scholarly journals Handheld echocardiographic screening for rheumatic heart disease in rural South Kordofan, Sudan by junior medicals: Supporting task shifting for control of a serious disease

Author(s):  
Amna M. Elazrag ◽  
Anfal M. Altahir ◽  
Azza A. Abbas ◽  
Elfatih A. Hasabo ◽  
Hayat A. Ahmed ◽  
...  

Abstract Background Rheumatic heart disease (RHD) is a major and preventable cause of cardiac mortality in Sudan, particularly in Kordofan. It can be detected early with a handheld echocardiography machine. Methods A cross-sectional study was conducted in South Kordofan State, Sudan (as part of a medical convoy organized by Khartoum Medical Students Association). A team of shortly trained medical students and newly graduated doctors conducted a handheld echocardiographic screening using a simplified protocol. All suspected cases were recorded and reviewed later by a senior pediatric cardiologist. Demographic and clinical features of screened subjects were studied. Data analysis was performed using the Statistical Package for Services and Solutions (SPSS 25). Descriptive statistics were presented as “number (%)” or “mean ± SD”. RHD prevalence was expressed as cases per 1000, and Chi-Square test/Fisher’s Exact test was used to compare RHD findings between different groups. Results The disease frequency was found to be 50 per 1000. Out of 452 screened subjects (age 10-25 years), 23 were found to have RHD with a male to female ratio of 1:1.5. Echocardiographic quality was acceptable in 93% of studies. The disease was mild in 70% and moderate or involving 2 valves in 30% of patients. Patients were contacted, advised to start penicillin prophylaxis and referred to cardiologists. Risk factors for the disease included father's occupation and village of residence. Conclusion Shortly trained junior medicals can assist in RHD echocardiographic surveillance in remote areas. South Kordofan state is highly endemic for RHD and a control program needs to be implemented. Handheld echocardiography is of value for early detection and management.

2020 ◽  
Vol 01 (01) ◽  
pp. 009-012
Author(s):  
Laudari S

Background and Aims: Secondary prophylaxis has remained the mainstay of rheumatic fever and rheumatic heart disease management. Despite the proven ef􀏐icacy and superiority of injectable penicillin in rheumatic heart disease patients, it has been underused in Nepal. Materials and Methods: This is a hospital based cross-sectional study during June 2014 to October 2018 over a period of 52 months at College of Medical Sciences-Bharatpur including 350 patients with clinical and/or echocardiographic evidence of de􀏐inite rheumatic heart disease. Data was collected from both cardiology outpatients and inpatients (admitted in cardioward/coronary care unit). Relevant data and information were entered into the pre-structured proforma and then analyzed by SPSS-16 software. Results: The age of the patients ranged from 6 to 80 years with mean age 36.76±4.6years with female preponderance (F:M=1.26:1). The predominantly involved isolated valve was mitral in 152 patients (44.43%) followed by aortic valve in 70 patients (20.00%) and rest 90 (25.71%) had dual valvular involvement. The common complications encountered were heart failure in 200(57.14%) and arrhythmias in 155(44.29%) patients. Two hundred ten (60.00%) of the patients received penicillin (oral and injectable) and erythromycin. Majority 180/210=85.71%) were prescribed on oral penicillin whereas only 46/210=21.90% received injectable penicillin; the ratio being 3.35:1. Conclusion: RHD is a leading cause of heart failure and death among young population. There is underuse of penicillin with very minimal focus on use of injectable penicillins currently. Hence, Nepal government and other non-governmental organizations should consider implementation of use of penicillin broadly and moreover focus on use and adherence of injectable penicillin. Keywords: Rheumatic Heart Disease, Penicillin, Underuse, Secondary Prophylaxis.


2012 ◽  
Vol 23 (1) ◽  
pp. 31-35
Author(s):  
Shahanaj Sharmin ◽  
Shahanara Chowdhury ◽  
Didarul Alam ◽  
Mohiuddin Ahmed ◽  
Fahamida Rashid ◽  
...  

