1
|
Supper I, Gratadour J, François M, Jaafari N, Boussageon R. A critical appraisal of acute sore throat guidelines using the AGREE II instrument: a scoping review. Fam Pract 2024; 41:223-233. [PMID: 37318355 DOI: 10.1093/fampra/cmad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Conflicting international guidelines exist on the management of sore throat by antibiotics. OBJECTIVES To assess with the Appraisal of Guidelines for Research and Evaluation II (AGREE) instrument the quality of guidelines for uncomplicated acute group A beta-haemolytic streptococcal (GABHS) sore-throat. To make a sensitivity analysis restricted to guidelines with a rigour of development score higher than 60% and to describe their recommendations on scores, tests, and antibiotic therapy, including their justification. METHODS A guideline literature review of acute GABHS sore throat, published between January 2000 and December 2019 in primary care and secondary care. The PubMed database, the Canadian Medical Association Infobase on Clinical Practice Guidelines and the International Network Guidelines were used. The quality of guidelines was assessed using the AGREE II instrument. The guidelines were classified into 2 categories: high-quality guidelines had to rate >60% for the rigour of development score, the others were classified as low-quality guidelines. RESULTS Significant heterogeneity between the 15 guidelines concerned the scores of the 6 assessment domains. Among them, 6 guidelines presented a score above 60% with regards to the rigor of development domain and used a systematic literature search method, citing meta-analyses of recent randomised clinical trials. Most of the 6 high-quality guidelines no longer recommended the systematic use of diagnostic scores and tests, nor antibiotic therapy to prevent acute rheumatic fever or loco-regional complications, except for high-risk patients. CONCLUSION Major discrepancies emphasise the need for only high-quality guidelines, based on adequately assessed evidence. Restricted antibiotic prescriptions to severe cases or high-risk patients would avoid antibiotic resistance.
Collapse
Affiliation(s)
- Irène Supper
- Department of General Practice, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
- UCBL, CNRS, UMR 5558, LBBE, EMET, University Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
- Maison de Santé Universitaire du pôle de santé des Etats-Unis, Lyon, Auvergne-Rhône-Alpes, France
| | - Johanna Gratadour
- Department of General Practice, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
| | - Mathilde François
- Universite Versailles Saint-Quentin-en-Yvelines UFR des sciences de la sante Simone Veil, General Practice, Guyancourt, France
- Centre de recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
| | - Nemat Jaafari
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Rémy Boussageon
- Department of General Practice, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
- UCBL, CNRS, UMR 5558, LBBE, EMET, University Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
- Maison de Santé Universitaire du pôle de santé des Etats-Unis, Lyon, Auvergne-Rhône-Alpes, France
| |
Collapse
|
2
|
Kumar K, Simpson T. Transcatheter Therapy for Mitral Valve Stenosis. Interv Cardiol Clin 2024; 13:271-278. [PMID: 38432769 DOI: 10.1016/j.iccl.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Mitral valve stenosis remains highly prevalent among the US population although with dramatically shifting demographics. The significance of rheumatic mitral disease in developing nations persists, despite improvements in preventative measures and early detection, and its presence in developed countries is still evident as observed through international migration. In addition, the substantial growth in the aging population with a heightened occurrence of concurrent cardiovascular risk factors is leading to an increased prevalence of chronic calcific degeneration and degeneration of previously repaired or replaced valves. This article aims to review various transcatheter therapies in the treatment of mitral valve stenosis.
Collapse
Affiliation(s)
- Kris Kumar
- Oregon Health and Science University, Portland, OR, USA.
| | | |
Collapse
|
3
|
Asrial AA, Reviono R, Soetrisno S, Setianto BY, Widyaningsih V, Nurwati I, Wasita B, Pudjiastuti A. Correlation between circulating fibrosis biomarkers with left atrial function and left atrial volume index in rheumatic mitral stenosis. NARRA J 2024; 4:e293. [PMID: 38798862 PMCID: PMC11125304 DOI: 10.52225/narra.v4i1.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/16/2023] [Indexed: 05/29/2024]
Abstract
Mitral stenosis is the most common rheumatic heart disease (RHD) disorder worldwide, including in Indonesia. This pathological condition causes left atrial pressure, leading to left atrial fibrosis that affects the structure and function of the left atrial as well as the clinical condition. The aim of this study was to assess the correlation between circulating fibrosis biomarkers with net atrioventricular compliance (Cn) as a parameter of left atrial function, and left atrial volume index (LAVI) as a parameter left atrium structure of changes. A cross-sectional study was conducted at Panti Rahayu Hospital and Permata Bunda Hospital, Purwodadi, Central Java, with a total of 40 RHD patients with severe mitral stenosis. The ELISA was used to measure the levels of carboxy-terminal propeptide of type I procollagen (PICP), matrix metalloproteinase I (MMP-1), tissue inhibitor matrix metalloproteinase 1 (TIMP-1), and transforming growth factor-β1 (TGF-β1). The left atrial function was assessed by measuring Cn, and the LAVI parameters were measured to assess left atrium structure/size. The mean levels of circulating fibrosis biomarkers were as follows: PICP 153.96±89.12 ng/mL; MMP-1 1.44±2.12 ng/mL; MMP-1/TIMP-1 ratio 0.38±0.54 and TGF-β1 2.66±1.96 pg/mL. From the echocardiographic evaluation, the mean Cn was 5.24±1.93 mL/mmHg and the mean LAVI was 152.55±79.36 mL/m2. There were significant correlation between MMP-1 and MMP-1/TIMP-1 ratio with Cn (r=0.345 and r=0.333, respectively; both had p<0.05). PICP and TGF-β1 biomarkers did not significantly correlate with Cn (p>0.05). Meanwhile, none of the biomarkers had a significant correlation with LAVI (p>0.05). This study highlights that MMP-1 and MMP-1/TIMP-1 ratio are potentially to be used as markers to determine the Cn in RHD patients with severe mitral stenosis. However, further studies with a higher sample size are needed to confirm this finding.
Collapse
Affiliation(s)
- An A. Asrial
- Department of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Universitas Sebelas Maret Hospital, Surakarta, Indonesia
| | - Reviono Reviono
- Department of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Pulmonology and Respiratory Medicine, Universitas Sebelas Maret Hospital, Surakarta, Indonesia
| | - Soetrisno Soetrisno
- Department of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Obstetrics and Gynecology, Universitas Sebelas Maret Hospital, Surakarta, Indonesia
| | - Budi Y. Setianto
- Department of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Vitri Widyaningsih
- Department of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Ida Nurwati
- Department of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Brian Wasita
- Department of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Pathology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Anggit Pudjiastuti
- Department of Cardiology and Vascular Medicine, Permata Bunda Hospital, Purwodadi, Indonesia
| |
Collapse
|
4
|
Kisling A, Gallagher R. Valvular Heart Disease. Prim Care 2024; 51:95-109. [PMID: 38278576 DOI: 10.1016/j.pop.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Valvular heart disease is a common abnormality seen in the primary care setting. There are many causes of valvular heart disease including congenital, degenerative, infectious, traumatic, and many more. There is a wide variety of types of valvular heart disease with each valve having the ability to develop both regurgitation and stenosis by multiple mechanisms. All these complexities make diagnosis and management of valvular heart disease complicated, especially in the context of comorbidities. For this reason, it is important for primary care physicians to have a thorough understanding of how these diseases present and when interventions are indicated.
Collapse
Affiliation(s)
- Adam Kisling
- Department of Medicine, Division of Cardiology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20814, USA.
| | - Robert Gallagher
- Department of Medicine, Division of Cardiology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20814, USA
| |
Collapse
|
5
|
Eltyeb EE, Alhazmi SA, Darraj AM, Alibrahim AH, Alhazmi MA, Muafa MA, Hakami FA, Daak II, Majrabi RQ. Acute Rheumatic Fever in Children: The Known and the Unknown Among Saudi Mothers in the Jazan Region. Cureus 2024; 16:e56349. [PMID: 38633968 PMCID: PMC11021851 DOI: 10.7759/cureus.56349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
Background Acute rheumatic fever (ARF) is a significant public health problem that causes morbidity and mortality in low and middle-income countries. Therefore, this study aims to assess mothers' knowledge of acute rheumatic fever and their attitudes in the Jazan region. Methods A cross-sectional study was conducted between the mothers using an online survey. The knowledge level was ranked as poor, fair, and good. In contrast, the attitudes were ranked as positive or negative. Association with sociodemographic variables was assessed, and statistical significance was set at p < 0.05. Results Four hundred thirty-six (436) mothers were included; 39.9% of them were aged 21-30 years, 68.8% were married, 57.3% were non-workers, and 72.2% were university-educated. Most of the mothers had a poor level of knowledge (53%); however, positive attitudes toward the disease were reported in 79.1% of mothers. The poor knowledge levels were related to age, marital status, occupation, and monthly income. Conclusion Despite having positive attitudes toward diagnosing and managing ARF, most of the mothers showed poor knowledge of acute rheumatic fever. This study highlights the situation in the Jazan region, which could be an essential basis for constructing an educational program to raise awareness and knowledge of acute rheumatic fever in the community.
Collapse
|
6
|
Kaewpechsanguan A, Chungsomprasong P, Durongpisitkul K, Vijarnsorn C, Chanthong P, Kanjanauthai S, Pacharapakornpong T, Thammasate P, Soongswang J. Manifestations of Rheumatic Carditis, Regression of Valvular Regurgitation, and Independent Predictors of Mitral Regurgitation Improvement After Rheumatic Carditis in Thai Children. Glob Heart 2024; 19:16. [PMID: 38344744 PMCID: PMC10854449 DOI: 10.5334/gh.1295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
Background Acute rheumatic fever (ARF) with carditis can lead to the development of rheumatic heart disease in children and young adults. Objective This study aimed to investigate the manifestations of rheumatic carditis, clinically significant regression of valvular regurgitation as assessed by echocardiography, and the independent predictors of mitral regurgitation (MR) improvement after rheumatic carditis in Thai children. Method Children diagnosed with rheumatic carditis during 2005-2020 at Siriraj Hospital (Bangkok, Thailand) were retrospectively enrolled. Trivial, and mild regurgitation were grouped as non-clinically significant (NCS) regurgitation. Valvular regression was defined moderate-severe regurgitation improving to NCS regurgitation. Results Eighty-one patients (mean age: 10 years, range: 8-12 years) were included. At presentation, 59 (72.8%) patients had combined mitral regurgitation (MR) and aortic regurgitation (AR), 20 (24.6%) patients had MR alone, and 2 (2.4%) patients had AR alone. Concerning severity, 28 (34.6%) and 30 (37%) patients presented with severe and moderate MR, respectively. Severe and moderate AR was found in 9 (11.1%) and 16 (19.8%) patients, respectively. At the one-year follow-up, 43.4% of moderate-severe MR, and 41.7% of moderate-severe AR improved to NCS regurgitation. Multivariate analysis revealed high erythrocyte sedimentation rate (ESR) (p = 0.01) and severe carditis (p = 0.05) at presentation to be independent predictors of MR improvement. Conclusion Thai children with rheumatic carditis had a high incidence of valvular regurgitation; however, the valvular damage was improved in most patients. High ESR and severe carditis independently predict MR improvement.
