Chronic Rheumatic Heart Disease Research Articles

INDEX ASSESSMENT OF PERIODONTAL TISSUES AND DETERMINATION OF TREATMENT NEEDS IN PATIENTS WITH CHRONIC RHEUMATIC HEART DISEASE

This study addresses the pressing scientific and practical issue in modern dentistry: enhancing dental care effectiveness for patients with chronic rheumatic heart disease. The purpose of this research is to comprehensively assess the condition of tooth-supporting tissues and quantify inflammatory phenomena in periodontal tissues among patients with chronic rheumatic heart disease, as well as to determine the necessary extent of periodontal care based on periodontal indices. Participants and methods. The periodontal tissues of 719 patients with chronic rheumatic heart disease from the Rheumatology Department of Lviv Regional Clinical Hospital, along with 290 clinically healthy individuals in the comparison group, were examined. To evaluate the clinical course of dystrophic-inflammatory periodontal diseases in patients with chronic rheumatic heart disease, we examined 267 individuals in the main group who had generalized periodontitis, categorized as follows: 42 patients with initial stage (I degree), 115 with moderate (II degree), and 110 with severe (III degree) periodontitis. The comparison group comprised 70 patients diagnosed with generalized periodontitis, among them, 21 had initial-stage disease, 29 had moderate-stage disease, and 20 had severe-stage disease. During the analysis, the oral hygiene was assessed by applying hygienic indices by J.C. Green and J.R. Vermillion (OHI-S, 1964) and Fedorov-Volodkina. The Muhlemann and Son index was used to objectively measure gingival papillary bleeding (RVI); the papillary-marginal-alveolar index (PMA) in the Parma modification, in combination with the Schiller-Pysarev test (1989), was employed to evaluate gingival inflammation. The periodontal index (PI) by A.L. Russel (1956) was used to assess the state of periodontal tissues, and pathological changes were recorded using the periodontal screening PSR test. Results were scored, and based on established criteria and scores, the need for treatment and its extent were determined. Results and discussion. According to the results of dental examinations in patients with chronic rheumatic heart disease, a high prevalence of periodontal diseases was found, reaching 92.49%. This was 13.18% higher compared to the prevalence in the control group. Dystrophic-inflammatory conditions with advanced severity levels were predominant, as evidenced by the index indicators. In chronic rheumatic heart disease patients, the average periodontal index was 6.11±0.10, compared to 4.14±0.19 in clinically healthy individuals (p < 0.05). Moreover, a higher lesion of periodontal tissues was observed in younger age groups. As the duration of rheumatic disease increased, the frequency of detecting generalized periodontitis also increased, with this condition being diagnosed in all subjects with a 10-year history of rheumatic disease. Conclusion. The Analysis of the research data on the condition of periodontal tissues, along with objective index assessments, reveals the following: periodontal diseases are more prevalent in individuals with chronic rheumatic heart disease, particularly affecting younger age groups. The severity and progression of these diseases are influenced by the course of the underlying condition. This underscores the presence of pathogenetic conditions that contribute to the rapid progression of the dystrophic-inflammatory process in periodontal tissues. It also emphasizes the importance of providing specialized periodontal care to patients with chronic rheumatic heart disease, with the level of care directly linked to the course and duration of the systemic disease.

PREVALENCE AND DIAGNOSTIC STRUCTURE OF PERIODONTAL DISEASES IN CHRONIC RHEUMATIC HEART DISEASE

The goal. This research addresses a significant scientific and practical challenge within modern therapeutic dentistry: assessing the periodontal status of patients suffering from chronic rheumatic heart disease.Material and Methods. The study analyzed the diagnostic structure and prevalence of dystrophic-inflammatory diseases of the periodontium in individuals diagnosed with chronic rheumatic heart disease, considering the clinical progression and severity of the condition. It involved examining 719 patients with chronic rheumatic heart disease from the rheumatology department of the Lviv Regional Clinical Hospital and 290 clinically healthy comparison subjects.Results and Discussion. The incidence of periodontal disease among patients with chronic rheumatic heart disease was found to be 92.49%, which is 13.18% higher than that in a comparable group. Dental examinations of patients with accompanying somatic pathologies revealed a high prevalence of periodontitis (92.49 ± 0.98%). An increased affliction of periodontal tissues was observed in younger age groups. The prevalence of generalized periodontitis was found to increase with the duration of the rheumatic disease, being diagnosed in all participants with a rheumatic disease duration of 10 years or more.Conclusions: the study's findings suggest that periodontal diseases are more prevalent in individuals with chronic rheumatic heart disease, particularly affecting younger demographics, with the severity and progression dynamics influenced by the duration of the underlying disease. This underscores the necessity for developing tailored comprehensive treatment and prevention strategies for dental diseases in this patient group, taking into account the nature and duration of the accompanying somatic disease.

