Search Results (101)

Acute Rheumatic Fever (ARF) is more common in children in the developing world. The current incidence in the United Kingdom is reported to be less than 1 in 100,000 children. It is, however, rare in the developed world, particularly in the adult Caucasian population. We present a case of ARF in a 39-year-old Caucasian female who needed multiple hospital admissions before the ARF diagnosis was made. A comprehensive, up-to-date literature review of ARF in Caucasians is lacking. Therefore, a systematic literature review (SLR) of Medline, PubMed, and Google Scholar was conducted to investigate the characteristics, management, and prognostic outcomes of new cases of ARF among Caucasians. A total of 10 cases were reported from six countries between 1990 and 2022. The mean age of patients was 33.2 (range 18–41), and most were females (6, 60%). The most common presenting symptoms were fever, arthralgia, and malaise. All patients met the modified Jones criteria for ARF diagnosis. All patients received antibiotics, with only one patient requiring corticosteroids. Two patients developed rheumatic heart disease (RHD), and none died as a result of ARF. This case-based literature review underscores the critical importance of a high index of clinical suspicion in promptly diagnosing ARF to mitigate long-term sequelae of RHD. Full article

Pulmonary arterial hypertension (PAH) is a severe complication associated with connective tissue diseases (CTDs), which is characterized by a significant influence on the patient’s prognosis and mortality. The prevalence of PAH varies depending on the type of CTD. Still, it is highly prevalent in patients with systemic sclerosis (SSc), systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), and primary Sjögren’s syndrome (pSS). Identifying rheumatic disease-specific risk factors is crucial for early diagnosis and intervention. Risk factors for PAH development include specific sociological factors (related to race, gender, and age), clinical features (particularly severe Raynaud’s phenomenon and multiple telangiectasias), cardiological factors (pericarditis and left heart disease), biochemical factors (elevated NT-proBNP and decreased HDL-cholesterol), serological factors (presence of ANA, e.g., anti-U1-RNP or SSA, and antiphospholipid antibodies), and pulmonary factors (interstitial lung disease and decreased DLCO or DLCO/alveolar volume ratio < 70%, FVC/DLCO > 1.6). The analysis of risk factors can be the most useful during the selection of patients at high risk of PAH development. The initial diagnosis of PAH is usually based on transthoracic echocardiography (TTE) and is finally confirmed by right heart catheterization (RHC). Targeted therapies can improve outcomes and include endothelin receptor antagonists, prostacyclin analogs, phosphodiesterase inhibitors, and tailored immunosuppressive treatments. Effective management strategies require a multidisciplinary approach involving rheumatologists, cardiologists, and pulmonologists. The risk stratification and individualized treatment strategies can enhance survival and quality of life in patients with PAH-CTD. Full article

Background: Rheumatic heart disease (RHD) remains a major contributor to childhood cardiovascular morbidity and mortality globally, particularly in low-resource settings. This study offers a thorough evaluation of the global, regional, and national burden of RHD among children aged 0–14 years, from 1990 to 2021, utilizing data from the 2021 Global Burden of Disease (GBD) study. Methods: We analyzed age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for RHD in 204 countries and territories. Novel methodological approaches included APC analysis to decompose temporal trends into age, period, and cohort effects, and inequality analysis to assess socioeconomic disparities. We calculated age-standardized rates and average annual percentage changes (AAPC) by sex, region, and socio-demographic index (SDI) level. Results: From 1990 to 2021, the global age-standardized death rate due to RHD in children declined by approximately 74%, from 1.24 to 0.32 per 100,000 (AAPC: −4.27%). Similarly, DALY rates dropped from 117.22 to 41.56 per 100,000 (AAPC: −3.30%). Despite this progress, the global age-standardized incidence rate increased modestly from 55.84 to 66.76 per 100,000 (AAPC: 0.58%), and prevalence rates also rose (AAPC: 0.53%). Females consistently experienced higher burden across all metrics. Inequality analysis demonstrated a concerning divergence: while mortality and DALY inequalities narrowed substantially (mortality slope index of inequality (SII) improved from −1.35 to −0.31), incidence and prevalence inequalities widened (incidence SII worsened from −112.60 to −131.90), indicating growing disparities in disease occurrence despite improved survival. Conclusions: While global mortality and DALYs from childhood rheumatic heart disease have declined substantially over the past three decades, a troubling paradox has emerged: rising incidence rates alongside widening socioeconomic inequalities in disease occurrence. This represents a critical public health challenge demanding targeted intervention strategies. The divergent trends in health outcomes, namely, improved survival rates but increased disease burden, reveal that while access to treatment has advanced, upstream prevention efforts remain critically inadequate among socioeconomically disadvantaged populations. Full article

