Pattern and severity of rheumatic valvular lesions in children in Khartoum, Sudan

We determined the pattern and severity of valvular involvement in 100 Sudanese patients with rheumatic heart disease [RHD] in 2 centres in Khartoum in 2003. All the patients underwent history taking, physical examination and Doppler echocardiography. The commonest lesions were mitral regurgitation [84%] and aortic regurgitation [40%]. Mitral stenosis alone was uncommon [9%] which could be due to a low detection rate related to the slow stenotic process and the subtle early signs. This, together with the inconsistent history of rheumatic fever, may lead to an underestimate of the prevalence of RHD. There was a strong correlation between severity of the lesion and irregular prophylaxis [P < 0.001]

Relationship between depression and non-adherence to anticoagulant therapy after valve replacement

Management of anticoagulant therapy after mechanical valve replacement is difficult in developing countries because of patient non-adherence. The effect of depression on adherence to drug therapy and to a clinic visit schedule was evaluated for 62 patients who received prostheses. All were prescribed a once-per-day regimen of warfarin and were scheduled for three appointments at the anticoagulant clinic for dose adjustment at 3-week intervals. According to the Center for Epidemiological Studies Depression Scale, 22 were depressed. Non-depressed patients were more compliant than depressed patients; adherence was inversely correlated with depression scores. While depression had no relationship with age, sex and cardiac symptoms, there was a relationship with anxiety and poor social support