Rheumatic heart disease presenting with paracentral acute middle maculopathy (PAMM): A case report from rural India

A 38-year-old gentleman presented to us with disturbance in his superior field of view for 3 days. His visual acuity in both eyes was 6/6, N6. The macula of the left eye had a hypopigmented band. OCT demonstrated hyperreflectivity of the inner plexiform, inner nuclear, and outer plexiform layers of the retina, and perimetry showed a corresponding visual field defect. The patient revealed a history of heart surgery 26 years ago, and an echocardiogram revealed mitral valve abnormalities. The history and findings led to a diagnosis of paracentral acute middle maculopathy (PAMM) secondary to rheumatic heart disease. The patient was referred to a cardiologist and started on anti-platelet medications. Thus, we report an unusual case of PAMM due to chronic rheumatic heart disease in a young male from remote rural India. In our case, we made sure to start the patient on anti-platelet medications to prevent future adverse events.

Correlation between mitral valve area and left atrial function in rheumatic mitral valve stenosis patients.

Rheumatic heart disease (RHD) continues to be one of the leading causes of cardiovascular morbidity and mortality. The mitral valve frequently develops mitral stenosis (MS), and it is the most prevalent valve lesion in patients with chronic RHD. Left atrial (LA) functional impairment is associated with rheumatic MS. The aim of this study was to evaluate the association between LA function and mitral valve area (MVA) in rheumatic MS patients, and to assess the echocardiographic parameters in sinus rhythm and atrial fibrillation (AF) patients. This was a cross-sectional, descriptive study that involved patients with rheumatic MS. Patients underwent a standard 12-lead electrocardiogram and echocardiographic examination. MVA was assessed and correlated with LA function. Comparison was made between sinus rhythm and AF patients. Eighty-one patients with rheumatic MS were included in this study, with 71.6% of them having associated MR. MVA showed a statistically highly significant positive correlation with LA and right ventricular (RV) function, and a statistically significant/highly significant negative correlation with their dimensions. A higher percentage of patients with severe MS was in AF (58.1%). There was a positive correlation between LA function and MVA in rheumatic MS patients. AF was related to the severity of MS.

Tenascin-C: as a diagnostic biomarker for rheumatic heart disease

BackgroundRheumatic fever is a long-term inflammatory disease that can happen if group A beta-hemolytic streptococci bacteria are not treated well enough. Rheumatic fever is recognized globally as the leading cause of heart disease in the pediatric population. This disease destroys the heart muscle, progressively deteriorating its structure and impairing the function of its valves over time.AimThe aim of this study is to determine the role of serum tenascin-C in the diagnosis of acute rheumatic fever and chronic rheumatic heart disease.MethodsThis case–control study involved a group of 60 Egyptian children. Among them, 20 were diagnosed with acute rheumatic fever, identified using the updated Jones criteria from 2015. Another 20 children, who were suffering from chronic rheumatic heart disease, were also act as a part of the study. The remaining 20 participants, healthy children carefully matched in age and sex, served as the control group.ResultsSerum tenascin-C level was significantly increased in acute rheumatic fever (ARF) and highly significantly increased in chronic rheumatic heart disease (CRHD) groups when compared with control group (P = 0.04, 0.01), respectively. There were highly significant difference between and within the studied groups regarding the mean of serum tenascin-C. Serum tenascin-C mean of ARF, CRHD, and control was 4.82 ± 18.7, 5.46 ± 1.6, and 3.78 ± 2.4, respectively, P = 0.02. Level of serum tenascin-C was lower in cases with severe mitral valve insufficiency. No significant link was found between the level of serum tenascin-C and C-reactive protein (CRP), ESR, and ASO titer, with a P-value greater than 0.5. ROC curve for serum tenascin-C in ARF patients was area under the curve = 0.682 (P = 0.05) with optimal serum tenascin-C cut-off point (> 3.76 ng/ml); ROC curve for serum tenascin-C in CRHD patients was AUC = 0.73 (P = 0.01) with cut-off point level (73.76 ng/ml).ConclusionPatients with ARF and CRHD have increased level of serum tenascin-C. Serum tenancin-C is superior in the diagnosis of ARF in comparison to CRP, ESR, and ASOT. Tenascin-C level can be used as a diagnostic marker for ARF and CRHD.