Background/Objective: Few studies have examined the direct relationship between cervical cancer and immune-related diseases. Therefore, this study aims to identify the association between cervical cancer and various underlying medical conditions using data from the Korean National Health Insurance System (NHIS). Methods: This retrospective cohort study was conducted using NHIS data from 2006 to 2022. A total of 1,344,628 women aged 19 years and older were included, of whom 68,275 were diagnosed with cervical cancer. Comorbidities were evaluated. The statistical analyses conducted included independent t-tests, chi-square tests, and multivariate logistic regression models to determine relative risks (RRs) and 95% confidence intervals (CIs). Results: The mean age of the patients with cervical cancer was significantly lower than that of the general population group. Body mass index and hypertension prevalence were higher in the cervical cancer group than in the general population group. Significant associations were observed between cervical cancer and respiratory tuberculosis (RR: 1.32, 95% CI: 1.27–1.38, p < 0.001), ischemic heart disease (RR: 1.72, 95% CI: 1.69–1.76, p < 0.001), chronic rheumatic heart disease (RR: 1.53, 95% CI: 1.44–1.64, p < 0.001), chronic viral hepatitis (RR: 1.33, 95% CI: 1.31–1.36, p < 0.001), and hematological malignancies (RR: 1.87, 95% CI: 1.67–2.09, p < 0.001). Conversely, cerebrovascular disease was associated with a reduced risk of cervical cancer (RR: 0.58, 95% CI: 0.57–0.60, p < 0.001). Conclusion: This study highlights the increased risk of cervical cancer in individuals with specific underlying diseases. These findings underscore the need for tailored screening and prevention strategies in high-risk populations. Full article

Group A β-hemolytic Streptococcus (GAS) is a Gram-positive, coccoid-shaped bacterium that tends to grow in chains; it is a non-spore-forming, facultatively anaerobic, catalase-negative, aerobic bacterium. It is known to cause a wide range of infections in children, ranging from mild upper respiratory tract infections, such as pharyngitis, to severe invasive disease. GAS also notably triggers post-infectious immune sequelae, including acute poststreptococcal glomerulonephritis (APSGN), acute rheumatic fever (ARF), and rheumatic heart disease (RHD), which are major health burdens, especially in low-income countries. In this review, we will present the general characteristics of GAS, highlighting its structural and microbiological features. We will also discuss its pathogenetic mechanisms, especially molecular mimicry, and its ability to cause autoimmune responses. Finally, we will elucidate some of the autoimmune sequelae that mark GAS infections, such as ARF, RHD, APSGN, and guttate psoriasis. Understanding GAS as a model pathogen for infection-induced autoimmunity provides insight into host–pathogen interactions and supports the development of targeted interventions. Emphasis on early diagnosis and antibiotic treatment is essential to reduce the burden of autoimmune complications Full article

We used the Queensland acute rheumatic fever (ARF) and rheumatic heart disease (RHD) register to describe the clinical phenotype and the characteristics of individuals diagnosed with ARF in Far North Queensland, Australia, between January 2012 and December 2023. There were 830 episodes of ARF in 740 individuals during the study period; 785/830 (95%) episodes occurred in First Nations Australians and 696/824 occurred in areas of socioeconomic disadvantage. There was no significant change in the overall incidence of ARF during the study period (Spearman’s rho = 0.51, p = 0.09). The median (interquartile range) age of the cohort was 15 (10–23) years, although 276/830 (33%) episodes of ARF occurred in individuals ≥ 20 years. Individuals with carditis, polyarthritis, an abnormal electrocardiogram, fever and elevated inflammatory markers were more likely to have confirmed ARF. The presence of polyarthralgia, monoarthritis or skin manifestations was not associated with a diagnosis of confirmed ARF. Individuals with monoarthralgia were less likely to have confirmed ARF. At the end of the study period, 264/706 (37%) individuals who had access to echocardiography had confirmed RHD. Individuals who did not have echocardiography documented as a component of their initial episode of care were more likely to have severe RHD at the end of the study (25/339 (7%) versus 7/401 (2%), p < 0.0001). ARF and RHD continue to be diagnosed in First Nations Australians in tropical Australia. It seems unlikely that Australia will achieve its stated aim of eliminating RHD by 2031. Full article

