Long-acting Penicillin Research Articles

Syphilitic uveitis in HIV-positive patients: report of a case series, treatment outcomes, and comprehensive review of the literature.

To report the clinical characteristics, treatment and outcomes of active syphilitic uveitis in human immunodeficiency virus (HIV) positive patients and compare them with the previously published data. Retrospective analysis of the case series from an infectious disease center in southern China was conducted. Comprehensive review of previously published cases of HIV positive syphilitic uveitis was conducted using the PubMed and Web of Science databases and the references listed in the identified articles. Twelve HIV positive patients with active syphilitic uveitis were collected. All were male, with age of 36.3y (range 27 to 53y). Five (41.7%) had a history of syphilis, and three of them had received anti-syphilis treatment. Ocular manifestations included corneal epithelial defect (13%), complicated cataract (17.4%), vitreous opacity (82.6%), optic disc edema (26.1%), macular edema (30.4%), neuro-retinitis (43.5%), and retinal hemorrhage (26.1%). After standardized syphilitic treatment, intraocular inflammation was reduced and vision improved in all cases. The literature review summarizes 105 previously reported cases of HIV positive syphilitic uveitis. High serum rapid plasma regain (RPR) titers may be associated with severe uveitis and poor vision. Treatment with penicillin, ceftriaxone sodium, or penicillin plus benzylpenicillin instead of using benzylpenicillin alone can significantly improve best-corrected visual acuity (BCVA) in HIV positive ocular syphilis patients. For HIV positive syphilitic uveitis patients, prompt diagnosis and appropriate treatment and follow-up are paramount. In our series, the clinical manifestations are diverse. Syphilis patients treated by penicillin G or long-acting penicillin before may still develop syphilitic uveitis. Patients who relapse after long-term penicillin treatment can still benefit from penicillin G.

Lactoferrin versus Long-Acting Penicillin in Reducing Elevated Anti-Streptolysin O Titer in Cases of Tonsillopharyngitis.

BackgroundBeta-Hemolytic streptococci are the most frequent bacteria causing tonsillitis. Lactoferrin may play a role in the treatment of chronic tonsillitis due to its direct antimicrobial activity.ObjectiveTo assess the possible role of lactoferrin in reduction of raised serum Anti-Streptolysin O Titer (ASOT) in cases of chronic tonsillopharyngitis in comparison to long acting penicillin.MethodsThis study included 117 children with tonsillopharyngitis with high ASOT randomly divided into three groups; group 1 treated with lactoferrin, group 2 treated with long acting penicillin and group 3 treated with both drugs. For all patients ASOT was measured after three and six months of starting treatment.ResultsThis study included 60 males and 57 females with the mean age (8.5 ± 2.4). There is statistically significant reduction in ASOT in all groups after three months of treatment. ASOT after 3 months was significantly lower in group1 (370±440) and group 3 (350±450) in comparison to group 2 (420±560) with p value 0.02, 0.004, respectively, with no significant difference in comparing group 1 to group 3 p value 0.4. Also, ASO titre after 6 months was significantly lower in group1 (350±420) and group 3 (340±440) in comparison to group 2 (420±550) with p value 0.02, 0.007, respectively, with no significant difference in comparing group 1 to group 3 p value 0.5. In comparing ASOT at three months and six months of treatment in the three studied groups; it decreased by 2% in group 1, and 1.6% in group 3 and no change in group 2.ConclusionLactoferrin alone or in combination with long acting penicillin is safe and more effective than long acting penicillin alone in reducing ASOT. Treatment for six months with lactoferrin alone or in combination with long acting penicillin could offer a better response.

