scholarly journals Toward the Knowledge of the Epidemiological Impact of Acute Rheumatic Fever in Italy

2021 ◽  
Vol 9 ◽  
Author(s):  
Antonino Maria Quintilio Alberio ◽  
Filippo Pieroni ◽  
Alessandro Di Gangi ◽  
Susanna Cappelli ◽  
Giulia Bini ◽  
...  
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Risk Group ◽  
Central Italy ◽  
Geographic Area ◽  
Joint Involvement ◽  
High Prevalence ◽  
Epidemiological Impact

Background: To estimate the incidence of Acute Rheumatic Fever (ARF) in Tuscany, a region of Central Italy, evaluating the epidemiological impact of the new diagnostic guidelines, and to analyse our outcomes in the context of the Italian overview.Methods: A multicenter and retrospective study was conducted involving children <18 years old living in Tuscany and diagnosed in the period between 2010 and 2019. Two groups were established based on the new diagnostic criteria: High-Risk (HR) group patients, n = 29 and Low-Risk group patients, n = 96.Results: ARF annual incidence ranged from 0.91 to 7.33 out of 100,000 children in the analyzed period, with peak of incidence registered in 2019. The application of HR criteria led to an increase of ARF diagnosis of 30%. Among the overall cohort joint involvement was the most represented criteria (68%), followed by carditis (58%). High prevalence of subclinical carditis was observed (59%).Conclusions: Tuscany should be considered an HR geographic area and HR criteria should be used for ARF diagnosis in this region.

Clinical features and diagnosis of acute rheumatic fever

ESC CardioMed ◽  
2018 ◽  
pp. 1138-1140
Author(s):  
Antoinette Cilliers
Keyword(s):  
High Risk ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Heart Association ◽  
Risk Groups ◽  
Group A ◽  
High Risk Populations ◽  
Minor Criteria

The diagnosis of acute rheumatic fever cannot be made using a single test. The diagnosis requires the recognition of a complex of clinical signs divided into major and minor manifestations as well as laboratory investigations aided by application of the Jones criteria, originally devised in 1944. The clinical manifestations are secondary to the effects of antibodies produced against the group A Streptococcus organism which cross-react against cardiac, skin, synovial, and neurological tissue associated with signs of inflammation. Several adjustments to the Jones criteria have been published over the last 70 years. The latest 2015 American Heart Association modification includes echocardiography/Doppler studies to diagnose subclinical carditis and also incorporates risk stratification whereby at-risk populations are divided into low- and moderate-to-high-risk groups. The presence of a single episode of a fever of at least 38°C and a slight elevation of the erythrocyte sedimentation rate to at least 30 mm/hour are classified as minor criteria in moderate- and high-risk populations. A monoarthritis or polyarthralgia are included as major criteria in the same risk group.

Chronic Lymphocytic Leukemia: Evaluation of Cytogenetic Markers as Prognostic Factors

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4860-4860
Author(s):  
Jose Carda ◽  
Patricia Sousa ◽  
Patricia Olim ◽  
Emília Magalhães ◽  
Luis Rito ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Retrospective Study ◽  
High Risk ◽  
Chronic Lymphocytic Leukemia ◽  
Progressive Disease ◽  
Risk Group ◽  
Staging System ◽  
Lymphocytic Leukemia ◽  
Intermediate Risk

