad Naushad
- Departments of Clinical Pharmacology & Therapeutics, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Ramesh C Mishra
- Cardiothoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | | | | | - Takallapally Ramesh Kumar
- Departments of Clinical Pharmacology & Therapeutics, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Vijay Kumar Kutala
- Departments of Clinical Pharmacology & Therapeutics, Nizam’s Institute of Medical Sciences, Hyderabad, India
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