Acute rheumatic fever: 10-year single-center experience: clinical and laboratory findings, with subclinical carditis and treatment complications

2021 ◽  
Vol 31 (9) ◽  
pp. 1489-1494
Author(s):  
Lida Bulbul ◽  
Mehmet Bedir Akyol ◽  
Hasret Ayyıldız Civan ◽  
Gizem Kara Elitok ◽  
Sami Hatipoglu ◽  
...  
Keyword(s):  
Side Effects ◽  
Acetylsalicylic Acid ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Statistical Significance ◽  
Laboratory Findings ◽  
Single Center Experience ◽  
Echocardiographic Evaluation ◽  
Significant Difference ◽  
Period Detection

AbstractBackground:Acute rheumatic fever in childhood continues to cause serious morbidity despite all developments. The objective of this study was to evaluate the clinical and laboratory characteristics of patients with acute rheumatic fever and to determine the frequency of subclinical carditis and the side effects of the drugs used in the treatment.Methods:The data of patients hospitalised between 2008 and 2018 with the diagnosis of acute rheumatic fever were included in the study. The relationship of gender and age with the frequency of major symptoms and the distribution of the drugs used in the treatment and their side effects were evaluated.Results:Medical records of 102 patients with complete data were reviewed. 56.9% of the patients were male and the mean age was 10.7 ± 1.9 years. The most common distribution of complaints found were arthritis (51%), arthralgia (25.5%) and fever (16.7%). 10.8% of all patients (n = 11) were diagnosed subclinical carditis via echocardiographic evaluation. The frequency of carditis was higher in female patients with a borderline statistical significance (p = 0.05). However, there was no statistically significant difference between gender and arthritis (p = 0.22) and carditis (p > 0.05). Anti-congestive therapy was required in 22% and inotropic treatment was needed in 6.1% cases. Toxic hepatitis developed in four cases during the acetylsalicylic acid treatment.Conclusions:In a 10-year period, detection of subclinical carditis in 10.8% cases supported that echocardiography should be performed as a standard method for the diagnosis of acute rheumatic fever. Patients should be followed closely in terms of hepatic toxicity due to acetylsalicylic acid used in the treatment.

scholarly journals Mechanical Thrombectomy in Stroke. Experience from Switching from Stent Retriever Only to Stent Retriever Combined with Aspiration Catheter

2021 ◽  
Vol 10 (9) ◽  
pp. 1802
Author(s):  
Grzegorz Meder ◽  
Paweł Żuchowski ◽  
Wojciech Skura ◽  
Violetta Palacz-Duda ◽  
Milena Świtońska ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Statistical Significance ◽  
Stent Retriever ◽  
Single Center Experience ◽  
Significant Difference ◽  
First Pass ◽  
Need To Evaluate ◽  
The Difference

Endovascular treatment is a rapidly evolving technique; therefore, there is a constant need to evaluate this method and its modifications. This paper discusses a single-center experience and the results of switching from the stent retriever only (SO) mechanical thrombectomy (MT) to the combined approach (CA), with a stent retriever and aspiration catheters. Methods: The study involved a retrospective analysis of 70 patients undergoing MT with the use of either SO or CA. The primary endpoint was the frequency of perfect reperfusion defined as grade 3 of the modified Thrombolysis in Cerebral Infarction scale (mTICI) after the first pass. The secondary endpoints were the procedure success, defined as mTICI grades 2b-3; time of the procedure; clinical outcome, measured by 90 days’ modified Rankin Scale (mRS) score; Δ NIHSS, defined as the difference between National Institutes of Health Stroke Scale (NIHSS) score at patients’ admission and discharge; and the total number of device passes. Results: Out of the 70 patients included, 33 were treated with SO and 37 with CA. In both groups, a total number of 42 patients received intravenous recombined tissue plasminogen activator (iv-rTPA: 20 patients (60.6%) in the SO group and 22 patients (59.5%) in the CA group (p = 1.000). There was a significant difference between the groups regarding first-pass success rate, with 46% in the CA group and 18% in the SO group, (OR 3.83, 95% CI 1.28 to 11.44, p = 0.016). Complete procedure success tended to be more frequent in the CA group than in the SO group—94.6% vs. 84.8% (OR 3.13, 95% CI 0.56 to 17.34, p = 0.193)—and CA tended to require a lower number of passes than SO (mean 1.76 vs. 2.09 passes per procedure, p = 0.114), yet these differences did not reach statistical significance. Mean duration of the procedure was significantly shorter in the CA group than in the SO group (49 min vs. 64 min, p = 0.017). There was a significant difference in clinical outcomes, with higher Δ NIHSS (9.3 in the CA group vs. 6.7 in the SO group, p = 0.025) after the procedure and 90-day mRS (median 2 in the CA group vs. 4 in the SO group, p = 0.031). Conclusions: Combining stent retrievers with aspiration catheters may offer a beneficial effect on angiographic results and clinical outcomes in stroke patients undergoing endovascular treatment.