Abstract Abstract 4860 Backgroud: Chronic lymphocytic leukemia (CLL) is one of the most frequent chronic lymphoproliferative disorders in Europe. It is characterized by persistent monoclonal lymphocitosis with localized or generalized lymphadenopathy. Despite the initial clinical presentation, it has a heterogeneous natural history, with the majority of patients living 10–12 years, but with some patients dying rapidly, within 2–3 years of diagnosis. Beside clinical prognostic factors, novel cytogenetic markers are recognized to be useful in predicting disease free and overall survival in CLL. AIMS: In a retrospective study throughout 10 years (1999-2009), we analyzed the clinical and biological presentation and compared the evolution and survival of patients with B-CLL using different cytogenetic markers. METHODS: We identified 112 cases (63 males and 49 females) of B-CLL with cytogenetic study by fluorescence in situ hybridization (FISH). RESULTS: Amongst 112 patients, the male to female (M/F) ratio was 1.3:1 and the median age was 70 (43-96) years. At diagnosis, the median lymphocyte count was 15.5 G/L (5.4-173). Fifty five patients (49%) had lymphadenopathies and seventeen (15%) had splenomegaly and/or hepatomegaly at presentation. By the revised Rai staging system seventy (63%) patients were included in low risk group, thirty (27%) in intermediate risk group and twelve (10%) in high risk group. The expression of ZAP-70 and CD38 by flow citometry was performed in 75 patients and revealed 13 (17%) patients CD38+ and 12 (16%) ZAP70+. The study of chromosomal aberrations with FISH showed thirty six patients (32%) with no abnormality, thirty six (32%) with isolated 13q deletion, fifteen (14%) with 12 trisomy, twelve (11%) with 11q deletion and thirteen (11%) with 17p deletion. Forty (36%) patients showed progressive disease in a median time of sixteen months (0-120), thirteen with 13qdel, seven with 17pdel and five with 12 trisomy. After treatment two patients showed progressive disease, six maintain a stable disease and thirty two obtain a remission, nine in complete remission. The Overall Survival (OS) at ten years was 70%. By the revised Rai staging system the OS at ten years was 80% for low risk, 70% for intermediate risk and all the high risk patients died during follow up. The OS at five years for the del13q-, 12 trisomy, del11q- and del17p- was 90%, 88%, 58% and 60%, respectively. SUMMARY: Chronic lymphocytic leukemia is currently considered a chronic disorder with a favourable outcome, but with a variable evolution to progressive disease. This retrospective study allowed the characterization of patient with CLL in our department and the acknowledgement that our results are quite similar to the published data. Disclosures: No relevant conflicts of interest to declare.

scholarly journals What Lies Ahead for Young Hearts in the 21st Century – Is It Double Trouble of Acute Rheumatic Fever and Kawasaki Disease in Developing Countries?

2021 ◽  
Vol 8 ◽  
Author(s):  
Aaqib Zaffar Banday ◽  
Sanjib Mondal ◽  
Prabal Barman ◽  
Archan Sil ◽  
Rajni Kumrah ◽  
...  
Keyword(s):  
Developing Countries ◽  
Heart Disease ◽  
High Risk ◽  
Kawasaki Disease ◽  
Rheumatic Fever ◽  
Health Care Providers ◽  
Acute Rheumatic Fever ◽  
Pediatric Population ◽  
Care Providers ◽  
Incidence Trends

Rheumatic heart disease (RHD), the principal long-term sequel of acute rheumatic fever (ARF), has been a major contributor to cardiac-related mortality in general population, especially in developing countries. With improvement in health and sanitation facilities across the globe, there has been almost a 50% reduction in mortality rate due to RHD over the last 25 years. However, recent estimates suggest that RHD still results in more than 300,000 deaths annually. In India alone, more than 100,000 deaths occur due to RHD every year (Watkins DA et al., N Engl J Med, 2017). Children and adolescents (aged below 15 years) constitute at least one-fourth of the total population in India. Besides, ARF is, for the most part, a pediatric disorder. The pediatric population, therefore, requires special consideration in developing countries to reduce the burden of RHD. In the developed world, Kawasaki disease (KD) has emerged as the most important cause of acquired heart disease in children. Mirroring global trends over the past two decades, India also has witnessed a surge in the number of cases of KD. Similarly, many regions across the globe classified as “high-risk” for ARF have witnessed an increasing trend in the incidence of KD. This translates to a double challenge faced by pediatric health care providers in improving cardiac outcomes of children affected with ARF or KD. We highlight this predicament by reviewing the incidence trends of ARF and KD over the last 50 years in ARF “high-risk” regions.

scholarly journals Atypical arthritis in a toddler: beware, save the heart

2020 ◽  
Vol 7 (5) ◽  
pp. 1177
Author(s):  
Sharani Boopathy ◽  
Kanimozhi Thandapani ◽  
Arulkumaran Arunagirinathan
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Age Of Onset ◽  
Joint Involvement ◽  
Cardiac Complications ◽  
General Physical ◽  
Systemic Examination ◽  
High Index Of Suspicion ◽  
Local Examination