A Review on Syphilis: Clinical Manifestation and Epidemiology

Syphilis is a persistent infection caused by the bacteria Treponema pallidum prevalent in low-income countries but rare in middle- and high-income countries. T. pallidum is known for its invasiveness and immune evasion; its clinical symptoms are produced by local inflammatory responses to replicating spirochetes and are often confused with other diseases. The spirochete has a prolonged latent phase in which people might be infected even if they don't display any symptoms. Individuals, as well as the entire population, are affected by the sickness. Only one drug, penicillin, is recommended for the treatment of syphilis, and response to therapy is evaluated by changes in serological test titers over months. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is emerging as a global public health problem. This is especially true among guys in high- and middle-income countries who have sex with men. Even though syphilis is a long-standing disease with well-established treatment ideas, diagnosis and therapy can be difficult due to the wide variety of symptoms and the difficulty of interpreting serological tests. The World Health Organization (WHO) has set a target of lowering syphilis incidence by 90% by 2030, but progress is slow. Countries can reduce the prevalence of syphilis by ensuring detection, treatment, and referral of infections by partners.

Study of the relation between serum levels of long-acting penicillin and the inflammatory markers: C-reactive protein and interleukin-6 in patients with chronic rheumatic heart disease

BackgroundThere is an evidence of a chronic inflammatory state in patients with chronic rheumatic valvular heart disease (RHD) as shown by high serum levels of high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL6). Despite the efficacy of long-acting penicillin (LAP) in secondary prevention of rheumatic fever, its effect on this inflammatory state is still unknown. So, we sought to study the effect of LAP on the inflammatory markers, CRP and IL-6, in patients with chronic rheumatic heart disease.ResultsEighty RHD patients coming to our hospital’s outpatient clinic for rheumatic fever secondary prophylaxis by regular administration of LAP were enrolled in the study. Patients were divided into 3 groups: group A, 70 patients with RHD already on prophylactic LAP, group B, 10 patients with RHD who have not yet started prophylactic LAP, and group C, control group of 10 healthy individuals not known to have RHD. Serum levels of LAP, IL-6, and CRP were measured for the three groups.Group A had significantly lower IL-6 levels than group B (25.22 ± 33.50 vs. 126.1 ± 33.76nng/ml, respectively, p < 0.0001). IL-6 levels were significantly lower in control subjects compared to patients in group B (3.600 ± 2.319, 25.22 ± 33.50 ng/ml, respectively, p < 0.0001). However, IL-6 levels in the control group were lower but non-significantly different compared to group A. CRP level was lower in group A than group B (8419 ± 4935 vs. 14400 ± 3375 mg/dl, respectively, p = 0.0002). CRP levels were significantly lower in control subjects compared to patients in group A and group B. IL-6 values were positively correlated with CRP values (r = 0.6387, p < 0.0001).CRP values were negatively correlated with LAP values (r = -0.5277, p < 0.0001). IL-6 values were negatively correlated with LAP values (r = − 0.4401, p < 0.0001). There was a highly significant difference between LAP level in compliant and non-compliant patients (1.045 ± 1.270 vs. 0.0785 ± 0.1057 ng/ml, respectively, p value < 0.0001).There was also a highly significant difference between CRP level in compliant and non-compliant patients (7640 ± 4558 vs. 13090 ± 4717 mg/dl, respectively, p = 0.005). Moreover, there was a significant difference between IL-6 levels in compliant and non-compliant patients (21.53 ± 32.70 vs. 47.40 ± 30.91 ng/ml, respectively, p value 0.03).ConclusionSerum LAP has a strong negative correlation with IL-6 and CRP levels. Regular administration of LAP strongly ameliorates the inflammatory state seen in patients with RHD.

Recurrent attacks of rheumatic fever among school-age children (6–12 years)

ObjectiveTo assess factors related to recurrence of rheumatic fever attacks among school-age children (6–12 years) in El-Mahala El-Kobra City, Gharbiya Governorate.BackgroundRecurrent episodes of acute rheumatic fever (ARF) can lead to rheumatic heart disease with considerable morbidity and mortality in children.Patients and methodsA cross-sectional study was conducted in a center for follow-up of patients with rheumatic fever and rheumatic heart diseases in El-Mahala El-Kobra City, Gharbiya Governorate. There were 237 cases aged 6–12 years attending the selected center during the years of the study (first of November 2015 to end of October 2017). All cases that attended the center for follow-up (after either single attack or recurrent attacks of rheumatic fever) were recruited in the study. Participants were interviewed using a self-designed questionnaire filled by the researcher to assess socioeconomic characteristics and family and dietary history. Laboratory investigations included erythrocyte sedimentation rate, C-reactive protein, antistreptolysin O titer, and hemoglobin percent, and also ECG and echocardiography were collected from patients' files.ConclusionThere was a significant association between recurrence of rheumatic fever attacks and age of the patient, tonsillectomy, regimen of taking long-acting penicillin, and lack of adherence to treatment.ResultsThe study revealed that among 237 studied rheumatic cases, 104 (43.9%) had recurrent attacks of ARF. The most significant factor associated with recurrent ARF was the age of the patient, negative history for tonsillectomy, a regimen of taking long-acting penicillin, and lack of adherence to its use.

