Complications Of Rheumatic Heart Disease Research Articles

HUSM endocarditis team's approach to acute ruptured chordae tendineae in chronic rheumatic heart disease.

Neglected rheumatic heart disease (RHD) can lead to severe complications and change patients' quality of life, particularly that of young patients. This report highlights the importance of public health education for patients and families in preventing RHD complications. In RHD management, prevention is better than cure.

Prevalence and associated factors of atrial fibrillation among patients with rheumatic heart disease attending public referral hospitals in Bahir Dar city, Northwest Ethiopia, 2023

BackgroundAtrial fibrillation (AF) is a supraventricular arrhythmia associated with uncoordinated atrial activation. Atrial fibrillation is complication of rheumatic heart disease and is associated with substantial morbidity and mortality. It is a growing public health problem and economic and social burden. Studies investigating the prevalence and factors associated with atrial fibrillation among chronic rheumatic heart disease patients in Ethiopia are scarce. Therefore, this study aimed to determine the prevalence and factors associated with atrial fibrillation in patients with chronic rheumatic heart disease.Methods and materialsA hospital-based cross-sectional study was conducted. A total of 410 patients were selected using a systematic random sampling method. The data were entered into Epi-Data version 4.6 and subsequently exported to SPSS version 26 software for analysis. A binary logistic regression model was applied to identify significant variables related to AF.ResultsIn this study, 410 patient charts were reviewed. The prevalence of atrial fibrillation was 43% (95% CI of 38% up to 48%). Male (AOR = 3.81, 95% CI 2.00-7.26), age greater than 30 years (AOR = 7.26, 95% CI 3.93–13.41), heart failure (AOR = 4.65, 95% CI 2.39–9.04), mitral valve stenosis (AOR = 6.36, 95% CI 2.92–13.87), and left atrial diameter enlargement (AOR = 3.41, 95% CI 1.64–7.09) were associated with atrial fibrillation.Conclusions and recommendationsAtrial fibrillation leads patients to frequent hospital admission and increases hospital mortality. As a result, health care professionals need to pay more attention to and apply more clinical treatment for older patients, those with heart failure, those with mitral valve stenosis, and those with left atrial diameter enlargement-associated causes of atrial fibrillation.

Outcomes and care quality metrics for people living with rheumatic heart disease and atrial fibrillation in Uganda

Atrial fibrillation (AF) is a common complication of rheumatic heart disease (RHD) and is challenging to treat in lower-resourced settings in which RHD remains endemic. We characterized demographics, treatment outcomes, and factors leading to care retention for participants with RHD and AF in Uganda. We conducted a retrospective analysis of the Uganda national RHD registry between June 2009 and May 2018. Participants with AF or atrial flutter were included. Demographics, survival, and care metrics were compared with participants without AF. Multivariable logistic regression was used to identify factors associated with retention in care among participants with AF. A total of 1530 participants with RHD were analyzed and 293 (19%) had AF. The median age was 24 (interquartile range 14-38) years. Mortality was similar in both groups (adjusted hazard ratio 1.183, P = .77) over a median follow-up of 203 (interquartile range 98-275) days. A total of 79% of AF participants were prescribed anticoagulation, and 43% were aware of their target international normalized ratio. Retention in care was higher in participants with AF (18% vs 12%, P < .01). Factors associated with decreased retention in care include New York Heart Association functional class III/IV (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI] 0.30-0.76) and distance to nearest health center (adjusted OR 0.94, 95% CI 0.90-0.99). Anticoagulation prescription was associated with enhanced care retention (adjusted OR 1.86, 95% CI 1.24-2.79). Participants with RHD and AF in Uganda do not experience higher mortality than those without AF. Anticoagulation prescription rates are high. Although retention in care is poor among RHD participants, those with concurrent AF are more likely to be retained.