The recognition and treatment of scabies has been incorporated into Australian guidelines for the prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). The incidence of both diagnosed ARF and RHD is increasing in Far North Queensland (FNQ) in northeast tropical Australia, but the local burden of scabies is incompletely defined. We reviewed the results of every skin scraping collected in FNQ’s public health system between 2000 and 2023; 121/4345 (2.8%) scrapings were positive, including 19/1071 (1.8%) in the last 5 years of the study; the proportion of scrapings that were positive for scabies declined over the study period. Individuals who tested positive for scabies were no more likely to have had a prior diagnosis of ARF or RHD compared to the matched controls (1/101 (1%) versus 3/101 (3%), p = 1.0). During a median of 14.7 years of follow-up, individuals who tested positive for scabies were also no more likely to have a diagnosis of ARF or RHD than matched controls (2/100 (2%) versus 6/98 (6%); hazard ratio (95% confidence interval): 0.30 (0.06–1.50) p = 0.14). Microbiologically confirmed scabies is uncommon in FNQ and appears to make a limited contribution to the local incidence of ARF and RHD. Full article

Rheumatic heart disease (RHD) and its complications are major health problems worldwide, especially in developing countries, owing to their high prevalence. Mitral stenosis (MS) is one of the most common lesions in RHD, either isolated or in combination with mitral regurgitation, and eventually leads to atrial fibrillation (AF), congestive heart failure, pulmonary hypertension (PH), and other complications, including ischemic stroke or limb ischemia, if not promptly diagnosed and treated. Recent studies have suggested that MS affects the cardiovascular system beyond mere obstructions. The presence of MS in RHD causes significant changes in the cardiovascular system, both upstream and downstream, affecting both the left and right ventricles. Rheumatic MS causes significant structural changes through inflammatory pathways and hemodynamic changes, owing to its obstructive effects. This review aims to discuss the vast changes in the cardiovascular system caused by rheumatic MS. Full article

Cardio-rheumatology is an evolving and interdisciplinary field lying at the intersection of rheumatology and cardiovascular medicine that recognizes that individuals with autoimmune and inflammatory rheumatic complications have a much higher likelihood of developing cardiovascular diseases (CVDs). Inflammasomes are multiprotein complexes stimulated by the immune system after the detection of pathogens or cellular injury. Inflammasomes undergo a two-stage activation process initiated by nuclear factor (NF)-κB, subsequently playing a crucial role in innate immunity through activation of caspase 1 and the consequent release of proinflammatory cytokines such as IL-18 and IL-1β. However, a loss of control of inflammasome activation can cause inflammatory diseases in humans. Recent studies have focused on the role of inflammasomes in inflammatory cascades implicated in the pathogenesis of several diseases. Here, we review inflammasome activation, its mechanism of action, and its role in CVD. In particular, we describe the role of inflammasomes in rheumatic heart disease, Kawasaki disease, familial Mediterranean fever, ankylosing spondylitis, and rheumatoid arthritis as exemplars to illustrate pathobiological mechanisms and the potential for targeting inflammasomes for therapeutic benefit. Full article

Objective: Patients with chronic inflammatory rheumatic diseases (CIRDs) have a higher incidence of coronary artery disease (CAD) due to accelerated atherogenesis. This study aimed to assess the extent and location of CAD lesions in CIRD patients compared to non-CIRD patients. Methods: A retrospective study was conducted on CIRD patients (rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) who underwent coronary angiography at Hospital Fundación Jiménez Díaz (Madrid, Spain) between 2018 and 2022. For each CIRD patient, at least two frequency-matched controls were selected based on sex, age (±2 years), diabetic status, and clinical indication for coronary angiography. The indications for coronary angiography in both groups were chronic coronary syndrome and acute coronary syndrome with or without ST elevation. Results: A total of 66 CIRD patients were included, with 42 (63.6%) women, and a median age of 66.6 years (range: 58.3–75.2). Compared to the controls, CIRD patients had a higher number of affected coronary arteries (2.03 vs. 1.56, p = 0.03). The mid-anterior descending artery and the right posterior descending artery were more frequently involved in CIRD patients than in controls (odds ratio [OR] of 2.45 and 3.53, respectively, p ≤ 0.02 for both comparisons). The frequency of coronary calcification was higher in CIRD patients, though the difference did not reach statistical significance (5 of 66 in CIRD patients vs. 3 of 140 in non-CIRD controls, OR of 3.74, p = 0.06). Revascularization was more commonly performed in patients with CIRD (50 of 66 vs. 85 of 140 in those without CIRD (OR: 2.02 [95% CI: 1.01–4.18]; p = 0.03). Conclusions: Patients with CIRD exhibit more extensive CAD, with a higher propensity for involvement inthe mid-anterior descending and right posterior descending arteries compared to patients without CIRD. These findings highlight the need for closer cardiovascular monitoring and early risk stratification in CIRD patients to improve the detection and management of CAD. Full article