Collapse
Affiliation(s)
- Araya Kaewpechsanguan
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paweena Chungsomprasong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kritvikrom Durongpisitkul
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chodchanok Vijarnsorn
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakul Chanthong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaluck Kanjanauthai
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thita Pacharapakornpong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ploy Thammasate
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jarupim Soongswang
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
7
|
Fakieha AY, Zafer DO, Alkalash SH, Fudah AA, Mujlid RM, Fakiha MY, Khafajy A, Shatla MM. Knowledge and Attitude of Rheumatic Fever and Rheumatic Heart Disease Among the Makkah City Population, Saudi Arabia. Cureus 2024; 16:e51539. [PMID: 38313935 PMCID: PMC10834212 DOI: 10.7759/cureus.51539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Background Rheumatic heart disease (RHD) is a prominent sequela of rheumatic fever (RF) and the most common cause of acquired valvular disease worldwide. Patients develop RHD as a result of autoimmune reactions caused by an untreated group A Streptococcus (GAS) throat infection, resulting in significant valvular destruction. Objectives The current study aimed to assess the knowledge and attitude of RF and RHD among the Makkah city population in Saudi Arabia. Methods An observational cross-sectional study was conducted on a convenience sample of 1364 adult participants from Makkah city in Saudi Arabia. Data were collected through an online survey that was disseminated on different electronic platforms. Then, the obtained data were analyzed using SPSS version 23 (IBM Corp., Armonk, New York, USA). Results A total of 1364 participants completed the questionnaire; female participants constituted 58.1% (n = 792) and those between 18 and 30 years old represented 57.6% of the sample (n = 785). Knowledge of rheumatic fever was classified as poor (31.9%, n = 435), fair (44.8%, n = 611), and good (23.3%, n = 318). Female participants were shown to have better knowledge than males (p = 0.034). The attitude toward rheumatic fever and rheumatic heart disease was classified as negative (27.9%, n = 380), neutral (49.1%, n = 670), and positive (23%, n = 314). Conclusions This study concludes that adults in Makkah city, Saudi Arabia, have poor knowledge about RF and RHD. There is a notable gap in their knowledge regarding the association between sore throat and RF, bacterial dermatitis and RF, the common age for RF, and the necessity of using antibiotics appropriately to prevent this disease. The study also revealed negative attitudes toward RF and RHD among Makkah citizens, but most of them recommended health education campaigns to increase public awareness about this important disease. The results of this study will assist in the development of awareness campaigns about RF and RHD. Finally, qualitative studies are recommended to fully understand what the population perceives about this morbidity.
Collapse
Affiliation(s)
| | - Dai O Zafer
- Department of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Safa H Alkalash
- Department of Community Medicine and Healthcare, Umm Al-Qura University, Al-Qunfudah, SAU
- Department of Family Medicine, Menoufia University, Shebin El-Kom, EGY
| | - Ahmed A Fudah
- Faculty of Dentistry, Umm Al-Qura University, Makkah, SAU
| | - Rami M Mujlid
- Faculty of Dentistry, Umm Al-Qura University, Makkah, SAU
| | | | - Abdullah Khafajy
- Department of Community Medicine and Healthcare of Pilgrims, Umm Al-Qura University, Makkah, SAU
| | - Mokhtar M Shatla
- Department of Community Medicine and Healthcare of Pilgrims, Umm Al-Qura University, Makkah, SAU
| |
Collapse
|
8
|
Kim DY, Cho I, Kim K, Gwak SY, Ha KE, Lee HJ, Ko KY, Shim CY, Ha JW, Kim WD, Kim IJ, Lee S, Kim IC, Choi KU, Kim H, Son JW, Hong GR. Outcomes of Severe Mitral Stenosis With the Revised Severity Criteria: Mitral Valve Replacement vs Percutaneous Mitral Valvuloplasty. Can J Cardiol 2024; 40:100-109. [PMID: 37716640 DOI: 10.1016/j.cjca.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND This study aimed to compare the outcomes, according to percutaneous mitral valvuloplasty (PMV) vs mitral valve replacement (MVR), of severe mitral stenosis (MS) with the updated criteria (MVA ≤ 1.5 cm2). METHODS From the Multicenter Mitral Stenosis With Rheumatic Etiology (MASTER) registry of 3140 patients, we included patients with severe MS who underwent PMV or MVR between January 2000 and December 2021 except for previous valvular surgery/intervention, at least moderate other valvular dysfunction, and thrombus at the left atrium/appendage. Moderately severe MS (MS-MS) and very severe MS (VS-MS) were defined as 1.0 cm2 < MVA ≤ 1.5 cm2 and MVA ≤ 1.0 cm2, respectively. Primary outcomes were a composite of cardiovascular (CV) death and heart failure (HF) hospitalization. Secondary outcomes were a composite of primary outcomes and redo intervention. RESULTS Among 442 patients (mean 56.5 ±11.9 years, women 77.1%), the MVR group (n = 260) was older, had more comorbidities, higher echoscore, larger left chambers, and higher right ventricular systolic pressure than the PMV group (n = 182). During a mean follow-up of 6.9 ± 5.2 years with inverse probability-weighted matching, primary outcomes did not differ, but the MVR group experienced fewer secondary outcomes (P = 0.010). In subgroup analysis of patients with MS-MS and VS-MS, primary outcomes did not differ. However, the MVR group in patients with VS-MS showed better secondary outcomes (P = 0.012). CONCLUSIONS PMV or MVR did not influence CV mortality or HF hospitalization in both MS-MS and VS-MS. However, because of increased early redo intervention in the PMV group in VS-MS, MVR would be the preferable option without clear evidence of suitable morphology for PMV.
Collapse
Affiliation(s)
- Dae-Young Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyu Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seo-Yeon Gwak
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Eun Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee Jeong Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyu-Yong Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - William Dowon Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - In-Jai Kim
- Division of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Pocheon, South Korea
| | - Seonhwa Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Kang-Un Choi
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Gyeongsan, South Korea
| | - Hojeong Kim
- Division of Physiology, Department of Biomedical Laboratory, Daegu Health College, Daegu, Korea
| | - Jang-Won Son
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Gyeongsan, South Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| |
Collapse
|
9
|
McBenedict B, Mansoor Z, Chaudhary A, Thomas A, Yaseen M, Hauwanga W. Temporal Trends of Age-Adjusted Mortality Rates for Rheumatic Heart Disease in Brazil From 2000 to 2021. Cureus 2024; 16:e52322. [PMID: 38357062 PMCID: PMC10866569 DOI: 10.7759/cureus.52322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Background Rheumatic heart disease (RHD) is a chronic cardiovascular condition stemming from an infectious origin, posing a substantial health burden, particularly in economically disadvantaged regions. It starts with acute rheumatic fever (ARF), a complication following group A Streptococcus infection, leading to heart valve damage and, over time, structural heart abnormalities. RHD contributes to premature deaths, especially in low-middle-income countries. Although the incidence and prevalence have generally reduced globally due to antibiotics and improved healthcare, it remains a significant public health concern in Brazil, echoing its prevalence in many developing nations around the world. RHD stands as a poignant testament to the intersection of socio-economic disparities and healthcare challenges within Brazil's diverse population. In Brazil, despite advancements in healthcare, RHD continues to impact communities, highlighting the urgent need for enhanced prevention strategies, access to quality healthcare services, and heightened awareness to combat this preventable, yet persistent, cardiac condition. Understanding the epidemiological landscape and socio-cultural factors influencing RHD in Brazil is crucial for developing targeted interventions aimed at mitigating its burden on individuals, families, and the healthcare system at large. Thus, our study focuses on analyzing age-related mortality rates linked to ARF and chronic RHD (ARHD) in Brazil from 2000 to 2021, particularly examining gender disparities. Materials and methods This retrospective cohort study employed a descriptive time-series approach, utilizing comprehensive nationwide data from Brazil spanning from 2000 to 2021 to assess trends in diverse age groups, among both sexes, enabling a detailed analysis of temporal patterns. Mortality data, extracted and categorized meticulously, were subjected to Joinpoint statistical analyses enabling comparative assessments, with average annual percent change (AAPC) and annual percent change (APC) serving as key metrics to quantify and interpret trends over the analyzed period. Results The acute RHD (ARHD)-related mortality declined over the analyzed years supported by AAPC, with higher mortality reduction in females. The age-adjusted mortality rate for "males and females" decreased from 78 to 67 deaths/100,000 from 2000 to 2021. Female mortality dropped from 85 to 69/100,000, and male mortality decreased from 73 to 63/100,000 over the same period. For ARHD, male age groups (20-29, 60-69, 70-79, 80+) showed declining mortality, while the 30-59 age group exhibited an upward. Females AAMR for chronic RHD (CRHD) decreased across all age groups, with significant reductions in the 80 years and above age group from 2000-2002 (APC: -11.94*) and steadily from 2002 onwards (APC: -1.33). Conclusions Our study revealed an overall decline in mortality rates for both acute and CRHD across both sexes. Females consistently exhibited higher mortality rates and a more pronounced reduction compared to males in both acute and CRHD. In ARHD, males experience the highest mortality in the 50-59 age group, while females have a peak in the 40-49 age group. The 60-69 age group had the highest mortality in CRHD for both sexes. Conversely, the 20-29 age group displayed the lowest mortality in CRHD, and the 80-89 age group had the lowest mortality in ARHD.
Collapse
Affiliation(s)
- Billy McBenedict
- Medicine, Hospital Universitário Antônio Pedro (Antonio Pedro University Hospital), Niteroi, BRA
| | - Zaeemah Mansoor
- Faculty of Health Sciences, Karachi Medical and Dental College, Karachi, PAK
| | | | - Anusha Thomas
- Neurology, Christian Medical College and Hospital, Ludhiana, IND
| | - Muhammad Yaseen
- Medicine and Surgery, Gambat Institute of Medical Sciences, Gambat, PAK
| | - Wilhelmina Hauwanga
- Family Medicine, Faculty of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, BRA
| |
Collapse
|
10
|
Dhungana S, Pandey A, Aryal N, Kayastha K, Pandey S, Thakur M. A rare case report of coexisting rheumatic heart disease and systemic lupus erythematous. Clin Case Rep 2024; 12:e8430. [PMID: 38197056 PMCID: PMC10774548 DOI: 10.1002/ccr3.8430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024] Open
Abstract
This case report discusses the rare coexistence of Systemic Lupus Erythematosus (SLE) and Rheumatic Heart Disease (RHD) in a 46-year-old female patient, challenging the conventional understanding of their distinct presentations. The patient exhibited migratory joint pains, palpitations, and shortness of breath. Diagnostic investigations confirmed SLE based on EULAR/ACR criteria, with positive anti-nuclear and anti-dsDNA antibodies. Concurrently, transthoracic echocardiography revealed severe mitral stenosis and regurgitation, leading to the diagnosis of RHD. The patient underwent successful open-heart surgery with mitral valve replacement. The discussion explores the rarity of this coexistence, emphasizing the need for cautious consideration and further research into potential immunological overlaps between SLE and RHD. The report concludes with a call for comprehensive studies to enhance our understanding of the pathophysiology connecting these two conditions.
Collapse
Affiliation(s)
| | | | - Nijita Aryal
- Nepal Medical College Teaching HospitalKathmanduNepal
| | | | | | | |
Collapse
|
11
|
Berhanu H, Mekonnen Y, Workicho A, Hassen K, Negeri Z, Sudhakar M, Mitiku S, Mossie A. The prevalence of rheumatic heart disease in Ethiopia: a systematic review and meta-analysis. Trop Dis Travel Med Vaccines 2023; 9:16. [PMID: 37828598 PMCID: PMC10571304 DOI: 10.1186/s40794-023-00192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/10/2023] [Indexed: 10/14/2023] Open
Abstract
Globally, more than 33 million people are living with rheumatic heart disease (RHD). A high prevalence of the disease is observed in people with poor socio-economic status, overcrowding, and low access to medical facilities. Even though different studies have been conducted in different settings, there is no reliable data regarding RHD prevalence. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of RHD in Ethiopia. PubMed/Medline, SCOPUS, HINARI, and Google Scholar databases were used to search for peer-reviewed articles. Articles published in English between the years 1992 and 2022 September were considered. The pooled prevalence of RHD was calculated using a random-effect model at a 95% confidence interval, including the weight of each study. Finally, statistical meta-analysis STATA version 16.0 software was used to calculate the pooled prevalence of RHD.A total of twelve cross-sectional studies were included in the meta-analysis. Individual study prevalence ranges from 0.32 to 32.78%. The pooled prevalence of RHD was 3.19% (95% CI: 1.46-5.56%). The prevalence was higher among the population who visited hospitals at 5.42% (95% CI: 1.09-12.7%) compared to schoolchildren at 0.73% (95% CI: 0.30-1.34%) and community-based studies at 3.83% (95% CI: 3.16-4.55%). Addis Ababa had the lowest prevalence of RHD (0.75% (95% CI: 0.38-1.25%), whereas the highest prevalence was observed in the Amhara region (8.95% (95% CI: 7.21-11.06%). A significant variation in the overall estimated prevalence of RHD was not observed between males and females.Trial registration Protocol registration (PROSPERO): CRD42021251553, Date of registration May 28 2021.