scholarly journals The efficacy and safety of naproxen in acute rheumatic fever: the comparative results of 11-year experience with acetylsalicylic acid and naproxen

2016 ◽  
Vol 58 (5) ◽  
pp. 473 ◽  
Author(s):  
İbrahim İlker Çetin ◽  
Filiz Ekici ◽  
Abdullah Kocabaş ◽  
Berna Şaylan Çevik ◽  
Sancar Eminoğlu ◽  
...  
Keyword(s):  
Acetylsalicylic Acid ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Efficacy And Safety ◽  
Comparative Results

THERAPEUTIC EFFECTS OF ACTH AND CORTISONE IN RHEUMATIC FEVER: CARDIOLOGIC OBSERVATIONS IN A CONTROLLED SERIES OF 100 CASES

PEDIATRICS ◽  
1956 ◽  
Vol 17 (1) ◽  
pp. 11-28
Author(s):  
T. N. Harris ◽  
Sidney Friedman ◽  
Herbert L. Needleman ◽  
Herbert A. Saltzman
Keyword(s):  
Rheumatic Fever ◽  
Hormone Therapy ◽  
Acute Rheumatic Fever ◽  
Supportive Therapy ◽  
Therapeutic Effects ◽  
Control Subjects ◽  
Significant Difference ◽  
And Control

The therapeutic effects of ACTH and cortisone have been studied in a series of 100 patients with acute rheumatic fever, with special emphasis on cardiologic observations. This series involved cyclical alternation among hormone-treated patients and control patients. The latter received symptomatic and supportive therapy, but not salicylates in large doses. Observations on such patients during the period of hospitalization (did not indicate any significant difference between hormone-treated and control subjects in terms of the appearance or disappearance of cardiac murmurs, the degree of transmission of apical systolic murmurs, incidence and duration of pericarditis, or other cardiologic phenomena recorded. Rates of occurrence of "rebound" phenomena and of complications of the hormone therapy have also been reported.

Echocardiographic Evaluation of Patients With Acute Rheumatic Fever and Rheumatic Carditis

Circulation ◽  
1996 ◽  
Vol 94 (1) ◽  
pp. 73-82 ◽  
Author(s):  
Ramachandran S. Vasan ◽  
Savitri Shrivastava ◽  
Manam Vijayakumar ◽  
Rajiv Narang ◽  
Bradford C. Lister ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Rheumatic Carditis ◽  
Echocardiographic Evaluation

Can subclinical valvitis detected by echocardiography be accepted as evidence of carditis in the diagnosis of acute rheumatic fever?