Patterns of Rheumatic Heart Disease Among Yemeni Patients in Cardiac Center of Al-Thawra General Hospital

Background: Rheumatic heart disease (RHD) is still a major public health problem and remains the most common cardiovascular cause of death among children and young adults. The recurrent episodes of acute rheumatic heart disease may cause the rapid progressive damage of the heart valves and chronic residual deformity resulting in stenosis or regurgitation or a combination of both stenosis and regurgitation.&#x0D; Methodology: A cross sectional Study, consecutive patients with RHD were enrolled from outpatient cardiac clinics and inpatient department of cardiac center of Al-thawra hospital in Sana’a city, Yemen between January and July 2020. Demographic, clinical, echocardiographic, and coronary angiography characteristics of patients were recorded.&#x0D; Results: 261 consecutive patients with rheumatic heart disease were analyzed with mean age of 33 ± 12.65, female patients represented 62.8% (165), illiterate patients represented 63.6% (166). The majority of the patients about 79.7% (208 patient) had mitral valve disease, 63.6% (166 patient) had aortic valve disease, 10.7% (28 patient) had organic tricuspid valve disease but the Isolated Mitral valve disease 23%( 60) , Isolated Aortic valve disease 10.3% (27) and Isolated organic tricuspid valve disease represent 4.2% (11) , double valve disease (mitral &amp; aortic ) represent 56% (146), triple valve disease (Mitral + Aortic + Tricuspid )represent 6.5% (17).A lot of complications of RHD detected in our study; CHF 36%(94) with low EF &lt;50% in 55.0%(144) and 34% (89) had dilated LV , 33.7%(86) developed AF , 14%(37) of the patient complicated by IE , spontaneous echo contrast 11%(29) but only 7.3%(19) developed Intra cardiac thrombus and new stroke 9.5% ( 25) , pericardial effusion 5.4% (14) and Active ARF 2.3%(6). Conclusion:&#x0D; Rheumatic heart disease is a big medical problem in Yemen and it affects children and young adults of poor and illiterate patients of both genders. The most common valvular lesion reported in our study was multivalvular lesion the predominant pure lesion was Mitral regurgitation followed by Mitral stenosis, Aortic regurgitation, with high organic affection of the tricuspid valve.

Prevalence, clinical characteristics and echocardiographic parameters of arrhythmias among patients with rheumatic heart disease attending Jakaya Kikwete Cardiac Institute: a prospective cohort study

BackgroundArrhythmia is a known complication of rheumatic heart disease (RHD). It is critical to recognize arrhythmias early on so that prompt preventative actions and vigilant monitoring may be considered while treating these patients.AimThis study aimed at determining the prevalence, clinical characteristics and echocardiographic parameters of arrhythmias among RHD patients attending Jakaya Kikwete Cardiac Institute (JKCI).MethodologyHospital-based cross-sectional study was conducted among 390 patients with an echocardiographic diagnosis of RHD aged 18years and above attending JKCI. Demographic and clinical information was documented. Echocardiography, a resting electrocardiography and 24 h ambulatory Holter monitoring electrocardiography were done. Chi square test was used to determine association between variables and those with a p value ≤ 0.2 were entered in a multivariate logistic regression analysis to determine the independent factors associated with arrhythmias. P value of < 0.05 was considered statistically significant. The receiver operating curve was used to determine the critical point for left atrial size beyond which arrhythmias develop.ResultsA total of 390 patients were included in the analysis. The median age was 39 years interquartile range (IQR 30–52). Females were 257/390 (65.9%). Asymptomatic patients were 208/390 (53.3%). Most patients belonged to New York heart Association (NYHA) functional class I&II 247/390 (62.1%). The most common valve lesion was mitral stenosis 228/390 (58.5%). Arrhythmias were found in 276/390 (70.77%) patients, of which 193/390 (49.5%) patients were from resting electrocardiography (ECG) and 88/197 (44.7%) patients from holter ECG. Independent factors for arrhythmias were, NYHA functional class III&IV (a0R 4.67, 95% CI 1.82-12.00 p = < 0.01) and severe left atrial diameter enlargement (aOR 7.28, 95% CI 3.17–16.70 p = < 0.01). The critical point beyond which arrhythmias develop was found to be left atrium diameter > 48 mm.ConclusionWe found a high prevalence of arrhythmias among patients with RHD. The independent predictors of arrhythmias were left atrium dilatation and NYHA functional class III-IV. We recommend close monitoring for arrhythmias among RHD patients in sinus rhythm with higher NYHA functional class and dilated left atrium.