Collapse
Affiliation(s)
- Hiwot Berhanu
- Department of Biomedical Sciences, Faculty of Medical Science, Jimma Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Yimer Mekonnen
- Department of Pharmacy, Faculty of Health Sciences, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abdulhalik Workicho
- Department of Epidemiology, Institute of Health, Jimma University, P.O.Box 378, Jimma, Ethiopia
| | - Kalkidan Hassen
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zenebe Negeri
- Department of Biomedical Sciences, Faculty of Medical Science, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Morankar Sudhakar
- Department of Health, Behavior and Society, Faculty of Public Health, Ethiopian Evidence Based Health Care CenterInstitute of HealthJimma University, Jimma, Ethiopia
| | - Shimelis Mitiku
- Department of Biomedical Sciences, Faculty of Medical Science, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Andualem Mossie
- Department of Biomedical Sciences, Faculty of Medical Science, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
12
|
Rwebembera J, Cannon JW, Sanyahumbi A, Sotoodehnia N, Taubert K, Yilgwan CS, Bukhman G, Masterson M, Bruno FP, Bowen A, Dale JB, Engel ME, Beaton A, Van Beneden C. Research opportunities for the primary prevention and management of acute rheumatic fever and rheumatic heart disease: a National Heart, Lung, and Blood Institute workshop report. BMJ Glob Health 2023; 8:e012356. [PMID: 37914184 PMCID: PMC10619102 DOI: 10.1136/bmjgh-2023-012356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/24/2023] [Indexed: 11/03/2023] Open
Abstract
Primary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) encompasses the timely diagnosis and adequate treatment of the superficial group A Streptococcus (GAS) infections pharyngitis and impetigo. GAS is the only known inciting agent in the pathophysiology of the disease. However, sufficient evidence indicates that the uptake and delivery of primary prevention approaches in RHD-endemic regions are significantly suboptimal. This report presents expert deliberations on priority research and implementation opportunities for primary prevention of ARF/RHD that were developed as part of a workshop convened by the US National Heart, Lung, and Blood Institute in November 2021. The opportunities identified by the Primary Prevention Working Group encompass epidemiological, laboratory, clinical, implementation and dissemination research domains and are anchored on five pillars including: (A) to gain a better understanding of superficial GAS infection epidemiology to guide programmes and policies; (B) to improve diagnosis of superficial GAS infections in RHD endemic settings; (C) to develop scalable and sustainable models for delivery of primary prevention; (D) to understand potential downstream effects of the scale-up of primary prevention and (E) to develop and conduct economic evaluations of primary prevention strategies in RHD endemic settings. In view of the multisectoral stakeholders in primary prevention strategies, we emphasise the need for community co-design and government engagement, especially in the implementation and dissemination research arena. We present these opportunities as a reference point for research organisations and sponsors who aim to contribute to the increasing momentum towards the global control and prevention of RHD.
Collapse
Affiliation(s)
- Joselyn Rwebembera
- Division of Adult Cardiology, Uganda Heart Institute Ltd, Kampala, Uganda
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Amy Sanyahumbi
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nona Sotoodehnia
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathryn Taubert
- American Heart Association International, Basel, Switzerland
- Department of Physiology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christopher Sabo Yilgwan
- Departments of Paediatrics and West African Center for Emerging Infectious Diseases, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Gene Bukhman
- Center for Integration Science in Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary Masterson
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Fernando P Bruno
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Asha Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - James B Dale
- Department of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mark E Engel
- AFROStrep Research Initiative, Cape Heart Institute, Department of Medicine, University of Cape Town, Rondebosch, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | | |
Collapse
|
13
|
Pamuk U, Alper Gürsu H, Azak E, İlker Çetin İ. Assessment of Myocardial Mechanics in Acute Rheumatic Fever Using Speckle-Tracking Echocardiography. Anatol J Cardiol 2023; 27:592-596. [PMID: 37466023 PMCID: PMC10541787 DOI: 10.14744/anatoljcardiol.2023.1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/25/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND This study aims to evaluate the role of speckle-tracking echocardiography to identify myocardial deformation in acute rheumatic fever. METHODS Twenty-seven patients and 27 healthy children were prospectively evaluated. The patient group was divided into 2 subgroups based on echocardiographic findings, with or without carditis. The left ventricular global longitudinal strain and strain rate, left ventricular global circumferential strain and strain rate, and right ventricular global lon-gitudinal strain and strain rate were assessed by speckle-tracking echocardiography. RESULTS In the acute phase of the disease, all values except the right ventricular global longitudinal strain were found to be significantly below the control group in the patient cohort. No significant difference was found between the patients grouped as carditis and non-carditis in the acute period. Comparison of the acute period with the post-treatment period revealed a significant increase in all strain values of the patients with carditis and significant increases observed in all values except left ventricular global longitudinal strain rate, left ventricular global circumferential strain rate, and right ventricular global longitudinal strain rate values in patients without carditis. Apart from the right ventricular global longitudinal strain rate, which was significantly lower in the non-carditis group compared to the control group, there was no significant difference in strain values between the patient and control groups following treatment. CONCLUSION In the present study, we found that all patients, including patients in whom no valvular involvement was detected by echocardiography in the acute phase of acute rheumatic fever, had a lower right and left ventricular strain and strain rate measurements and that these findings improved after treatment, suggesting that strain echocardiography may be a helpful diagnostic method, especially in patients without valvular involvement.
Collapse
Affiliation(s)
- Utku Pamuk
- Department of Pediatrics, Division of Pediatric Cardiology, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Hazım Alper Gürsu
- Department of Pediatric Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| | - Emine Azak
- Department of Pediatric Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| | - İbrahim İlker Çetin
- Department of Pediatric Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| |
Collapse
|
14
|
MacDonald B, Tarca A, Causer L, Maslin K, Bruce D, Schreiber-Wood R, Kumar M, Ramsay J, Andrews D, Budgeon C, Katzenellenbogen J, Bowen AC, Carapetis J, Friedberg MK, Yim D. Left ventricular remodelling in rheumatic heart disease - trends over time and implications for follow-up in childhood. BMC Cardiovasc Disord 2023; 23:462. [PMID: 37715115 PMCID: PMC10503178 DOI: 10.1186/s12872-023-03497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is the most common form of acquired heart disease worldwide. In RHD, volume loading from mitral regurgitation leads to left ventricular (LV) dilatation, increased wall stress, and ultimately LV dysfunction. Improved understanding of LV dynamics may contribute to refined timing of intervention. We aimed to characterize and compare left ventricular remodelling between rheumatic heart disease (RHD) severity groups by way of serial echocardiographic assessment of volumes and function in children. METHODS Children with RHD referred to Perth Children's Hospital (formally Princess Margaret Hospital) (1987-2020) were reviewed. Patients with longitudinal pre-operative echocardiograms at diagnosis, approximately 12 months and at most recent follow-up, were included and stratified into RHD severity groups. Left ventricular (LV) echocardiographic parameters were assessed. Adjusted linear mixed effect models were used to compare interval changes. RESULTS 146 patients (median age 10 years, IQR 6-14 years) with available longitudinal echocardiograms were analysed. Eighty-five (58.2%) patients had mild, 33 (22.6%) moderate and 28 (19.2%) severe RHD at diagnosis. Mean duration of follow-up was 4.6 years from the initial diagnosis. Severe RHD patients had significantly increased end-systolic volumes (ESV) and end-diastolic volumes (EDV) compared to mild/moderate groups at diagnosis (severe versus mild EDV mean difference 27.05 ml/m2, p < 0.001, severe versus moderate EDV mean difference 14.95 ml/m2, p = 0.006). Mild and moderate groups experienced no significant progression of changes in volume measures. In severe RHD, LV dilatation worsened over time. All groups had preserved cardiac function. CONCLUSIONS In mild and moderate RHD, the lack of progression of valvular regurgitation and ventricular dimensions suggest a stable longer-term course. Significant LV remodelling occurred at baseline in severe RHD with progression of LV dilatation over time. LV function was preserved across all groups. Our findings may guide clinicians in deciding the frequency and timing of follow-up and may be of clinical utility during further reiterations of the Australia and New Zealand RHD Guidelines.
Collapse
Affiliation(s)
- Bradley MacDonald
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia.
- School of Population and Global Health, University of Western Australia, Perth, Australia.
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia.
| | - Adrian Tarca
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Louise Causer
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Katie Maslin
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Di Bruce
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Rachel Schreiber-Wood
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Mohit Kumar
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - James Ramsay
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - David Andrews
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Charley Budgeon
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Judith Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Perth, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia
| | - Asha C Bowen
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia
| | - Jonathan Carapetis
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia
| | - Mark K Friedberg
- Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Deane Yim
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| |
Collapse
|
15
|
Magalhães T, Melo C, Sampaio M, Correia-Costa A, Sousa R. Hyperkinetic Movement Disorder in a Child. Pediatr Rev 2023; 44:e24-e28. [PMID: 37653135 DOI: 10.1542/pir.2021-005247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Tiago Magalhães
- Department of Pediatrics
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cláudia Melo
- Pediatric Neurology Unit, Department of Pediatrics, and
- Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Ana Correia-Costa
- Department of Pediatric Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Raquel Sousa
- Pediatric Neurology Unit, Department of Pediatrics, and
| |
Collapse
|
16
|
Liang Y, Yu D, Lu Q, Zheng Y, Yang Y. The rise and fall of acute rheumatic fever and rheumatic heart disease: a mini review. Front Cardiovasc Med 2023; 10:1183606. [PMID: 37288267 PMCID: PMC10242100 DOI: 10.3389/fcvm.2023.1183606] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction The incidences of acute rheumatic fever (ARF) and rheumatic heart disease (RHD), which were leading causes of death in children in the 1920s, have decreased substantially. Considering the recent resurgence of scarlet fever and increased incidence of streptococcal pharyngitis in children, an investigation of the current status of ARF and RHD may be worthwhile. Objective To summarize the prevalence trends, pathogenic factors, and prevention strategies for ARF and RHD in children. Methods A selective search of literature published between January 1920 and February 2023 was done in PubMed, using the terms "acute rheumatic fever", "rheumatic heart disease", "group A Streptococcus", "pharyngitis", "pharyngeal tonsillitis", "scarlet fever", "impetigo", "obstructive sleep apnea syndrome" and "child". Results Overcrowded homes and inadequate sanitation led to recurrent group A streptococcal infection, and the causal relationship between group A streptococcal infection and ARF/RHD was well established. Streptococcal infectious diseases, such as group A streptococcal pharyngeal tonsillitis, SF, impetigo, and obstructive sleep apnea syndrome, were associated with the occurrence of ARF and RHD. ARF and RHD were still prevalent in young people of developing countries and economically poor populations of high-income countries. Universal disease registration systems were critical to locating disease outbreaks, tracking disease transmission, and identifying high-risk populations. Four-level prevention strategies were effective in reducing the incidence and mortality of ARF and RHD. Conclusions Registry and preventive measures for ARF and RHD should be strengthened in areas of dense population; poor sanitation; resurgence of SF; and high incidence of streptococcal pharyngitis, impetigo, and obstructive sleep apnea syndrome.