2001 ◽  
Vol 11 (3) ◽  
pp. 255-260 ◽  
Author(s):  
Süheyla Özkutlu ◽  
Canan Ayabakan ◽  
Muhsin Saraçlar
Keyword(s):  
Mitral Regurgitation ◽  
Acetylsalicylic Acid ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Clinical Evidence ◽  
Clinical Signs ◽  
Mitral Insufficiency ◽  
The One ◽  
Echocardiographic Findings

Aim: Subclinical valvar insufficiency, or valvitis, has recently been identified using Doppler echocardiography in cases of acute rheumatic fever with isolated arthritis or chorea. The prognosis of such patients with acute rheumatic fever and subclinical valvitis is critical when determining the duration of antibiotic prophylaxis. We aimed, therefore, prospectively to investigate the association of silent valvitis in patients having rheumatic fever in the absence of clinical evidence of cardiac involvement, and to evaluate its prognosis. Methods and Results: Between November 1998 and September 1999, we identified 26 consecutive patients with silent valvitis in presence of rheumatic fever but in the absence of clinical signs of carditis. The patients, eight female and 18 male, were aged from 6 to 16 years, with a mean of 9.9± 2.7 years. Major findings were arthritis in 16, chorea in 7, and arthritis and erythema marginatum in 1 patient. Two cases had arthralgia with equivocal arthritic signs and Doppler echocardiographic findings of pathologic mitral regurgitation. Silent pathologic mitral regurgitation was found in 12 cases, and aortic regurgitation in 2 cases. All patients with arthritic findings were treated with acetylsalicylic acid with one exception, this patient receiving both prednisone and acetylsalicylic acid. No antiinflammatory treatment was given to patients with chorea. After a mean follow-up of 4.52 months, valvar regurgitation disappeared in 4 patients, including the one with migratory arthralgia and no other major criterions. All six patients with chorea and silent carditis still have mitral insufficiency. Conclusion: Acute rheumatic fever without clinical carditis is not a benign entity. Doppler echocardiographic findings of subclinical valvar insufficiency, therefore, should be considered as carditis when seeking to establish the diagnosis of acute rheumatic fever.

scholarly journals Retrospective evaluation of the patients with the diagnosis of acute rheumatic fever: A single center experience of 5 years

2014 ◽  
Vol 4 (2) ◽  
pp. 87-96
Author(s):  
Sukru Gungor ◽  
Onder Doksoz ◽  
Ali Fettah ◽  
Hikmet Tekin Nacaroglu ◽  
Utku Arman Orun ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Retrospective Evaluation ◽  
Single Center ◽  
Single Center Experience

Incidence and clinical features of acute rheumatic fever in Kayseri, Central Anatolia, 1998–2011

2014 ◽  
Vol 25 (4) ◽  
pp. 745-751 ◽  
Author(s):  
Nazmi Narin ◽  
Fatma Mutlu ◽  
Mustafa Argun ◽  
Abdullah Ozyurt ◽  
Ozge Pamukcu ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Pediatric Cardiology ◽  
Age Groups ◽  
Central Anatolia ◽  
Adolescent Population ◽  
Male Ratio ◽  
Significant Difference ◽  
Acquired Heart Disease ◽  
The Mean

AbstractBackgroundIn developing countries, acute rheumatic fever is the most common cause of acquired heart disease in the paediatric and adolescent population. It is believed that vulnerability to developing acute rheumatic fever is associated with several factors such as socio-economic and living conditions.AimDetermine the incidence and clinical characteristics of acute rheumatic fever in the Central Anatolia region of Kayseri within the last 14 years, and to make a comparison of two 7-year periods.Material and methodsWe performed a retrospective analysis of 624 patients who were diagnosed with acute rheumatic fever at the Department of Pediatric Cardiology in the Medical Faculty of Erciyes University between January, 1998 and December, 2011.ResultsThe mean age of patients was 10.9±2.7 years. The female/male ratio was 1.4. When patients were categorised according to age groups, the largest group represented 376 patients (60.3%) aged between 10 and 14 years. The estimated incidence rate of acute rheumatic fever was 7.4/100,000 in the Central Anatolia region of Kayseri. Among the major findings, the most common included carditis at 54%, arthritis at 35%, Sydenham’s chorea at 25%, and subcutaneous nodules at 0.5%, respectively. No significant difference was found between the first 7-year period and second 7-year period in distributions of age, gender, and major findings.ConclusionAlthough there has been socio-economic development in Turkey in the recent years, the incidence of acute rheumatic fever is still high in the Central Anatolia region of Kayseri.