Aim of our study was to see the maternal and fetal outcomes in women presenting with heart disease during pregnancy and labout. This cross sectional study was carried out in 48 pregnant women with cardiac disease from July 2005 to Dec 2006, in the department of Gynae and Obst at Chittagong Medical College Hospital Chittagong. The Mewan age was 25.40 ±4.46 years. 31(64.6%) patients were from middle class. 27 (56.3%) patients belonged to mulliparous group. 33(68.8%) patients received regular antenatal care, of the 43 (89.7%) patients had rheumatic heart disease and 5(10.5%) had congenital heart disease. Among the rheumatic heart disease, 50% had mitral stenosis. 35(72.9%) patients had in grade-1, 12(25%) had in grade-II, and 1(2.1%) had in grade-III. (64.5%) had normal vaginal delivery, 7(14.5%) had LSCS. 4(8.3%) had heard failure and 1 patient (2.1%) expired due to heart failure, 40(83.3%) were delivered at term, 7(14.6%) had preterm labour and 1(2.1%) had still birth. Regarding birth weight, 17(35.4%) had LBW (Low birth weight), 31(64.6%) had normal birth weight. Rheumatic heart disease is the commonest cardiac lesion among Pregnant women. Fetomaternal morbidity and mortality are strongly correlated with maternal cardiac functional classification. The management of these cases should be multidisciplinary to optimize care of these patients. JCMCTA 2012; 23(1): 31-35


Author(s):  
Sarah Wangilisasi ◽  
Pilly Chillo ◽  
Delila Kimambo ◽  
Mohammed Janabi ◽  
Appolinary Kamuhabwa

Abstract Background: Secondary prophylaxis against repeated attacks of acute rheumatic fever is an important intervention in patients with rheumatic heart disease (RHD) and it aims to prevent throat infection by group A beta-hemolytic streptococcus (GAS), however its implementation faces many challenges. This study aimed to assess throat colonization, antibiotic susceptibility and factors associated with GAS colonization among patients with RHD attending care at Jakaya Kikwete Cardiac Institute in Dar-es-Salaam, Tanzania. Methods: A descriptive cross sectional study of RHD patients attending the Jakaya Kikwete Cardiac Institute was conducted from March to May 2018, where we consecutively enrolled all patients known to have RHD and coming for their regular clinic follow-up. A structured questionnaire was used to obtain patients’ socio-demographic information, factors associated with GAS colonization as well as status of secondary prophylaxis use and adherence. Throat swabs were taken and cultured to determine the presence of GAS, and isolates of GAS were tested for antibiotic susceptibility using Kirby-Bauer disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) version 2015. Antibiotics of interest were chosen according to the Tanzanian Treatment Guidelines. Results: In total 194 patients with RHD were enrolled, their mean age was 28.4 ±16.5 years and 58.2% were females. Only 58 (29.9%) patients were on regular prophylaxis, 39 (20.1%) had stopped taking prophylaxis, while 97 (50.0%) had never been on prophylaxis. Throat cultures were positive for GAS in 25 (12.9%) patients. Patients who stopped prophylaxis were 3.26 times more likely to be colonized by GAS when compared to patients on regular prophylaxis. Majority (96%) of GAS isolates were susceptible to Penicillin, Ceftriaxone and Ciprofloxacin, while the highest resistance (20%) was observed with Vancomycin. No GAS resistance was observed against Penicillin. Conclusion: The prevalence of GAS throat colonization is high among this population and is associated with stopping prophylaxis. The proportion of patients on regular secondary prophylaxis is unacceptably low and interventions should target both patients’ and physicians’ barriers to effective secondary prophylaxis.


2015 ◽  
Vol 4 (3) ◽  
Author(s):  
Marhamah Hasnul ◽  
Najirman Najirman ◽  
Yanwirasti Yanwirasti

