Episodes Of Acute Rheumatic Fever Research Articles

Clinical profile of paediatric acute rheumatic fever and rheumatic heart disease in Western Australia: 1987 to 2020.

To describe the clinical profile of acute rheumatic fever (ARF) presentations to paediatric cardiology tertiary services in Western Australia (WA). A retrospective clinical audit of individuals with confirmed ARF referred to the only paediatric tertiary cardiac service in WA (1 January 1987 to 31 December 2020). Comparisons between inpatient, outpatient, remote and non-remote groups were assessed. Four hundred seventy-one episodes of ARF in 457 individuals (235 male; median age = 8 years) met clinical criteria. The majority were Aboriginal and Torres Strait Islander children (91.2%), with 62.1% living in remote areas. The number of ARF and rheumatic heart disease (RHD) diagnoses per year increased from 1987 to 2017 with notable peaks in 2013 and 2017. The average annual incidence of tertiary-referred ARF in WA of 4-15-year-olds from 1987 to 2020 was 4.96 per 100 000. ARF features included carditis (59.9%), chorea (31%), polyarthritis (30%) and polyarthralgia (24.2%). RHD was evident in 61.8% of cases and predominantly manifested as mitral regurgitation (55.7%). Thirty-four children (7.4%) with severe RHD underwent valvular surgery. 12% had at least one recurrent ARF episode. Remote individuals had more than double the rate of recurrence compared to non-remote individuals (P = 0.0058). Compared to non-remote episodes, remote presentations had less polyarthritis (P = 0.0022) but greater proportions of raised ESR (P = 0.01), ASOT titres (P = 0.0073), erythema marginatum (P = 0.0218) and severe RHD (P = 0.0133). The high proportion of Aboriginal and Torres Strait Islander Australians affected by ARF/RHD in WA reflects the significant burden of disease within this population. Children from remote communities were more likely to present with concurrent severe RHD. Our study reinforces the persisting need to improve primary and secondary ARF initiatives in rural and remote communities.

Application of Transthoracic Echocardiography for Cardiac Safety Evaluation in the Clinical Development Process of Vaccines Against Streptococcus pyogenes.

Superficial infections with Streptococcus pyogenes (Strep A), pharyngitis and impetigo can induce acute rheumatic fever, an autoimmune sequela manifesting mostly with arthritis and rheumatic carditis. Valvular heart damage can persist or advance following repeated episodes of acute rheumatic fever, causing rheumatic heart disease. Acute rheumatic fever and rheumatic heart disease disproportionately affect children and young adults in developing countries and disadvantaged communities in developed countries. People living with rheumatic heart disease are at risk of experiencing potentially fatal complications such as heart failure, bacterial endocarditis or stroke. Transthoracic echocardiography plays a central role in diagnosing both rheumatic carditis and rheumatic heart disease. Despite the obvious medical need, no licensed Strep A vaccines are currently available, as their clinical development process faces several challenges, including concerns for cardiac safety. However, the development of Strep A vaccines has been recently relaunched by many vaccine developers. In this context, a reliable and consistent safety evaluation of Strep A vaccine candidates, including the use of transthoracic echocardiography for detecting cardiac adverse events, could greatly contribute to developing a safe and efficacious product in the near future. Here, we propose a framework for the consistent use of transthoracic echocardiography to proactively detect cardiac safety events in clinical trials of Strep A vaccine candidates.

Current Clinical Profile of Acute Rheumatic Fever and Recurrent Acute Rheumatic Fever in Pakistan.

