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Javadi V, Mansourizadeh E, Pourmoshtagh H, Rahmani K, Hassas Yeganeh M. Monoarthritis as the initial presentation of acute rheumatic fever in Iran: A single-center retrospective cross-sectional study. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:328-333. [PMID: 38807722 PMCID: PMC11129065 DOI: 10.22088/cjim.15.2.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/09/2023] [Accepted: 08/16/2023] [Indexed: 05/30/2024]
Abstract
Background In Iran, there is a lack of information and studies on acute rheumatic fever (ARF), a global health issue. The limited understanding of ARF's prevalence and primary clinical symptoms has led to confusion. This research investigates the characteristics of children aged 3-17 years who experience ARF with monoarthritis as their initial symptom. Methods A retrospective evaluation of medical records of children diagnosed with ARF was conducted. The study aimed to determine the prevalence of monoarthritis as the first manifestation of ARF and its association with age, gender, family history, and cardiac involvement. Categorical variables were analyzed using the chi-square test with a significance level of < 0.05 and a confidence interval of 95%, using SPSS software (Version 23). Results The study included 62 patients with ARF, comprising 41 (66.1%) boys with an average age of 8.48±3.27 years. Among these patients, 12 exhibited cardiac involvement according to the revised Jones criteria, with 5 clinical carditis and 7 cases of subclinical carditis. Monoarthritis was the initial symptom in seven patients (11.29%); five (71.4%) also had carditis. There was a significant association (p<0.001) between monoarthritis and carditis. Conclusion The study concludes that monoarthritis may be an early sign of ARF in children and correlates significantly with cardiac involvement. However, more extensive research with more significant participant numbers is necessary to understand ARF in Iran comprehensively. A thorough cardiac examination is also crucial for patients with ARF and monoarthritis.
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Affiliation(s)
- Vadood Javadi
- Department of Pediatric Rheumatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Mansourizadeh
- Department of Pediatric Rheumatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Pourmoshtagh
- Department of Pediatrics, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Rahmani
- Department of Pediatric Rheumatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Hassas Yeganeh
- Department of Pediatric Rheumatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shahid S, Khurram H, Billah B, Akbar A, Shehzad MA, Shabbir MF. Machine learning methods for predicting major types of rheumatic heart diseases in children of Southern Punjab, Pakistan. Front Cardiovasc Med 2022; 9:996225. [PMID: 36312229 PMCID: PMC9596762 DOI: 10.3389/fcvm.2022.996225] [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: 08/16/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Rheumatic heart disease (RHD) is a major health problem in the world, particularly in developing countries. This study aimed to predict mitral regurgitation (MR) and mitral stenosis (MS) RHD among children with RHD. Methodology Data was collected from the Pediatric Cardiology Department at Chaudhry Pervaiz Elahi Institute of Cardiology Multan, Pakistan from March to October 2019. A sample of 561 children aged 4–14 years, who were diagnosed with RHD of either MR or MS, were recruited from the hospital’s outpatient department. The presence of multivariate outliers was detected, and different machine learning methods, including subset logistic regression, subset logistic regression after deletion, stepwise winsorized logistic regression, robust logistic regression, subset deep neural network, and random forest models were compared using the area under receiver operating characteristics (ROC) curve, sensitivity, and specificity. Parsimony was also considered in model selection. Results Out of 561 patients in this study, 75.94% had RHD MR and 24.06% had RHD MS. The average age of study participants was 9.19 ± 2.45 years and of them 55.43% were male. Among the male participants, 58.6 and 45.2% had MR and MS, respectively; and among female participants, those were 70.4 and 29.6%, respectively. Subset logistic regression after deletion appeared as competitive with a discrimination power of 90.1% [95% CI 0.818–0.983]. The sensitivity and specificity of this model were 85.1 and 70.6%. Conclusion The best predictive model was subset logistic regression after deletion. The predicted method will be used in the decision-making process, which helps early diagnosis of the disease and leads to prevention. The study findings provide the proper guideline for earlier diagnosis of the RHD MR and MS cases among children with RHD in Pakistan.