Collapse
Affiliation(s)
- Yunmei Liang
- Department of Pediatrics, Beijing Chaoyang Hospital Affiliated to the Capital Medical University, Beijing, China
| | - Dingle Yu
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, China
| | - Qinghua Lu
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, China
- Microbiology Laboratory, National Center for Children’s Health, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Yuejie Zheng
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, China
| | - Yonghong Yang
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, China
- Microbiology Laboratory, National Center for Children’s Health, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
17
|
Park MH, Pandya PK, Zhu Y, Mullis DM, Wang H, Imbrie-Moore AM, Wilkerson R, Marin-Cuartas M, Woo YJ. A Novel Rheumatic Mitral Valve Disease Model with Ex Vivo Hemodynamic and Biomechanical Validation. Cardiovasc Eng Technol 2023; 14:129-140. [PMID: 35941509 PMCID: PMC9905378 DOI: 10.1007/s13239-022-00641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Rheumatic heart disease is a major cause of mitral valve (MV) dysfunction, particularly in disadvantaged areas and developing countries. There lacks a critical understanding of the disease biomechanics, and as such, the purpose of this study was to generate the first ex vivo porcine model of rheumatic MV disease by simulating the human pathophysiology and hemodynamics. METHODS Healthy porcine valves were altered with heat treatment, commissural suturing, and cyanoacrylate tissue coating, all of which approximate the pathology of leaflet stiffening and thickening as well as commissural fusion. Hemodynamic data, echocardiography, and high-speed videography were collected in a paired manner for control and model valves (n = 4) in an ex vivo left heart simulator. Valve leaflets were characterized in an Instron tensile testing machine to understand the mechanical changes of the model (n = 18). RESULTS The model showed significant differences indicative of rheumatic disease: increased regurgitant fractions (p < 0.001), reduced effective orifice areas (p < 0.001), augmented transmitral mean gradients (p < 0.001), and increased leaflet stiffness (p = 0.025). CONCLUSION This work represents the creation of the first ex vivo model of rheumatic MV disease, bearing close similarity to the human pathophysiology and hemodynamics, and it will be used to extensively study both established and new treatment techniques, benefitting the millions of affected victims.
Collapse
Affiliation(s)
- Matthew H Park
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Pearly K Pandya
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Danielle M Mullis
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
| | - Annabel M Imbrie-Moore
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Robert Wilkerson
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
| | - Mateo Marin-Cuartas
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA.
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
| |
Collapse
|
18
|
Holloway AR. Acute Rheumatic Fever. Pediatr Ann 2022; 51:e457-e460. [PMID: 36476197 DOI: 10.3928/19382359-20221006-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute rheumatic fever (ARF) and its sequela rheumatic heart disease remain significant causes of cardiovascular morbidity and mortality worldwide. When caring for patients originating from a geographic setting where ARF is endemic, a high index of suspicion for ARF is indicated. Early recognition of ARF with the initiation of treatment and secondary prevention is vital to prevent irreversible cardiac valve damage. This article covers the epidemiology, clinical manifestations, and diagnostic considerations of ARF. Specifically, the differing diagnostic criteria between high- and low-risk populations are emphasized. It will also review management and prevention strategies for ARF. [Pediatr Ann. 2022;51(12):e457-e460.].
Collapse
|
19
|
Sheng X, Chen C, Ji Z, Hu H, Zhang M, Wang H, Pang B, Zhai J, Zhang D, Zhang J, Guo L. Development of a core outcome set on Traditional Chinese Medicine and Western Medicine for rheumatic heart disease: a study protocol. BMJ Open 2022; 12:e062497. [PMID: 36368756 PMCID: PMC9660565 DOI: 10.1136/bmjopen-2022-062497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Globally, rheumatic heart disease (RHD) is an important cause of acquired heart disease in children and adolescents. Clinical trials on RHD treatment with Traditional Chinese Medicine (TCM) or integrated medicine are gradually increasing in China. However, because the outcomes of clinical trials are subject to heterogeneity and selective reporting, similar studies cannot be merged and compared, complicating assessing the effectiveness and safety of TCM, and diminishing the value of clinical trials. Therefore, there is an urgent need to design a TCM or integrated medicine core outcome set (COS) for RHD. METHODS AND ANALYSIS The development of this study will take place in four stages under the direction of a multidisciplinary advisory board. (1) Establishing a comprehensive outcomes checklist through a systematic review of previously published research, retrieval of clinical trial registration centres, patient's semistructured interviews, and clinician's questionnaire surveys; (2) Screen stakeholder groups from various fields to participate in the Delphi survey; (3) Two e-Delphi surveys will be conducted to determine the outcomes of various concerned stakeholder groups; (4) Hold a face-to-face consensus meeting to develop the COS-TCM-RHD. ETHICS AND DISSEMINATION The ethical approval for this study has been obtained from the Tianjin University of Traditional Chinese Medicine Ethics Committee (TJUTCM-EC20210008). The findings will be disseminated in peer-reviewed journals and meetings. TRIAL REGISTRATION NUMBER This study has been registered at the Core Outcome Measures in Effectiveness Trials (COMET) database (Registration #1743).
Collapse
Affiliation(s)
- Xiaodi Sheng
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Chinese Clinical Trials Core Outcome Set Research Center, Tianjin, China
| | - Chao Chen
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhaochen Ji
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Chinese Clinical Trials Core Outcome Set Research Center, Tianjin, China
| | - Haiyin Hu
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Chinese Clinical Trials Core Outcome Set Research Center, Tianjin, China
| | - Mingyan Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Chinese Clinical Trials Core Outcome Set Research Center, Tianjin, China
| | - Hui Wang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Chinese Clinical Trials Core Outcome Set Research Center, Tianjin, China
| | - Bo Pang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Chinese Clinical Trials Core Outcome Set Research Center, Tianjin, China
| | - Jingbo Zhai
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Chinese Clinical Trials Core Outcome Set Research Center, Tianjin, China
| | - Dong Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Chinese Clinical Trials Core Outcome Set Research Center, Tianjin, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Chinese Clinical Trials Core Outcome Set Research Center, Tianjin, China
| | - Liping Guo
- Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| |
Collapse
|
20
|
Muacevic A, Adler JR, Malik F, Lopez O, Yatham P, Malik R, Rosen G. A Rare Case of Pulmonic and Aortic Valve Infective Endocarditis: A Case Report. Cureus 2022; 14:e31820. [PMID: 36579216 PMCID: PMC9788795 DOI: 10.7759/cureus.31820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022] Open
Abstract
Infective endocarditis (IE) is a microbial infection affecting cardiac valves. IE most often affects the aortic valve and is commonly caused by community-acquired, penicillin-sensitive streptococcus that enters through the oral cavity. In this report, we present a case of a 66-year-old man with a medical history of congenital pulmonic stenosis status after pulmonic valve (PV) repair. The patient underwent a transesophageal echocardiogram showing a 1 cm × 0.7 cm mobile vegetation attached to the ventricular aspect of the right coronary aortic cusp and a 1.1 cm × 0.5 cm mobile vegetation attached to the arterial aspect of the PV cusp. In conclusion, concomitant right- and left-sided IE is an exceedingly rare condition. Due to its rarity and complexity of presentation, pulmonic valve endocarditis (PVE) requires a multidisciplinary approach to its perioperative management to prevent systemic complications.
Collapse
|
21
|
Soesanto AM. Editorial: New challenges with the management of rheumatic heart disease. Front Surg 2022; 9:1030172. [PMID: 36303846 PMCID: PMC9592842 DOI: 10.3389/fsurg.2022.1030172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
|
22
|
Owusu IK, Acheamfour-Akowuah E, Wiafe YA. Clinical and Socio-Demographic Profiles of Patients Seen with Rheumatic Heart Disease in a Cardiac Clinic of a Tertiary Hospital in Ghana. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2022. [DOI: 10.2147/rrcc.s372472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
23
|
Spagnolello O, Fabris S, Portella G, Raafat Shafig Saber D, Giovanella E, Badr Saad M, Langer M, Ciccozzi M, d’Ettorre G, Ceccarelli G. Rates and Determinants of Hospital-Acquired Infection among ICU Patients Undergoing Cardiac Surgery in Developing Countries: Results from EMERGENCY'NGO's Hospital in Sudan. Antibiotics (Basel) 2022; 11:antibiotics11091227. [PMID: 36140005 PMCID: PMC9494959 DOI: 10.3390/antibiotics11091227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction. Knowledge of local and regional antimicrobial resistance (AMR) is crucial in clinical decision-making, especially with critically ill patients. The aim of this study was to investigate the rate and pattern of infections in valvular heart disease patients admitted to the intensive care unit (ICU) at the Salam Centre for Cardiac Surgery in Khartoum, Sudan (run by EMERGENCY NGO). Methods. This is a retrospective, observational study from a single, large international referral centre (part of a Regional Programme), which enrolled patients admitted to the ICU between 1 January and 31 December 2019. Data collected for each patient included demographic data, operating theatre/ICU data and microbiological cultures. Results. Over the study period, 611 patients were enrolled (elective surgery n = 491, urgent surgery n = 34 and urgent medical care n = 86). The infection rate was 14.2% and turned out to be higher in medical than in surgical patients (25.6% vs. 12.4%; p = 0.002; OR = 2.43) and higher in those undergoing urgent surgery than those undergoing elective (29.4% vs. 11.2%; p = 0.004; OR = 3.3). Infection was related to (a) SOFA score (p < 0.001), (b) ICU length of stay (p < 0.001) and (c) days from ICU admission to OT (p = 0.003). A significant relationship between the type of admission (elective, urgent surgery or medical) and the presence of infections was found (p < 0.001). The mortality rate was higher among infected patients (infected vs. infection-free: 10.3% vs. 2.1%; p < 0.001; OR = 5.38; 95% CI: 2.16−13.4; p < 0.001). Conclusions. Hospital-acquired infections remain a relevant preventable cause of mortality in our particular population.
Collapse
Affiliation(s)
- Ornella Spagnolello
- Intensive Care Unit, Salam Centre for Cardiac Surgery, EMERGENCY’NGO, Khartoum, Sudan
- Department of Public Health and Infectious Diseases, University of Rome “La Sapienza”, 00185 Rome, Italy
- Correspondence: (O.S.); (G.C.)
| | - Silvia Fabris
- National Centre for Control and Emergency Against Animal Diseases and Central Crisis Unit—Unit III, Directorate General for Animal Health and Veterinary Medicinal Products, Italian Ministry of Health, 00153 Rome, Italy
- Medical Statistics and Epidemiology Unit, Campus Bio-Medico University, 00128 Rome, Italy
| | - Gina Portella
- Intensive Care Unit, Salam Centre for Cardiac Surgery, EMERGENCY’NGO, Khartoum, Sudan
| | | | - Elena Giovanella
- Intensive Care Unit, Salam Centre for Cardiac Surgery, EMERGENCY’NGO, Khartoum, Sudan
| | - Manahel Badr Saad
- Intensive Care Unit, Salam Centre for Cardiac Surgery, EMERGENCY’NGO, Khartoum, Sudan
| | - Martin Langer
- Intensive Care Unit, Salam Centre for Cardiac Surgery, EMERGENCY’NGO, Khartoum, Sudan
| | - Massimo Ciccozzi
- Medical Statistics and Epidemiology Unit, Campus Bio-Medico University, 00128 Rome, Italy
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, University of Rome “La Sapienza”, 00185 Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome “La Sapienza”, 00185 Rome, Italy
- Migrant and Global Health Research Organization (Mi-HeRO), Rome 00176, Italy
- Correspondence: (O.S.); (G.C.)
| |
Collapse
|
24
|
Oben G, Duncanson M, Adams J, Satyanand T. State of child health: acute rheumatic fever in Aotearoa New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2113102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Glenda Oben
- Te Ratonga Mātai Tahumaero Taitamariki o Aotearoa—New Zealand Child and Youth Epidemiology Service, Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Mavis Duncanson
- Te Ratonga Mātai Tahumaero Taitamariki o Aotearoa—New Zealand Child and Youth Epidemiology Service, Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Judith Adams
- Te Ratonga Mātai Tahumaero Taitamariki o Aotearoa—New Zealand Child and Youth Epidemiology Service, Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | | |
Collapse
|
25
|
Impact of mitral regurgitation on left ventricular remodeling and function in children with rheumatic heart disease. Int J Cardiovasc Imaging 2022; 38:2667-2676. [DOI: 10.1007/s10554-022-02678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
|
26
|
Infective Endocarditis in High-Income Countries. Metabolites 2022; 12:metabo12080682. [PMID: 35893249 PMCID: PMC9329978 DOI: 10.3390/metabo12080682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.
