Assessment of Myocardial Mechanics in Acute Rheumatic Fever Using Speckle-Tracking Echocardiography.

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.

Assessment of serum galectin-3 levels in acute rheumatic fever.

BACKGROUND: Galectin-3 is a biomarker which takes a role in both acute and chronic inflammation as well as fibrosis and oxidative stress. Increased levels of it are associated with cardiovascular diseases. This study was performed to investigate the levels of galectin-3 in acute rheumatic fever (ARF). METHODS: 30 patients with ARF and 26 healthy children were included. Galectin-3 levels of the patients were compared with the controls, as well as within the patients before and after the treatment. RESULTS: The patients had significantly lower galectin-3 levels on admission than the control (p=0.02), but its levels were not significantly different between these groups at the end of treatment (p=0.714). The mean galectin-3 levels of the patients were increased after the treatment (p < 0.001). Severity of carditis and galectin-3 levels were negatively correlated (r=-539, p=0.02). CONCLUSIONS: Children with ARF have significantly reduced levels of galectin-3 and there is a negative correlation between the severity of the carditis and galectin-3 levels. Studies with larger sample sizes may give more accurate data about the role of galectin-3 in ARF.

Burden of Group A Streptococcal Pharyngitis, Rheumatic Fever, and Rheumatic Heart Disease in India: A Systematic Review and Meta-Analysis.

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.

How Do Patients with Chronic Diseases Make Usage Decisions regarding Mobile Health Monitoring Service?

Objectives: The increasing population of patients with chronic diseases generates great challenge of chronic disease management. The occurrence of mobile health monitoring service (MHMS) is beneficial to chronic disease prevention and health promotion. The objective of this study is to investigate how patients with chronic diseases make usage decisions on MHMS. Study Design: A survey. Methods: 213 respondents with chronic diseases were asked to rate their level of health severity, negative health emotions, and health uncertainty avoidance. SmartPLS was used to test the measurement model. Results: Of 213 research respondents, 159 of them have one chronic disease, while 54 have more than one such disease. Perceived health severity of patients with chronic diseases positively influences MHMS usage intentions, while negative health emotions do not. Health uncertainty avoidance strengthens the effect of health severity but weakens the effect of negative health emotions on MHMS usage intentions. Conclusion: Patients with chronic diseases have a unique decision-making process regarding MHMS usage in which their special health-related factors and tendencies play a critical role in determining behavioral intentions.

Busca ativa por cardiopatias congênitas é factível? Experiência em oito cidades Brasileiras / Active search for congenital heart disease is possible? Experience from eight brazilian cities

Fundamentos: As cardiopatias congênitas são causa de alta morbimortalidade na faixa etária pediátrica. Em regiões em desenvolvimento, a falta de diagnóstico precoce pode acarretar a piora do quadro; uma busca ativa por cardiopatias congênitas pode colaborar na resolução dessa situação.Objetivo: Descrever os principais achados de uma busca ativa por cardiopatias na infância, realizada em oito cidades brasileiras do estado da Paraíba. Métodos: Estudo realizado em oito cidades brasileiras do estado da Paraíba. A busca ativa compreendeu duas fases. Na primeira, os centros de saúde locais realizaram a triagem de crianças com sintomas ou história clínica de doenças cardiovasculares. Na segunda fase, realizada uma consulta clínica com posterior realização de ecocardiograma para identificação de cardiopatias. As frequências obtidas foram analisadas. Variáveis categóricas foram comparadas utilizando-se o teste do qui-quadrado. Resultados: Atendidas 440 crianças. Destas, 192 (43,63%) apresentaram alterações ao ecocardiograma. As presenças de sopro e da síndrome de Down mostraram correlação significativa (p<0,05) com a cardiopatia congênita. A maioria dos casos era de cardiopatia congênita por shunt (64,1%), seguida pelos defeitos valvares (12,5%) e pelas cardiopatias obstrutivas acianogênicas (8,3%). Conclusão: A busca ativa realizada foi capaz de identificar um número expressivo de cardiopatias congênitas na infância, não reconhecidas previamente, e inserir esses pacientes nos serviços de saúde para o tratamento adequado, garantindo-lhes melhor qualidade de vida.

