INTRODUCTION: Degenerative mitral stenosis (DMS) is frequently cited as increasing in prevalence in the developed world, although comparatively little is known about DMS in comparison to rheumatic mitral stenosis (RMS). METHOD: A retrospective observational study was conducted on 745 cases of native-valve mitral stenosis (MS) with median follow-up time of 7.25 years. Clinical and echocardiographic parameters were compared. Univariate and multivariate Cox regression analyses were performed for a composite of all-cause mortality and heart failure hospitalisation. RESULTS: Patients with DMS compared to RMS were older (age, mean ± standard deviation: 69.6 ± 12.3 versus [vs] 51.6 ± 14.3 years, respectively; P<0.001) and a greater proportion had medical comorbidities such as diabetes mellitus (78 [41.9%] vs 112 [20.0%], P<0.001). The proportion of cases of degenerative aetiology increased from 1.1% in 1991-1995 to 41.0% in 2016-2017. In multivariate analysis for the composite outcome, age (hazard ratio [HR] 95% confidence interval [CI] of 1.032 [1.020-1.044]; P<0.001), diabetes mellitus (HR 1.443, 95% CI 1.068-1.948; P=0.017), chronic kidney disease (HR 2.043, 95% CI 1.470-2.841; P<0.001) and pulmonary artery systolic pressure (HR 1.019, 95% CI 1.010- 1.027; P<0.001) demonstrated significant indepen-dent associations. The aetiology of MS was not independently associated with the composite outcome. CONCLUSION DMS is becoming an increasingly common cause of native-valve MS. Despite numerous clinical differences between RMS and DMS, the aetiology of MS did not independently influence a composite of mortality or heart failure hospitalisation.
Humans ; Mitral Valve Stenosis/etiology* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Rheumatic Heart Disease/mortality* ; Echocardiography ; Hospitalization/statistics & numerical data* ; Heart Failure/epidemiology* ; Singapore/epidemiology* ; Proportional Hazards Models ; Diabetes Mellitus/epidemiology*

INTRODUCTION

Childhood Polyarteritis Nodosa (PAN) is a rare, systemic necrotizing vasculitis of the small to medium-sized vessels with an uncertain global distribution. The primary etiology is unknown. However, PAN is commonly associated with preceding Group A streptococcus infection in children. The most common cutaneous manifestations of PAN include tender subcutaneous nodules, livedo reticularis, digital ischemia and ulceration. To date, no reports have documented cutaneous PAN as a sequela of rheumatic fever.

This is a report of a 7-year-old Filipino male who presented with multiple, well-defined erythematous to hyperpigmented, firm, tender nodules, with some areas of lace or net-like macules and patches, some resolved leaving hyperpigmentation measuring 1x1 cm to 2x2 cm on the lower back, bilateral upper and lower extremities accompanied by fever, malaise, arthralgia and myalgia with a previous history of rheumatic fever. A 6mm skin punch biopsy revealed findings consistent with PAN. The patient was managed with prednisone. Due to the limited response to treatment, he was eventually given mycophenolate mofetil.

Childhood polyarteritis nodosa (PAN) is a rare form of necrotizing inflammation of the medium-sized blood vessels primarily linked to Group A streptococcal infection in children, with no known reported cases associated with rheumatic fever. However, in this case, we were able to observe that PAN could present as a probable rare sequela of rheumatic fever. This warrants close follow-up among such patients.

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that poses a major healthcare challenge. In China, approximately 5 million patients are reported to have RA. Notably, Chinese patients with RA often experience a prolonged disease course and increased disease activity, leading to a substantial disease burden. The Chronic Disease Management Group of the Special Committee on Rheumatology and Immunology of Cross-Straits Medicine Exchange Association has advocated for an all-encompassing, continuous, and proactive scientific management approach for RA. This initiative has culminated in the formulation of the "Expert Recommendations for the Chronic Disease Management of Rheumatoid Arthritis", a comprehensive guideline developed through extensive consultations and consideration of the unique characteristics of RA. We have outlined 16 expert recommendations, addressing 10 key aspects central to RA management. We aim to enhance treatment outcomes for patients, streamline the distribution of medical resources, and reduce treatment-related burden on society, families, and individuals affected by this condition.
Humans ; Rheumatic Fever ; Arthritis, Rheumatoid/drug therapy* ; Rheumatology ; Chronic Disease ; Disease Management ; Antirheumatic Agents/therapeutic use*

PURPOSE

The combined mitral stenosis (MS) and aortic regurgitation (AR) impose opposite loading conditions on the left ventricle. Physiologically, the relief of MS may increase the severity of AR.