The importance of concomitant mitral regurgitation for estimates of mitral valve area by pressure half time in patients with chronic rheumatic heart disease

AimsAim was to study how concomitant mitral regurgitation (MR) assessed by qualitative and quantitative methods influence mitral valve area (MVA) calculations by the pressure half time method (MVAPHT) compared to reference MVA (planimetry) in patients with rheumatic heart disease. Methods and resultsIn 72 patients with chronic rheumatic heart disease, MVAPHT was calculated as 220 divided by the pressure half time of the mitral early inflow Doppler spectrum. Direct measurement by planimetry was used as reference MVA and was mean (SD) 0.99 (0.69–1.99) cm2. Concomitant MR was present in 82%. MR severity was assessed qualitatively in all, semi-quantitatively by measuring the vena contracta width in 58 (81%), and quantitatively by calculation of the regurgitant volume in 28 (39%).MVA was significantly underestimated by MVAPHT, with increasing MR. In regression analyses MVAPHT underestimated MVA by 0.19 cm2 per higher grade of MR severity in qualitative assessment, and by 0.12–0.13 cm2 per mm larger vena contracta width and 10 ml larger regurgitant volume, respectively. The presented associations were more evident when i) MR severity was quantified compared to qualitative assessment and ii) reference measurements were made by three-dimensional transoesophageal recordings compared to transthoracic recordings. ConclusionMVAPHT underestimated mitral valve area compared to planimetry in patients with MS and concomitant MR. This study highlights the importance of taking the MR severity into account when evaluating MVA based on the PHT method. Direct measurements should be included in clinical decision making.

Preliminary results of studying the prevalence of atrial fibrillation and the adequacy of prevention of thromboembolic complications

Abstract Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia that complicates the course of various cardiovascular diseases, and is also accompanied by the frequent development of thromboembolic complications (TEC), primarily ischemic stroke. In this regard, AF represents a huge socio-economic problem for the health system and society as a whole. Purpose study the real situation in terms of the incidence of various forms of AF and the adequacy of the prevention of TEC among the population of family clinic (FC) №5 in Tashkent. Materials and methods To achieve this goal, out of 12 districts of Tashkent, a (FP) №5 of M. Ulugbek district of Tashkent was selected with a total population of 21,606 people. After exclusion from the study of persons under 18 years of age (n=3546), the total number of adults was 18060 people. Random selection (n=1407) was performed using computer programs with the function of a random number generator in Microsoft Excel. The risk of TEC and bleeding in patients with various forms of AF was assessed using the CHA2DS2-VASc and HAS-BLED score. The study of the situation regarding the compliance of the use of anticoagulants with the current recommendations of the ESC (2020) was carried out by analyzing the structure of the pharmacological prevention of feasibility studies at the time of the survey. Research results: A total of 1407 (725 (51.53%) men) of the population were examined, registered with FC№5 in the M. Ulugbek district of Tashkent. It was found that 406 (28.86%) of the examined patients were diagnosed with coronary heart disease and/or hypertension, 5 (0.36%) of the population were diagnosed with chronic rheumatic heart disease and 369 (26.23%) people with a disease of other organs and systems. In 627 (44.56%) examined patients, non-organic pathologies were found. In general, it was found that 16 (1.13%) out of the total number of examined patients had various clinical forms of AF of both valvular (18.75%) and non-valvular etiology (81.25%). In general, among the identified clinical forms of AF, the permanent form of AF prevailed, amounting to 56.25%, and persistent ones, including long-term persistent and paroxysmal AF were detected in 4 (25%) and 2 (18.75%) patients, respectively. An analysis of the characteristics of the pharmacological prevention of thromboembolic complications showed that at the time of the survey, only 50% of patients were taking the oral anticoagulant therapy recommended in the standards (12.5% warfarin, without proper control of INR and 37.5% of novel oral anticoagulants). Conclusions 1) It was found that the prevalence of various forms of AF was 16 (1.13%) of the total number of patients examined: of these, 56.25% had a permanent form, 25% had a persistent form, and 18.75% had a paroxysmal form. 2) According to the ESC 2020 recommendations, the prevention thromboembolic complications in patients with AF is assessed as unsatisfactory.