Background: Congenital heart defects are the cause of high morbidity and mortality in pediatric patients. In developing regions, the lack of early diagnosis may lead to worsening of the condition; an active search for congenital heart diseases can assist in resolving this situation. Objective: To describe the key findings of an active search for heart diseases in childhood, held in eight Brazilian cities in the state of Paraíba. Methods: A study conducted in eight Brazilian cities in the state of Paraíba. The active search included two phases. In the first, local health centers screened children with symptoms or a history of cardiovascular diseases. In the second phase, a clinical consultation with echocardiogram to identify diseases was conducted. The frequencies were then analyzed. Categorical variables were compared using the chi-square test. Results: 440 children were assisted. Of these, 192 (43.63%) had abnormalities on echocardiogram. The presence of heart sounds and Down’s syndrome showed a significant correlation (p <0.05) with the congenital heart disease. Most cases were congenital heart disease by shunt (64.1%), followed by valve defects (12.5%) and acyanogenic obstructive heart diseases (8.3%). Conclusion: The active search conducted was able to identify a significant number of congenital heart diseases in childhood not previously recognized and inserting these patients in health services for appropriate treatment, thus ensuring them a better quality of life.

Assessment of atrial electromechanical delay in children with acute rheumatic fever.

PURPOSE: There may be an increase in the risk of atrial arrhythmia due to left atrial enlargement and the influence on conduction system in acute rheumatic fever. The aim of this study is to investigate atrial electromechanical delay and P-wave dispersion in patients with acute rheumatic fever. PATIENTS: A total of 48 patients diagnosed with acute rheumatic fever and 40 volunteers of similar age, sex, and body mass index were included in the study. The study groups were compared for M-mode echocardiographic parameters, interatrial electromechanical delay, intra-atrial electromechanical delay, and P-wave dispersion. RESULTS: Maximum P-wave duration, P-wave dispersion, and interatrial electromechanical delay were significantly higher in patients with acute rheumatic fever compared with the control group (p < 0.001). However, there was no difference in terms of intra-atrial electromechanical delay (p > 0.05). For patients with acute rheumatic fever, a positive correlation was identified between the left atrium diameter and the P-wave dispersion and interatrial electromechanical delay (r = 0.524 and p < 0.001, and r = 0.351 and p = 0.014, respectively). Furthermore, an important correlation was also identified between the P-wave dispersion and the interatrial electromechanical delay (r = 0.494 and p < 0.001). CONCLUSION: This study shows the prolongation of P-wave dispersion and interatrial electromechanical delay in acute rheumatic fever. Left atrial enlargement can be one of the underlying reasons for the increase in P-wave dispersion and interatrial electromechanical delay.

Assessment of the natural history of forefoot bursae using ultrasonography in patients with rheumatoid arthritis: a twelve-month investigation.

OBJECTIVE: To determine the natural history and clinical significance of forefoot bursae over a 12-month period in patients with rheumatoid arthritis (RA). METHODS: Patients with RA (n=149) attending rheumatology outpatient clinics were assessed at baseline. A total of 120 participants, mean±SD age 60.7±12.1 years and mean±SD disease duration 12.99±10.4 years, completed the 12-month followup (98 women, 22 men, 93 rheumatoid factor positive, 24 rheumatoid factor negative, and 3 unknown). Musculoskeletal ultrasound (US) was used to identify forefoot bursae in all of the participants. Clinical markers of disease activity (well-being visual analog scale [VAS], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] level, and Disease Activity Score in 28 joints [DAS28]) and foot symptoms on the Leeds Foot Impact Scale (LFIS) Questionnaire were recorded on both occasions. RESULTS: Presence of US-detectable forefoot bursae was identified in 93.3% of returnee (n=120) participants (individual mean 3.7, range 0-11) at baseline. Significant associations were identified between bursae presence and patient-reported foot impact for impairment/footwear (LFISIF ; baseline: r=0.226, P=0.013 and 12 months: r=0.236, P=0.009) and activity limitation/participation restriction (LFISAP; baseline: r=0.254, P=0.005 and 12 months: r=0.235, P=0.010). After 12 months, 42.5% of participants had an increase in the number of US-detectable forefoot bursae and 45% of participants had a decrease. Changes in bursae number significantly correlated with changes in LFISIF (r=0.216, P=0.018) and LFISAP (r=0.193, P=0.036). No significant associations were identified between changes in bursae and changes in global well-being VAS, ESR, CRP level, or DAS28. CONCLUSION: The findings of this study suggest that forefoot bursae may regress or hypertrophy over time in patients with RA, and that these changes may be associated with self-reported foot impairment and activity restriction.