Determine upper limit of normal range of antistreptolysin-O titer in normal school children from 5 to 15 years old

ObjectiveTo determine upper limit of normal range of antistreptolysin-O (ASO) titer in normal school children from 5 to 15 years old in Menoufia Governorate.BackgroundAlthough ASO titer has provided a useful guideline to physicians this has been shown to vary with age, geographical location, and site of infection.Patients and methodsA cross-sectional study was carried out in Menoufia Governorate and the samples were collected from outpatient clinics of Menoufia university hospital other than infection (by advertising in the outpatient clinics for analysis streptococcus laboratory for free in children aged 5–15 years) in the period from July 2016 to May 2017. Two hundred children aged 5–15 years were participated in this study after consent from their parents. The children were categorized into two groups: group 1: include children aged 5–10 years and group 2: include children aged 11–15 years. Full history, routine, physical examination, and special investigations were taking.ResultsThere was statistically significant difference between residence and social classes in the studied group. Also, there was statistically significant difference between age groups regarding ASO titer among rural patients. There was highly significant correlation between number of attacks of acute follicular tonsillitis with ASO titer level, age groups, and social classes.ConclusionThe upper limit of normal ASO titer in normal Egyptian children is quite high, reaching up to 398.5 IU/ml. Therefore, an isolated high ASO titer is not sufficient to diagnose acute rheumatic fever. Basal levels of ASO titer increase with age but age does not affect the peak level during acute streptococcal infection. Additional studies will be required for establishment of standard values to avoid over diagnosis of acute rheumatic fever and complications of long-acting penicillin.

Clinical and hematologic outcomes after splenectomy for congenital hemolytic anemia

Aim The aim was to delineate clinical and hematological outcomes of splenectomy in congenital hemolytic anemia patients. Patients and methods It was a retrospective descriptive study in the Pediatric Hematology Ward involving patients aged 4–18 years from 2010 to 2016. Data were collected using a structured questionnaire and analyzed using the Statistical Package for the Social Sciences, Version 20. Results The study was performed on 104 patients, 60 males and 44 females, age range 4–18 years. The mean age was 9.19 ± 3.33. Postoperative complications developed in 26% of patients, mostly wound infection, hematological parameters, especially hemoglobin level, are elevated after splenectomy and is equal to 6.74 ± 1.27 g% in most patients. Splenectomy decreases blood transfusion needs to 50% of the presplenectomy stage and increases the interval in between blood transfusion after splenectomy to the double. Conclusion Splenectomy to the children who suffered from congenital hemolytic anemia such as beta thalassemia major, sickle cell anemia and spherocytosis improved hematological parameters, especially hemoglobin level, so the number of blood transfusions and hospital admissions decreased that improved the quality of life. On the other side, there are early and late postoperative complications which can be avoided by proper perioperative vaccination and taking postoperative 2-weekly long-acting penicillin. Rationale Identify the clinical and hematological outcomes of splenectomy in children due to hematological disorders, especially β-thalassemia major. In the locality splenectomy is still one of the most important modalities used in the partial treatment of chronic hemolytic anemia.

Clonidine for pain-related distress in Aboriginal children on a penicillin regimen to prevent recurrence of rheumatic fever.