Study on the Effect of Nano Albumin Paclitaxel Combined with Carboplatin in the Treatment of Lung Squamous Cell Carcinoma

2020 ◽  
Vol 20 (12) ◽  
pp. 7439-7443
Author(s):  
Hui Wang ◽  
Shaoyu Mou ◽  
Min Tu
Keyword(s):  
Squamous Cell Carcinoma ◽  
Side Effects ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Advanced Nsclc ◽  
Statistical Significance ◽  
Lung Squamous Cell Carcinoma ◽  
Albumin Binding ◽  
Significant Difference ◽  
Carboplatin Auc

This study aims to compare the efficacy and side effects of albumin-binding paclitaxel plus carboplatin (NAB PC) and paclitaxel plus carboplatin (PC) in the first-line treatment of advanced non-small cell lung cancer (NSCLC). A total of 60 patients with advanced NSCLC diagnosed by histopathology or cytology were randomly divided into nab PC group (albumin-binding paclitaxel 130 mg/mL, D1, D; carboplatin AUC = 6, D1) and PC group (paclitaxel 175 mg/mL, D1; carboplatin AUC = 6, D1), one cycle every three weeks. RECIST 1.1 standard was used to evaluate the short-term objective efficacy, and who acute and subacute toxicity classification standard was used to evaluate the toxicity. The total effective rate (RR) and disease control rate (DCR) of NAB PC group were 40.0% and 80.0%, respectively, which were higher than 23.3% and 60.0% of the PC group, respectively. This difference was statistically significant (p < 0.05). In squamous cell carcinoma, the RR of NAB PC group and PC group were 57.1% (8/14) and 23.1% (3/13) respectively, with a statistically significant difference (p < 0.05); in non-squamous cell carcinoma, the RR of the two groups were 25.0% (4/16) and 23.3% (4/17) without statistical significance (p > 0.05). The median progression free survival time of the NAB PC group and PC group was 6.5 and 5.9 months, respectively, with no significant difference (p>0.05). No significant difference arose in the incidence of grade III–IV toxicity between the two groups (p > 0.05). The incidence of neutropenia in the NAB PC group was higher than that in the PC group (p < 0.05). The therapeutic effect of paclitaxel combined with carboplatin in the treatment of advanced NSCLC is better, the effect of paclitaxel combined with carboplatin is better, and the side effects can be tolerated, which is worthy of clinical application. Patients are more satisfied with their care.

scholarly journals AB0150 ACPA-STATUS AND RHEUMATOID ARTHRITIS: MUCH MORE TO BE REVEALED!

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1102-1102
Author(s):  
K. Maatallah ◽  
S. Miri ◽  
H. Ferjani ◽  
D. Ben Nsib ◽  
W. Triki ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Assessment Tool ◽  
Statistical Significance ◽  
Joint Damage ◽  
Atlantoaxial Dislocation ◽  
Negative Group ◽  
Laboratory Findings ◽  
Significant Difference ◽  
Frax Score ◽  
Acpa Status