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Affiliation(s)
- Sana Shahid
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
| | - Haris Khurram
- Department of Sciences and Humanities, National University of Computer and Emerging Sciences, Chiniot, Pakistan,*Correspondence: Haris Khurram,
| | - Baki Billah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Atif Akbar
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
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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
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Mokitimi N, van der Donck K, Moutlana H, Chakane PM. Profile of adult patients presenting for rheumatic mitral valve surgery at a tertiary academic hospital. Cardiovasc J Afr 2021; 32:261-266. [PMID: 34292292 PMCID: PMC8756030 DOI: 10.5830/cvja-2021-024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 05/25/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Peri-operative morbidity and mortality are increased in patients with rheumatic heart disease. Pre-operative risk stratification is imperative for optimisation and a better outcome. METHODS This was a descriptive, retrospective, contextual study. A consecutive convenience sampling method was used. Eighty-nine patients who underwent mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital between January 2014 and December 2015 were enrolled. The objectives of the study were to describe the demographic profile of the patients presenting for rheumatic mitral valve surgery, describe their peri-operative cardiovascular and echocardiographic parameters, and risk stratify according to their clinical and echocardiographic parameters. Demographic, echocardiographic and laboratory data as well as the cardiovascular examination were analysed. Descriptive statistics using proportions (percentages), means (standard deviations) or medians (interquartile ranges) were used where appropriate. RESULTS A total of 102 patients were reviewed. Thirteen were excluded due to significant missing data. Of the 89 analysed, all had demographic data, 81 had cardiovascular clinical examination data, 82 had echocardiographic data and 52 had laboratory data. Forty-seven patients presented with mitral regurgitation (MR) and 35 had mitral stenosis (MS). Data included two mixed mitral valve disease patients with predominant regurgitation who were classified under the MR group. In total, 45% (39 patients) had arrhythmias and 49% (42 patients) had congestive cardiac failure at presentation for surgery. The overall mean (SD) pulmonary artery systolic pressure was 57 (20) mmHg and mean (SD) left atrial size was 53 (11) mm. Those with MS presented with mean (SD) mitral valve area of 0.9 (0.2) cm2. Of the analysed MR patients, 51% presented with left ventricular ejection fraction < 60% and 55% with left ventricular end-systolic diameter > 40 mm. Among the analysed MS patients, 59% had mitral valve area < 1 cm2. A substantial number (49% MR and 54% MS) of collected records were not eligible for analysis and stratification using the American Heart Association/American College of Cardiology (ACC/AHA) guidelines for valvular heart disease due to missing vital information. Of the 24 MR patients analysed utilising the 2014/2017 AHA/ACC guidelines, 13 had asymptomatic severe MR (stage C) and 11 had symptomatic severe MR (stage D). One patient had progressive MS (stage B), eight had asymptomatic severe MS (stage C) and seven had symptomatic severe MS (stage D). CONCLUSIONS The majority of those who could be stratified presented in stages C and D of disease progression; however, they also presented with concomitant clinical and echocardiographic features that placed them at high risk of perioperative morbidity.
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Affiliation(s)
- Nolwazi Mokitimi
- Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Katherina van der Donck
- Department of Cardiothoracic Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hlamatsi Moutlana
- Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Palesa Motshabi Chakane
- Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Sara H, Bouchra O, Angéla FK, Samira EF, Nehemie N, Samir A. Acute rheumatic fever in children: Experience at the hospital Hassan II of Fez, Morocco. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Lilyasari O, Prakoso R, Kurniawati Y, Roebiono PS, Rahajoe AU, Sakidjan I, Harimurti GM. Clinical Profile and Management of Rheumatic Heart Disease in Children and Young Adults at a Tertiary Cardiac Center in Indonesia. Front Surg 2020; 7:47. [PMID: 32903397 PMCID: PMC7434961 DOI: 10.3389/fsurg.2020.00047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/23/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: Rheumatic heart disease (RHD) remains a major public health issue affecting children and young adults in developing countries. This study aimed to evaluate the clinical characteristics, management, and reactivation of RHD among children and young adults. Patients and Methods: This was a hospital-based retrospective study conducted at the National Cardiovascular Center Harapan Kita, Indonesia; we retrieved relevant data from patients diagnosed with RHD between 2012 and 2018. Results: Two hundred and seventy-nine patients were diagnosed with rheumatic heart disease, of whom 108 were children (mean age of 12.02 ± 3.36 years) and 171 were young adults (mean age was 24.9 ± 3.84). RHD was more common in female than in male young adults (1.5:1). Hospitalization due to RHD complications such as congestive heart failure was seen in 11.11% of cases in children, while pulmonary hypertension was present in 19.95% young adult cases. Reactivation of RHD occurred in 17.2% (48/279) cases, significantly in children (p < 0.001). Overall, the mitral valve (either isolated or combined) was the organ most affected in children (39.13%) and young adults (44.81%). Isolated mitral regurgitation was more common in children (13/21, 61.9%), while isolated mitral stenosis was more common in young adults (19/47, 40.42%). There was a high rate of rheumatic tricuspid valve disease in all populations (193/279, 69.17%) and reported involvement of pulmonary regurgitation (46/279, 16.48%). Multivalve lesions were more common than single lesions in both groups, with a combination of mitral and tricuspid regurgitation the predominant type in children (32/43, 74.41%) and mixed mitral lesion and tricuspid regurgitation in young adults (22/72, 30.56%). We observed a significant occurrence of quadrivalve lesions in children (p = 0.039). Valve repair was more common in children (49.07%) and replacement in young adults (32.16%), with low in-hospital mortality. Compliance with secondary prophylaxis was a significant challenge. Conclusion: Chronic RHD often presented with complications of the disease or reactivation of rheumatic fever (RF). Inadequate treatment of RF/RHD leads to extensive valvular damage and consequent disabilities. Efforts toward active early diagnosis and prompt treatment of RF/RHD and effective preventive measures are essential.