Inclusion of echocardiography as diagnostic tool and polyarthralgia and monoarthritis as major criteria for high-risk populations in the Revised Jones Criteria 2015 is likely to surface substantial variability in clinical manifestations among various populations. This study aimed to compare clinical profile of patients presenting with first and recurrent episodes of acute rheumatic fever (ARF) using most recent criteria. 130 consecutive patients with ARF were included in the study from August 2019 to March 2022. World Heart Federation standardized echocardiographic criteria were used for cardiac evaluation. The socio-demographic variables, clinical details and relevant investigations were recorded. Median age was 13(6-26) years. Male to female ratio was 1.6:1. Majority was of low socioeconomic status (90%) and with > 5 family members in a house (83.8%). 27 patients (20.8%) were with ARF while 103 (79.2%) with recurrent ARF. Carditis was the most common presenting feature (n = 122, 93.8%), followed by polyarthralgia (n = 46, 35.4%), polyarthritis (n = 32, 24.6%), subcutaneous nodules (n = 10, 7.7%), monoarthritis (n = 10, 7.7%), and chorea (n = 5, 3.8%). Monoarthralgia was more common in ARF than recurrence (29.4% vs. 3.2%, p = 0.004). Carditis (97.1% vs. 81.5%, p = 0.01) and congestive cardiac failure (18.5% vs. 5.9%, p = 0.001) were more common in recurrent ARF than ARF. Diagnostic categorization of Jones criteria for different populations has highlighted important variability in clinical presentation of ARF. Monoarthralgia is common in first episode of ARF. Carditis is the most common feature in recurrent ARF. Polyarthralgia is seen with higher frequency that polyarthritis. Subcutaneous nodules seem to be more common in our population.

Clinical profile of acute rheumatic fever in children in Pakistan: A study at a tertiary care hospital.

Objective: To determine the clinical profile of children presenting with acute rheumatic fever (ARF) at a tertiary care healthcare facility. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: January 2021 to December 2022. Material & Methods: We analyzed children of both genders aged between 1 month to 18 years and presenting with ARF. At the time of enrollment, medical history was obtained and physical as well as clinical examinations were performed. The demographical and clinical information were recorded. ARF was labeled as per “Modified Jones Criteria”. A special proforma was formed to record study data. Results: In a total of 154 children, 96 (62.3%) were female while the mean age was 9.3±4.6 years. Forty four (28.6%) patients were having first episode of ARF while 110 (71.4%) had recurrence of ARF. Fever was noted to be the most common presentation noted in 121 (78.6%) patients of ARF. Arthritis was significantly more common among patients with first episode of ARF when compared to recurrence of ARF (70.5% vs. 29.1%, p<0.0001). Degree of carditis was significantly more severe among patients with recurrence of ARF (p<0.0001). Conclusion: Majority of the acute rheumatic fever patients present with recurrence of acute rheumatic fever. Fever was the commonest clinical presentation while arthritis was significantly more prevalent among patients with first episode of acute rheumatic fever.

Acute rheumatic fever and rheumatic heart disease in children and adolescents in Victoria, Australia.

To describe the epidemiology and clinical profile of children and adolescents with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Victoria, Australia. A retrospective audit was undertaken of children and adolescents with ARF and RHD attending the Royal Children's and Monash Children's Hospitals in Victoria, Australia between 2010 and 2019. Potential cases were identified by searching multiple sources for relevant ICD-10-AM codes and keywords, then reviewed manually. For confirmed cases, we collected data on patient demographics, clinical features, comorbidities and management. Of 179 participants included, there were 108 Victorian residents and 71 non-Victorian residents. 126 had at least one episode of ARF during the study period and 128 were diagnosed with RHD. In the Victorian resident group, the overall incidence of ARF was 0.8 per 100 000 5-14 year olds. This incidence was higher in Victorian Aboriginal and/or Torres Strait Islander (3.8 per 100 000) and Pacific Islander (32.1 per 100 000) sub-populations. Of 83 Victorian residents who had an ARF episode, 11 (13%) had a recurrence. Most Victorian residents with RHD had mixed aortic and mitral valve pathology (69.4%) and moderate to severe disease (61.9%). Most non-Victorian residents were Aboriginal and/or Torres Strait Islander people (80.3%) and were commonly transferred for tertiary or surgical management of RHD (83.1%). ARF and RHD continue to affect the health of significant numbers of children and adolescents living in Victoria, including severe and recurrent disease. Specialised services and a register-based control program may help to prevent complications and premature death.