Participants were Filipinos 19 years or older, admitted because of severe MS with mild to moderate AR. The outcome of percutaneous transmitral commissurotomy (PTMC) was divided into two groups: (1) significant AR that included the increase in severity of AR: mild to moderate/severe or moderate to severe AR, and (2) the insignificant AR group, which included any decrease in the severity of AR: moderate to mild or persistence of mild or moderate AR. These groups were compared from baseline, 24 hours, 1 month, and 6 months using the same echocardiographic parameters. The numerical data between significant and insignificant tricuspid regurgitation were compared using nonparametric Mann-Whitney U test and categorical data using the χ2 test.

A total of 43 participants were analyzed. At 24 hours post-PTMC, the significant AR group had significantly lower left ventricular end-diastolic dimension (3.83 vs 4.5, P = 0.008), left ventricular end-systolic dimension (2.33 vs 2.97, P = 0.017), right ventricular fraction area change (38.6 vs 48.7, P = 0.025), and left ventricular outflow tract (1.66 vs 2.02, P = 0.020) and higher systolic pulmonary arterial pressure (57 vs 32.4, P = 0.008). At 1 and 6 months, there were no significant differences in echocardiographic parameters between the significant and insignificant AR groups' left ventricular end-diastolic dimension (4.58 vs 4.5, 4.64 vs 4.57), left ventricular end-systolic dimension (3.1 vs 2.9, 2.9 vs 2.91), and systolic pulmonary arterial pressure (28 vs 34.7, 33.8 vs 32.4). Those with significant AR had a higher mean Wilkin score (mean, 10; P = 0.007) and subvalvular thickening (mean, 2.6; P = 0.005).

On short-term follow-up, the presence of mild to moderate AR before PTMC does not lead to severe AR. The outcomes regardless of the group showed a good functional class and no significant echocardiographic differences when compared.

PURPOSE: The gap in evidence in the management of multivalvular lesions can be addressed by providing more data on clinical and echocardiographic outcomes after percutaneous transmitral commissurotomy (PTMC) in patients with concomitant significant tricuspid regurgitation (TR) at baseline. METHODS This is a single-center cohort study of adult Filipinos 19 years or older, admitted between January 2019 and October 2020 due to severe mitral stenosis with moderate to severe TR subjected to PTMC. The outcome post-PTMC was divided into 2 groups: significant TR, which included the progression of moderate to severe TR or persistence of severe TR, and insignificant TR group, which included those with mild TR, regression of moderate to mild TR, severe to moderate, or persistence of moderate TR. The clinical and echocardiographic parameters of these groups were compared at baseline, at 24 hours, 1 month, and 6 months postprocedure. The numerical data between significant and nonsignificant TR were compared using nonparametric Mann–Whitney U test and categorical data using the x2 test.
Rheumatic Heart Disease ; Mitral Valve Stenosis ; Tricuspid Valve Insufficiency ; tricuspid regurgitation

The present study analyzed the efficacy evaluation indexes of the randomized controlled trials(RCTs) of Chinese medi-cine in the treatment of rheumatic heart disease to lay the foundation for the construction of the corresponding core outcome index set. Clinical RCTs with a definite diagnosis of rheumatic heart disease were retrieved from CNKI, Wanfang, VIP, Sino Med, Pub Med, EMbase, and Cochrane Library from January 1, 2010, to December 31, 2020. Thirty-five RCTs were included, involving 3 314 patients and 41 efficacy evaluation indexes, which covered seven domains [traditional Chinese medicine(TCM) symptoms/syndromes, symp-toms/signs, physical and chemical examination, quality of life, long-term prognosis, economic evaluation, and safety events]. Physi-cal and chemical examination(56. 91%) and symptoms/signs(29. 27%) were the more frequently applied. The number of indexes used in a single trial ranged from 1 to 15, with an average of 4. The measurement time points of the top five indexes in the frequency of use were as follows: total response rate was reported at five measurement time points, ranging from 14 days to 6 months; left ventri-cular ejection fraction was measured at eight time points ranging from 5 days to 6 months; left ventricular end systolic diameter was measured at six time points, ranging from 5 days to 6 months; interleukin-2(IL-2) and tumor necrosis factor-α(TNF-α) were repor-ted 28 days after treatment. At present, there are many problems in the efficacy outcome indexes of RCTs in the treatment of rheumatic heart disease with TCM, such as large difference in quantity, unclear primary and secondary indexes, unreasonable selection of " surro-gate indexes", insufficient attention to long-term prognostic indexes and safety event indexes, non-standard application of composite in-dexes, long measurement period, and lack of TCM characteristics. It is urgent to establish the core outcome set for TCM treatment of rheumatic heart disease.
Drugs, Chinese Herbal/therapeutic use* ; Humans ; Medicine, Chinese Traditional ; Quality of Life ; Randomized Controlled Trials as Topic ; Rheumatic Heart Disease/drug therapy* ; Treatment Outcome