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Affiliation(s)
- Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Radityo Prakoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Yovi Kurniawati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Poppy S Roebiono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Anna Ulfah Rahajoe
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Indriwanto Sakidjan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Ganesja M Harimurti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
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Acute rheumatic fever in south-east of Turkey: clinical features and epidemiological evaluation of the patients over the last 25 years. Cardiol Young 2020; 30:1086-1094. [PMID: 32611460 DOI: 10.1017/s1047951120001596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study evaluates clinical and epidemiological features of acute rheumatic fever using the data of last 25 years in our hospital in south-east of Turkey. The medical records of 377 patients with acute rheumatic fever admitted to Pediatric Cardiology Department of Çukurova University during 1993-2017 were retrospectively analysed. Two hundred and six patients were admitted between 1993 and 2000, 91 between 2001 and 2008, and 80 between 2009 and 2017. The largest age group (52%) were between 9 to 12 years of age and approximately two-thirds of the patients presented in the spring and winter seasons (62.8%). Among the major findings, the most common included carditis 83.6% (n = 315), arthritis at 74% (n = 279), Sydenham's chorea at 13.5% (n = 51), and only two patients (0.5%) had erythema marginatum and two patients (0.5%) had subcutaneous nodule. Carditis was the most common manifestation observed in 315 patients (83.6%). The most commonly affected valve was the mitral valve alone (54.9%), followed by a combined mitral and aortic valves (34%) and aortic valve alone (5.7%). Of the patients with carditis, 48.6% (n = 153) had mild carditis, of which 45 had a subclinical. Sixty-two patients (19.7%) had moderate and 100 patients (31.7%) had severe carditis. At the follow-up, 2 patients died and 16 patients underwent valve surgery. Twenty-eight (7.4%) patients' valve lesions were completely resolved. Conclusion: Although the incidence of acute rheumatic fever decreased, it still is an important disease that can cause serious increases in morbidity and mortality rates in our country.
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Sharma N, Toor D. Impact of Socio-Economic Factors on Increased Risk and Progression of Rheumatic Heart Disease in Developing Nations. Curr Infect Dis Rep 2019; 21:21. [DOI: 10.1007/s11908-019-0677-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Munteanu V, Petaccia A, Contecaru N, Amodio E, Agostoni CV. Paediatric acute rheumatic fever in developed countries: Neglected or negligible disease? Results from an observational study in Lombardy (Italy). AIMS Public Health 2018; 5:135-143. [PMID: 30094276 PMCID: PMC6079050 DOI: 10.3934/publichealth.2018.2.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Acute Rheumatic Fever (ARF) is a multisystemic disease that results from an autoimmune reaction due to group A streptococcal infection. The disease affects predominantly children aged 5 to 15 years and although its incidence in developed Countries declined since the early 1900s, to date there is a paucity of data that confirm this epidemiological trend. Objective The study aimed to assess the burden of ARF in term of hospitalization and to describe the characteristics of acute rheumatic fever (ARF) in the paediatric population of Lombardy. Study design The study was carried out by analyzing hospital discharge records of patients resident of Lombardy and aged 0–17 years old who, from 2014 to 2016, were hospitalized with the diagnosis of ARF. The following variables have been studied: age, sex, municipality of residence, date of diagnosis of each patient, hospital of admission, and presentation of the disease. Results From 2014 to 2016, 215 patients were found to meet the inclusion criteria and diagnosed as affected from Acute Rheumatic Fever. The rate of hospitalization showed a slightly increasing trend from 3.42 in 2014 to about 5.0 in 2016. Moreover, ARF presented a typical seasonal trend with lower cases in the autumn and a peak of hospitalization in the spring. Conclusion To date, ARF seems to be a rare but not negligible disease in southern central European countries, and in Lombardy we estimated an annual hospitalization rate of 4.24 cases per 100,000 children. The increasing trend found in our study suggests that the burden of the disease could be reduced by involving multidisciplinary health professionals who, in addition to the paediatrician of free choice, would promote evidence based medicine management of the disease during all its clinical phases.