Abstrak Penyakit jantung rematik (PJR) adalah penyakit jantung sebagai akibat adanya gejala sisa (sekuele) dari demam rematik (DR) yang ditandai dengan terjadinya cacat katup jantung. Tujuan penelitian ini adalah melihat karakteristik pasien penyakit jantung rematik.yang dirawat. Metode yang digunakan adalah deskriptif observasional dengan desain cross sectional study dan pendekatan retrospektif untuk menilai karakteristik pasien PJR di RSUP Dr. M. Djamil Padang dari Januari 2009 - Desember 2012. Populasi dan sampel sebanyak 54 sampel. Hasil penelitian menunjukkan distribusi pasien terbanyak pada kelompok umur 11-20 tahun (50%), perempuan (57,41%), tingkat pendidikan SD/sederajat dan SLTP/sederajat masing-masing 25,93%, pelajar/mahasiswa (53,70%), dan berasal dari daerah rural (70,37%). Sebagian besar pasien mengeluhkan keluhan utama sesak napas (62,96%). Hasil pemeriksaan elektrokardiografi memperlihatkan LVH sebesar 35,19% dan AF sebesar 27,78%. Berdasarkan pemeriksaan foto toraks umumnya pasien telah mengalami kardiomegali (92,59%). Berdasarkan pemeriksaan ekokardiografi yang paling banyak ditemukan adalah kelainan katup regurgitasi mitral (30,40%), derajat kerusakankatup berat (36,80%), dan fraksi ejeksi normal (72,97%). Pada penelitian ini dapat disimpulkan bahwa terdapat variasi karakteristik dari penderita PJR yang ada di RSUP Dr. M. Djamil Padang. Kata kunci: penyakit jantung rematik, karakteristikAbstract Rheumatic heart disease is a cardiovascular disease caused by delayed sequele of rheumatic fever characterized by heart valve damage. The objective of this study was to observe the characteristics of RHD patients.This study is a descriptive observasional with cross-sectional study design and the retrospective by observing the characteristics of RHD patients in RSUP Dr. M. Djamil Padang from Januari 2009 – December 2012. The population and sample of this study was 54 patients. The result of this study showed that majority of the patients at the age group 11-20 years (50%), female (57.41%), elementary education degree/equal and junior high/equal of each 25.93%, students/university students (53.70%), and come from rural areas (70.37%). Most patients complained experiencedbreathlessness (62.96%). The result of electrocardiography showed LVH is the the highest (35.19%) and AF 27.78%. Based on chest X-ray examination majority of the patients showed a cardiomegaly (92.59%). Based on echocardiography examination, the most heart valve damage is mitral regurgitation (30.40%), the severity is severe (36.80%), and the fraction ejection is in normal limit (72.97%). The conclusion of this research, there are variation in the characteristics of RHD patients in RSUP Dr. M. Djamil Padang.Keywords: rheumatic heart disease, characteristics


2020 ◽  
Vol 58 (230) ◽  
Author(s):  
Rajesh Nepal ◽  
Madhab Bista ◽  
Sahadeb Prasad Dhungana

Introduction: Rheumatic heart disease is a sequel of rheumatic fever which causes heart valve damage. This study was conducted to look at the pattern of valve lesions and treatment practices in patients with rheumatic heart disease. Methods: A cross-sectional study conducted at the tertiary care center with a diagnosis of rheumatic heart disease from July 2018 to January 2020 by convenient sampling. Ethical clearance was obtained from the Institutional Review Committee (ref no. 55/2018). Data were analyzed by using Statistical package for social sciences version 20. Results: Out of 600 patients, 428 (71.3%) were female. The mean age was 44.24±14.24 years. The isolated mitral valve was affected in 280 (46.6%). Dual involvement of mitral and aortic valve was present in 294 (49%). Only 14 (2.3%) had involvement of isolated aortic valve involvement. Overall, mitral stenosis was the most common abnormality 508 (84.6%) followed by mitral regurgitation 418 (69.6%), aortic regurgitation 320 (53.3%), and aortic stenosis 63 (10.5%). Assessment of the severity of lesions showed that 247 (41.2%) patients had severe mitral stenosis, 119 (19.8%) severe mitral regurgitation, 14 (2.3%) severe aortic stenosis, and 11 (1.8%) severe aortic regurgitation. Majority 493 (82.2%) were treated with medical therapies. Surgical procedures were performed in 51 (8.5%). The use of anticoagulation was in 212 (35.3%) of eligible patients. Conclusions: Mitral valve was affected commonly both in isolation and combination. The majority of patients who were eligible for cardiac interventions were treated medically with suboptimal use of anticoagulation and secondary prophylaxis.


2021 ◽  
Vol 59 (237) ◽  
Author(s):  
Basant Sharma ◽  
Eliza Koirala ◽  
Sudhir Regmi ◽  
Jaya Dhungana ◽  
Bandana Khanal Neupane ◽  
...  