Ultrasound imaging for the rheumatologist XXX. Sonographic assessment of the painful knee.

The knee joint is a frequent focus of attention for rheumatologists when assessing patients presenting to a clinic and may represent underlying intra-articular inflammatory pathology or involvement of the surrounding soft tissues. This study describes the correlation between clinical and ultrasound findings in patients presenting with a variety of rheumatic disorders and knee pain. US imaging provides for a sensitive and detailed identification of different intra- and peri-articular pathology responsible for knee pain.

Prevention and control of rheumatic fever and rheumatic heart disease: the Cuban experience (1986-1996-2002).

BACKGROUND: Rheumatic fever (RF) and rheumatic heart disease (RHD) are still major medical and public health problems mainly in developing countries. Pilot studies conducted during the last five decades in developed and developing countries indicated that the prevention and control of RF/RHD is possible. During the 1970s and 1980s, epidemiological studies were carried out in selected areas of Cuba in order to determine the prevalence and characteristics of RF/RHD, and to test several long-term strategies for prevention of the diseases. METHODS: Between 1986 and 1996 we carried out a comprehensive 10-year prevention programme in the Cuban province of Pinar del Rio and evaluated its efficacy five years later. The project included primary and secondary prevention of RF/RHD, training of personnel, health education, dissemination of information, community involvement and epidemiological surveillance. Permanent local and provincial RF/RHD registers were established at all hospitals, policlinics and family physicians in the province. Educational activities and training workshops were organised at provincial, local and health facility level. Thousands of pamphlets and hundreds of posters were distributed, and special programmes were broadcast on the public media to advertise the project. RESULTS: There was a progressive decline in the occurrence and severity of acute RF and RHD, with a marked decrease in the prevalence of RHD in school children from 2.27 patients per 1,000 children in 1986 to 0.24 per 1,000 in 1996. A marked and progressive decline was also seen in the incidence and severity of acute RF in five- to 25-year-olds, from 18.6 patients per 100,000 in 1986 to 2.5 per 100,000 in 1996. There was an even more marked reduction in recurrent attacks of RF from 6.4 to 0.4 patients per 100,000, as well as in the number and severity of patients requiring hospitalisation and surgical care. Regular compliance with secondary prophylaxis increased progressively and the direct costs related to treatment of RF/RHD decreased with time. The implementation of the programme did not incur much additional cost for healthcare. Five years after the project ended, most of the measures initiated at the start of the programme were still in place and occurrence of RF/RHD was low.

Febre reumática: quando a amidalite se torna pesadelo / Viva Legal

Fala sobre a febre reumática, o que é, como é provocada e como pode ser prevenida. Informa que, apesar de pouco conhecida, apresenta alta incidência, sendo considerada caso de saúde pública. Cita os principais sintomas e tratamentos das infecções por estreptococos e as diversas complicações que a doença pode trazer, mostrando que pode ser evitada, desde que essas infecções sejam tratadas a tempo e de maneira correta, procurando um serviço de saúde rapidamente

Demanda hospitalaria, manifestaciones clínicas y prevención de fiebre reumática y cardiopatía en el Instituto de Salud del Niño 1989-1993 / Hospital demand, clinical sign and prevention of rheumatic fever and rheumatic cardiopathy in the Instituto de Salud del Niño 1989-1993