DOACs and rheumatic valvulopathy: always a red light?

Despite the sharp decline in most high-income industrialized countries, rheumatic heart disease (RHD) continues to be highly prevalent in many rural, low- and middle-income countries. RHD most frequently involves the mitral valve, both in the form of isolated regurgitation and in the form of regurgitation associated with mitral stenosis (mitral stenosis, MS). Atrial fibrillation (AF) is a common complication of RHD that is independently associated with an increased risk of death, heart failure, and systemic thromboembolism. Few studies have focused on the issue of the best oral anticoagulation strategy for patients with RHD and AF. Randomized trials establishing the non-inferiority of new direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs) in the prevention of stroke and systemic embolism excluded AF patients with mechanical valves or with moderate-to-severe MS. Nevertheless, variable proportions of patients with other VHD types were included. Recently, the INVICTUS trial demonstrated that in patients with RHD-related AF, direct oral anticoagulant rivaroxaban is inferior to VKAs in preventing stroke, systemic embolism, myocardial infarction, or death and is similar in bleeding risk. These results confirm and reinforce the recommendations of current international guidelines supporting the use of VKAs in patients with RHD-related AF.

Population-based assessment of cardiovascular complications of rheumatic heart disease in Fiji: a record-linkage analysis

ObjectiveTo determine population-based rates of non-fatal complications of rheumatic heart disease (RHD).DesignRetrospective cohort study based on multiple sources of routine clinical and administrative data amalgamated by probabilistic record-linkage.SettingFiji, an upper-middle-income...

Altered Expression of Transfer-RNA-Derived Small RNAs in Human With Rheumatic Heart Disease.

Rheumatic heart disease (RHD) remains a severe public health problem in developing countries. Atrial fibrillation (AF) is a medical complication of RHD. Although the understanding of disease pathogenesis has advanced in recent years, the key questions need to be addressed. Transfer RNA–derived small RNAs (tsRNAs) are a novel type of short non-coding RNAs with potential regulatory functions in various physiological and pathological processes. The present study used tsRNAs sequencing to investigate the relationship between RHD and atrial fibrillation (AF). Three paired cardiac papillary muscles were taken from six rheumatic RHD patients with AF (3 cases) or without AF (3 cases) from January 2016 to January 2017 in Xiangya Hospital, Central South University. A total of 219 precisely matched tsRNAs were identified, and 77 tsRNAs (fold change > 2.0 and P < 0.05) were differently changed. Three tsRNAs (AS-tDR-001269, AS-tDR-001363, AS-tDR-006049) were randomly selected and confirmed by qRT-PCR. The results of qRT-PCR were consistent with tsRNAs sequencing, suggesting the tsRNAs sequencing was reliable. Subsequently, we predicted the target mRNAs of the three tsRNAs. Moreover, we verified the functions of tsRNAs targeting mRNAs in vitro. Finally, bioinformatics analysis indicated that the target genes were abundant in regulation of transcription, DNA binding, intracellular. Most of the genes were predicted to interplay with cytokine-cytokine receptor by KEGG analysis. Our findings uncover the pathological process of AF in RHD through tsRNAs sequencing. This research provides a new perspective for future research on elucidating the mechanism of AF in RHD and offers potential new candidates for the treatment and diagnosis.