Work disability due to cardiovascular diseases in newly diagnosed patients in Ukraine during the first year of the war (2022) compared to prior nine years (2013-2021)

Aim: Cardiovascular diseases (CVDs) are a significant problem in Ukraine, accounting for over 60% of all deaths in the country. It is expected that the ongoing Russian aggression will augment this problem. The study aimed to analyze the trends of work disability due to CVDs in newly-diagnosed patients between 2013 and 2022.Methods: This retrospective study included data obtained from the official document “Report on the Causes of Disability and Indications for Medical, Professional, and Social Rehabilitation” commissioned by the Ministry of Health of Ukraine. The data on disability due to CVD were obtained from 24 regions and the city of Kyiv for 2013-2022.Results: Between 2013 and 2022, the average incidence of work disability due to CVD per 10000 working-age individuals was 9.86. Among these disabilities, cerebrovascular diseases accounted for the highest proportion, followed by ischemic heart disease (IHD). The incidence of CVD-related primary disabilities displayed a variable upward trend over the observed period, with cerebrovascular diseases and hypertensive diseases showing clear upward trends. Compared to 2021, in the year 2022 (corresponding to the beginning of the Russian aggression) an 20% increase has been observed for CVDs, while for cerebrovascular diseases, IHD, hypertensive disease, acute rheumatic fever, and chronic rheumatic heart disease the increase was 20%, 18%, 22%, and 14%, respectively. The CVD-related work disability varied substantially in different regions of Ukraine.Conclusions: During the first year of the war in Ukraine (the year 2022) there was an increase in primary disability due to CVD compared to the period between 2013 and 2021. This may be associated with war-related psychosocial factors and global impact on CVD. The regions in southwestern parts of Ukraine proved to be especially prone to this increase requiring special attention.

Mortality Risk and Burden From a Spectrum of Causes in Relation to Size-Fractionated Particulate Matters: Time Series Analysis.

There is limited evidence regarding the adverse impact of particulate matters (PMs) on multiple body systems from both epidemiological and mechanistic studies. The association between size-fractionated PMs and mortality risk, as well as the burden of a whole spectrum of causes of death, remains poorly characterized. We aimed to examine the wide range of susceptible diseases affected by different sizes of PMs. We also assessed the association between PMs with an aerodynamic diameter less than 1 µm (PM1), 2.5 µm (PM2.5), and 10 µm (PM10) and deaths from 36 causes in Guangzhou, China. Daily data were obtained on cause-specific mortality, PMs, and meteorology from 2014 to 2016. A time-stratified case-crossover approach was applied to estimate the risk and burden of cause-specific mortality attributable to PMs after adjusting for potential confounding variables, such as long-term trend and seasonality, relative humidity, temperature, air pressure, and public holidays. Stratification analyses were further conducted to explore the potential modification effects of season and demographic characteristics (eg, gender and age). We also assessed the reduction in mortality achieved by meeting the new air quality guidelines set by the World Health Organization (WHO). Positive and monotonic associations were generally observed between PMs and mortality. For every 10 μg/m3 increase in 4-day moving average concentrations of PM1, PM2.5, and PM10, the risk of all-cause mortality increased by 2.00% (95% CI 1.08%-2.92%), 1.54% (95% CI 0.93%-2.16%), and 1.38% (95% CI 0.95%-1.82%), respectively. Significant effects of size-fractionated PMs were observed for deaths attributed to nonaccidental causes, cardiovascular disease, respiratory disease, neoplasms, chronic rheumatic heart diseases, hypertensive diseases, cerebrovascular diseases, stroke, influenza, and pneumonia. If daily concentrations of PM1, PM2.5, and PM10 reached the WHO target levels of 10, 15, and 45 μg/m3, 7921 (95% empirical CI [eCI] 4454-11,206), 8303 (95% eCI 5063-11,248), and 8326 (95% eCI 5980-10690) deaths could be prevented, respectively. The effect estimates of PMs were relatively higher during hot months, among female individuals, and among those aged 85 years and older, although the differences between subgroups were not statistically significant. We observed positive and monotonical exposure-response curves between PMs and deaths from several diseases. The effect of PM1 was stronger on mortality than that of PM2.5 and PM10. A substantial number of premature deaths could be preventable by adhering to the WHO's new guidelines for PMs. Our findings highlight the importance of a size-based strategy in controlling PMs and managing their health impact.