Background:Anti-citrullinated protein antibodies (ACPA) are commonly associated with Rheumatoid arthritis (RA). RA is, therefore, classified as immunopositive or immunonegative, with disparate mechanisms in predisposition.Objectives:Our study aimed to determine the baseline characteristics and differences of ACPA-positive and ACPA-negative RA.Methods:We conducted a cross-sectional study including 224 patients with RA. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria. The patients were divided according to their ACPA status into two groups: ACPA-positive group (G1) and ACPA-negative group (G2). We compared clinical, radiological, and laboratory findings between the two groups, as well as extra-articular manifestations, comorbidities including fractures and osteoporosis. The Fracture Risk Assessment Tool (FRAX) was used to estimate the 10-year probability of major osteoporotic fracture (MOF) and also hip fracture (FH).Results:Of the 224 patients, 31.6% were negative for ACPA (n=71). Female predominance was found in both groups with a sex ratio of 0.25 (p=0.203). ACPA-negative subjects were younger (57±11 versus 59±12 years) (p= 0.305).The initial presentation of RA was different between the two groups without reaching statistical significance. In the ACPA-negative group, alteration of general condition was more frequent (16.9% in G2 versus 13.7% in G1) (p=0.533), with a tendency to oligo-articular onset (18.5% in G2 versus 6.7% in G1) (p=0.737). ACPA-positivity was more associated with an acute start of symptoms (10.4% in G1 versus 8.4% in G2) (p=0.639)There was no significant difference in the mean DAS28-VS (5.2±1.1 in G2 versus 5.5±1.3 in G1) and DAS28-CRP levels (5±1 in G2 versus 5.3±1.2 in G1) (p=0.069 and p=0.098 respectively).ACPA-positive RA was, however, significantly associated with more structural joint damage: erosions (55.9±53 in G1 versus 78±36 in G2, p=0.01), joint space narrowing (50.4±45.5 in G1 versus 33.1±36.6 in G2, p=0.003), Sharp/van der Heijde radiographic score (126.6 ±103.2 in G1 versus 88.8±81.5 in G2, p=0.004). ACPA-positive RA patients had more atlantoaxial dislocation: 20.2% in G1 versus 7% in G2 (p=0.012). There was no significant difference in hip involvement (9.8% in G1 versus 14% G2) (p=0.344).There were no significant differences in extra-articular manifestations between the two groups: Rheumatoid nodules (10.4% in G1 versus 18.3% in G2) (p=0.891), Sjögren’s syndrome (16.3% in G1 versus 16.9% in G2)(p=0.715), amyloidosis (0.6% in G1) (p=1), pulmonary fibrosis (5.8% in G1 versus 4.2% in G2) (p=0.757), neurological signs (4.5% in in G1 versus 5.6% in G2) (p=0.733), anaemia (5.8% in G1 versus 1.4% in G2) (p=0.175).When analyzing comorbidities, no significant differences were found: diabetes (10.4% in G1 versus 18.3% in G2) (p=0.103), cardiovascular diseases (19.6% in G1) (p=1), neurological diseases (0.06% in G1 versus 1.4% in G2) (p=0.534), dysthyroidism (2.6% in G1 versus 5.6% in G2) (p=0.267), dyslipidemia (3.2% in G1 versus 4.2% in G2) (p=0.711), cancer (1.3% in G1) (p=1). There were neither significant differences in the prevalence of fracture (21.5% in G1 versus 18.3% in G2) (p=0.574), and osteoporosis (23.6% in G1 versus 29.5% in G2) (p=0.347), between the two groups. However, ACPA-positive patients presented with a significantly higher FRAX score of MOF (2±2.8 in G1 versus 1.2±1 in G2) (p=0.006), and FRAX score of FH (0,9±1.8 in G1 versus 0.3±0.5 in G2) (p=0.003).Conclusion:ACPA status appears to influence both the clinical presentation and radiological progression of RA patients. ACPA-positive patients present with an acute start of symptoms, with more structural damages and atlantoaxial dislocation. Comorbidities, including osteoporosis, does not seem affected by ACPA status. However, regardless of osteoporosis, ACPA-positivity is associated with a higher probability of major osteoporotic and hip fractures. Further research is needed to clarify this relationship.Disclosure of Interests:None declared

Sign in / Sign up

Export Citation Format

Share Document