Acute rheumatic fever still poses a dreadful threat to pediatric morbidity and mortality. A 2 year old toddler presented to us with non migratory polyarticular joint pain and swelling. General physical and systemic examination was normal. Local examination revealed swelling and tenderness of multiple small and large joints. Further evaluation fulfilled Modified Jones criteria and she was diagnosed to have acute rheumatic fever. Other close differentials were simultaneously ruled out. Child was started on naproxen because of aspirin toxicity. There was significant response for therapy and complete resolution of joint involvement was noted on follow up. We report this case to emphasize the fact that rheumatic fever might have bizarre clinical presentation and may also affect infants and toddlers deviating the typical age of onset. There is a need for earliest possible initiation of adequate management and follow up to prevent permanent cardiac complications. This warrants high index of suspicion even in uncommon age group.

scholarly journals BLEEDINGS IN THE HIGH-RISK GROUP OBSTETRIC HOSPITAL

2018 ◽  
Vol 5 (1) ◽  
pp. 37-40
Author(s):  
Elena M. Guseva
Keyword(s):  
High Risk ◽  
Blood Loss ◽  
Risk Group ◽  
Placenta Previa ◽  
Massive Hemorrhage ◽  
High Risk Group ◽  
Massive Blood Loss ◽  
High Prevalence ◽  
Causes Of Deaths ◽  
Stage Analysis

Massive hemorrhage and hemorrhagic shock as main causes of deaths in pregnancy, occupy up to 25% in the structure of mortality rate in obstetrics. In the past decade, the decline in the share of deaths of mothers has occurred due to postpartum bleedings and bleedings in detachment or placenta previa. The aim of the study was to determine the frequency and structure of massive bleedings in a high-risk group obstetric hospital. Methods. A retrospective descriptive cohort study was executed in 2 stages: at the 1st stage - a study of 396 deliveries histories with main nosological forms leading to possible pathological hemorrhage, in the II stage - analysis of 55 cases of massive blood loss. The object of the study was puerperas with placenta previa; puerperas with deliveries complicated by hypotonic bleeding or premature detachment of the placenta; puerperas with the massive blood loss. Duration of the study: from 01.01.2011 to 31.12. 2015. Results. The most frequent nosological form leading to abnormal blood loss is premature placental abruption. The frequency of cases of massive blood loss (more than 1000 ml) is 0.28% of the total number of deliveries and is more common in primigravidae (56.4%), mainly during surgical delivery (88%). Out of all massive bleedings, 45.5% are due to uterine hypotension. Amputation of the uterus was performed in 18.2% of the number of all cases of the massive hemorrhage. Conclusion. The high prevalence rate of the premature detachment of the placenta is explained by the uncontrollability of this pathology, in contrast to hypotonic bleeding in the postpartum period. The organ-preserving management in massive obstetric hemorrhages is not widely used.

Early screening of risk for multi-drug resistant organisms in the emergency department in patients with pneumonia and early septic shock: single-center, retrospective cohort study

2020 ◽  
Author(s):  
Wen-Lin Su ◽  
I-Shiang Tzeng ◽  
Hao-Ai Shui ◽  
Meng-Yu Wu ◽  
Ming-Yieh Peng ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
High Risk ◽  
Antibiotic Therapy ◽  
Retrospective Cohort ◽  
Risk Group ◽  
Low Risk ◽  
Icu Mortality ◽  
Early Screening ◽  
High Prevalence