Clinical profile of atrial fibrillation in hospitalized patients: experience from two tertiary centers of Bangladesh

Background: Chronic rheumatic heart disease (RHD), particularly mitral stenosis, is traditionally thought to be the dominating cause of atrial fibrillation (AF) in Bangladesh. But over the past decades, parallel to the changes in dominating disease pattern, rheumatic fever and possibly RHD has declined in the country. Also, the current practice of anticoagulation in AF here is not known. The study was carried out to explore the current aetiology and clinical profile of AF in hospitalized patients. Methods: This cross-sectional study included 302 consecutive adult patients with AF admitted in 2 hospitals in Dhaka, Bangladesh. History, clinical examination and investigations including transthoracic echocardiography were done to find out the aetiology, type of AF, selected complications and the pharmacotherapy including anticoagulation practice in hospitalized AF patients. Results: The mean age of the patients was 54.00 ± 12.46 years (range 14 to 85 years). The most common etiology was rheumatic valvular heart disease (47.7%), followed by ischaemic heart disease (IHD) (29.5%) and hypertensin (5.0%). Majority (249, 82%) had coarse AF and only 18% had fine AF. Thirteen (4.3%) patients presented with stroke and 7 (2.3%) had left atrial thrombus. The most common drugs used were beta blocker (32.78%), digoxin (32.45%) and combination of beta blocker and digoxin (23.84%). Anticoagulant was used in 56.95% cases. Among the anticoagulants, warfarin was most commonly prescribed (69.18%), followed by rivaroxaban and apixaban in 15.69% and 13.95% cases, respectively. Conclusion: RHD is still the dominating cause of AF in hospitalized patients in Bangladesh. Despite high prevalence of rheumatic valvular AF, anticoagulants are underused. Warfarin is far more commonly used than the direct oral anticoagulants (DOACs). BIRDEM Med J 2023; 13(3): 143-148

Association between migraine and cardiovascular disease mortality: A prospective population-based cohort study.

The study assessed the association between migraine and cardiovascular disease (CVD) mortality in the US population. Previous studies have drawn different conclusions about the association between migraine and CVD mortality based on different populations; therefore, it is important to explore the relationship between migraine and CVD mortality in the US population. This prospective cohort study included 10,644 participants from the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Participants who reported having severe headache or migraine were classified as having migraine. Mortality data were obtained by linkage of the cohort database to the National Death Index as of December 31, 2019. Based on the International Classification of Diseases, Tenth Revision, CVD mortality includes the following disease codes: I00-I09 (acute rheumatic fever and chronic rheumatic heart diseases), I11 (hypertensive heart disease), I13 (hypertensive heart and renal disease), I20-I25 (ischemic heart diseases), I26-I28 (pulmonary embolism and other acute pulmonary heart diseases), I29 (various cardiovascular diseases caused by different reasons), I30-I51 (other forms of heart disease), and I60-I69 (cerebrovascular diseases). Data were analyzed from October to November 2022. Among 10,644 adults included in the study (mean age, 46.4 [0.3] years, 5430 men [47.4%]), 2106 (20.4%) had migraine. During a median follow-up period of 201 months, there were 3078 all-cause deaths and 997 CVD deaths. Compared to individuals without migraine, those with migraine had an adjusted hazard ratio (HR) of 1.30 (95% confidence interval [CI], 1.04-1.62; p = 0.019) for CVD mortality and 1.23 (95% CI, 1.13-1.35; p < 0.001) for all-cause mortality. In subgroup analyses, migraine was associated with CVD mortality in participants who were women (HR, 1.43; 95% CI, 1.06-1.93), aged < 45 years (HR, 1.69; 95% CI, 1.04-2.76), non-Hispanic White (HR, 1.42; 95% CI, 1.09-1.86), those with a body mass index < 30 kg/m2 (HR, 1.36; 95% CI, 1.03-1.78), former or current smokers (HR, 1.36; 95% CI, 1.00-1.85), former or current alcohol drinkers (HR, 1.33; 95% CI, 1.03-1.72), and those without metabolic syndrome (HR, 1.31; 95% CI, 1.01-1.71). The association between migraine and CVD mortality was robust in sensitivity analyses, after excluding participants who died within 2 years of follow-up (HR, 1.31; 95% CI, 1.05-1.65) or those with a history of cancer at baseline (HR, 1.28; 95% CI, 1.01-1.62). Migraine was associated with a higher CVD mortality rate in the US population.