An observational analysis of trends in rheumatic heart disease incidence and mortality in EU15+ countries over 29 years

Abstract Background Rheumatic heart disease (RHD) is a debilitating sequela of acute rheumatic fever (ARF), caused by Group A streptococcus (GAS) infection. Repeated episodes of ARF results in valvular damage over time. As a preventable disorder which was once common worldwide, RHD has largely been eradicated in affluent nations due to widespread availability of penicillin, improvement in socioeconomic standards and advancements in health and social infrastructures. However, it has been speculated that the global refugee crisis, especially in Europe, might contribute to a resurgence of RHD cases in these regions. Purpose This observational study aimed to analyse trends in RHD incidence and mortality rates in European Union 15+ (EU15+) over a 29-year period. Methods Data was obtained from the Global Burden of Disease database. Age-standardised mortality and incidence rates for RHD were extracted for the EU15+ countries for the years 1990–2019. Trends were subsequently analysed using Joinpoint regression analysis. Results Over the 29-year period, an overall declining trend in RHD incidence and mortality across EU 15+ nations was observed. The United Kingdom demonstrated the largest decrease in RHD incidence amongst females (−54.9%) and Finland amongst males (−55.3%). Both RHD incidence and mortality were higher among females compared to males across EU15+ countries over the observed period. The most recent incidence trends, starting predominantly after 2014, demonstrated a rise in RHD incidence in most countries. For both sexes, increases were seen in Australia, Belgium, Ireland, Italy, Netherlands, Norway, Sweden and USA. For males specifically, increase in RHD incidence was seen in Spain, and Finland, and for females only in Canada and Ireland. The recent increasing RHD incidence rates ranged from +0.4% to + 24.7% for males and +0.6% to +11.4% for females. Conclusion Whilst overall there are decreases in incidence and mortality from RHD, we observe more than half of EU15+ countries have increasing incidence trends in RHD in recent years. This increasing trend primarily started after 2014, overlapping with the start of the European migration crisis. Although speculative, disparities in access to healthcare for migrants, amongst other socioeconomic factors, may be potential causes; subsequently, further efforts by governments and public health officials are required to recognise and control the resurgence of RHD in high income nations. Funding Acknowledgement Type of funding sources: None.

Acute Rheumatic Fever and Rheumatic Heart Disease: Highlighting the Role of Group A Streptococcus in the Global Burden of Cardiovascular Disease.

Group A Streptococcus (GAS) causes superficial and invasive infections and immune mediated post-infectious sequalae (including acute rheumatic fever/rheumatic heart disease). Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are important determinants of global cardiovascular morbidity and mortality. ARF is a multiorgan inflammatory disease that is triggered by GAS infection that activates the innate immune system. In susceptible hosts the response against GAS elicits autoimmune reactions targeting the heart, joints, brain, skin, and subcutaneous tissue. Repeated episodes of ARF—undetected, subclinical, or diagnosed—may progressively lead to RHD, unless prevented by periodic administration of penicillin. The recently modified Duckett Jones criteria with stratification by population risk remains relevant for the diagnosis of ARF and includes subclinical carditis detected by echocardiography as a major criterion. Chronic RHD is defined by valve regurgitation and/or stenosis that presents with complications such as arrhythmias, systemic embolism, infective endocarditis, pulmonary hypertension, heart failure, and death. RHD predominantly affects children, adolescents, and young adults in LMICs. National programs with compulsory notification of ARF/RHD are needed to highlight the role of GAS in the global burden of cardiovascular disease and to allow prioritisation of these diseases aimed at reducing health inequalities and to achieve universal health coverage.

Data-independent acquisition mass spectrometry in severe rheumatic heart disease (RHD) identifies a proteomic signature showing ongoing inflammation and effectively classifying RHD cases