Abstract Background Pneumonia is the fourth leading cause of death globally, with rapid progression during septic shock. Multidrug-resistant organisms (MDROs) are becoming more common with some healthcare-associated pneumonia events. Early detection of MDRO risk may improve the outcomes; however, the risk of MDROs in patients with pneumonia and septic shock is unknown and may need broad spectrum multidrug antibiotic therapy. This study investigated the disease outcomes and multidrug antibiotic therapy of pneumonia with early septic shock in patients admitted in the emergency department (ED), a population with a high prevalence of MDROs, after early screening of MDROs risk. Methods In this retrospective cohort study, patients with pneumonia and sepsis (n=533) admitted to the ED at the Taipei Tzu Chi Hospital from 2013 to 2019 were enrolled. The study population was divided into the high-risk and low-risk groups (patients from the communities or long-term care facilities with high and low prevalence of MDROs) and further divided into four subgroups to those whose screening procedure completed within 1 or 6 h of admission (high-risk within 1 h, high-risk within 6 h, low-risk within 1 h, and low risk within 6 h groups). The ICU mortality and multidrug antibiotic therapy were compared. Results The high-risk MDROs groups had higher percentage of P. aeruginosa than the low-risk group. Furthermore, the appropriate ED first antibiotics were higher in the “within 1 h” than in the “within 6 h” subgroup of the high-risk MDROs group. In multivariate analysis, the “within 6 h” high-risk MDROs subgroup had an adjusted odds ratio of 7.191 (95% CI: 2.911–17.767, p <0.001) and 2.917 (95% CI:1.456–5.847, p=0.003) for the ICU mortality and multidrug therapy in the ICU, respectively, after adjusting for other confounding factors. Conclusions Delayed MDRO screening in the high risk group had significant higher ICU mortality and multidrug antibiotic therapy in patients with pneumonia and early septic shock in the ED, especially in areas with a high prevalence of MDROs.

The influence of age and comorbidities on the outcomes of surgical treatment with free tissue transfer: a retrospective study

2020 ◽  
Vol 74 (4) ◽  
pp. 8-12
Author(s):  
Małgorzata Czesak ◽  
Maria Sobol ◽  
Antoni Bruzgielewicz ◽  
Kazimierz Niemczyk ◽  
Ewa Osuch-Wójcikiewicz
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Head And Neck ◽  
Free Flap ◽  
Risk Group ◽  
Free Tissue Transfer ◽  
Low Risk ◽  
Local Complications ◽  
Tissue Transfer ◽  
Significant Difference

<b>Introduction:</b> Microvascular free tissue transfer enables the reconstruction of complex head and neck defects. The aim of the study was to assess the results of treatment of patients undergoing reconstructive surgery and to identify factors affecting these results, with particular reference to patient’s age. <br><b>Materials and Methods:</b> All patients who underwent free-flap head and neck reconstruction in our institution between 2010 and 2017 were included in this retrospective study. A series of 66 patients met the inclusion criteria and were divided into 2 age groups: group G1 aged <65 years (n = 41) and group G2 aged ≥65 years (n = 25). Minor local complications and general complications as well as comorbidities were analyzed. <br> <b>Results:</b> No correlation was found between advanced age and the risk of free flap failure as well as the incidence of local minor complications. General complications were more frequent in the G2 group (32%) than in the G1 group (19.5%), although this is not a statistically significant difference. A statistically significant difference was found between the age and the patient’s health status according to ASA (P = 0.010). In the younger low-risk group, 12 patients (29.3%) had general and local complications, while in the older low-risk group only 1 (4%). General and local complications were found in 5 (12.2%) high-risk G1 patients and in 7 (28%) high-risk G2 patients. <br><b>Conclusion(s):</b> Patients with advanced head and neck malignant tumors should undergo reconstructive microsurgery regardless of age.

Novel Prognostic Model Of Primary Mediastinal Large B-Cell Lymphoma (PMBL): A Multicenter Cooperative Retrospective Study In Japan