Introduction: Cardiac disease in pregnancy is a major cause of maternal mortality and morbidity in women, particularly in resource limited countries like Nepal. Rheumatic Heart Disease is the commonest cardiac disease complicating pregnancy. There is very limited data and evidence from Nepal regarding rheumatic heart disease complicating the pregnancy. The study aims to find out the prevalence of rheumatic heart disease among cardiac disease patients in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted among 41 women with cardiac disease who delivered babies at Chitwan Medical College from 1st January 2018 to 31st December 2019, after taking ethical approval from the Institutional Review Committee. A convenient sampling method was used. Statistical Package for the Social Sciences was used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 41 pregnant women with cardiac disease, 32 (78%) (95% Confidence Interval = 65.32-90.68) had rheumatic heart disease. The mean age of the affected pregnant women was 24.9±4.49 years. Out of 32 patients with rheumatic heart disease, postpartum haemorrhage was the most common maternal complication 5 (15.6%) followed by hypertension 4 (9.7%). Conclusions: Rheumatic Heart Disease was highly common among pregnant women with cardiac disease.


2016 ◽  
Vol 24 (2) ◽  
pp. 101-109 ◽  
Author(s):  
Eduardo LV Lopes ◽  
Andrea Z Beaton ◽  
Bruno R Nascimento ◽  
Alison Tompsett ◽  
Julia PA dos Santos ◽  
...  

Background The global burden of rheumatic heart disease is nearly 33 million people. Telemedicine, using cloud-server technology, provides an ideal solution for sharing images performed by non-physicians with cardiologists who are experts in rheumatic heart disease. Objective We describe our experience in using telemedicine to support a large rheumatic heart disease outreach screening programme in the Brazilian state of Minas Gerais. Methods The Programa de Rastreamento da Valvopatia Reumática (PROVAR) is a prospective cross-sectional study aimed at gathering epidemiological data on the burden of rheumatic heart disease in Minas Gerais and testing of a non-expert, telemedicine-supported model of outreach rheumatic heart disease screening. The primary goal is to enable expert support of remote rheumatic heart disease outreach through cloud-based sharing of echocardiographic images between Minas Gerais and Washington. Secondary goals include (a) developing and sharing online training modules for non-physicians in echocardiography performance and interpretation and (b) utilising a secure web-based system to share clinical and research data. Results PROVAR included 4615 studies that were performed by non-experts at 21 schools and shared via cloud-telemedicine technology. Latent rheumatic heart disease was found in 251 subjects (4.2% of subjects: 3.7% borderline and 0.5% definite disease). Of the studies, 50% were preformed on full functional echocardiography machines and transmitted via Digital Imaging and Communications in Medicine (DICOM) and 50% were performed on handheld echocardiography machines and transferred via a secure Dropbox connection. The average time between study performance date and interpretation was 10 days. There was 100% success in initial image transfer. Less than 1% of studies performed by non-experts could not be interpreted. Discussion A sustainable, low-cost telehealth model, using task-shifting with non-medical personal in low and middle income countries can improve access to echocardiography for rheumatic heart disease.


2019 ◽  
Vol 5 (3) ◽  
pp. 186-191
Author(s):  
Abrar Wahab ◽  
Md Mahabub Ul Islam ◽  
Mehbuba Mehnoor Laboni ◽  
Anisa Fatema ◽  
Abeda Saleha Renesa ◽  
...  

Rheumatic heart disease (RHD) is a significant public health problem and Non-adherence to treatment is an important and often unrecognized risk factor for cardiovascular mortality. The study aimed to assess self-reported medication adherence by 8-item Morisky Medication Adherence Scale (MMAS-8) among rheumatic heart disease patients and determine the associated factors. A cross-sectional study was carried out by applying a structured interview to Rheumatic heart disease patients aged 18 or higher in a tertiary hospital in Bangladesh. Among Rheumatic heart disease patients, 63.5% showed medium adherence, 36.5% showed low adherence to medication. Walking habit (P= 0.000), exercise habit (P=0.000), smoking habit (P=0.000), and duration of RHD (P=0.005) found significantly associated with medication adherence. Multiple logistic regression analysis also revealed, don't have walking habit more than 10 minutes at a time (AOR=2.416, 95% CI: 1.212-4.816), don't having exercise habit (AOR=2.420, 95% CI: 1.206 – 4.859), don't having habit of smoking (AOR=0.392, 95% CI: 0.183 – 0.841), duration of RHD for less than 15 (AOR=4.190, 95% CI: 0.851 – 20.631) are independent predictors of adherence. Our study demonstrated medium to low medication adherence in the Morisky Medication Adherence Scale among rheumatic heart disease patients. Asian J. Med. Biol. Res. June 2019, 5(3): 186-191


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