Collapse
|
27
|
Dixit J, Brar S, Prinja S. Burden of Group A Streptococcal Pharyngitis, Rheumatic Fever, and Rheumatic Heart Disease in India: A Systematic Review and Meta-Analysis. Indian J Pediatr 2022; 89:642-650. [PMID: 34379301 DOI: 10.1007/s12098-021-03845-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the burden of group A streptococcal pharyngitis (GAS) pharyngitis, rheumatic fever (RF), and rheumatic heart disease (RHD) in India using existing data sources, as well as to recognize the most serious gaps in GAS disease burden data. METHODS Four electronic databases-PubMed, Scopus, Embase, and Web of Science were searched using a comprehensive search strategy. Data were identified primarily from observational studies including school surveys, community-based and hospital-based studies. The standard methodological procedures as per Cochrane guidelines were used. Eligible studies were pooled for estimating prevalence, incidence, and case fatality rate using R software version 3.3.3. The protocol was registered with PROSPERO; registration number CRD42018075742. RESULTS The pooled prevalence of GAS pharyngitis among asymptomatic children and pharyngitis cases aged 5 to 15 y was estimated as 2.79 percent [95% Confidence interval (CI): 1.58-4.89] and 13 percent (95% CI: 3.18-41.97), respectively. The prevalence rate of rheumatic fever was found to be 0.04% (95% CI: 0.01-0.17). The pooled prevalence rate of RHD among children aged 5-15 y using clinical auscultation and echocardiography was estimated as 0.36 percent (95% CI: 0.02-7.52) and 0.28 percent (95% CI: 0.08-1.03), respectively. CONCLUSION The study emphasizes the importance of developing a population-based surveillance framework to track patterns, management strategies, and outcomes in order to develop informed recommendations for launching contextual measures to regulate RF and RHD.
Collapse
Affiliation(s)
- Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sehr Brar
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| |
Collapse
|
28
|
Gurbuz F, Canbulat Sahiner N, Unal E, Gurbuz AS, Baysal T. Breastfeeding does not protect against the development of carditis in children with acute rheumatic fever. Cardiol Young 2022; 33:1-5. [PMID: 35718952 DOI: 10.1017/s1047951122001834] [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] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Acute rheumatic fever is an autoimmune disease that develops due to streptococcal infection. The positive effect of breastfeeding on the development of the child's immune system is well documented. In this study, we aimed to investigate the effect of breast milk intake period on the development of carditis. MATERIALS AND METHODS Patients (n: 182) who were diagnosed with acute rheumatic fever between 2010 and 2019 were enrolled in the study. The patients were divided into groups according to carditis development. The demographic, socio-economic, and breastfeeding data were compared between groups. RESULTS The mean age of the patients was 10.5 ± 3.4, and 43.4 % (n: 79) of them were female. Independent predictors of the development of carditis in the first acute rheumatic fever episode were the number of children at home (OR: 1.773, CI 95%: 1.105, 2.845; p: 0.018) and breast milk intake less than 6 months (OR: 0.404, CI 95%: 0.174, 0.934; p: 0.034). Independent predictors of the development of carditis in any of the acute rheumatic fever episodes were the number of children at home (OR: 1.858, CI 95%: 1.100, 3.137; p: 0.021) and female gender (OR: 3.504, CI 95%: 1.227, 10.008; p: 0.019). The only independently predictor of the development of chorea during acute rheumatic fever was female gender (OR: 3.801, CI 95%: 1.463, 9.874; p: 0.006). CONCLUSION Although the occurrence of carditis is less common during the first acute rheumatic fever attack in patients with breast milk intake less than six months, this advantage is lost in recurrent attacks. This study showed that breast milk does not have a negative effect on acute rheumatic fever carditis.
Collapse
Affiliation(s)
- Funda Gurbuz
- Department of Nursing, Karamanoglu Mehmetbey University Health Sciences Institute, Karaman, Turkey
| | - Nejla Canbulat Sahiner
- Department of Nursing, Karamanoglu Mehmetbey University Health Sciences Institute, Karaman, Turkey
| | - Emin Unal
- Department of Pediatric Cardiology, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
| | - Ahmet Seyfeddin Gurbuz
- Department of Cardiology, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
| | - Tamer Baysal
- Department of Pediatric Cardiology, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
| |
Collapse
|
29
|
Bea C, Vela S, García-Blas S, Perez-Rivera JA, Díez-Villanueva P, de Gracia AI, Fuertes E, Oltra MR, Ferrer A, Belmonte A, Santas E, Pellicer M, Colomina J, Doménech A, Bodi V, Forner MJ, Chorro FJ, Bonanad C. Infective Endocarditis in the Elderly: Challenges and Strategies. J Cardiovasc Dev Dis 2022; 9:jcdd9060192. [PMID: 35735821 PMCID: PMC9224959 DOI: 10.3390/jcdd9060192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022] Open
Abstract
The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term "elderly" corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population.
Collapse
Affiliation(s)
- Carlos Bea
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sara Vela
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
| | | | | | - Ana Isabel de Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Eladio Fuertes
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Maria Rosa Oltra
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Ana Ferrer
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Andreu Belmonte
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Mauricio Pellicer
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Javier Colomina
- Servicio de Microbiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Alberto Doménech
- Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Vicente Bodi
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Maria José Forner
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Correspondence:
| |
Collapse
|
30
|
Ben-David EI, Blumenfeld O, Shapira-Daniels A, Shapira OM. Validation of the society of thoracic surgeons predicted risk of mortality score for long-term survival after cardiac surgery in Israel. J Cardiothorac Surg 2022; 17:68. [PMID: 35382843 PMCID: PMC8985317 DOI: 10.1186/s13019-022-01809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 03/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Long-term survival is an important metric in assessing procedural value. We previously confirmed that the Society of Thoracic Surgeons predicted risk of mortality score (PROM) accurately predicts 30-day mortality in Israeli patients. The present study investigated the ability of the PROM to reliably predict long-term survival. Methods Data on 1279 patients undergoing cardiac surgery were prospectively entered into our database and used to calculate PROM. Long-term mortality was obtained from the Israeli Social Security Database. Patients were stratified into five cohorts according to PROM (A: 0–0.99%, B: 1.0–1.99%, C: 2.0–2.99%, D: 3.0–4.99% and E: ≥ 5.0%). Kaplan–Meier estimates of survival were calculated for each cohort and compared by Wilcoxon signed-rank test. We used C-statistics to assess model discrimination. Cox regression analysis was performed to identify predictors of long-term survival. Results Follow-up was achieved for 1256 (98%) patients over a mean period of 62 ± 28 months (median 64, range 0–107). Mean survival of the entire cohort was 95 ± 1 (95% CI 93–96) months. Higher PROM was associated with reduced survival: A—104 ± 1 (103–105) months, B—96 ± 2 (93–99) months, C—93 ± 3 (88–98) months, D—89 ± 3 (84–94) months, E—74 ± 3 (68–80) months (p < 0.0001). The Area Under the Curve was 0.76 ± 0.02 indicating excellent model discrimination. Independent predictors of long-term mortality included advanced age, lower ejection fraction, reoperation, diabetes mellitus, dialysis and PROM. Conclusions The PROM was a reliable predictor of long-term survival in Israeli patients undergoing cardiac surgery. The PROM might be a useful metric for assessing procedural value and surgical decision-making.
Collapse
Affiliation(s)
- Eyal I Ben-David
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel. .,St George's Hospital Medical School, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Orit Blumenfeld
- The Israel Center for Disease Control, Division of Medical Technologies and Research, Ministry of Health, Ramat Gan, Israel
| | - Ayelet Shapira-Daniels
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Oz M Shapira
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
31
|
Cupe-Chacalcaje K, Benites-Yshpilco L, Cachicatari-Beltrán A, Urdanivia-Ruiz D, Rafael-Horna E, Rojas P, Lévano-Pachas G, Baltodano-Arellano R. [Rheumatic mitral aggression. Usefulness of 3d transesophageal echocardiography]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:98-111. [PMID: 37283602 PMCID: PMC10241339 DOI: 10.47487/apcyccv.v3i2.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/28/2022] [Indexed: 06/08/2023]
Abstract
Rheumatic heart disease is the leading cause of cardiovascular disease in children under 25 years of age worldwide, with the highest prevalence in low-income countries. The usual and distinctive finding of rheumatic aggression is mitral stenosis, which leads to serious cardiovascular consequences. International guidelines establish transthoracic echocardiography (TTE) as the diagnostic test for rheumatic heart disease; however, it has limitations in the measurement of planimetry and those inherent to Doppler. Transesophageal 3D echocardiography (TTE-3D) is a new modality that shows realistic images of the mitral valve and has the added value of accurately locating the plane of maximum stenosis and better determining commissural involvement.
Collapse
Affiliation(s)
- Kelly Cupe-Chacalcaje
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | - Lindsay Benites-Yshpilco
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | | | - Dante Urdanivia-Ruiz
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | - Eliana Rafael-Horna
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | - Paol Rojas
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | - Gerald Lévano-Pachas
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | - Roberto Baltodano-Arellano
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
- . Universidad Nacional Mayor de San Marcos, Lima, Perú. Universidad Nacional Mayor de San Marcos Universidad Nacional Mayor de San Marcos Lima Peru
| |
Collapse
|
32
|
Depietri G, Carli N, Sica A, Oliviero D, Costagliola G, Striano P, Bonuccelli A, Frisone F, Peroni D, Consolini R, Foiadelli T, Orsini A. Therapeutic aspects of Sydenham's Chorea: an update. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 92:e2021414. [PMID: 35441610 PMCID: PMC9179053 DOI: 10.23750/abm.v92is4.12663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022]
Abstract
Sydenham’s Chorea (SC) is a hyperkinetic movement disorder associated with neuropsychiatric manifestations. It is believed to be caused by the autoimmune response following a group A beta-hemolytic streptococcal (GABHS) pharyngitis, and it is one of the major diagnostic criteria for Acute Rheumatic Fever (ARF) diagnosis. Despite having been known and studied for centuries, there are still no standardized therapies or official guidelines for SC treatment, so that it is necessarily left to physicians’ clinical experience. Antibiotic treatment, symptomatic therapies, and immunomodulatory treatment are the three pillars upon which SC patients’ management is currently based, but they still lack a solid scientific basis. The aim of this writing is precisely to review the state of the art of SC’s treatment, with an overview of the advances made in the last 5 years. However, since the therapeutic uncertainties are a mere reflection of the severe gap of knowledge that concerns SC’s pathogenesis and manifestations, the importance of high-quality research studies based on homogenized methodologies, instruments, and measured outcomes will also be stressed. (www.actabiomedica.it)
Collapse
Affiliation(s)
- Greta Depietri
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa.
| | - Niccolo Carli
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa.
| | - Attilio Sica
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa.
| | - Domenico Oliviero
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa.
| | - Giorgio Costagliola
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
| | - Pasquale Striano
- Pediatric Neurology Unit, Dinogmi, Giannina Gaslini's. Istitute, University of Genoa, Italy.
| | - Alice Bonuccelli
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy.
| | - Flavia Frisone
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy.
| | - Diego Peroni
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy.
| | - Rita Consolini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy.
| | - Thomas Foiadelli
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia.
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy.
| |
Collapse
|
33
|
Belay W, Dessie A, Ahmed H, Gedlu E, Mariyo A, Shehibo A, Tigabu Z, Aliyu MH, Soslow J. Secondary prevention of rheumatic heart disease in Ethiopia: a multicenter study. BMC Cardiovasc Disord 2022; 22:26. [PMID: 35109807 PMCID: PMC8809239 DOI: 10.1186/s12872-022-02473-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Ethiopia has a high acute rheumatic fever (ARF) and rheumatic heart disease (RHD) prevalence, and to our knowledge, there are no data on the status of secondary prevention in children with RHD. This study describes the status of secondary RHD prevention. Methods A multicenter, prospective study was performed on children aged 5–17 years with RHD in Ethiopia. Good adherence was defined as at least 80% completion of benzathine penicillin (BPG) or oral Amoxicillin within the previous year. The primary outcome measure was adherence to prophylaxis, expressed as a proportion. Socio-demographics, severity of RHD, and ARF recurrence were evaluated. Results A total of 337 children with a mean age of 12.9 ± 2.6 years were included. The majority (73%) had severe aortic/mitral disease. Participants were on BPG (80%) or Amoxicillin (20%) prophylaxis. Female sex (P = 0.04) use of BPG (0.03) and shorter mean duration of prophylaxis in months (48.5 ± 31.5 vs. 60.7 ± 33, respectively, P < 0.008) predicted good adherence. Running out of medications (35%), interrupted follow-up (27%), and the COVID-19 pandemic (26%) were the most common reasons for missing prophylaxis. Recurrence of ARF was higher in participants on Amoxicillin compared with BPG (40% vs. 16%, P < 0.001) and in those with poor adherence compared with good adherence (36.8% vs. 17.9%, respectively, P = 0.005). Type and duration of prophylaxis (OR 0.5, CI = 0.24, 0.9, P = 0.02; OR = 1.1, CI = 1.1, 1.2, P = 0.04, respectively), and sex (OR = 1.9, CI = 1.1, 3.4, P = 0.03) were independent predictors of poor adherence. Conclusion Poor adherence is prevalent in Ethiopian children living with RHD. Amoxicillin is a suboptimal option for prophylaxis as its use is associated with lower adherence and a higher rate of ARF recurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02473-4.