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 638-638 ◽  
Author(s):  
Tomohiro Aoki ◽  
Koji Izutsu ◽  
Ritsuro Suzuki ◽  
Chiaki Nakaseko ◽  
Hiroshi Arima ◽  
...  
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Pericardial Effusion ◽  
Prognostic Model ◽  
Cell Lymphoma ◽  
Risk Group ◽  
B Cell Lymphoma ◽  
Intermediate Risk ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background and Objective Primary mediastinal large B-cell lymphoma (PMBL) accounts for 2 to 4% of non-Hodgkin lymphomas and is characterized by distinct clinical, pathological and genetic features. Although the utility of DA-EPOCH-R without radiotherapy (RT) and a PET-guided RT approach were recently reported, a standard therapy has not yet been established, mostly due to the lack of data from prospective randomized studies. In addition, the prognosis for patients (pts) with relapsed PMBL is not well understood. Therefore, we conducted a multicenter, cooperative retrospective study to evaluate the clinical outcome of pts with PMBL. Patients and Methods We analyzed a total of 345 pts with newly diagnosed PMBL from 65 institutes between May 1986 and September 2012 in Japan. Pts were treated according to each institutional protocol or physicians' decisions. In pts treated with R-CHOP, the role of PET before RT was analyzed. In addition, we analyzed prognostic factors for PMBL pts and constructed a novel prognostic model using data from patients treated with R-CHOP. Results The median age was 32 (range, 17-83) years, and female pts were predominant (58%) among the patient population. Median tumor diameter was 10 cm. Stage I/II, low-risk by IPI, and PS 0/1 were also predominant (68%, 52% and 75%, respectively). The presence of pleural or pericardial effusion, elevated lactate dehydrogenase level and extra-nodal lesions were observed in 46%, 80% and 44% of pts, respectively. With a median follow-up of 48 months in surviving pts, overall survival (OS) and progression-free survival (PFS) at 4 years were 87% and 70%, respectively. The OS and PFS were improved in pts treated with rituximab(R)-containing chemotherapy (n = 267) (4-year OS: 91% vs. 77%, P < 0.001; 4-year PFS: 75% vs. 54%, P < 0.001, respectively). The OS at 4 years for patients treated with CHOP (n = 44), R-CHOP (n = 187), DA-EPOCH-R (n = 9), second- or third-generation regimens (n = 45; 28 with R and 17 without R), and chemotherapy followed by ASCT (n = 57; 43 with R and 14 without R) were 67%, 90%, 100%, 91% and 92%, respectively (P < 0.001). The PFS at 4 years were 40%, 71%, 100%, 83% and 76%, respectively (P < 0.001) (Figure 1). Consolidative RT was given to 42% of the patient population. A total of 119 of 187 pts treated with R-CHOP were assessed by PET/CT after the completion of R-CHOP, and 64 pts received consolidative RT after R-CHOP. In pts with negative PET after R-CHOP (n = 84), the OS (100% vs. 100%, P > 0.99) and PFS (92% vs. 72%, P = 0.36) at 4 years were similar when comparing pts treated with (n =25) or without RT (n =59). However, in pts with positive PET after R-CHOP (n = 28), both OS (100% vs. 60%, P = 0.010) and PFS (80% vs. 17%, P < 0.001) at 4 years were superior in pts who received RT (n = 21) than in pts who did not receive RT (n = 7). A total of 97 pts (28%) relapsed or progressed after first-line therapy. Of these, 67 (19%) and 11 pts (3%) relapsed in the mediastinum and CNS, respectively. Median time from initial diagnosis to relapse or progression was 9 months. Median OS after relapse or progression was 16 months and was higher in patients treated with stem-cell transplantation (SCT) (n = 58; 44 ASCT, 14 allogeneic SCT) than in patients who did not undergo SCT (4-year OS: 67% vs. 31%, P < 0.001). The IPI was predictive for OS (P = 0.002) and PFS (P < 0.001) in pts with PMBL treated with R-CHOP. Moreover, multivariate analysis showed that the presence of pleural or pericardial effusion was a significant and independent prognostic factor for PFS. We constructed a novel prognostic model (PMBL prognostic index; PMBIPI) and classified pts treated with R-CHOP into three different risk groups using these two factors (the presence of pleural or pericardial effusion, and IPI high/intermediate-risk or high-risk). For 93 pts (51%) classified as the low-risk group (0 factor), OS and PFS at 4 years were 97% and 89%, respectively. For 61 pts (34%) classified as the intermediate-risk group (1 factor), OS and PFS at 4 years were 85% and 59%, respectively. For 27 pts (15%) classified as the high-risk group (2 factors), OS and PFS at 4 years were 72% (P = 0.001) and 44% (P < 0.001), respectively (Figure 2). Conclusions The combination of R and chemotherapy improved outcomes for patients with PMBL. In addition, PET could predict the necessity for RT in pts with PMBL treated with R-CHOP. PMBIPI is a promising tool for risk-stratification of pts with PMBL. These findings require further validation in prospective studies. Disclosures: No relevant conflicts of interest to declare.

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