Recent Trends in Cardiovascular Disease Mortality in Kazakhstan.

Cardiovascular diseases (CVD) are the leading cause of mortality in Kazakhstan. In the last decade, Kazakhstan has carried out a number of reforms in the healthcare sector, in particular, to reduce mortality from significant diseases, including CVD. This study aimed to provide the trend of avoidable mortality from CVD in Kazakhstan. We extracted data from the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan on population by age; mortality rates from chronic rheumatic heart disease (I05-I09); hypertensive diseases (I10-I15); ischaemic heart disease (I20-I25); cerebrovascular diseases (I60-I69) from 2011 to 2021, by gender and 5-year age group (0, 1-4, 5-9, 74). We applied join point regression to calculate the average annual percentage change (AAPC). In addition, crude mortality and trends were calculated per 100,000 population. The avoidable mortality rates, including treatable and preventable mortality decreased between 2011 and 2019 and then increased in the last two years (2020 and 2021) in all four studied disease groups. The AAPC showed that total avoidable mortality rates decreased between 2011 and 2021-6.0 points (-10.6 to - 1.1) (p = 0.017), whereas in males -4.2 (-8.3 to 0.1) and females - 5.1 (-8.8 to -1.3) (p = 0.009). Avoidable mortality rates from ischemic heart disease, cerebrovascular and hypertensive disease has been reduced stronger in male compared to female. The crude mortality declined over the period given; however, among young people mortality is still high. Our findings showed that avoidable mortality from CVD decreased over the last years, which could be related to the policy on strengthening the primary care on early diagnosis and detection of CVD and its risk factors. However, primary healthcare facilities need to improve activities on health literacy (drug adherence, risk factors) of the population, including the prevention of CVD.

Left atrial strain predicts improvement in left atrial functions of severe rheumatic mitral stenoses undergoing successful percutaneous transmitral commissurotomy.

Chronic rheumatic heart disease (RHD) is prevalent in India. The mitral valve in isolation or combination with the aortic or tricuspid valve is involved in 31.6% and 52.8% of chronic RHD patients, respectively. The left atrium (LA) functions as a reservoir during the cardiac cycle. Therefore, the LA enlargement leads to longitudinal lengthening, measured as a positive strain, permitting the measurement of the longitudinal strain of LA. This study aimed to assess the LA functions using peak atrial longitudinal strain (PALS) in patients with severe rheumatic mitral stenoses (MS) in sinus rhythm who underwent successful percutaneous transvenous mitral commissurotomy (PTMC). We recruited 56 patients with severe rheumatic MS for the study, of which 06 PTMC procedures were considered unsuccessful. So, 50 patients of chronic severe rheumatic MS in sinus rhythm undergoing PTMC were enrolled in a tertiary care centre of the Armed Forces from August 2017 to May 2019. Patients included in the study were not consecutive, and patients with atrial fibrillation (AF) were excluded. PALS improved post-PTMC (P<.001) in this study, effectively concluding that PALS is impaired in patients with severe symptomatic MS and is acutely enhanced after treatment. PALS is a good indicator of LA function and may predict the success of PTMC on the rheumatic mitral valve.

Chronic Rheumatic Heart Disease with Infective Endocarditis in a 62-year-old Female Masquerading as Chronic Obstructive Airway Disease

Chronic Rheumatic Heart Disease with Infective Endocarditis in a 62-year-old Female Masquerading as Chronic Obstructive Airway Disease

A CASE REPORT OF CITROBACTER KOSERI ENDOCARDITIS

The present case report describes the clinical course of a patient ,who presented with citrobacter koseri endocarditis (subacute)with background chronic rheumatic heart disease. Which was initially treated medically , followed by elective double valve replacement. Perioperatively he developed complete heart block which was managed by permanent pacemaker implantation successfully.