Collapse
Affiliation(s)
- Wubishet Belay
- Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way 5th Floor, Nashville, TN, 37232, USA.
| | | | - Hayat Ahmed
- Black Lion Specialized Referral Hospital, Addis Ababa University College of Medicine and Health Sciences, Addis Ababa, Ethiopia
| | - Etsegenet Gedlu
- Black Lion Specialized Referral Hospital, Addis Ababa University College of Medicine and Health Sciences, Addis Ababa, Ethiopia
| | - Abinet Mariyo
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abdulkadir Shehibo
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemene Tigabu
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
| | - Jonathan Soslow
- Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way 5th Floor, Nashville, TN, 37232, USA
| |
Collapse
|
34
|
Acute rheumatic fever in the paediatric population: a descriptive study in the Malaysian state of Sabah. Cardiol Young 2022; 32:83-87. [PMID: 33941307 DOI: 10.1017/s1047951121001621] [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] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Rheumatic heart disease is among the leading causes of acquired valvular heart disease in the developing world. However, there is no data available for rheumatic heart disease in the paediatric population of Sabah. This study collected data for acute rheumatic fever admissions among the paediatric population in Sabah over a period of 3 years. METHODS This is a retrospective cohort study. All records for admissions to paediatric wards in Sabah for acute rheumatic fever from January 2016 to December 2018 were collected. The patient records were then traced and required information were collected. RESULTS A total of 52 cases of acute rheumatic fever were admitted. It was observed that the incidence of acute rheumatic fever was 74.4 per 100,000 paediatric admissions. Patients from the West Coast Division made up most of the admissions (n = 24, 46.2%). Male patients (n = 35, 67.3%) of the indigenous Kadazan-Dusun ethnicity (n = 21, 40.4%) were most commonly encountered. The mean age at time of presentation was 9.58 years. Most cases admitted (n = 38, 73.1%) were categorised as Priority 1 (severe rheumatic heart disease). CONCLUSION Most patients who were admitted had symptoms of heart failure and were diagnosed with severe rheumatic heart disease. Although this disease is preventable, the incidence in Sabah remains high. This study was limited as we only looked at patients who were admitted and we foresee the real incidence to be higher. Hence, there is an urgent need for a rheumatic heart disease registry in Malaysia to gather more data for prevention and early intervention.
Collapse
|
35
|
Rakhimova I, Semenova Y, Khaibullin T, Kuanysheva A, Kovalchuk V, Abdrakhmanov A. Cryptogenic Stroke and Embolic Stroke of Undetermined Source: Risk Factors and Approaches for Detection of Atrial Fibrillation. Curr Cardiol Rev 2022; 18:e211221199213. [PMID: 34939547 PMCID: PMC9893140 DOI: 10.2174/1573403x18666211221145714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/17/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Stroke is a problem worldwide because of its high mortality and disability rates. Almost 90% of strokes are ischemic, and more than half of the deaths are caused by an ischemic stroke. Most risk factors for stroke are manageable so that it can be avoided with proper prevention. Despite the success in determining the causes of stroke in recent years, selectively, the "culprit" causing stroke remains unsolved. In such cases, a diagnosis of undetermined etiology (cryptogenic stroke) or embolic stroke of undetermined source (ESUS) is generated, resulting the prevention of a recurrent cerebrovascular occurrence impossible. Atrial fibrillation (AF) can be a cause of stroke by causing blood clots in the chambers of the heart. PURPOSE The aim was to determine the optimal method of heart rate monitoring in patients with ischemic stroke, as methods and approaches for detecting AF are very diverse, but there is still no single opinion, which would be universal. PROCEDURES In our review, we consider epidemiology, risk factors for the stroke of undetermined etiology, as well as analytical methods for detecting heart rhythm disturbances in this category of patients. FINDINGS Atrial fibrillation (AF) is detected by thorough monitoring of heart rate of patients with cryptogenic stroke and ESUS can be diagnosed in up to 46% of patients. . CONCLUSION After AF detection, consideration should be given to prescribing anticoagulants, instead of antiplatelet agents, for the secondary prevention of stroke.
Collapse
Affiliation(s)
- Idaliya Rakhimova
- Department of Cardiology and Interventional Arrhythmology, Semey State Medical University, Semey, Kazakhstan
| | - Yuliya Semenova
- Department of Cardiology and Interventional Arrhythmology, Semey State Medical University, Semey, Kazakhstan
| | - Talgat Khaibullin
- Department of Cardiology and Interventional Arrhythmology, Semey State Medical University, Semey, Kazakhstan
| | - Anargul Kuanysheva
- Department of Cardiology and Interventional Arrhythmology, Semey State Medical University, Semey, Kazakhstan
| | - Vitalii Kovalchuk
- Department of Semashko City Hospital, Saint Petersburg, Russian Federation
| | - Ayan Abdrakhmanov
- National Research Cardiac Surgery Center, Nur-Sultan 010000, Kazakhstan
| |
Collapse
|
36
|
Tobing TCL, Ontoseno T, Rahayuningsih S, Ganie RA, Siregar Y. Relationship between Environmental Factors and Rheumatic Heart Disease. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background. Rheumatic fever (RF) and rheumatic heart disease (RHD) are the most common acquired heart diseases in children. Environmental factors have been reported to play an important role in RHD’s prevalence
Aim. The main purpose of this study is to assess the associations between environmental factors and RHD in children.
Methods. A case control study was conducted in the Department of Child Health, Haji Adam Malik Hospital from April to June 2017. The case group consisted of children aged 5-18 years with RHD while control group consisted of healthy children. Demographic, anthropometric, and laboratory data were collected along with environmental factors. Statistical analysis was done using Statistical Product and Service Solution (SPSS). A P value of <0,05 with 95% confidence interval was considered significant.
Results. A total of 39 children were enrolled in each group. Subjects’ father who only went to elementary and junior high school had a higher risk of having children with RHD (OR 28; p = 0.032 and OR 15.75; p = 0.011, respectively). Subjects’ mother who only went to junior high school had 7 times higher risk of having children with RHD (p = 0.026). Low monthly income increased the risk of RHD (OR 3,68; p = 0,009). Tap water usage, meat consumption more than once per week, and feasibility to buy clothes >1 pair per year decreased the risk of RHD at 0,31 (p = 0,013), 0,3 (p = 0,016), and 0,04 times (p <0,001) respectively.
Conclusion. Parent’s education, monthly family income, water source, frequency of meat consumption, and feasibility to buy clothes are related to RHD in children.
Collapse
|
37
|
The Role of 2D and 3D Echo in Mitral Stenosis. J Cardiovasc Dev Dis 2021; 8:jcdd8120171. [PMID: 34940526 PMCID: PMC8705457 DOI: 10.3390/jcdd8120171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Mitral stenosis is an important cause of heart valve disease globally. Echocardiography is the main imaging modality used to diagnose and assess the severity and hemodynamic consequences of mitral stenosis as well as valve morphology. Transthoracic echocardiography (TTE) is sufficient for the management of most patients. The focus of this review is the role of current two-dimensional (2D) and three-dimensional (3D) echocardiographic imaging for the evaluation of mitral stenosis.
Collapse
|
38
|
Gürses D, Koçak G, Tutar E, Özbarlas N. Incidence and clinical characteristics of acute rheumatic fever in Turkey: Results of a nationwide multicentre study. J Paediatr Child Health 2021; 57:1949-1954. [PMID: 34227703 DOI: 10.1111/jpc.15619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the incidence and clinical features of acute rheumatic fever (ARF) in Turkey, following the revised Jones criteria in 2015. METHODS This multicentre study was designed by the Acquired Heart Diseases Working Group of the Turkish Pediatric Cardiology and Pediatric Cardiac Surgery Association in 2016. The data during the first attack of 1103 ARF patients were collected from the paediatric cardiologists between 1 January 2016 and 31 December 2016. RESULTS Turkey National Institute of Statistics records of 2016 were used for the determination of ARF incidence with regard to various cities and regions separately. The estimated incidence rate of ARF was 8.84/100 000 in Turkey. The ARF incidence varied considerably among different regions. The highest incidence was found in the Eastern Anatolia Region as 14.4/100 000, and the lowest incidence was found in the Black Sea Region as 3.3/100 000 (P < 0.05). Clinical carditis was the most common finding. The incidence of clinical carditis, subclinical carditis, polyarthritis, aseptic monoarthritis, polyarthralgia and Sydenham's Chorea was 53.5%, 29.1%, 52.8%, 10.3%, 18.6% and 7.9%, respectively. The incidences of clinical carditis, subclinical carditis, polyarthritis and polyarthralgia were found to be significantly different among different regions (P < 0.05). CONCLUSION The findings of this nationwide screening of ARF suggest that Turkey should be included in the moderate-risk group.
Collapse
Affiliation(s)
- Dolunay Gürses
- Department of Pediatric Cardiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Gülendam Koçak
- Department of Pediatric Cardiology, Bahçeşehir University School of Medicine, İstanbul, Turkey
| | - Ercan Tutar
- Department of Pediatric Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Nazan Özbarlas
- Department of Pediatric Cardiology, Çukurova University School of Medicine, Adana, Turkey
| | | |
Collapse
|
39
|
Wilson ZM, Craster K. Suspected acute rheumatic fever in a young man in England. BMJ Case Rep 2021; 14:e244469. [PMID: 34753720 PMCID: PMC8578939 DOI: 10.1136/bcr-2021-244469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 11/04/2022] Open
Abstract
A 24-year-old fit and well Caucasian man was referred to acute hospital via his General Practitioner with chest pain, palpitations, shortness of breath and an antecedent sore throat. Investigations revealed pericardial and pleural effusions, pericardial thickening on MRI, mild mitral regurgitation on echocardiogram and a raised Antistreptolysin O (ASO) titre.He was treated as acute rheumatic fever (ARF) with a prolonged course of penicillin, supportive therapy with bisoprolol and colchicine with lansoprazole cover. The patient made a full recovery and subsequent cardiac MRI showed resolution of all changes.
Collapse
Affiliation(s)
| | - Katie Craster
- Acute Medicine, Royal Devon and Exeter Hospital, Exeter, UK
| |
Collapse
|
40
|
Yang X, Chen H, Zhang D, Shen L, An G, Zhao S. Global magnitude and temporal trend of infective endocarditis, 1990-2019: results from the Global Burden of Disease Study. Eur J Prev Cardiol 2021; 29:1277-1286. [PMID: 34739047 DOI: 10.1093/eurjpc/zwab184] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/01/2021] [Indexed: 12/17/2022]
Abstract
AIMS To estimate the spatiotemporal patterns in infective endocarditis (IE) burden along with its attributable risk factors at the national, regional, and global levels, which is essential to optimize the targeted prevention, clinical practice, and research. METHODS AND RESULTS Based on all available data sources, the incidence, mortality, and disability-adjusted life years (DALYs) of IE in 204 countries and regions from 1990 to 2019 were reconstructed by Global Burden of Disease Study 2019 using the Cause of Death Ensemble model, spatiotemporal Gaussian process regression, and DisMod-MR 2.1. We depicted the epidemiological characteristics of IE in detail by gender, region, and age. Globally, 1 090 527 incident cases, 66 322 deaths, and 1 723 594 DALYs of IE were estimated in 2019. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) increased from 9.91 and 0.73 to 13.80 and 0.87 per 100 000 person-years over the past 30 years, respectively. ASIR were consistently more pronounced in higher socio-demographic index (SDI) regions. The leading ASMR in 2019 appeared in the High SDI region, with the largest increase in the past three decades. The age-specific burden rate of IE among people over 25 years old usually increased with age, and the annual increasing trend was more obvious for people over 60 years of age, especially in higher SDI regions. CONCLUSION The incidence and mortality of IE have continued to rise in the past 30 years, especially in higher SDI regions. The patient population was gradually shifting from the young to the elderly.