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Affiliation(s)
- Viorica Munteanu
- Department of Paediatrics, IRCCS Ospedale Maggiore Policlinico, DISCCO, University of Milan, Milan, Italy
| | - Antonella Petaccia
- Department of Paediatrics, IRCCS Ospedale Maggiore Policlinico, DISCCO, University of Milan, Milan, Italy
| | - Nicolae Contecaru
- Health Protection Agency of Brianza (Italy), Viale Elvezia n.2 Monza (MB) 20900
| | - Emanuele Amodio
- Health Protection Agency of Brianza (Italy), Viale Elvezia n.2 Monza (MB) 20900
| | - Carlo Virginio Agostoni
- Department of Paediatrics, IRCCS Ospedale Maggiore Policlinico, DISCCO, University of Milan, Milan, Italy
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Abstract
Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.
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Affiliation(s)
- Scott Dougherty
- Department of Internal Medicine, Ministry of Health, Belau National Hospital, Koror, Republic of Palau
| | - Maziar Khorsandi
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Philip Herbst
- Division of Cardiology, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
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Boyarchuk O, Boytsanyuk S, Hariyan T. Acute rheumatic fever: clinical profile in children in western Ukraine. J Med Life 2017; 10:122-126. [PMID: 28616087 PMCID: PMC5467252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Acute rheumatic fever (ARF) may have different clinical manifestations in different countries according to the genetic predisposition, prevalence of rheumatogenic strains, social and economic conditions. The purpose of this study was to determine the clinical characteristics of ARF in Western Ukraine and to improve the detection of the cases. A retrospective analysis of 85 medical clinical cases of in-hospital patients aged from 4 to 17 years old was performed. The cases covered patients who underwent treatment in the City Children's Hospital of Ternopil during 2000 and 2013 with the ARF diagnosis, which was established according to Jones criteria. 65.9% of the ARF patients were admitted to the hospital from October to March. Fever (65.9%) and joint syndrome (78.8%) were the most common causes for admission to the medical care. The admission diagnosis was wrong in 34 (40.0%) children who underwent the treatment. The most frequent major Jones criteria of ARF were carditis (84.7%) and polyarthritis (54.1%). Chorea was significantly less common than carditis (р < 0,001). The adequate treatment of the preceding streptococcal infection was administered in 25 children (53.2%). CONCLUSIONS The significant incidence of misdiagnoses in the ARF children during admission to the hospital, especially the interpretation of joint syndrome, indicates that physicians need an extra awareness. The lack of specific clinical signs of rheumatic carditis makes it a diagnostic challenge. The revised Jones criteria (2015) for the diagnosis of ARF can improve carditis detection. The adequate treatment of the preceding streptococcal infection may prevent ARF. Abbreviations: ARF = acute rheumatic fever.