Granulicatella adiacens infective endocarditis complicated with splenic infarct in pregnancy: A case report and literature review

Infective endocarditis (IE) contributes to high morbidity and mortality due to therapeutic challenges despite of advances in treatment options. The epidemiology, clinical manifestations, complications, diagnostic difficulties and dilemmas, suitable timing for surgery were constantly changing and leading to poor prognosis of this illness. We report a case of Granulicatella adiacens infective endocarditis complicated with embolism and splenic infarct in a pregnant lady with chronic rheumatic heart disease successfully treated with antimicrobial therapy and surgical intervention.&#x0D; Key words: G. adiacens, Infective Endocarditis, Splenic Infarct, Pregnancy&#x0D; Citation: Hamid NA, PS Muthialu VRNM, Mazlan MZ, Wan Isa WYH, Hashim AMB, Mamat AZ, Zon EM, Hassan SA, Salmuna ZN. Granulicatella adiacens infective endocarditis complicated with splenic infarct in pregnancy: A case report and literature review. Anaesth. pain intensive care 2023;27(6):786−789; DOI: 10.35975/apic.v27i6.2359&#x0D; Received: November 15, 2023; Reviewed: November 16, 2023; Accepted: November 16, 2023

Chronic rheumatic heart disease and Takayasu arteritis, friend or foe? A case report

Chronic rheumatic heart disease and Takayasu arteritis, friend or foe? A case report

Global and national trends in the evolution of infective endocarditis

For the recent 20 years, substantial changes have occurred in all aspects of infectious endocarditis (IE), the evolution of risk factors, modernization of diagnostic methods, therapeutic and preventive approaches. The global trends are characterized by increased IE morbidity among people older than 65 who use intravenous psychoactive drugs. The epidemiological trend is represented by reduced roles of chronic rheumatic heart disease and congenital heart defects, increased proportion of IE associated with medical care, valve replacement, installation of intracardiac devices, and increased contribution of Staphylococcus spp. and Enterococcus spp. to the IE etiology. Additional visualization methods (fluorodeoxyglucose positron emission tomography with 18F-fludesoxyglucose (18F-FDG PET-CT), labeled white blood cell single-photon emission computed tomography (SPECT), and modernization of the etiological diagnostic algorithm for determining the true pathogen (immunochemistry, polymerase chain reaction, sequencing) also become increasingly important. The COVID-19 pandemic has also adversely contributed to the IE epidemiology. New prospects of treatment have emerged, such as bacteriophages, lysins, oral antibacterial therapy, minimally invasive surgical strategies (percutaneous mechanical aspiration), endovascular mechanical embolectomy. The physicians' compliance with clinical guidelines (CG) is low, which contributes to the high rate of adverse outcomes of IE, while simple adherence to the CG together with more frequent use of surgical treatment doubles survival. Systematic adherence to CG, timely prevention and implementation of the Endocarditis Team into practice play the decisive role in a favorable prognosis of dynamically changing IE. This article presents the authors' own data that confirm the evolutionary trends of current IE.

A clinical case of SARS-CoV-2 infection complicated by acute respiratory distress syndrome, pulmonary edema, and heart failure in the presence of chronic venous congestion in a patient with chronic rheumatic heart disease

The article presents a clinical case of SARS-CoV-2 infection complicated by acute respiratory distress syndrome, pulmonary edema, and heart failure in the presence of chronic venous congestion in a patient with chronic rheumatic heart disease. A female patient R., 65 years old, was hospitalized at the Republican Cardiological Dispensary with a diagnosis of novel coronavirus infection COVID-19 (severe course); the virus was identified. Competing diagnosis: (1) acute viral myocarditis;(2) chronic rheumatic heart disease with combined mitral-aortic disease. Complications of the underlying disease included viral interstitial pneumonia (75%) and pulmonary edema. The patient was admitted at day 8 from the onset of the disease with complaints of increase in body temperature up to 38.5 °C, chest pain, and shortness of breath. She was treated in the outpatient setting without visible improvement. The patient had a history of chronic rheumatic heart disease. Due to persistent fever, patient received computed tomography showing interstitial pneumonia of viral etiology. The diagnosis of COVID-19 was based on a typical clinical presentation and a positive PCR test in nasopharyngeal swabs. Nonspecific changes were observed in the electrocardiogram. Treatment was initiated without positive dynamics, and a fatal outcome occurred. According to the autopsy data, the organs showed signs of chronic venous congestion (brown induration of the lungs, nutmeg fibrosis, cyanotic induration of the spleen and kidneys). The infiltrates consisting of lymphocytes and eosinophils were detected in the myocardium. Also, edema of the intercellular space, plethora of microvasculature vessels, and dystrophic changes in cardiomyocytes were detected. The presence of Aschoff-Talalaev granulomas with fibrinoid necrosis and avulsion of the chorda of the mitral valve leaflet was observed. Morphologically, there were signs of pulmonary infarction with a polysegmental character. Thus, in the presented case, the scientific novelty was the extremely rare development of mitral valve chord avulsion in aortic-mitral disease after infection with SARS-CoV-2, which was the cause of acute heart failure. It is likely that the process was aggravated by concomitant diffuse interstitial serous myocarditis and fibrinoid necrosis in granulomas.