Abstract 11331: Economic and Social Challenges Faced by People Living with Rheumatic Heart Disease in a Resource Limited Setting

Introduction: Rheumatic heart disease (RHD) has nearly been eradicated in wealthy nations but remains a significant public health concern in low-resource countries like Uganda. Many people living with RHD (PLWRHD) is these settings have not been diagnosed and many who are diagnosed have late-stage disease. Objectives: To explore the social and economic challenges faced by PLWRHD in a resource limited setting. Methods: This was a qualitative study. We conducted in depth interviews on a sample of 36 RHD patients randomly selected from a computer-generated list from RHD registries in the Northern, Central, and South-western regions. The selected participants were interviewed by trained qualitative research staff. All interviews were tape recorded and transcribed verbatim. Data were analyzed by thematic content analysis and useful codes were generated by both inductive and deductive approaches. Generated codes were collapsed into themes. Coding was done by 3 independent researchers who compared their results and agreed on one codebook which was updated iteratively. Results: Of the 36 interviewed participants, 18 had congestive heart and another 18 had no congestive heart failure, a complication of RHD. Economic challenges faced by PLWRHD included financial burdens to family, debts incurred to meet treatment costs, selling off assets and loss of jobs. Social challenges entailed poor support at schools for RHD patients, school drop outs, family instability, poor social relations and poor community perception of RHD. Conclusion: Understanding challenges faced will enable designing of interventions that improve the quality of life of PLWRHD and significantly influence future policies on RHD management.

Incidence and predictors of stroke in patients with rheumatic heart disease

ObjectiveIschaemic stroke is a severe complication of rheumatic heart disease (RHD), which may result in permanent disability and death. This study aimed to assess the incidence and predictors of stroke...

A rare case on Rheumatic Heart Disease with Urosepsis and Septic shock

Rheumatic heart disease(RHD) is an inflammatory disease that mostly occurs in children of 5-15 years old. The major complications of RHD include arrhythmias, especially atrial fibrillation, stroke, infective endocarditis, cardiac failure, and also noted that problems increased in pregnancy. This is a rare case of RHD and urosepsis in a 67- year- old patient with a known history of cerebrovascular accident, pulmonary Arteriovenous(AV) malformation, acute renal failure, and hyponatremia presented to the emergency department with complaints of fever, severe breathlessness, and cough. The patient initially showed clinical manifestations of elevated inflammatory markers, neutrophilic leucocytosis, and hyponatremia, indicating septic shock. Our patient had been empirically treated with Piperacillin-Tazobactam because of the clinical features of urosepsis with septic shock. Based on Bronchoalveolar lavage(BAL) culture with non-fermenter Presumptive Acinetobacter and Klebsiella species and culture sensitivity report antibiotics were changed to Colistin and meropenem. The presence of carbapenem-resistant Klebsiella pneumoniae (CR Kp) entails stopping meropenem and adding tigecycline. Further creatinine clearance declined, and the drug Colistin was changed to Polymixin B. Meropenem was readministered based on the culture reports with scanty growth of multidrug-resistant Proteus mirabilis. Rational use of antibiotics along with the appropriate supportive measures is a meaningful measure in treating a rare and complicated condition of RHD with urosepsis.

How is juvenile rheumatic heart disease different: baseline results from a prospective north Indian registry