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Affiliation(s)
- O Boyarchuk
- Department of Children’s Diseases and Pediatric Surgery, I. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
| | - S Boytsanyuk
- Department of Children’s Diseases and Pediatric Surgery, I. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
| | - T Hariyan
- Department of Children’s Diseases and Pediatric Surgery, I. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
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Rodriguez-Fernandez R, Amiya R, Wyber R, Widdodow W, Carapetis J. Rheumatic heart disease among adults in a mining community of Papua, Indonesia: findings from an occupational cohort. HEART ASIA 2015; 7:44-48. [PMID: 26294934 PMCID: PMC4537650 DOI: 10.1136/heartasia-2015-010641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/01/2015] [Accepted: 07/07/2015] [Indexed: 11/22/2022]
Abstract
Background Rheumatic heart disease (RHD) remains a significant cause of cardiovascular morbidity and mortality in developing countries such as Indonesia. Yet, despite being one of the most readily preventable chronic diseases, RHD has received scant research or policy attention, particularly in South-East Asia. Aim To describe the pattern of RHD occurrence in a sample of presenting cases from an occupational cohort in Papua Province, Indonesia. Methods Clinical records of 15 608 mining workers (96.4% men, mean age 36.3±7.4 years) were reviewed retrospectively to identify and extract data on all rheumatic fever (RF) and RHD cases admitted to two hospitals in Papua during 2008–2013. Collected data included basic demographics, employment history and echocardiographic findings. Results 83 RHD cases (95.6% men, mean age 39.6±12.5 years) and 3 RF cases were identified between 2008 and 2013. Increased RHD risk was observed among those aged 35–44 (HR=3.60) and 45–68 (HR=4.46) years relative to the youngest age group (p<0.01). RHD incidence density was 6.84 per 10 000 person years of follow-up. Among cases, mitral stenosis was the most common valvular lesion at initial presentation (41.0%), and 6.0% were multivalvular. Conclusions The prevalence of RHD in Papuan mining workers correlates with adult prevalence data in other populations with a high RHD burden, highlighting RHD as a significant health issue into adulthood. The late stage at which most patients presented points to a strong need for earlier intervention. Both primary and secondary preventive measures must be considered critical tools to prevent and reduce RHD burden, particularly among older age groups.
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Affiliation(s)
- Rodrigo Rodriguez-Fernandez
- Freeport Public Health and Malaria Control , International SOS , Kuala Kencana, Papua , Indonesia ; NCD Asia Pacific Alliance , Tokyo , Japan
| | - Rachel Amiya
- NCD Asia Pacific Alliance , Tokyo , Japan ; Department of Family Nursing , University of Tokyo, Graduate School of Medicine , Tokyo , Japan
| | - Rosemary Wyber
- University of Western Australia, Telethon Kids Institute , Subiaco, Western Australia , Australia
| | - Wishnu Widdodow
- Department of Cardiology and Vascular Medicine , University of Indonesia , Jakarta , Indonesia
| | - Johnathan Carapetis
- University of Western Australia, Telethon Kids Institute , Subiaco, Western Australia , Australia
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Affiliation(s)
- Mohammed R Essop
- From the Division of Cardiology, CH-Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa.
| | - Ferande Peters
- From the Division of Cardiology, CH-Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
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Spina GS, Sampaio RO, Branco CE, Miranda GB, Rosa VEE, Tarasoutchi F. Incidental histological diagnosis of acute rheumatic myocarditis: case report and review of the literature. Front Pediatr 2014; 2:126. [PMID: 25478552 PMCID: PMC4238348 DOI: 10.3389/fped.2014.00126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/30/2014] [Indexed: 11/13/2022] Open
Abstract
Rheumatic fever (RF) remains endemic in many countries and frequently causes heart failure due to severe chronic rheumatic valvular heart disease, which requires surgical treatment. Here, we report on a patient who underwent an elective surgical correction for mitral and aortic valvular heart disease and had a post-operative diagnosis of acute rheumatic carditis. The incidental finding of Aschoff bodies in myocardial biopsies is frequently reported in the nineteenth-century literature, with prevalences as high as 35%, but no clinical or prognostic data on the patients is included. The high frequency of this finding after cardiac surgery in classical reports suggests that these patients were not using secondary prophylaxis for RF. We discuss the clinical diagnosis of acute rheumatic myocarditis in asymptomatic patients and the laboratorial and imaging methods for the diagnosis of acute rheumatic carditis. We also discuss the prognostic implications of this finding and review the related literature.
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Affiliation(s)
- Guilherme S Spina
- Valvular Heart Disease Department, Heart Institute (InCor), University of São Paulo Medical School , São Paulo , Brazil
| | - Roney O Sampaio
- Valvular Heart Disease Department, Heart Institute (InCor), University of São Paulo Medical School , São Paulo , Brazil
| | - Carlos E Branco
- Valvular Heart Disease Department, Heart Institute (InCor), University of São Paulo Medical School , São Paulo , Brazil
| | - George B Miranda
- Valvular Heart Disease Department, Heart Institute (InCor), University of São Paulo Medical School , São Paulo , Brazil
| | - Vitor E E Rosa
- Valvular Heart Disease Department, Heart Institute (InCor), University of São Paulo Medical School , São Paulo , Brazil
| | - Flávio Tarasoutchi
- Valvular Heart Disease Department, Heart Institute (InCor), University of São Paulo Medical School , São Paulo , Brazil
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