Clinical profile of acute rheumatic fever in Pakistan

2003 ◽  
Vol 13 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Hasina Suleman Chagani ◽  
Kalimuddin Aziz
Keyword(s):  
Prospective Study ◽  
Rheumatic Fever ◽  
Sore Throat ◽  
Acute Rheumatic Fever ◽  
Clinical Profile ◽  
First Episode ◽  
History Of

We designed a multi-hospital prospective study of children less than 12 years to determine the comparative clinical profile, severity of carditis, and outcome on follow up of patients suffering an initial and recurrent episodes of acute rheumatic fever. The study extended over a period of 3 years, with diagnosis based on the Jones criteria. We included 161 children in the study, 57 having only one episode and 104 with recurrent episodes. Those seen in the first episode were differentiated from those with recurrent episodes on the basis of the history. The severity of carditis was graded by clinical and echocardiographic means. In those suffering their first episode, carditis was significantly less frequent (61.4%) compared to those having recurrent episodes (96.2%). Arthritis was more marked in the first episode (61.4%) compared to recurrent episodes (36.5%). Chorea was also significantly higher in the first episode (15.8%) compared to recurrent episodes (3.8%). Sub-cutaneous nodules were more-or-less the same in those suffering the first (7%) as opposed to recurrent episodes (5.8%), but Erythema marginatum was more marked during the first episode (3.5%), being rare in recurrent episodes at 0.9%. Fever was recorded in approximately the same numbers in first (45.6%) and recurrent episodes (48.1%). Arthralgia, in contrast, was less frequent in first (21.1%) compared to recurrent episodes (32.7%). A history of sore throat was significantly increased amongst those suffering the first episode (54.4%) compared to recurrent episodes (21.2%). When we compared the severity of carditis in the first versus recurrent episodes, at the start of study mild carditis was found in 29.8% versus 10.6%, moderate carditis in 26.3% versus 53.8%, and severe carditis in 5.3% versus 31.8% of cases, respectively. At the end of study, 30.3% of patients suffering their first episode were completely cured of carditis, and all others showed significant improvement compared to those with recurrent episodes, where only 6.8% were cured, little improvement or deterioration being noted in the remainder of the patients. We conclude that the clinical profile of acute rheumatic fever, especially that of carditis, is milder in those suffering their first attack compared to those with recurrent episodes.

Long-term observations of rheumatic carditis

1992 ◽  
Vol 2 (3) ◽  
pp. 254-260 ◽  
Author(s):  
Kalim-ud-Din Aziz ◽  
L. Cheema ◽  
A.D. Memon
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Recurrent Infection ◽  
Secondary Prophylaxis ◽  
First Episode ◽  
Initial Attack ◽  
Rheumatic Carditis ◽  
Rheumatic Heart

AbstractA total of 246 consecutive patients were seen with the diagnosis of acute rheumatic fever (and/or rheumatic heart disease) and were followed for 587.7 patient years. The episode of acute rheumatic fever was the first in 64 of these patients, whereas recurrent acute rheumatic fever was seen in 26 and the other 156 patients had chronic rheumatic carditis. At presentation, those suffering an initial attack had less frequent and less severe carditis when compared to those suffering recurrent infection (p<0.05). Improvement in carditis during follow-up was noted in those having an initial attack (p<0.1), while deterioration occurred following recurrent infection (p<0.01), and no change was noted for those with chronic infection. Recurrences of acute rheumatic fever were most frequent in those presenting with their initial infection (21%) or reinfection (35%), and dropout from follow-up was highest in the group with first infection (38%) compared to those with recurrent infection (15%) and chronic carditis (25%). Non-recognition of the first episode of acute rheumatic fever and failure of secondary prophylaxis were found to be the major contributors to the observed increased pool of recurrent and chronic rheumatic heart disease. We conclude that, in the absence of programmed primary prophylaxis of acute rheumatic fever, the best chance of controlling the progression of carditis or affecting cure is to recognize the first episode ofacute rheumatic fever and then ensure strict adherence to secondary prophylaxis. Since the prognosis of recurrent carditis is poor, the best management of moderate to severe recurrent carditis is early reparative valvar surgery wherever possible.