ПОТЕРИ РОССИЙСКОГО НАСЕЛЕНИЯ ОТ ПРЕДОТВРАТИМЫХ ПРИЧИН СЕРДЕЧНО-СОСУДИСТОЙ СМЕРТНОСТИ В ПЕРИОДЫ ДО И ВО ВРЕМЯ ПАНДЕМИИ

Significance. The healthcare system can manage preventable causes of death if timely and effective interventions are in place including interventions aimed at improving living conditions and lifestyle of the population. Which diseases of the circulatory system are preventable? These are chronic rheumatic heart diseases and arterial hypertension at least in ages 5-64, and cerebrovascular diseases. The updated list of treatable diseases includes ischemic heart disease originally considered as a non-manageable cause. In the pre-COVID period the mortality structure underwent quality changes in terms of diseases and age distribution since the impact of preventive measures can manifest itself both in the decreased share of preventable causes and increased life expectancy of patients with cardio-vascular diseases. Did the gain in the age structure of preventable mortality from cardio-vascular diseases (CVD) sustain during the pandemic? The purpose of the study is to analyze contribution of preventable causes to cardio-vascular diseases mortality in the pre-COVID period and during the pandemic in Russia. Material and methods. The study used ROSSTAT data (Russian Federal State Statistics Service) to analyze data on cardio-vascular diseases mortality in the Russian Federation in 1999-2021. Male and female mortality was calculated for ages 5-64 years – the age interval of preventability. Since access to health care and risk factors of cardio-vascular diseases differ among urban and rural settings, rural and urban mortality was analyzed separately. Potential years of life lost (PYLL) were calculated as the sum products of the absolute number of deaths and potential years lost in each age group divided by 10 000 population of the corresponding age. Results. In most cases, the contribution of preventable causes to cardio-vascular diseases mortality in ages 5-64 has been steadily decreasing since 2003. The share of chronic rheumatic heart diseases equaling to less than one percent in males in the beginning of the century has decreased more than 3-fold during the pandemic. Similar trends are registered in female mortality, yet at higher rates. It should be emphasized here that mortality from chronic rheumatic heart diseases has been reducing since the end of the last century including throughout the period of social and economic collapse. The contribution of arterial hypertension to cardio-vascular diseases mortality is also low. The highest contribution to cardio-vascular diseases mortality is made by ischemic heart disease. Unlike other diseases under study, its contribution is higher among male urban population. Heart failure is associated with the lowest contribution to cardio-vascular diseases mortality. During the pandemic, its share has decreased in male mortality while hardly changed in females. The contribution of cerebrovascular diseases to cardio-vascular diseases mortality has significantly decreased sustaining this decline throughout the pandemic. In general, the contribution of preventable causes to cardio-vascular diseases mortality in ages 5-64 has been steadily reducing in males from 79.9% in 2003 to 72.7% in 2019 and to 71.6% in 2021 and in females from 80.5%% to 69.5% and 69.8%, respectively. The contribution of preventable causes in male mortality is higher among urban population compared to rural one (73.1% versus 71.3% in 2019, 71.9% versus 70.7% in 2021), while mortality in urban and rural females is almost the same. Conclusion. Analysis of preventable causes of cardio-vascular diseases mortality concludes as follows: First, it is those causes that have contributed the most to the decrease in mortality; Second, at the preventability age interval, the impact of preventive measures manifests itself in changes in mortality from ischemic heart disease and cerebrovascular diseases. Third, to ensure reduction in male mortality from cerebrovascular diseases it is necessary to intensify measures aimed at preventing alcohol use. Forth, it makes sense to analyze effectiveness of measures aimed at preventing avoidable mortality from diseases of the circulatory system using PYLL-70.