Abstract Introduction Juvenile rheumatic heart disease (RHD) refers to RHD in patients &amp;lt;20 years of age. There are no contemporary data highlighting the differences between juvenile and older RHD patients. Purpose We aim to report the age related differences in the pattern, and consequencies of valvular dysfunction in patients of RHD. Methods The 2475 consecutive patients of RHD diagnosed using clinical and echocardiographic criteria were registered prospectively from 2011 till December 2019. Patients were divided into 3 groups according to their age: Group 1 (Juvenile RHD), Group 2 (21–50 years), and Group 2 (&amp;gt;51 years).The data concerning the socio-demographic and clinical profile were recorded systematically, and the nature and severity of valvular dysfunction was assessed by echocardiography. The data were analyzed using the Epi-InfoTM Software. Results Out of 2475 RHD patients, Juvenile RHD comprised of 211 (8.5%) patients. Group 2 and 3 comprised of 1691 (68.3%) and 573 (23.2%) patients respectively. Overall, 1767 (71.4%) patients were females, however this female predilection was less pronounced in juvenile RHD (55.5% females vs 44.5% males) as compared to older groups. Past history of acute rheumatic fever was more commonly recorded in Juvenile RHD group (37.9% vs 18.8% in group 2 and 10% in group 3, p=0.0001). At the time of registration, the presence of advanced heart failure symptoms (dyspnea class III and IV) (11.4% group 1 vs 13.9% group 2 vs 20.6% group 3, p&amp;lt;0.0001), right heart failure symptoms (0.9% group 1 vs 2.5% group 2 vs 7.3% group 3, p&amp;lt;0.01), thromboembolic events (0% group 1 vs 4.1% group 2 vs 3.3% group 3, p&amp;lt;0.01), atrial fibrillation (2.8% group 1 vs 24.5% group 2 vs 45.9% group 3, p&amp;lt;0.0001), and pulmonary hypertension (27.1% group 1 vs 40.3% group 2 vs 51.9% group 3, p&amp;lt;0.01), were all more commonly recorded in non-juvenile older RHD groups. Multivalvular involvement was also less common in juvenile RHD (34.6% vs 42.4% and 44.5%, p=0.04). Mitral regurgitation was the most common lesion in Juvenile RHD followed by aortic regurgitation (68.7% and 40.2% respectively). Stenotic lesions (both mitral and aortic) were present more commonly in older age groups. Conclusion RHD is predominantly a disease of females, however the predilection is less common in juvenile patients. Juvenile RHD predominantly affects the mitral valve and mainly leads to regurgitant lesions. As the age advances, the complications of RHD, mainly heart failure symptoms, thromboembolic events, pulmonary hypertension, and atrial fibrillation, become more common. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Self sponsored registry

Clinical Profile and Management of Rheumatic Heart Disease in Children and Young Adults at a Tertiary Cardiac Center in Indonesia.

Introduction: Rheumatic heart disease (RHD) remains a major public health issue affecting children and young adults in developing countries. This study aimed to evaluate the clinical characteristics, management, and reactivation of RHD among children and young adults.Patients and Methods: This was a hospital-based retrospective study conducted at the National Cardiovascular Center Harapan Kita, Indonesia; we retrieved relevant data from patients diagnosed with RHD between 2012 and 2018.Results: Two hundred and seventy-nine patients were diagnosed with rheumatic heart disease, of whom 108 were children (mean age of 12.02 ± 3.36 years) and 171 were young adults (mean age was 24.9 ± 3.84). RHD was more common in female than in male young adults (1.5:1). Hospitalization due to RHD complications such as congestive heart failure was seen in 11.11% of cases in children, while pulmonary hypertension was present in 19.95% young adult cases. Reactivation of RHD occurred in 17.2% (48/279) cases, significantly in children (p < 0.001). Overall, the mitral valve (either isolated or combined) was the organ most affected in children (39.13%) and young adults (44.81%). Isolated mitral regurgitation was more common in children (13/21, 61.9%), while isolated mitral stenosis was more common in young adults (19/47, 40.42%). There was a high rate of rheumatic tricuspid valve disease in all populations (193/279, 69.17%) and reported involvement of pulmonary regurgitation (46/279, 16.48%). Multivalve lesions were more common than single lesions in both groups, with a combination of mitral and tricuspid regurgitation the predominant type in children (32/43, 74.41%) and mixed mitral lesion and tricuspid regurgitation in young adults (22/72, 30.56%). We observed a significant occurrence of quadrivalve lesions in children (p = 0.039). Valve repair was more common in children (49.07%) and replacement in young adults (32.16%), with low in-hospital mortality. Compliance with secondary prophylaxis was a significant challenge.Conclusion: Chronic RHD often presented with complications of the disease or reactivation of rheumatic fever (RF). Inadequate treatment of RF/RHD leads to extensive valvular damage and consequent disabilities. Efforts toward active early diagnosis and prompt treatment of RF/RHD and effective preventive measures are essential.