Acute Rheumatic Fever in Western Pennsylvania and the Tristate Area

PEDIATRICS ◽  
1987 ◽  
Vol 80 (3) ◽  
pp. 371-374 ◽  
Author(s):  
Ellen R. Wald ◽  
Barry Dashefsky ◽  
Cindy Feidt ◽  
Darleen Chiponis ◽  
Carol Byers
Keyword(s):  
Rheumatic Fever ◽  
Sore Throat ◽  
Urban Areas ◽  
Acute Rheumatic Fever ◽  
Urban Setting ◽  
Streptococcal Infections ◽  
White Children ◽  
History Of ◽  
Asian Child ◽  
Demographic Features

Acute rheumatic fever is reported to have declined and perhaps be vanishing. Prompted by the occurrence of 17 cases of acute rheumatic fever in an 18-month period in 1985 and 1986, we reviewed the records of 243 children with acute rheumatic fever who were cared for at Children's Hospital of Pittsburgh or Mercy Hospital between 1965 and 1986. Acute rheumatic fever was diagnosed using the modified Jones criteria and cases were classified by major criteria as arthritis, arthritis and carditis, carditis alone, carditis and chorea, chorea alone, and arthritis and chorea. Among the 17 recent patients, 59% had carditis, 30% had chorea, and 24% had arthritis alone. The proportion of children who had particular major manifestations was similar in the last two decades and in 1985 to 1986. The recent children with acute rheumatic fever ranged in age from 6 to 13 years with a mean and median age of 10 years. There were 16 white children and one Asian child. Only four children lived in an urban setting. When demographic features of the children were contrasted with those in the previous two decades, a decrease in the proportion of children who lived in urban areas and who were black was noted. Four children had a history of preceding sore throat but only three sought medical care; nine children had no memorable illness and four had either a nonrespiratory illness or a respiratory infection without sore throat. This resurgence of rheumatic fever serves as a reminder that a diligent approach to the diagnosis and therapy of streptococcal infections remains essential.

The natural history of acute rheumatic fever in Kuwait: A prospective six year follow-up report

1986 ◽  
Vol 39 (5) ◽  
pp. 361-369 ◽  
Author(s):  
Hassan A. Majeed ◽  
Abdul Mohsin Yousof ◽  
Faisal A. Khuffash ◽  
Abdul Razak Yusuf ◽  
Suhair Farwana ◽  
...  
Keyword(s):  
Natural History ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
History Of

scholarly journals Outbreak of Foodborne Botulism in Alexandria, Egypt: Modulating Indications for Administration of Heptavalent Botulinum Antitoxin

2021 ◽  
Author(s):  
Sara A Ghitani ◽  
Maha A Ghanem ◽  
Eman A Sultan ◽  
Maram Atef ◽  
Maii F Henaidy
Keyword(s):  
Prospective Study ◽  
Clinical Characteristics ◽  
Personal Data ◽  
Poison Center ◽  
Supportive Treatment ◽  
Past Medical History ◽  
Salted Fish ◽  
History Of ◽  
Foodborne Botulism

Abstract Background: In October 2019, 94 patients were admitted into Alexandria Poison Center (APC) with a history of ingestion of Feseekh (salted fish). As a trial to allocate the resources, not all patients were given Heptavalent botulinum antitoxin (HBAT) immediately.The current study aimed to portray the clinical characteristics of the cases, explore the possible relation between these characteristics and necessity of HBAT administration, explore the reliability of MLT, and to establish a clinical guide for management with preservation of resources.Subject and Method: the current prospective study included 94 patients who were admitted to Alexandria Poison Center (APC) in the period from 29 th September to 27 th October 2019. The patients' data was recorded using a checklist that includes: personal data, past medical history, clinical assessment, investigations, treatment and the outcome. The checklist was carried out to assess and follow up each patient. Hospitalized patients were categorized according to symptoms consistent with botulism. The equine HBAT, made by Emergent BioSolutions Canada Inc. (formerly Can gene Corporation) was used in the treatment.Results: HBAT was given to (36.2%) patients only out of the total admission. However, 87.2% of patients were completely cured, whereas 10.6% of patients were discharged with mild neurological sequelea and death occurred only in two cases (2.2%).Conclusion: 63.8% of cases with suspected foodborne botulism toxicity could be managed by supportive treatment only with no need for HBAT.

Clinical profile of 116 patients undergoing post-COVID follow-up - A prospective study

2021 ◽  
Author(s):  
P Modi ◽  
A Patankar ◽  
M Bhanushali ◽  
S Patel ◽  
G Nair ◽  
...  
Keyword(s):  
Prospective Study ◽  
Clinical Profile ◽  
A Prospective Study

scholarly journals Environmental and social determinants of acute rheumatic fever: a longitudinal cohort study

2019 ◽  
Vol 147 ◽  
Author(s):  
J. W. Cannon ◽  
M. Abouzeid ◽  
N. de Klerk ◽  
C. Dibben ◽  
J. R. Carapetis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Early Childhood ◽  
Rheumatic Fever ◽  
Middle Childhood ◽  
Acute Rheumatic Fever ◽  
Close Contact ◽  
Large Family ◽  
World Health ◽  
History Of ◽  
Tract Infections