Indigenous children and adolescents in Australia and globally bear the burden of acute rheumatic fever (ARF). It has been virtually eliminated in well-resourced, developed settings. ARF is an autoimmune response to infection with group A Streptococcus. The mainstay of management is long-acting intramuscular penicillin injections to prevent recurrence of ARF and development of rheumatic heart disease (RHD), comprising valvular pathology and attendant complications. In Australia, penicillin injections are currently prescribed every 28 days for 5-10 years after diagnosis of ARF, depending on cardiac involvement. Adherence to this regimen reduces ARF recurrences and RHD progression. 'Days at risk' of ARF recurrence are calculated as the number of days after day 28 that an injection is not received. Adherence to the injection schedule has been reported as difficult in most global locations due to the painful nature of the injections, the long timeframes of the prescription, young age of patients, access problems and costs in some locations. The newly updated Australian guideline on the prevention, diagnosis and management of ARF and RHD has a chapter dedicated to secondary prophylaxis. This chapter takes into account cultural considerations and advises on ways to minimise pain and distress of injections in children such as pain gate strategies, distraction techniques and concurrent injection of local anaesthetic. Some children continue to find the injection regimen traumatising despite strategies to reduce pain and fear. Clinicians providing the injections to children also find the injecting episodes distressing if pain is not effectively minimised. An Aboriginal Community Controlled Health Service in a remote setting in northern Australia addressed the issue of severe trauma of injection episodes experienced by an Aboriginal boy aged 7 years. Usual strategies were not effective, so advice was sought from an expert anaesthetist at a tertiary hospital. As a result, oral clonidine 3 &micro;g/kg was trialled 45 minutes prior to the penicillin injection. Procedural coaching and monitoring protocols specific to administration of clonidine in children under their care were created by the health service. The initial dose of clonidine was delivered with the child as an inpatient. Clonidine was successful in reducing pain related distress and facilitating adherence to the penicillin regimen. Subsequent doses were delivered and monitored in a remote setting by nurses. After 18 months, the boy no longer required clonidine due to his increased coping capacity. A second child was recognised with similar trauma and has been taking clonidine for pre-procedural sedation for 6 months with good effect and no adverse effects. An additional child was similarly prescribed clonidine without success. Failure in that instance was attributed to lack of procedural coaching and receiving the initial dose of clonidine in an emergency department in hurried circumstances. Individualised child-focused and culturally appropriate care in remote settings is feasible: in this instance team planning for use of clonidine and procedural coaching when other measures have failed. However, for children with RHD, or other comorbidities, advice from the child's treating cardiologist is required prior to prescribing clonidine due to possible adverse consequences. These include hypotension and atrioventricular block, which could lead to haemodynamic compromise in the setting of moderate to severe RHD.

Assessment of Health-Related Quality of Life in Children with Rheumatic Heart Disease at Upper Egypt

Background: Many published literatures suggested that RHD can cause stress and anxiety in patients, with increased risks of evolving physical and psychosocial impairments. These include not only pain and fatigue but also difficulties with activities of daily living. Objective: The study aimed to evaluate the HRQOL in children with RHD and delineate the HRQOL domains in various clinical subtypes of RHD. Patients and methods: The present study was a cross-sectional, comparative, study that was conducted on 120 RHD patients who were recruited from Upper Egypt University Hospitals (Aswan, Assiut, and Qena hospitals) for six months. Also, 120 age and sex-matched healthy volunteers were included as the control group. Results: In our cohort, the most common presentation of the included patients was pancarditis with arthritis (33.3%), followed by polyarthritis (31.7%), and fever with pan carditis (20%). One-third of the patients had a history of one hospital admission, and 26.7% had a history of two or more admission. Besides, 65% had swollen, redness, hotness, limitation of movement in the lower limb. All patients were on long-acting penicillin and 10.8% had a history of cardiac surgery. In the present study, the mean serum CRP level was notably high in patients with RHD (mean 114.63 ±113.5mg/dL). Conclusion: Rheumatic heart disease imposed a considerable burden on the quality of life of the Egyptian pediatric population. In our study, we found that Egyptian patients with rheumatic heart disease had significant impairments on the physical, emotional, social, and school functioning, as compared to their counterpart healthy population.

How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018).