BackgroundRheumatic heart disease (RHD) remains a major source of morbidity and mortality in developing countries. A deeper insight into the pathogenetic mechanisms underlying RHD could provide opportunities for drug repurposing, guide recommendations for secondary penicillin prophylaxis, and/or inform development of near-patient diagnostics.MethodsWe performed quantitative proteomics using Sequential Windowed Acquisition of All Theoretical Fragment Ion Mass Spectrometry (SWATH-MS) to screen protein expression in 215 African patients with severe RHD, and 230 controls. We applied a machine learning (ML) approach to feature selection among the 366 proteins quantifiable in at least 40% of samples, using the Boruta wrapper algorithm. The case–control differences and contribution to Area Under the Receiver Operating Curve (AUC) for each of the 56 proteins identified by the Boruta algorithm were calculated by Logistic Regression adjusted for age, sex and BMI. Biological pathways and functions enriched for proteins were identified using ClueGo pathway analyses.ResultsAdiponectin, complement component C7 and fibulin-1, a component of heart valve matrix, were significantly higher in cases when compared with controls. Ficolin-3, a protein with calcium-independent lectin activity that activates the complement pathway, was lower in cases than controls. The top six biomarkers from the Boruta analyses conferred an AUC of 0.90 indicating excellent discriminatory capacity between RHD cases and controls.ConclusionsThese results support the presence of an ongoing inflammatory response in RHD, at a time when severe valve disease has developed, and distant from previous episodes of acute rheumatic fever. This biomarker signature could have potential utility in recognizing different degrees of ongoing inflammation in RHD patients, which may, in turn, be related to prognostic severity.

C86. Secondary Prophylaxis For Rheumatic Heart Disease During The Pandemic Era: A Case Report

BackgroundRheumatic heart disease (RHD) is heart diseases results from recurrent episodes of acute rheumatic fever (ARF). It often occurs in developing countries and its pathogenesis is not clearly understood. RHD can be controlled with prophylaxis that requires patients to visit healthcare facility regularly. However, the current pandemic condition is a challenge for patients to receive routine treatment and evaluation.Case SummaryA 17-years-old girl comes to emergency room with complaints of shortness of breath with mark limitation of physical activity 3 days prior to admission. The patient also complaint with joint pain and leg swelling. She was diagnosed Rheumatic Heart Disease and received prophylactic penicillin injections every month. However, since the pandemic, She do vice versa. In physical examination was found pansystolic murmur on aortic valve and bilateral lower extremity edema. Echocardiography showed moderate mitral regurgitation and mild aortic regurgitation. This patient was hospitalized and treated with benzathine penicillin G, prednisone, aspirin, furosemide and captopril.DiscussionManagement of ARF includes eradication cause of infection, treat complications, and secondary prevention. Administration of secondary prophylaxis is useful for reduce new bacterial strains that can cause recurrent acute or chronic attacks. First line of secondary prophylaxis for ARF is intramuscular benzathine penicillin G that given per month. In this current pandemic conditions, patients are expected to continue prophylaxis therapy and follow up the disease with using pandemic health protocols.

C86. Secondary Prophylaxis For Rheumatic Heart Disease During The Pandemic Era: A Case Report

BackgroundRheumatic heart disease (RHD) is heart diseases results from recurrent episodes of acute rheumatic fever (ARF). It often occurs in developing countries and its pathogenesis is not clearly understood. RHD can be controlled with prophylaxis that requires patients to visit healthcare facility regularly. However, the current pandemic condition is a challenge for patients to receive routine treatment and evaluation.Case SummaryA 17-years-old girl comes to emergency room with complaints of shortness of breath with mark limitation of physical activity 3 days prior to admission. The patient also complaint with joint pain and leg swelling. She was diagnosed Rheumatic Heart Disease and received prophylactic penicillin injections every month. However, since the pandemic, She do vice versa. In physical examination was found pansystolic murmur on aortic valve and bilateral lower extremity edema. Echocardiography showed moderate mitral regurgitation and mild aortic regurgitation. This patient was hospitalized and treated with benzathine penicillin G, prednisone, aspirin, furosemide and captopril.DiscussionManagement of ARF includes eradication cause of infection, treat complications, and secondary prevention. Administration of secondary prophylaxis is useful for reduce new bacterial strains that can cause recurrent acute or chronic attacks. First line of secondary prophylaxis for ARF is intramuscular benzathine penicillin G that given per month. In this current pandemic conditions, patients are expected to continue prophylaxis therapy and follow up the disease with using pandemic health protocols.

Mitral valve thickening in acute rheumatic fever as a predictor of late valvar dysfunction.