AbstractAcute rheumatic fever (ARF), an auto-immune response to a group AStreptococcusinfection and precursor to rheumatic heart disease (RHD), remains endemic in many socio-economically disadvantaged settings. A Global Resolution on ARF and RHD was recently adopted at the 71st World Health Assembly where governments committed to improving efforts to prevent and control ARF and RHD. To inform these efforts, the objectives of this study were to examine associations between childhood ARF in the UK between 1958 and 1969 and a range of environmental and social factors. Of 17 416 children from the nationally representative birth cohort of the National Child Development Study, ARF was reported in 23 children during early childhood (between birth and the 7-year follow-up) and in 29 additional children during middle childhood (between the 7- and 11-year follow-ups). Risk factors associated with ARF in both early and middle childhood were: a large family size; attendance at a private nursery or class; a history of nephritis, kidney or urinary tract infections; and a history of throat or ear infections. Risk factors for ARF in early childhood alone were families with fathers in a professional or semi-professional occupation and families who moved out of their local neighbourhood. Risk factors in late childhood alone included overcrowding and free school meals. These data suggest that prevention strategies in ARF endemic settings may be enhanced by targeting, for example, new members entering a community and children in environments of close contact, such as a nursery or shared bedrooms.

QT dispersion in acute rheumatic fever

2006 ◽  
Vol 16 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Tugcin Bora Polat ◽  
Yalim Yalcin ◽  
Celal Akdeniz ◽  
Cenap Zeybek ◽  
Abdullah Erdem ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Qt Dispersion ◽  
Control Group ◽  
Healthy Children ◽  
Rheumatic Carditis ◽  
Normal Children ◽  
A Value ◽  
The Mean

Background:Disturbances of conduction are well known in the setting of acute rheumatic fever. The aim of this study is to investigate the QT dispersion as seen in the surface electrocardiogram of children with acute rheumatic fever.Methods:QT dispersion was quantitatively evaluated in 88 children with acute rheumatic fever. Patients were divided into two groups based on the absence or presence of carditis. As a control group, we studied 36 healthy children free of any disease, and matched for age with both groups. Repeat echocardiographic examinations were routinely scheduled in all patients at 3 months after the initial attack to study the evolution of valvar lesions.Results:The mean QT dispersion was significantly higher in children with rheumatic carditis. But there was no statistical difference between children without carditis and normal children. Among the children with carditis, the mean dispersion was higher in those with significant valvar regurgitation. Dispersion of greater than 55 milliseconds had a sensitivity of 85%, and specificity of 70%, in predicting rheumatic carditis, while a value of 65 milliseconds or greater had sensitivity of 81% specificity of 85% in predicting severe valvar lesions in acute rheumatic carditis. At follow-up examination, a clear reduction on the QT dispersion was the main finding, reflecting an electrophysiological improvement.Conclusions:These observations suggest that QT dispersion is increased in association with cardiac involvement in children with acute rheumatic fever.

scholarly journals A Prospective Study on Changes in Nutritional Status and Growth Following Two Years of Ketogenic Diet (KD) Therapy in Children with Refractory Epilepsy

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1596 ◽  
Author(s):  
Marisa Armeno ◽  
Antonella Verini ◽  
Mariana del Pino ◽  
Maria Beatriz Araujo ◽  
Graciela Mestre ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Prospective Study ◽  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Growth Monitoring ◽  
Male Predominance ◽  
History Of ◽  
A Prospective Study ◽  
Growth Deceleration

Introduction: Epilepsy is a neurological disorder characterized by an increased susceptibility to seizures. The ketogenic diet (KD) is currently the most important alternative non-pharmacological treatment. Despite its long history of clinical use, it is not clear how this diet affects longitudinal growth in children. Methods: A prospective study was designed to evaluate growth and nutritional status in 45 children on KD. Growth was assessed by measuring weight, height, and body mass index (BMI). Standard deviation scores (SDS) were calculated for all measurement parameters at KD initiation and at a two-year follow-up. Results: Overall, 45 patients who completed 24 months on KD were enrolled. Median age was 6.6 years (0.8 to 17.3), with a male predominance (n = 23); 74% of the 45 patients were responders on seizure reduction at three months; 26% of patients were non-responders. In our study, using −1 SDS as a cut-off point, growth deceleration was observed in 9% (n: 4) of the patients; however, the nutritional status was maintained or even improved. No correlation with age, sex, or ambulatory status was found. Conclusions: The nutritional follow-up of these patients was helpful to improve overweight and thinness but could not avoid growth deceleration in some of them. These findings confirm that children with refractory epilepsy on KD treatment require careful growth monitoring.

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