Rheumatic heart disease (RHD) as a chronic sequela of repeated episodes of acute rheumatic fever (ARF), remains a cause of cardiac morbidity in Egypt although it is given full attention through a national RHD prevention and control program. The present report reviews our experience with subjects presenting with ARF or its sequelae in a single RHD centre and describes the disease pattern over the last decade. A cross-sectional study was conducted in El-Mahalla RHD centre between 2006 and 2018. A total of 17014 individual were enrolled and evaluated. Diagnosis ARF was based on the 2015 revised Jones criteria and RHD was ruled in by echocardiography. The majority of the screened subjects were female (63.2%), in the age group 5–15 years (64.6%), rural residents (61.2%), had primary education (43.0%), and of low socioeconomic standard (50.2%). The total percentage of cases presenting with ARF sequelae was 29.3% [carditis/RHD (10.8%), rheumatic arthritis (Rh.A) (14.9%), and Sydenham’s chorea (0.05%)]. Noticeably, 72% were free of any cardiac insult, of which 37.7% were victims of misdiagnoses made elsewhere by untrained practitioners who prescribed for them long term injectable long-acting penicillin [Benzathine Penicillin G (BPG)] without need. About 54% of the study cohort reported the occurrence of recurrent attacks of tonsillitis of which 65.2% underwent tonsillectomy. Among those who experienced tonsillectomy and/or received BPG in the past, 14.5% and 22.3% respectively had eventually developed RHD. Screening of family members of some RHD cases who needed cardiac surgery revealed 20.7% with undiagnosed ARF sequalae [RHD (56.0%) and Rh.A (52.2%)]. Upon the follow-up of RHD cases, 1.2% had improved, 98.4% were stable and 0.4% had their heart condition deteriorated. Misdiagnosis of ARF or its sequelae and poor compliance with BPG use may affect efforts being exerted to curtail the disease. Updating national guidelines, capacity building, and reliance on appropriate investigations should be emphasized. Since the genetic basis of RHD is literally confirmed, a family history of RHD warrants screening of all family members for early detection of the disease.

Subcutaneous administration of benzathine benzylpenicillin G has favourable pharmacokinetic characteristics for the prevention of rheumatic heart disease compared with intramuscular injection: a randomized, crossover, population pharmacokinetic study in healthy adult volunteers.

Benzathine penicillin G has been used as monthly deep intramuscular (IM) injections since the 1950s for secondary prevention of acute rheumatic fever and rheumatic heart disease (RHD). Injection frequency and pain are major programmatic barriers for adherence, prompting calls for development of better long-acting penicillin preparations to prevent RHD. We hypothesized that subcutaneous (SC) administration of benzathine penicillin G could delay penicillin absorption when compared with IM injections. To compare the pharmacokinetic profile and tolerability of benzathine penicillin G according to different routes of administration, 15 healthy males participated in a randomized crossover study to receive benzathine penicillin G by either SC or IM routes, with a 10 week washout period before the second dose by the alternative route. Ultrasound guidance confirmed injection location. Penicillin concentrations and pain scores were measured for 6 weeks following injections. SC administration was well tolerated with no significant differences in pain scores. Following SC injection, the principal absorption half-life (95% CI) was 20.1 (16.3-29.5) days and 89.6% (87.1%-92.0%) of the drug was directed via this pathway compared with 10.2 (8.6-12.5) days and 71.3% (64.9%-77.4%) following IM administration. Lower peak and higher trough penicillin concentrations resulted following SC injection. Simulations demonstrated that SC infusion of higher doses of benzathine penicillin G could provide therapeutic penicillin concentrations for 3 months. SC administration of benzathine penicillin G is safe and significantly delays penicillin absorption. High-dose benzathine penicillin G via the SC route would fulfil many product characteristics required for the next generation of longer-acting penicillins for use in RHD.