Collapse
Affiliation(s)
- Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Dandan Zhang
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Lin Shen
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Guipeng An
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Department of Cardiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Shaohua Zhao
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| |
Collapse
|
41
|
Stacey I, Hung J, Cannon J, Seth RJ, Remenyi B, Bond-Smith D, Griffiths K, Sanfilippo F, Carapetis J, Murray K, Katzenellenbogen JM. Long-term outcomes following rheumatic heart disease diagnosis in Australia. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab035. [PMID: 35919882 PMCID: PMC9242034 DOI: 10.1093/ehjopen/oeab035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/15/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
Aims Rheumatic heart disease (RHD) is a major contributor to cardiac morbidity and mortality globally. This study aims to estimate the probability and predictors of progressing to non-fatal cardiovascular complications and death in young Australians after their first RHD diagnosis. Methods and results This retrospective cohort study used linked RHD register, hospital, and death data from five Australian states and territories (covering 70% of the whole population and 86% of the Indigenous population). Progression from uncomplicated RHD to all-cause death and non-fatal cardiovascular complications (surgical intervention, heart failure, atrial fibrillation, infective endocarditis, and stroke) was estimated for people aged <35 years with first-ever RHD diagnosis between 2010 and 2018, identified from register and hospital data. The study cohort comprised 1718 initially uncomplicated RHD cases (84.6% Indigenous; 10.9% migrant; 63.2% women; 40.3% aged 5–14 years; 76.4% non-metropolitan). The composite outcome of death/cardiovascular complication was experienced by 23.3% (95% confidence interval: 19.5–26.9) within 8 years. Older age and metropolitan residence were independent positive predictors of the composite outcome; history of acute rheumatic fever was a negative predictor. Population group (Indigenous/migrant/other Australian) and sex were not predictive of outcome after multivariable adjustment. Conclusion This study provides the most definitive and contemporary estimates of progression to major cardiovascular complication or death in young Australians with RHD. Despite access to the publically funded universal Australian healthcare system, one-fifth of initially uncomplicated RHD cases will experience one of the major complications of RHD within 8 years supporting the need for programmes to eradicate RHD.
Collapse
Affiliation(s)
- Ingrid Stacey
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Joseph Hung
- Medical School, University of Western Australia, Perth, Australia
| | - Jeff Cannon
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rebecca J Seth
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Bo Remenyi
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Daniela Bond-Smith
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia.,University of Hawai'i Economic Research Organisation, University of Hawai'i, Honolulu, HI, USA
| | - Kalinda Griffiths
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Centre for Big Data Research, The University of New South Wales, Sydney, Australia.,Centre for Health Equity, University of Melbourne, Melbourne, Australia
| | - Frank Sanfilippo
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,Perth Children's Hospital, Perth, Australia
| | - Kevin Murray
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| |
Collapse
|
42
|
Ayinuola O, Ayinuola YA, Qiu C, Lee SW, Ploplis VA, Castellino FJ. Binding of the kringle-2 domain of human plasminogen to streptococcal PAM-type M-protein causes dissociation of PAM dimers. Microbiologyopen 2021; 10:e1252. [PMID: 34964287 PMCID: PMC8633249 DOI: 10.1002/mbo3.1252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
The direct binding of human plasminogen (hPg), via its kringle-2 domain (K2hPg ), to streptococcal M-protein (PAM), largely contributes to the pathogenesis of Pattern D Group A Streptococcus pyogenes (GAS). However, the mechanism of complex formation is unknown. In a system consisting of a Class II PAM from Pattern D GAS isolate NS88.2 (PAMNS88.2 ), with one K2hPg binding a-repeat in its A-domain, we employed biophysical techniques to analyze the mechanism of the K2hPg /PAMNS88.2 interaction. We show that apo-PAMNS88.2 is a coiled-coil homodimer (M.Wt. ~80 kDa) at 4°C-25°C, and is monomeric (M.Wt. ~40 kDa) at 37°C, demonstrating a temperature-dependent dissociation of PAMNS88.2 over a narrow temperature range. PAMNS88.2 displayed a single tight binding site for K2hPg at 4°C, which progressively increased at 25°C through 37°C. We isolated the K2hPg /PAMNS88.2 complexes at 4°C, 25°C, and 37°C and found molecular weights of ~50 kDa at each temperature, corresponding to a 1:1 (m:m) K2hPg /PAMNS88.2 monomer complex. hPg activation experiments by streptokinase demonstrated that the hPg/PAMNS88.2 monomer complexes are fully functional. The data show that PAM dimers dissociate into functional monomers at physiological temperatures or when presented with the active hPg module (K2hPg ) showing that PAM is a functional monomer at 37°C.
Collapse
Affiliation(s)
- Olawole Ayinuola
- W. M. Keck Center for Transgene ResearchUniversity of Notre DameNotre DameIndianaUSA
| | - Yetunde A. Ayinuola
- W. M. Keck Center for Transgene ResearchUniversity of Notre DameNotre DameIndianaUSA
| | - Cunjia Qiu
- W. M. Keck Center for Transgene ResearchUniversity of Notre DameNotre DameIndianaUSA
- Department of Chemistry and BiochemistryUniversity of Notre DameNotre DameIndianaUSA
| | - Shaun W. Lee
- W. M. Keck Center for Transgene ResearchUniversity of Notre DameNotre DameIndianaUSA
- Department of Biological SciencesUniversity of Notre DameNotre DameIndianaUSA
| | - Victoria A. Ploplis
- W. M. Keck Center for Transgene ResearchUniversity of Notre DameNotre DameIndianaUSA
- Department of Chemistry and BiochemistryUniversity of Notre DameNotre DameIndianaUSA
| | - Francis J. Castellino
- W. M. Keck Center for Transgene ResearchUniversity of Notre DameNotre DameIndianaUSA
- Department of Chemistry and BiochemistryUniversity of Notre DameNotre DameIndianaUSA
| |
Collapse
|
43
|
Kulik E, Stuart B, Willcox M. Predictors of rheumatic fever in sore throat patients: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 116:286-297. [PMID: 34636404 PMCID: PMC8978297 DOI: 10.1093/trstmh/trab156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/17/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background Concerns about rheumatic fever (RF) drive antibiotic prescriptions for sore throat (ST) in endemic areas. Better guidance is needed on which patients are likely to develop RF in order to avoid misuse and overuse of antibiotics. Our aim was to identify predictive factors for RF in ST patients. Methods Multiple databases were searched to identify cohort, case–control, cross-sectional or randomised controlled trials that measured RF incidence in ST patients. An inverse variance random effects model was used to pool the data and calculate odds ratios (ORs). Results Seven studies with a total of 6890 participants were included: three RCTs and four observational studies. Factors significantly associated with RF development following ST were positive group A streptococcal (GAS) swab (OR 1.74 [95% confidence interval {CI} 1.13 to 2.69]), previous RF history (OR 13.22 [95% CI 4.86 to 35.93]) and a cardiac murmur (OR 3.55 [95% CI 1.81 to 6.94]). Many potential risk factors were not reported in any of the included studies, highlighting important evidence gaps. Conclusions ST patients in endemic areas with a positive GAS swab, previous RF history and a cardiac murmur are at increased risk of developing RF. This review identifies vital gaps in our knowledge of factors predicting RF development in ST patients. Further research is needed to develop better clinical prediction tools and rationalise antibiotic use for ST.
Collapse
Affiliation(s)
- Ellen Kulik
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Beth Stuart
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| | - Merlin Willcox
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK
| |
Collapse
|
44
|
Abstract
PURPOSE OF REVIEW Rheumatic heart disease (RHD) is a neglected disease of poverty, which presents challenges for patients, communities, and health systems. These effects are magnified in low resource countries, which bear the highest disease burden. When considering the impact of RHD, it is imperative that we widen our lens in order to better understand how RHD impacts the over 40 million people currently living with this preventable condition and their communities. We aimed to perform an updated literature review on the global impact of RHD, examining a broad range of aspects from disease burden to impact on healthcare system to socioeconomic implications. RECENT FINDINGS RHD accounts for 1.6% of all cardiovascular deaths, resulting in 306,000 deaths yearly, with a much higher contribution in low- and middle-income countries, where 82% of the deaths occurred in 2015. RHD can result in severe health adverse outcomes, markedly heart failure, arrhythmias, stroke and embolisms, and ultimately premature death. Thus, preventive, diagnostic and therapeutic interventions are required, although insufficiently available in undersourced settings. As examples, anticoagulation management is poor in endemic regions - and novel oral anticoagulants cannot be recommended - and less than 15% of those in need have access to interventional procedures and valve replacement in Africa. RHD global impact remains high and unequally distributed, with a marked impact on lower resourced populations. This preventable disease negatively affects not only patients, but also the societies and health systems within which they live, presenting broad challenges and high costs along the pathway of prevention, diagnosis, and management.
Collapse
|
45
|
Okello E, Ndagire E, Muhamed B, Sarnacki R, Murali M, Pulle J, Atala J, Bowen AC, DiFazio MP, Nakitto MG, Harik NS, Kansiime R, Longenecker CT, Lwabi P, Agaba C, Norton SA, Omara IO, Oyella LM, Parks T, Rwebembera J, Spurney CF, Stein E, Tochen L, Watkins D, Zimmerman M, Carapetis JR, Sable CA, Beaton A. Incidence of acute rheumatic fever in northern and western Uganda: a prospective, population-based study. Lancet Glob Health 2021; 9:e1423-e1430. [PMID: 34419237 PMCID: PMC11144057 DOI: 10.1016/s2214-109x(21)00288-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute rheumatic fever is infrequently diagnosed in sub-Saharan African countries despite the high prevalence of rheumatic heart disease. We aimed to determine the incidence of acute rheumatic fever in northern and western Uganda. METHODS For our prospective epidemiological study, we established acute rheumatic fever clinics at two regional hospitals in the north (Lira district) and west (Mbarara district) of Uganda and instituted a comprehensive acute rheumatic fever health messaging campaign. Communities and health-care workers were encouraged to refer children aged 3-17 years, with suspected acute rheumatic fever, for a definitive diagnosis using the Jones Criteria. Children were referred if they presented with any of the following: (1) history of fever within the past 48 h in combination with any joint complaint, (2) suspicion of acute rheumatic carditis, or (3) suspicion of chorea. We excluded children with a confirmed alternative diagnosis. We estimated incidence rates among children aged 5-14 years and characterised clinical features of definite and possible acute rheumatic fever cases. FINDINGS Data were collected between Jan 17, 2018, and Dec 30, 2018, in Lira district and between June 5, 2019, and Feb 28, 2020, in Mbarara district. Of 1075 children referred for evaluation, 410 (38%) met the inclusion criteria; of these, 90 (22%) had definite acute rheumatic fever, 82 (20·0%) had possible acute rheumatic fever, and 24 (6%) had rheumatic heart disease without evidence of acute rheumatic fever. Additionally, 108 (26%) children had confirmed alternative diagnoses and 106 (26%) had an unknown alternative diagnosis. We estimated the incidence of definite acute rheumatic fever among children aged 5-14 years as 25 cases (95% CI 13·7-30·3) per 100 000 person-years in Lira district (north) and 13 cases (7·1-21·0) per 100 000 person-years in Mbarara district (west). INTERPRETATION To the best of our knowledge, this is the first population-based study to estimate the incidence of acute rheumatic fever in sub-Saharan Africa. Given the known rheumatic heart disease burden, it is likely that only a proportion of children with acute rheumatic fever were diagnosed. These data dispel the long-held hypothesis that the condition does not exist in sub-Saharan Africa and compel investment in improving prevention, recognition, and diagnosis of acute rheumatic fever. FUNDING American Heart Association Children's Strategically Focused Research Network Grant, THRiVE-2, General Electric, and Cincinnati Children's Heart Institute Research Core.