BackgroundRheumatic heart disease (RHD) complicating acute rheumatic fever (ARF) remains an important health problem in developing countries. No definitive diagnostic test for ARF exists and the role of Doppler echocardiography (DEC) for long-term prognostic evaluation following ARF is not well established.ObjectiveTo investigate the prognostic value of DEC in patients with ARF as a predictor of chronic valve dysfunction.MethodsProspectively enrolled patients with clinical ARF had a DEC performed soon after diagnosis and repeated at 1, 3, 6 and 12 months and thereafter at every 1–2 years. We defined chronic valve dysfunction by ≥ 3 of the following: increased valve thickening, commissure fusion, subvalvular thickening, reduced leaflet mobility, non-trivial mitral and/or aortic regurgitation. We performed univariate analysis and developed multivariate logistic regression models to identify variables that may influence evolution to RHD. p <0.05 was considered significant.ResultsWe evaluated 70(57% men) patients, 10.8±5.6 years-old during the ARF episode and followed for 95±26 months. Chronic valve dysfunction was identified in 36(51.4%) which fulfilled criteria for RHD and 10(27.8%) of them died or underwent valve surgery. Univariate analysis showed that mitral valve thickening and presence of mitral regurgitation at baseline DEC, were associated with RHD(p<0.01). Multivariate logistic regression showed that only mitral valve thickness either as a continuous (Odds-Ratio:5.8;95%CI:1.7–19.7) or as a categorical variable (Odds-Ratio:4.04;95%CI:1.06–15.3) was an independent predictor of chronic valve dysfunction.ConclusionsMitral leaflets thickening documented at the time of diagnosis of ARF is a consistent prognostic marker for the subsequent evolution to RHD.

Abstract 13789: Identification of a Proteomic Signature Showing Ongoing Inflammation in Severe Rheumatic Heart Disease

Introduction: Rheumatic heart disease (RHD) remains a major source of morbidity and mortality in developing countries. A deeper insight into the pathogenetic mechanisms underlying RHD could provide opportunities for drug repurposing, guide recommendations for secondary penicillin prophylaxis, and/or inform development of near-patient diagnostics. Methods: We conducted a proteomic study in 215 African patients with severe RHD and 230 controls, using the SWATH-MS technique. We applied a machine learning (ML) approach to feature selection among the 366 proteins quantifiable in at least 40% of samples, using the Boruta wrapper algorithm. The case-control differences and contribution to AUC of the ROC for each of the 56 proteins identified by the Boruta algorithm were calculated by Logistic Regression adjusted for age, sex and BMI. Biological pathways and functions enriched for proteins were identified using ClueGo pathway analyses. Results: Adiponectin, complement component C7 and fibulin-1, a component of heart valve matrix, were each higher in cases when compared with controls. Ficolin-3, a protein with calcium-independent lectin activity that activates the complement pathway, was lower in cases than controls. The top 6 biomarkers from the Boruta analyses conferred an AUC of 0.90 indicating excellent discriminatory capacity between RHD cases and controls. Conclusions: These results support the presence of an ongoing inflammatory response in RHD, at a time when severe valve disease has developed, and distant from previous episodes of acute rheumatic fever. This biomarker signature could have potential utility in recognizing different degrees of ongoing inflammation in RHD patients, which may in turn be related to prognostic severity.

Persisting burden and challenges of rheumatic heart disease.

Rheumatic heart disease (RHD) is the result of episodes of acute rheumatic fever with valvular (and other cardiac) damage caused by an abnormal immune response to group A streptococcal infections, usually during childhood and adolescence. As a result of improved living conditions and the introduction of penicillin, RHD was almost eradicated in the developed world by the 1980s. However, being a disease of poverty, its burden remains disproportionately high in the developing world, despite being a fundamentally preventable disease. Rheumatic heart disease generates relatively little attention from the medical and science communities, in contrast to other common infectious problems (such as malaria, HIV, tuberculosis), despite the major cardiovascular morbidity/mortality burden imposed by RHD. This relative neglect and paucity of funding have probably contributed to limited fundamental medical advances in this field for over 50 years. Given the importance of prevention before the onset of major valvular damage, the main challenges for RHD prevention are improving social circumstances, early diagnosis, and effective delivery of antibiotic prophylaxis. Early identification through ultrasound of silent, subclinical rheumatic valve lesions could provide an opportunity for early intervention. Simple echocardiographic diagnostic criteria and appropriately trained personnel can be valuable aids in large-scale public health efforts. In addition, a better understanding of the immunogenic determinants of the disease may provide potential routes to vaccine development and other novel therapies.