A Comparative study to evaluate the effectiveness of Tonsillectomy with Long term Penicillin in the management of recurrent tonsillitis

Introduction: Tonsillitis is widespread among children and has serious poststreptococcal complications, and both the patients and the otolaryngology surgeon have to face the question on what is the role and benefit of using long-acting penicillin and whether it is an alternative method of treatment to surgery? This study was carried out to evaluate the effectiveness of tonsillectomy compared with long-acting penicillin in the treatment of recurrent tonsillitis, comparing their effects on the levels of the antistreptolysin O titer (ASOT) and erythrocyte sedimentation rate (ESR). Methods: This study was carried out as a prospective study. A total of 100 Children were chosen for this study. Subjects fulfilling the inclusion criteria like , Age of 5–15 years , Children suffering from recurrent tonsillitis with signs of chronic tonsillitis: inequality in the size of the tonsils, enlarged cervical lymph nodes, and pus in the tonsillar crypts 6 , Severe attacks of tonsillitis: seven times in 1 year or five times in each of 2 years, or three times in each of 3 years & An ASOT of greater than 400 IU/ml and an ESR of greater than 30 ml/1 at 1/2 h 10,11.were selected by simple random sampling method. Results : The frequencies of occurrence of fever, cough, obstructive sleep apnea, unequal tonsil size, and pus in the tonsillar crypts were 80% , 51 % , 4% , 52% , and 48 %, respectively. Effect of tonsillectomy versus the effect of long-acting penicillin on ASOT, we found that the levels after 3 months were lower in patients who were treated by tonsillectomy than in those who were treated with long-acting penicillin; the difference between both the groups was found to be statistically significant. Conclusion: This study presents important insight into the alternate treatment regimens of Recurrent Tonsillitis in rural children. This study demonstrates that the first line of treatment of recurrent chronic tonsillitis is tonsillectomy, as it is both clinically effective and cost-effective for children and that the second line of treatment is long-acting penicillin with long-term follow-up, and in patients, have contraindications for surgery such as bleeding diathesis.

P3130Relation between serum levels of long acting penicillin and the inflammatory markers: High sensitivity C-reactive protein and interleukin-6 in patients with chronic rheumatic heart disease

Abstract Background There is evidence of a chronic inflammatory state in patients with chronic rheumatic valvular heart disease (RhD) as shown by high serum levels of high sensitivity C-reactive protein (CRP) and interleukin-6 (IL6). Despite the efficacy of long acting penicillin (LAP) in secondary prevention of rheumatic fever, its effect on this inflammatory state is still unknown Objective We sought to study the effect of (LAP) on the inflammatory markers, (CRP) and (IL-6), in patients with chronic rheumatic heart disease. Methods Eighty patients having (RhD) patients coming to our university hospitals outpatient clinic for rheumatic fever secondary prophylaxis by regular administration of (LAP) were enrolled in. the study. Patients were divided into to 3 groups: Group A; 70 patients with (RhD) already on prophylactic (LAP), Group B; 10 patients with (RhD) who have not yet started prophylactic (LAP), Group C; control group of 10 healthy individuals not known to have (RhD). Serum levels of (LAP), (IL6) and (CRP) were measured for the three groups. Results . Group A had significantly lower (IL6) levels than group B (25.22±33.50 vs. 126.1±33.76ng/ml, respectively, p&lt;0.0001). (IL6) levels were significantly lower in control subjects compared to patients in group B (3.600±2.319, 25.22±33.50 ng/ml respectively, p&lt;0.0001). However, IL6 levels in the control group were lower but non-significantly different compared to Group A . (CRP) level was lower in group A than group B (8419±4935 vs. 14400±3375mg/dl respectively, p=0.0002). (CRP) levels were significantly lower in control subjects compared to patients in group A and group B. (IL6) values were positively correlated with (CRP) values (r=0.6387, p&lt;0.0001). (CRP) level negatively correlated with Long acting penicillin level (r=−0.5277, p&lt;0.0001). (IL-6) level negatively correlated with (LAP) level (r=−0.4401, p&lt;0.0001). There was a highly significant difference between (LAP) level in compliant and non-compliant patients (1.045±1.270 vs. 0.0785±0.1057ng/ml, respectively, p value &lt;0.0001). There was also a highly significant difference between (CRP) level in compliant and non-compliant patients (7640±4558 vs. 13090±4717 mg/dl, respectively, p value 0.005).Moreover, there was a significant difference between (IL-6) levels in compliant and non-compliant patients (21.53±32.70 vs. 47.40±30.91 ng/ml, respectively, p value 0.03). Conclusion Serum (LAP) has a strong negative correlation with (IL-6) and (CRP) levels. Regular administration of (LAP) strongly ameliorates the inflammatory state seen in patients with (RhD).