Collapse
Affiliation(s)
- Emmy Okello
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda; Department of Medicine, Makerere University, Kampala, Uganda
| | - Emma Ndagire
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Babu Muhamed
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Rachel Sarnacki
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Meghna Murali
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Jafesi Pulle
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Jenifer Atala
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, and Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia
| | - Marc P DiFazio
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - M G Nakitto
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Nada S Harik
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Rosemary Kansiime
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Chris T Longenecker
- Case Western Reserve University, Health Education Campus, Cleveland, OH, USA
| | - Peter Lwabi
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Collins Agaba
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Scott A Norton
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Isaac Otim Omara
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Linda Mary Oyella
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Tom Parks
- Wellcome Center for Human Genetics, The London School of Tropical Medicine and Hygiene, London, UK
| | | | - Christopher F Spurney
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Elizabeth Stein
- University of Washington School of Medicine, Seattle, WA, USA
| | - Laura Tochen
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - David Watkins
- Department of Medicine and Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, and Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia
| | - Craig A Sable
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; The University of Cincinnati School of Medicine, Cincinnati, OH, USA.
| |
Collapse
|
46
|
Kusumanegara J, Mallapasi MN, Kabo P, Usman U, Syamsuddin D, Faruk M. Left atrial reverse remodeling improves sinus restoration following mitral valve replacement: A case report. Int J Surg Case Rep 2021; 86:106305. [PMID: 34418809 PMCID: PMC8384937 DOI: 10.1016/j.ijscr.2021.106305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction Mitral stenosis is one of the most common abnormalities in rheumatic heart disease (RHD). These patients often experience atrial fibrillation, due to left atrial dilatation, causing a high risk of thromboembolic events; rhythm or heart rate control are thus important treatment strategies. In patients undergoing surgery, sinus rhythm restoration is not fully understood, and not all surgical patients return to sinus rhythm. We report an adult woman with mitral regurgitation who experienced sinus restoration after mitral valve replacement (MVR) surgery. Case presentation A 44-year-old woman presented with chief complaints of orthopnea and shortness of breath during activity for 2 months. Electrocardiography (ECG) revealed atrial fibrillation with normal ventricular response, and echocardiography showed severe mitral stenosis with Wilkins score of 10 (3-2-3-2), moderate mitral and aortic regurgitation due to RHD, moderate tricuspid regurgitation with probable pulmonary hypertension, normal left ventricular systolic function, ejection fraction of 60.5% (biplane). MVR surgery was performed using a mechanical mitral valve. Postoperative ECG found sinus rhythm and first-degree AV block. Postoperative echocardiography found a decreased left Atrial volume index of 70.8 mL/m2, indicating further remodeling of the patient's heart. Conclusion Sinus restoration sometimes occurs in patients after MVR. The correction procedure causes minimal anatomical changes, particularly the loss of non-conductive and pathological tissue, followed by hemodynamic changes that eventually lead to the left atrial reverse remodeling mechanism. Mitral stenosis is one of the most common abnormalities in rheumatic heart disease. Sinus restoration is sometimes found after mitral valve replacement. Non-conductive tissue loss and improved hemodynamics can lead to sinus restoration.
Collapse
Affiliation(s)
- Jayarasti Kusumanegara
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Wahidin Sudirohusodo Hospital, Makassar, Indonesia.
| | - Muhammad Nuralim Mallapasi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Wahidin Sudirohusodo Hospital, Makassar, Indonesia.
| | - Peter Kabo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Umar Usman
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Deni Syamsuddin
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| |
Collapse
|
47
|
Teixeira AL, Vasconcelos LP, Nunes MDCP, Singer H. Sydenham's chorea: from pathophysiology to therapeutics. Expert Rev Neurother 2021; 21:913-922. [PMID: 34353207 DOI: 10.1080/14737175.2021.1965883] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sydenham's chorea is an autoimmune chorea emerging after a group A beta-hemolytic streptococcal (GABHS) infection, i.e. a rheumatic chorea with or without the presence of carditis or arthritis. The disorder, defined by the presence of chorea, is also associated with cognitive and behavioral symptoms, including emotional lability, anxiety, depressive and obsessive-compulsive symptoms. The authors review the pathophysiology, clinical characteristics, and available evidence on therapeutic strategies, the latter including the secondary prevention of GABHS infections, reduction of chorea, and immune modulation. Sydenham's chorea has been regarded as a model for pediatric autoimmune neuropsychiatric disorders, however, the field is marked by conflicting results and controversies. Regarding therapeutics, there are limited high-quality interventional studies and the selection of treatment strategy often relies on the clinician's experience. A serial treatment algorithm is presented based upon the severity of clinical presentation and response to symptomatic pharmacotherapy.
Collapse
Affiliation(s)
- Antonio L Teixeira
- Infectious Diseases and Tropical Medicine Graduation Program, School of Medicine, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil.,Institute of Education and Research, Santa Casa Bh, Belo Horizonte, Brazil.,Neuropsychiatry Program, Ut Health Science Center at Houston, USA
| | - Luiz P Vasconcelos
- Infectious Diseases and Tropical Medicine Graduation Program, School of Medicine, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Maria do Carmo Pereira Nunes
- Infectious Diseases and Tropical Medicine Graduation Program, School of Medicine, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Harvey Singer
- Department of Neurology, Johns Hopkins Medicine and Kennedy Krieger Institute, Baltimore, MD, USA
| |
Collapse
|
48
|
Ghosh S, King-Morris K, Shultz J. Concomitant Acute Rheumatic Fever and Acute Post Streptococcal Glomerulonephritis. Cureus 2021; 13:e16357. [PMID: 34395134 PMCID: PMC8359909 DOI: 10.7759/cureus.16357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 11/28/2022] Open
Abstract
Acute rheumatic fever (RF) and acute post Streptococcal glomerulonephritis (APSGN) are non-suppurative complications of a Group A Streptococcus (GAS) infection. The concomitant incidence of both complications in a patient is rare because nephritogenic and rheumatogenic strains belong to different serotypes of Group A beta-hemolytic Streptococcus (GABHS). We present a case of a 47-year-old female who had concomitant acute RF and APSGN from a Streptococcus pyogenes infection. It is important to have a high clinical suspicion for the sequela of GABHS infection in the setting of cardiac and renal disease following upper respiratory infection (URI) symptoms even in adults and in geographic locations with the nearly undetectable burden of acute RF because of the importance of secondary prophylaxis with an antibiotic.
Collapse
Affiliation(s)
- Somshukla Ghosh
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | - Joshua Shultz
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| |
Collapse
|
49
|
de Loizaga SR, Arthur L, Arya B, Beckman B, Belay W, Brokamp C, Hyun Choi N, Connolly S, Dasgupta S, Dibert T, Dryer MM, Gokanapudy Hahn LR, Greene EA, Kernizan D, Khalid O, Klein J, Kobayashi R, Lahiri S, Lorenzoni RP, Otero Luna A, Marshall J, Millette T, Moore L, Muhamed B, Murali M, Parikh K, Sanyahumbi A, Shakti D, Stein E, Shah S, Wilkins H, Windom M, Wirth S, Zimmerman M, Beck AF, Ollberding N, Sable C, Beaton A. Rheumatic Heart Disease in the United States: Forgotten But Not Gone: Results of a 10 Year Multicenter Review. J Am Heart Assoc 2021; 10:e020992. [PMID: 34348475 PMCID: PMC8475057 DOI: 10.1161/jaha.120.020992] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. Methods and Results Twenty‐two US pediatric institutions participated in a 10‐year review (2008–2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management. Geocoding was used to determine a census tract‐based socioeconomic deprivation index. Descriptive statistics of patient characteristics and regression analysis of RHD classification, disease severity, and initial antibiotic prescription according to community deprivation were obtained. Data for 947 cases showed median age at diagnosis of 9 years; 51% and 56% identified as male and non‐White, respectively. Most (89%) had health insurance and were first diagnosed in the United States (82%). Only 13% reported travel to an endemic region before diagnosis. Although 96% of patients were prescribed secondary prophylaxis, only 58% were prescribed intramuscular benzathine penicillin G. Higher deprivation was associated with increasing disease severity (odds ratio, 1.25; 95% CI, 1.08–1.46). Conclusions The majority of recent US cases of ARF and RHD are endemic rather than the result of foreign exposure. Children who live in more deprived communities are at risk for more severe disease. This study demonstrates a need to improve guideline‐based treatment for ARF/RHD with respect to secondary prophylaxis and to increase research efforts to better understand ARF and RHD in the United States.
Collapse
Affiliation(s)
| | - Lindsay Arthur
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital Little Rock AR
| | - Bhawna Arya
- Seattle Children's Hospital/University of Washington School of Medicine Seattle WA
| | | | - Wubishet Belay
- Monroe Carell Jr Children's Hospital at Vanderbilt Nashville TN
| | - Cole Brokamp
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | - Nak Hyun Choi
- Morgan Stanley Children's Hospital of New York PresbyterianColumbia University Medical Center New York NY
| | - Sean Connolly
- Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL
| | - Soham Dasgupta
- Children's Healthcare of AtlantaEmory University Atlanta GA
| | - Tavenner Dibert
- University of Florida Health, Shands Children's Hospital Gainesville FL
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elizabeth Stein
- Seattle Children's Hospital/University of Washington School of Medicine Seattle WA
| | | | - Hannah Wilkins
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital Little Rock AR
| | | | - Scott Wirth
- Cincinnati Children's Hospital Medical Center Cincinnati OH
| | | | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | - Nicholas Ollberding
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | | | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| |
Collapse
|
50
|
Samaan AA, Said K, Aroussy WE, Hassan M, Romeih S, El Sawy A, Fawzy ME, Yacoub M. Left Ventricular Remodeling Following Balloon Mitral Valvuloplasty in Rheumatic Mitral Stenosis: Magnetic Resonance Imaging Study. Front Cardiovasc Med 2021; 8:674435. [PMID: 34150869 PMCID: PMC8212956 DOI: 10.3389/fcvm.2021.674435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Rheumatic heart disease affects primarily cardiac valves, it could involve the myocardium either primarily or secondary to heart valve affection. The influence of balloon mitral valvuloplasty (BMV) on left ventricular function has not been sufficiently studied. Aim: To determine the influence of balloon mitral valvuloplasty (BMV) on both global and regional left ventricular (LV) function. Methods: Thirty patients with isolated rheumatic mitral stenosis (MS) were studied. All patients had cardiac magnetic resonance imaging (CMR) before, 6 months and 1 year after successful BMV. LV volumes, ejection fraction (EF), regional and global LV deformation, and LV late gadolinium enhancement were evaluated. Results: At baseline, patients had median EF of 57 (range: 45–69) %, LVEDVI of 74 (44–111) ml/m2 and LVESVI of 31 (14–57) ml/m2 with absence of late gadolinium enhancement in all myocardial segments. Six months following BMV, there was a significant increase in LV peak systolic global longitudinal strain (GLS) (−16.4 vs. −13.8, p < 0.001) and global circumferential strain (GCS) (−17.8 vs. −15.6, p = 0.002). At 1 year, there was a trend towards decrease in LVESVI (29 ml/m2, p = 0.079) with a significant increase in LV EF (62%, p < 0.001). A further significant increase, compared to 6 months follow up studies, was noticed in GLS (−17.9 vs. −16.4, p = 0.008) and GCS (−19.4 vs. −17.8 p = 0.03). Conclusions: Successful BMV is associated with improvement in global and regional LV systolic strain which continues for up to 1 year after the procedure.
Collapse
Affiliation(s)
- Amir Anwar Samaan
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.,Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Karim Said
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.,Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Wafaa El Aroussy
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mohammed Hassan
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Soha Romeih
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Amr El Sawy
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Mohammed Eid Fawzy
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Magdi Yacoub
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt.,Department of Cardiothoracic Surgery, Imperial College London, London, United Kingdom
| |
Collapse
|