An investment case for the prevention and management of rheumatic heart disease in the African Union 2021–30: a modelling study

SummaryBackgroundDespite declines in deaths from rheumatic heart disease (RHD) in Africa over the past 30 years, it remains a major cause of cardiovascular morbidity and mortality on the continent. We present an investment case for interventions to prevent and manage RHD in the African Union (AU).MethodsWe created a cohort state-transition model to estimate key outcomes in the disease process, including cases of pharyngitis from group A streptococcus, episodes of acute rheumatic fever (ARF), cases of RHD, heart failure, and deaths. With this model, we estimated the impact of scaling up interventions using estimates of effect sizes from published studies. We estimated the cost to scale up coverage of interventions and summarised the benefits by monetising health gains estimated in the model using a full income approach. Costs and benefits were compared using the benefit–cost ratio and the net benefits with discounted costs and benefits.FindingsOperationally achievable levels of scale-up of interventions along the disease spectrum, including primary prevention, secondary prevention, platforms for management of heart failure, and heart valve surgery could avert 74 000 (UI 50 000–104 000) deaths from RHD and ARF from 2021 to 2030 in the AU, reaching a 30·7% (21·6–39·0) reduction in the age-standardised death rate from RHD in 2030, compared with no increase in coverage of interventions. The estimated benefit–cost ratio for plausible scale-up of secondary prevention and secondary and tertiary care interventions was 4·7 (2·9–6·3) with a net benefit of $2·8 billion (1·6–3·9; 2019 US$) through 2030. The estimated benefit–cost ratio for primary prevention scale-up was low to 2030 (0·2, <0·1–0·4), increasing with delayed benefits accrued to 2090. The benefit–cost dynamics of primary prevention were sensitive to the costs of different delivery approaches, uncertain epidemiological parameters regarding group A streptococcal pharyngitis and ARF, assumptions about long-term demographic and economic trends, and discounting.InterpretationIncreased coverage of interventions to control and manage RHD could accelerate progress towards eradication in AU member states. Gaps in local epidemiological data and particular components of the disease process create uncertainty around the level of benefits. In the short term, costs of secondary prevention and secondary and tertiary care for RHD are lower than for primary prevention, and benefits accrue earlier.FundingWorld Heart Federation, Leona M and Harry B Helmsley Charitable Trust, and American Heart Association.

Using an Indigenous framework to contextualise Immunology education within the Health Sciences setting

Abstract Indigenous Māori and Pacific children and young people remain disproportionately affected by Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD), with rates in Aotearoa/New Zealand and the Pacific Region of significant concern. ARF is the body’s autoimmune response to an untreated Group A Streptococcal (GAS) throat or skin infection. If multiple or severe episodes of ARF occur and are left untreated, this can lead to permanent cardiac damage known as RHD. RHD remains a major cause of morbidity and mortality globally. In the absence of a GAS vaccine, the best recommended treatment and management approach consists of painful monthly intramuscular injections of Benzathine Penicillin G (BPG) administered to the upper thigh area, and given for at least 10 years or more. A new Penicillin for ARF/RHD prevention is urgently needed. The purpose of this work was to employ the use of an Indigenous Pacific framework within the undergraduate Health Sciences education setting to support learning and teaching efforts appropriate to vulnerable communities affected by ARF and RHD. The Talanoa approach was utilised within the classroom setting to support discussions relating to ARF and RHD and vulnerable communities that was appropriate and respectful to the Indigenous cultural setting. Well-received by students, this approach was not only applicable to the cultural setting for those communities affected by ARF/RHD in Aotearoa/New Zealand, but also helped with contextualisation, supporting courteous class discussions with relevant in-class learning opportunities and experiences. This work highlighted the importance of Indigenous frameworks for supporting Immunology education within the Health Sciences education setting.