Clinical outcomes for young people with screening-detected and clinically-diagnosed rheumatic heart disease in Fiji

BackgroundEchocardiographic screening is under consideration as a disease control strategy for rheumatic heart disease (RHD). However, clinical outcomes of young people with screening-detected RHD are unknown. We aimed to describe the outcomes for a cohort with screening-detected RHD, in comparison to patients with clinically-diagnosed RHD. MethodsA retrospective cohort study included all young people with screening-detected RHD in the Central Division of Fiji in the primary cohort. Screen-negative and clinically-diagnosed comparison groups were matched 1:1 to the primary cohort. Data were collected on mortality, clinical complications and healthcare utilisation from the electronic and paper health records and existing databases. ResultsSeventy participants were included in each group. Demographic characteristics of the groups were similar (median age 11years, 69% female, median follow-up 7years). There were nine (12.9%) RHD-related deaths in the clinically-diagnosed group and one (1.4%) in the screening-detected group (Incident Rate Ratio: 9.6, 95% CI 1.3–420.6). Complications of RHD were observed in 39 (55.7%) clinically-diagnosed cases, four (20%) screening-detected cases and one (1.4%) screen-negative case. There were significant differences in the cumulative complication curves of the groups (p<0.001). Rates of admission and surgery were highest in the clinically-diagnosed group, and higher in the screening-detected than screen-negative group. ConclusionsYoung people with screening-detected RHD have worse health outcomes than screen-negative cases in Fiji. The prognosis of clinically-diagnosed RHD remains poor, with very high mortality and complication rates. Further studies in other settings will inform RHD screening policy. Comprehensive control strategies are required for disease prevention.

Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease: A Data-Linkage and Survival Analysis Approach.

Background:We investigated adverse outcomes for people with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) and the effect of comorbidities and demographic factors on these outcomes.Methods:Using linked data (RHD register, hospital, and mortality data) for residents of the Northern Territory of Australia, we calculated ARF recurrence rates, rates of progression from ARF to RHD to severe RHD, RHD complication rates (heart failure, endocarditis, stroke, and atrial fibrillation), and mortality rates for 572 individuals diagnosed with ARF and 1248 with RHD in 1997 to 2013 (94.9% Indigenous).Results:ARF recurrence was highest (incidence, 3.7 per 100 person-years) in the first year after the initial ARF episode, but low-level risk persisted for >10 years. Progression to RHD was also highest (incidence, 35.9) in the first year, almost 10 times higher than ARF recurrence. The median age at RHD diagnosis in Indigenous people was young, especially among males (17 years). The development of complications was highest in the first year after RHD diagnosis: heart failure incidence rate per 100 person-years, 9.09; atrial fibrillation, 4.70; endocarditis, 1.00; and stroke, 0.58. Mortality was higher among Indigenous than non-Indigenous RHD patients (hazard ratio, 6.55; 95% confidence interval, 2.45–17.51), of which 28% was explained by comorbid renal failure and hazardous alcohol use. RHD complications and mortality rates were higher for urban than for remote residents.Conclusions:This study provides important new prognostic information for ARF/RHD. The residual Indigenous survival disparity in RHD patients, which persisted after accounting for comorbidities, suggests that other factors contribute to mortality, warranting further research.