Elimination of Mother-to-child Transmission of Syphilis: Challenge and Solution

Abstract Congenital syphilis (CS) is a significant public health problem worldwide. The majority of cases of CS are caused by in utero transmission. The World Health Organization launched the global elimination of CS initiative with the goal of reducing mother-to-child transmission of syphilis. The risk for CS is mainly related to three factors: (1) high maternal prevalence, (2) low coverage of antenatal care services, and (3) treatment failure. The long-acting penicillin preparations such as benzathine penicillin G are the preferred therapies for maternal syphilis. There are several challenges in preventing CS from both pregnant women and their health care providers. These problems include that prenatal care lack or delay, syphilis management flaws from health care providers, lacks of basic information, and awareness about maternal syphilis and CS by public. Many efforts have been made to solve the problems. These include that dual elimination of mother-to-child transmission (EMTCT) of both human immunodeficiency virus (HIV) and syphilis or triple EMTCT of HIV, syphilis and hepatitis B, World Health Organization country validation of EMTCT of syphilis and HIV, set up a CS case review board and a National Day to combat syphilis and CS.

The consequence of the first attack of acute rheumatic fever with subclinical carditis

Background: Immune mediated damage of RF occurs most prominently in the heart, joints, brain, skin and subcutaneous tissues, however RF leaves no lasting damage to the brain, joint or skin, it is the leading cause of acquired heart disease in children and adolescents worldwide, therefore carditis is the most important manifestation of RF. Echocardiography along with color; Doppler imaging is now worldwide used for early detection of cardiac involvement even in the absence of clinical evidence, which in this case is called subclinical carditis (SCC) and was reported to cause similar consequences to clinically evident carditis.Methods: A retrospective study carried out on 35 patients already diagnosed to have RF and subclinical RHD and attending the cardiology clinic at Alexandria University Children’s Hospital (AUCH) from December 2015 to November 2016. Data collected from patients' files and then appropriately updated during subsequent follow-up visits.Results: 35 children already diagnosed to have RF and subclinical RHD were included in the current study, 22 patients (66.6%) improved completely with no residual cardiac lesion, 10 patients (30.3%) had persistent lesion and one patient (3.1%) had worsened condition.Conclusions: The most important predictors of poor prognosis according to the current study were recurrence and lack of regular compliance to long acting penicillin (LAP). Furthermore the outcome was not influenced by the treatment given in the initial attack.

Clinical characteristics of children with chronic rheumatic valvular heart disease in Cardiology Unit, Assiut University Children Hospital

Background: chronic rheumatic heart disease (RHD) is still common in developing countries and associated with major complications and high mortality. Aim: to describe clinical characteristics of children with chronic rheumatic valvular heart disease. Patients and Methods: the study included fifty patients with chronic rheumatic valvular heart disease attending Assiut University Children Hospital over six months. Full through history and clinical examinations were done to all cases. All cases have been subjected to chest X-ray, standard 12-lead ECG, and echocardiography. Results: female patients were slightly commoner than male patients. Mitral valve was the commonest valve affected followed by aortic valve. Regarding ECG, left atrial hypertrophy was the commonest finding and mitral regurge was the commonest valve lesion. While, left atrial hypertrophy was the commonest finding in chest X-ray. Respecting echocardiography, there was slightly increased in left ventricular end diastolic diameter and left atrium. Heart failure was the most common complication that occurs in RHD patients. Patients’ compliant with long acting penicillin (LAP) were more than non-compliant. Conclusion: echocardiography is the most important tool for evaluation of valvular heart disease. Left atrial hypertrophy is the commonest finding by ECG. There is increase in left ventricular end diastolic diameter and left atrium by echocardiography. Left atrial hypertrophy is the commonest finding in chest X-ray. Mitral valve is the commonest valve affected followed by aortic valve. Patients’ compliant with LAP are more than non-compliant patients. Recommendation: echocardiography must be used as a screening tool for early detection of subtle cases of RHD. Application of control programs with special emphasis on the regular use of secondary prophylaxis.