Introduction: Coronary artery fistula (CAF) is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. This is a rare defect and occurs in only 0.2% of the population. Most of the cases are congenital but acquired causes are also reported. A CAF may occur as an isolated cardiac defect or with other cardiac diseases such as rheumatic heart disease (RHD). Only a few cases of coexisting CAF and RHD have been reported. Local data reports only 0.69% CAFs associated with congenital malformations of the heart. Only 61 patients among all patients who underwent coronary arteriography in 34 years were reported to have a CAFs. We report a case of severe mitral stenosis (MS) with a double CAF from the left circumflex (LCx) artery draining into the left atrium. Case: A 46-year old female with RHD with severe MS came in due to progressive dyspnea. The coronary angiogram revealed two fistulous tracts originating from the LCx draining into the left atrium. She underwent mitral valve replacement (MVR) surgery, left atrial plication, and closure of the fistula drainage the left atrium. The postoperative course was uneventful. Discussion A CAF is often asymptomatic until the second decade of life. Untreated, this may progress and cause ischemic and heart failure signs and symptoms. The presence of MS caused elevated left atrial pressure which might have prevented the increase in the volume of blood draining from the LCx artery to the left atrium through the fistulas. Hence, the MS might have prevented the dilatation of the two fistulas. Surgical correction is also indicated in the fistulas since resolution of the mitral stenosis with MVR will decrease the LA pressure which might result to dilatation and increased drainage of the fistulas causing complications later.
Rheumatic Heart Disease

We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthia mandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 µm in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthia mandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, most cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.
Aged ; Balamuthia mandrillaris ; Biopsy ; Brain ; Cerebrum ; Diagnosis ; Encephalitis ; Fever ; Humans ; Immunosuppressive Agents ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Rheumatic Fever ; Spasm ; Stupor ; Thigh ; Trophozoites ; Upper Extremity

Atrial fibrillation (AF), the most common chronic arrhythmia in adults, is rarely reported in children. Moreover, most of the previously reported children with AF have comorbidities, such as structural heart diseases, rheumatic diseases, and thyroid diseases. This case report is about a healthy 9-year-old boy who was diagnosed with AF without cardiac anomaly. He visited the emergency department with chest pain and palpitation, lasting 2 hours. His electrocardiogram showed narrow-complex tachycardia, which led to the diagnosis of supraventricular tachycardia. The administration of adenosine revealed rapid irregular P waves. After electrical cardioversion, cardiac rhythm was converted to normal sinus rhythm. This case report suggests that when children with narrow-complex tachycardia visit the emergency department, the possibility of AF, in addition to supraventricular tachycardia, should be considered if the RR intervals are markedly irregular.
Adenosine ; Adult ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Cardiovascular Diseases ; Chest Pain ; Child ; Comorbidity ; Diagnosis ; Electric Countershock ; Electrocardiography ; Emergency Service, Hospital ; Humans ; Male ; Pediatrics ; Rheumatic Heart Disease ; Tachycardia ; Tachycardia, Supraventricular ; Thyroid Diseases

BACKGROUND: Rheumatic fever (RF) and Rheumatic heart disease (RHD) patients Rheumatic Heart Disease (RHD) patients necessitate secondary prophylaxis with benzathine penicillin G (BPG) injection every 3 weeks to prevent recurrences and complications. Patients with rheumatic fever on regular benzathine penicillin G injection usually experience moderate to severe pain resulting to poor compliance to treatment. 

OBJECTIVES: This study aims to compare the effect of BPG diluted in lidocaine hydrochloride 1%  versus diluted water in reducing injection pain in patients with RF and RHD.

METHODS: This is a randomized double-blind crossover study conducted at the PCMC OPD. Thirty-three patients diagnosed with RF and RHD were divided into 2 groups; the first group received BPG diluted in sterile water followed by BPG diluted in lidocaine hydrochloride  1% after 21 days, the second group received the same medication in reverse order. Pain scale was measured using Universal pain assessment tool immediately after injection. Paired T test was used to compare the pain score results of the two groups.

RESULTS: Pain score was significantly less in patients who received BPG diluted in lidocaine hydrochloride 1%; from an average pain score of 4.88 to 0.63 (p<0.0001), among those who received BPG diluted in sterile water. No adverse effects were seen in all patients.

CONCLUSION: This study concluded that BPG diluted in lidocaine hydrochloride 1% significantly and safely reduced post-injection pain. In all patients diagnosed with RF and RHD, BPG injection should be diluted in lidocaine hydrochloride 1% to decrease injection pain and improve patient's compliance.