The importance of cardiovascular pathology contributing to maternal death: Confidential Enquiry into Maternal Deaths in South Africa, 2011–2013

SummaryAimsCardiac disease is emerging as an important contributor to maternal deaths in both lower-to-middle and higher-income countries. There has been a steady increase in the overall institutional maternal mortality rate in South Africa over the last decade. The objectives of this study were to determine the cardiovascular causes and contributing factors of maternal death in South Africa, and identify avoidable factors, and thus improve the quality of care provided.MethodsData collected via the South African National Confidential Enquiry into Maternal Deaths (NCCEMD) for the period 2011–2013 for cardiovascular disease (CVD) reported as the primary pathology was analysed. Only data for maternal deaths within 42 days post-delivery were recorded, as per statutory requirement. One hundred and sixty-nine cases were reported for this period, with 118 complete hospital case files available for assessment and data analysis.ResultsPeripartum cardiomyopathy (PPCM) (34%) and complications of rheumatic heart disease (RHD) (25.3%) were the most important causes of maternal death. Hypertensive disorders of pregnancy, HIV disease infection and anaemia were important contributing factors identified in women who died of peripartum cardiomyopathy. Mitral stenosis was the most important contributor to death in RHD cases. Of children born alive, 71.8% were born preterm and 64.5% had low birth weight. Seventy-eight per cent of patients received antenatal care, however only 33.7% had a specialist as an antenatal care provider. Avoidable factors contributing to death included delay in patients seeking help (41.5%), lack of expertise of medical staff managing the case (29.7%), delay in referral to the appropriate level of care (26.3%), and delay in appropriate action (36.4%).ConclusionThe pattern of CVD contributing to maternal death in South Africa was dominated by PPCM and complications of RHD, which could, to a large extent, have been avoided. It is likely that there were many CVD deaths that were not reported, such as late maternal mortality (up to one year postpartum). Infrastructural changes, use of appropriate referral algorithm and training of primary, secondary and tertiary staff in CVD complicating pregnancy is likely to improve the outcome. The use of simple screening equipment and point-of-care testing for early-onset heart failure should be explored via research projects.

Serum Levels of IL-17 and IL-23 in Patients With Rheumatic Mitral Stenosis.

Rheumatic mitral valve stenosis (RMS) is a complication of rheumatic heart disease (RHD) and leads to significant morbidity and mortality. RHD is a chronic inflammatory and autoimmune disease that is associated with cytokine activities. The etiology of RMS is not fully understood yet. Interleukin (IL)-17 and IL-23 have a key role in development of the autoimmunity. The expression of these cytokines in RMS remains unclear. In this study, we investigated the serum levels of IL-17 and IL-23 in RMS patients compared to healthy subjects.A total of 35 patients admitted to cardiology outpatient clinic between December 2014 and May 2015 who were diagnosed with RMS formed the study group. Age- and gender-matched 35 healthy subjects were included as the control group. Statistical analyses were performed using SPSS 18.0 and P value <0.05 was considered as statistically significant.The patients with RMS had higher WBC count, hsCRP, systolic pulmonary artery pressure (PAPs), left atrial diameter (LAD), IL-17, and IL-23 levels compared to the control subjects. The levels of IL-17 (P = 0.012) and IL-23 (P = 0.004) were significantly higher in the RMS group. Correlation analysis revealed that IL-17 and IL-23 levels had a significant correlation with each other and with hsCRP and LAD.We demonstrated that serum levels of IL-17 and IL-23 are significantly higher in patients with RMS compared to those of healthy subjects. IL-17 and IL-23 expression may have a possible role in inflammatory processes that result in RMS development.

Rheumatic valvulopathies occurence, pattern and follow-up in rural area: the experience of the Shisong Hospital, Cameroon.