Clinical characteristics of children with chronic rheumatic valvular heart disease in Cardiology Unit, Assiut University Children Hospital

Background: chronic rheumatic heart disease (RHD) is still common in developing countries and associated with major complications and high mortality. Aim: to describe clinical characteristics of children with chronic rheumatic valvular heart disease. Patients and Methods: the study included fifty patients with chronic rheumatic valvular heart disease attending Assiut University Children Hospital over six months. Full through history and clinical examinations were done to all cases. All cases have been subjected to chest X-ray, standard 12-lead ECG, and echocardiography. Results: female patients were slightly commoner than male patients. Mitral valve was the commonest valve affected followed by aortic valve. Regarding ECG, left atrial hypertrophy was the commonest finding and mitral regurge was the commonest valve lesion. While, left atrial hypertrophy was the commonest finding in chest X-ray. Respecting echocardiography, there was slightly increased in left ventricular end diastolic diameter and left atrium. Heart failure was the most common complication that occurs in RHD patients. Patients’ compliant with long acting penicillin (LAP) were more than non-compliant. Conclusion: echocardiography is the most important tool for evaluation of valvular heart disease. Left atrial hypertrophy is the commonest finding by ECG. There is increase in left ventricular end diastolic diameter and left atrium by echocardiography. Left atrial hypertrophy is the commonest finding in chest X-ray. Mitral valve is the commonest valve affected followed by aortic valve. Patients’ compliant with LAP are more than non-compliant patients. Recommendation: echocardiography must be used as a screening tool for early detection of subtle cases of RHD. Application of control programs with special emphasis on the regular use of secondary prophylaxis.

Syphilis.

Treponema pallidum subspecies pallidum (T. pallidum) causes syphilis via sexual exposure or via vertical transmission during pregnancy. T. pallidum is renowned for its invasiveness and immune-evasiveness; its clinical manifestations result from local inflammatory responses to replicating spirochaetes and often imitate those of other diseases. The spirochaete has a long latent period during which individuals have no signs or symptoms but can remain infectious. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is re-emerging as a global public health problem, particularly among men who have sex with men (MSM) in high-income and middle-income countries. Syphilis also causes several hundred thousand stillbirths and neonatal deaths every year in developing nations. Although several low-income countries have achieved WHO targets for the elimination of congenital syphilis, an alarming increase in the prevalence of syphilis in HIV-infected MSM serves as a strong reminder of the tenacity of T. pallidum as a pathogen. Strong advocacy and community involvement are needed to ensure that syphilis is given a high priority on the global health agenda. More investment is needed in research on the interaction between HIV and syphilis in MSM as well as into improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine.

PREVENTION OF ACUTE RHEUMATIC FEVER: CURRENT ASPECTS

The program for the prevention of acute rheumatic fever (ARF) and recurrent attacks of the disease includes primary and secondary prevention. The basis for the primary prevention of ARF are activities aimed at increasing the level of the body’s innate immunity and adaptive responses to adverse environmental conditions, as well as the timely diagnosis and adequate antimicrobial therapy of group A streptococcus throat infections, such as sore throat and pharyngitis. Secondary prevention aims to prevent recurrent attacks and disease progression in individuals who have experienced ARF and provides regular twenty-four-hour administration of long-acting penicillin (benzathine benzylpenicillin)

COMPARATIVE STUDY BETWEEN ORAL PENICILLIN AND LONG ACTING PENICILLIN IN TREATMENT OF RECURRENT STREPTOCOCCAL TONSILLOPHARYNGITIS.

30Nov 2016 COMPARATIVE STUDY BETWEEN ORAL PENICILLIN AND LONG ACTING PENICILLIN IN TREATMENT OF RECURRENT STREPTOCOCCAL TONSILLOPHARYNGITIS. Shahin Aly Dabour , Yaser Mahmud Ismail , Effat Hussein Assar , Eman R. Abd Almonaem and Hatem Hamid Yousef. Pediatric department, Faculty of medicine, Banha University, Qalyubia, Egypt. Clinical pathology department, Faculty of medicine, Banha University, Qalyubia, Egypt.