Se estudiaron retrospectivamente 66 pacientes hospitalizados en el Servicio de Cardiología del Instituto de Salud del Niño-entre 1989 y 1993- con el diagnóstico de fiebre reumática y cardiopatía reumática. Se encontró un aumento significativo en los 3 últimos años. El promedio en días de hospitalización se duplicó en 1993 respecto a 1989. El grupo etáreo más afectado fue entre los 11-15 años, con 39 pacientes (59 por ciento). El 74.5 por ciento tuvieron clase funcional III o IV, el 98 por ciento compromiso cardíaco; la lesión valvular más encontrada fue de insuficiencia aórtica (41 por ciento); la complicación más frecuente fue endocarditis infecciosa en 15 pacientes (23 por ciento). Fueron operados 8 pacientes sin mortalidad quirúrgica, 4 pacientes (6 por ciento) fallecieron de complicaciones clínicas. El severo compromiso cardiovascular mostrado en nuestra casuística se debe a una recurrencia elevada de carditis reumática por una ineficaz prevención. Ello hace imprescindible la implementación de un programa ampliado de prevención que considere la administración de fármacos y las condiciones sociales del enfermo para mejorar sus condiciones de vida.

Evaluación ecocardiográfica en pacientes con fiebre reumática con corea de Sydenham / Echocardiographic assessment in patients with rheumatic fever and sydenham chorea

Se estudiaron mediante ecocardiografía a 24 niños con fiebre reumática (FR) manifestada por corea de Sydenham "pura" (CSP). Fueron distribuidos en dos grupos de 12 enfermos cada uno. En uno se incluyeron los casos con CSP; seis de estos tuvieron reactantes de la fase aguda del proceso inflamatorio positivos (proteína C reactiva positiva y/o velocidad de sedimentación acelerada). El otro grupo se integró con los niños que tuvieron historia de artralgias, artritis transitoria o que a la auscultación tuviesen un solplo cardiaco con o sin reactantes de la fase aguda de la inflamación positivos. Ninguno de los 24 niños recibió tratamiento con antiinflamatorios. Se encontró alteración valvular mitral en 18/24 casos, hallazgo que difiere ampliamente de los informes que se han hecho sobre esta enfermedad. Se discute y se insiste en la necesidad de realizar estudios ecocardiográficos a los niños con FR, complementar su evaluación clínica; la existencia en ellos de lesión valvular puede modificar el pronóstico y el manejo integral de los niños

Controlling rheumatic heart disease in developing countries.

The streptococcal infection that leads to rheumatic heart disease, which accounts for one third to half of the cardiac admissions in developing countries, appears to spread especially rapidly in overcrowded living conditions. Rheumatic fever can be prevented by antibiotic treatment for streptococcal sore throat in children (primary prophylaxis), and its progression towards rheumatic heart disease can also be stopped by antibiotic therapy (secondary prophylaxis). At present, the most cost-effective control strategy appears to be secondary prophylaxis.

Percutaneous mitral balloon valvotomy and the new demographics of mitral stenosis.

OBJECTIVE: This review discusses the latest developments in selected clinical features and catheter-based therapy of mitral stenosis. DATA SOURCES: English-language journal articles and reviews in the clinical and epidemiological literature as related to mitral valve stenosis from 1965 through March 1993, identified by bibliography review and expert consultation. STUDY SELECTION: Selected studies included clinical trials with adequate patient population description and short- and long-term (5 years) follow-up for topics related to mitral valve stenosis in the clinical literature. DATA EXTRACTION: Two reviewers participated in extracting the data with the aim of presenting a balanced and comprehensive review of the subject. DATA SYNTHESIS AND CONCLUSIONS: The main conclusions are (1) mitral stenosis should no longer be viewed as a largely "geriatric disease" in the United States due to a recent inflow many young immigrants from countries where rheumatic fever continues partially or wholly unabated; (2) clinical and anatomical features of mitral stenosis are age-dependent; when clinical presentation occurs at 30 vs 70 years of age, for example, the degree of valve obstruction may be similar but differences exist in the frequency of atrial fibrillation, the magnitude of reduction in cardiac output, the degree of valve deformity and calcification, and the frequency of coexistent coronary artery disease; and (3) mitral stenosis therapy has undergone a reorientation with the introduction of percutaneous mitral balloon valvotomy, which has proven to be safe, cost-effective, and to provide short- and long-term improvements in symptomatic and hemodynamic status in selected patients.