Rheumatic heart disease (RHD) remains a major public health problem in developing countries. Whereas Africa has 10% of the world's population, broadly as many as half of the 2.4 million children affected by RHD live on the continent. We report on the occurrence and pattern of valve involvement in RHD using echocardiography in our centre and post surgical follow-up. In this retrospective study, transthoracic echocardiography (TTE) data collected from the Shisong cardiac centre over a period of 24 months (August 2005 to August 2007) were reviewed. Patients with a precordial murmur were selected. A total of 262 echocardiographic examinations were done in the centre over the two-year study period. The screening allowed us to see two categories of patients: 169 (64.5%), 79 male and 90 female, out of the 262 patients with abnormal results had an echocardiographic diagnosis of RHD, 80 (30.5%) patients had congenital heart disease. The 13 (5%) patients left had innocent murmur. Mitral valve regurgitation was the commonest echocardiographic diagnosis present in 101 patients (59.7%). Thirty-six (13.7%) patients had mixed mitral valve disease, 40 (23.7%) had mixed aortic and mitral valve disease, 42 (25%) had pure mitral stenosis and 26 (15.3%) had pure aortic regurgitation. The complications of RHD being observed included secondary pulmonary hypertension in 20 patients (11.8%) and functional tricuspid regurgitation was seen in 39 (21.9%). The congenital heart disease were: tetralogy of Fallot 29.1%, isolated ventricular septal defect 62.5%, isolated atrial septal defect 3.2%, atrioventricular canal 1.1%, patent ductus arteriosus 2.2%, common arterial trunk 1.9%. Our data showed that in children above 10-years-old in rural zone of Cameroon presenting with a precordial murmur RHD has to be suspected. Acute rheumatic fever primary and secondary prevention as well as rheumatic fever registers are important for the disease eradication in our countries. More surgical centres for a better management of the RHD complications are needed in sub-Saharan Africa. Due to poverty and illiteracy of parents, the post surgical follow up of patients is challenging.

Sudden Death Due to Undiagnosed Rheumatic Heart Disease in a Child

We report the case of a 5-year-old boy who died from complications of rheumatic heart disease with atypical presentation. He was hospitalized for recent inflammatory and neurological symptoms. He was diagnosed with viral encephalitis. He died the day after he was discharged. The macroscopic autopsy findings were unremarkable. Histology revealed typical rheumatic heart disease. Neuropathology showed cerebral infarction due to an embolic event linked with the rheumatic valvulitis. The cause of death was determined as heart failure due to rheumatic heart disease secondary to an undiagnosed acute rheumatic fever. It is related to an autoimmune response to infection with group A streptococcus. It mainly affects children in developing countries. In our case, viral encephalitis was consistent with the medical history and the proper diagnosis was made on histological analysis. Forensic pathologists should consider this diagnosis facing a sudden unexpected death in childhood, even in industrialized countries.

Chronic rheumatic heart disease in Abeokuta, Nigeria: Data from the Abeokuta heart disease registry

Background: Rheumatic heart disease (RHD) is a major public health problem in resource-poor countries. According to the World Health Organization (WHO), rheumatic fever (RF)/RHD affects about 15.6 million people worldwide, with 282,000 new cases and 233,000 deaths each year. There are about 2 million people with RHD requiring repeated hospitalization and 1 million likely to require surgery globally.Objective: The objective of the study is to explore the pattern of RHD in Abeokuta where such a study has not been reported in the past.Materials and Methods: This is an analysis of a prospectively collected data over a period of 5 years (Jan 2006-Dec 2010). We collected information on the bio-data, clinical features and echocardiographic diagnoses.Results: During this period, a total of 107 cases of RHD were seen, 66 females (61.7%) and 41 males (38.3%) aged 43.9 ± 19.3 years (range, 7 to 92 years). Mitral regurgitation was the most common lesion (63.6%). Other common lesions include pure mitral stenosis (14.0%), mixed mitral valve disease (6.5%), and mixed mitral and aortic regurgitation (5.6%). Complications of RHD observed included secondary pulmonary hypertension, valvular cardiomyopathy, atrial fibrillation, stroke and infective endocarditis.Conclusions: Our data show that RHD is an important cause of heart disease in this city although the prevalence is lower than studies done in southern Nigeria in the 60s and 70s. Most present with complications and many do not have access to surgical therapy. There is, therefore, a need for improved surveillance and control of the disease at the community level.