Active learning strategies incorporating Immunology based teaching examples for Health Sciences Education

Abstract Clinically relevant Immunology based teaching examples for postgraduate Health Sciences education offer valuable opportunities to support and reinforce understanding and learning of basic principles. The appropriate reference to significant health conditions as teaching examples that are of immediate relevance to specific population groups requires care. Active learning strategies that incorporate Immunology based teaching examples and references to Māori and Pacific population groups living in Aotearoa/New Zealand and the Pacific Region, are much needed to support Health Sciences education. The autoimmune condition known as Acute Rheumatic Fever (ARF) resulting from untreated Group A Streptococcal (GAS) infection of the throat and skin, and subsequent cardiac damage known as Rheumatic Heart Disease (RHD) that occurs if repeated or severe untreated ARF episodes happen, disproportionately affect Māori and Pacific population groups living in Aotearoa/New Zealand and the Pacific Region. These conditions were incorporated into active teaching approaches to support postgraduate Health Sciences students, with appropriate cultural context. Students participating in postgraduate classes that utilised active learning strategies with appropriate incorporation and reference to the ARF/RHD setting, demonstrated high levels of engagement and in-class participation, and as evidenced by formal and informal student feedback, fostered in-depth understanding of the Immunology principles being taught. This highlights the importance of appropriate reference and context for active learning strategies that incorporate Immunology based teaching examples when relating to specific population groups.

The integration of Immunology based Pharmacological elements for Health Sciences education

Abstract Health Sciences education supports learning across multiple discipline areas. Appropriate integration of different subject aspects for students when using particular conditions as in-class teaching examples is important. This work highlights the use of integrated teaching approaches within Health Sciences education to support learning of Immunology based Pharmacology elements relevant to the drug design context for the prevention of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD). ARF is the body’s autoimmune reaction to an untreated Group A Streptococcal (GAS) infection of the throat or skin. If a severe, or repeated ARF episodes occur that are left untreated, permanent cardiac damage can occur known as RHD. In the absence of a GAS vaccines, the most effective management plan for ARF/RHD involves painful monthly Benzathine Penicillin G injections for at least 10 years or more. These BPG injections prevent recurrent GAS infections that may trigger ARF and lead to RHD. Adherence to BPG injection regimens remain problematic, and a new Penicillin for ARF/RHD prevention that is less painful and longer lasting, is urgently needed. Local and international research efforts are well underway to support the generation of a new Penicillin for this purpose. When integrated teaching approaches that included online interactive websites were used to support learning of Immunology based Pharmacology elements relevant to the drug design context for ARF/RHD prevention, students demonstrated better in-class engagement, participation and concept understanding, expressing approval and improved confidence with the teaching content.

Immunology education within an undergraduate program for Health Sciences education

Abstract Immunology education remains an essential component for undergraduate Health Sciences education across the health professions. The clinical relevance of Immunology teaching can be emphasised by utilisation and appropriate reference to pertinent health conditions affecting populations locally and across the global setting. Health issues of significance to Māori and Pacific populations groups in Aotearoa/New Zealand and in the Pacific Region include Cancer and Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD). ARF is the body’s autoimmune response to untreated Group A Streptococcal (GAS) infection of the throat or skin. If left untreated, repeated or severe ARF episodes can lead to permanent cardiac damage known as RHD. RHD is a significant cause of morbidity and mortality worldwide. The growing global burden of cancer remains of concern, while Pacific Peoples and Māori are disproportionately affected by specific cancers. The utilisation of two areas with strong Immunological relevance for teaching examples in undergraduate Health Sciences education were shown to support improved understanding, class participation, topical interest, and research focus for Medical students engaged within Health Sciences education platforms in Aotearoa/New Zealand. This highlights the value of supporting Immunology education efforts by incorporating appropriate reference to pertinent health conditions relevant to populations groups locally and across the global setting.

Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children

Acute rheumatic fever (ARF) is a sequela of streptococcal infection—typically following 2 to 3 weeks after group A streptococcal pharyngitis—that occurs most commonly in children and has rheumatologic, cardiac, and neurologic manifestations. Rheumatic heart disease (RHD) refers to the long-term cardiac damage caused by either a single severe episode or multiple recurrent episodes of ARF. Secondary prophylaxis with regular intramuscular injections of benzathine penicillin G (BPG) is a key component to prevent ARF and RHD recurrent. This study aimed to evaluate the secondary prophylaxis effectiveness based on the profile of clinical manifestations and blood laboratory findings. The data were collected by interviews, complete blood counts, the anti-streptolysin titer O (ASTO) analysis, the C-reactive protein Assay, electrocardiography, and echocardiography. Data were analyzed using SPSS 18, and the results were presented as the percentage frequency. The samples were 63 patients with ARF and RHD who get secondary prophylaxis, consisting of 32 males (50.8%) and 31 females (49.9%). The echocardiography examination showed that valve regurgitation was more common than valve stenosis, indicating longer P-R interval in 49 subjects (77.7%). Sixty subjects (92.2%) received secondary prophylaxis with BPG injection, and three subjects (4.8%) got Erythromycin oral. The main factor of secondary prophylaxis adherence is pain and injection disliking. How to Cite this Article Pubmed Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. 2020; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Web Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. http://www.sysrevpharm.org/?mno=11016 [Access: March 29, 2021]. doi:10.31838/srp.2020.9.63 AMA (American Medical Association) Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. 2020; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Vancouver/ICMJE Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. (2020), [cited March 29, 2021]; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Harvard Style DIMIATI, H., SOFIA, . S. & GANI, . B. A. (2020) for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP, 11 (9), 452-457. doi:10.31838/srp.2020.9.63 Turabian Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. 2020. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Reviews in Pharmacy, 11 (9), 452-457. doi:10.31838/srp.2020.9.63 Chicago Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. Systematic Reviews in Pharmacy 11 (2020), 452-457. doi:10.31838/srp.2020.9.63 MLA (The Modern Language Association) Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. Systematic Reviews in Pharmacy 11.9 (2020), 452-457. Print. doi:10.31838/srp.2020.9.63 APA (American Psychological Association) Style DIMIATI, H., SOFIA, . S. & GANI, . B. A. (2020) for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Reviews in Pharmacy, 11 (9), 452-457. doi:10.31838/srp.2020.9.63

Pentraxin 3 levels and correlation with disease severity in patients with acute rheumatic fever

Objectives This study aims to investigate serum pentraxin 3 (PTX3) levels during acute episode of acute rheumatic fever (ARF) and their relationship with disease severity.Patients and methods The prospective study was conducted between January 2015 and December 2018 and included 52 ARF patients (22 girls, 30 boys, mean age 10.7±2.1 years; range, 5 to 16 years) experiencing an acute episode and 22 healthy children (13 girls, 9 boys, mean age 10.3±3.8 years; range, 5 to 16 years). ARF patients were classified into three groups based on the clinical course: isolated arthritis (n=17), mild carditis (n=19), and moderate/severe carditis (n=16). Blood samples were collected from all patients before treatment and from the healthy children in the control group to measure PTX3 levels. PTX3 was measured using sandwich enzyme-linked immunosorbent assay method.Results Plasma PTX3 levels were significantly higher in ARF group compared to the control group (4.7±5.2 and 1.2±1.7 ng/mL, p<0.001). Subgroup analysis of serum PTX3 levels in ARF patients with isolated arthritis, mild carditis, and moderate/severe carditis (3.2±3.1 ng/mL, 4.3±5 ng/mL, and 6.7±6.6 ng/mL, respectively) showed that serum PTX3 was significantly higher in the moderate/severe carditis group compared to the other groups (p<0.05). Analysis of echocardiographic data showed that serum PTX3 was positively correlated with left ventricular end-diastolic diameter, left atrial diameters, and mitral A velocity and negatively correlated with E/A ratio (p<0.05; r=0.231, 0.402, 0.562, -0.586, respectively).ConclusionHigh PTX3 level during an acute episode of ARF may help predict the clinical course and the severity of accompanying carditis. However, prospective studies with larger sample sizes are needed.