Rheumatic heart disease (RHD) poses a significant global health challenge, necessitating improved diagnostic tools. This study investigated the use of self-supervised multi-task learning for automated echocardiographic analysis, aiming to predict echocardiographic views, diagnose RHD conditions, and determine severity. We compared two prominent self-supervised learning (SSL) methods: DINOv2, a vision-transformer-based approach known for capturing implicit features, and simple contrastive learning representation (SimCLR), a ResNet-based contrastive learning method recognised for its simplicity and effectiveness. Both models were pre-trained on a large, unlabelled echocardiogram dataset and fine-tuned on a smaller, labelled subset. DINOv2 achieved accuracies of 92% for view classification, 98% for condition detection, and 99% for severity assessment. SimCLR demonstrated good performance as well, achieving accuracies of 99% for view classification, 92% for condition detection, and 96% for severity assessment. Embedding visualisations, using both Uniform Manifold Approximation Projection (UMAP) and t-distributed Stochastic Neighbor Embedding (t-SNE), revealed distinct clusters for all tasks in both models, indicating the effective capture of the discriminative features of the echocardiograms. This study demonstrates the potential of using self-supervised multi-task learning for automated echocardiogram analysis, offering a scalable and efficient approach to improving RHD diagnosis, especially in resource-limited settings. Full article

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other conditions, which are leading causes of global morbidity and mortality. It is very important to establish preventive measures against CVDs, including hypertension. Against this background, forest bathing/shinrin-yoku is attracting attention as a new method of health promotion and disease prevention. Forest bathing/shinrin-yoku is an activity that utilizes the healing effects of forests to promote people’s health and prevent disease by stimulating the five senses, including sight, smell, hearing, taste, and touch, through forest visits. Since 2004, many scientific studies on the psychological and physiological effects of forest bathing/shinrin-yoku have been conducted, and many original scientific articles have been published. It has been reported that forest bathing/shinrin-yoku boosted immune system by increasing human natural killer activity and anticancer proteins in natural killer, lowered blood pressure and pulse rate, reduced stress hormones including adrenaline, noradrenaline in urine and cortisol in serum and saliva, increased the parasympathetic nervous activity and decreased the sympathetic nervous activity, improved sleep, reduced the negative emotions and increased positive feelings. In this article, the author reviewed the preventive effects of forest bathing/shinrin-yoku on CVDs from the perspectives of the effects of forest bathing/shinrin-yoku on stress hormones, parasympathetic nervous and sympathetic nervous systems, sleep, blood pressure and heart/pulse rate, and other mechanisms based on the published scientific evidence. Full article

The data about pregnancy while having a low ejection fraction are scarce, since pregnancy is not recommended for women with an ejection fraction of less than 30%. There is an increased risk of obstetrical complications and adverse maternal-fetal outcomes. Pregnancy is a rough journey for this group of patients. However, a successful pregnancy can be achieved when cardiac complications are managed during pregnancy. The early recognition of women at risk of cardiovascular events and early referral can optimize the maternal and neonatal outcomes with close collaboration between the maternal-fetal medicine specialist and the cardiologist. The study’s aim was to assess the experience of our tertiary center with regard to the adverse maternal outcome for women with an ejection fraction ≤ 30% compared to those with an EF > 30% in our tertiary center. The fetal and obstetric outcome for pregnancies with an EF ≤ 30% was compared to that for pregnancies with an EF > 30%. Methodology: After receiving the approval of the local Ethical Board Review, a retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSHRC) in the city of Riyadh, Kingdom of Saudi Arabia. Our study population included women with cardiomyopathy (acquired or congenital) who were followed up or delivered in KFSHRC from the period of January 2004 till March 2020. Cases were identified by reviewing the database from the Cardiac Center Echocardiograph and maternal fetal medicine unit. The data on the maternal and fetal outcome were gathered from the hospital medical records. An adverse maternal outcome included: death, hospitalization due to decompensated heart failure, and worsening cardiovascular status during pregnancy. Adverse fetal outcomes included: miscarriages, termination of pregnancy, FGR, and placental insufficiency. Obstetrics complications included: complications related to the mode of delivery, antepartum hemorrhage, postpartum hemorrhage, or preeclampsia. Results: Our study included 44 subjects, examining the differences between those with an ejection fraction greater than 30 (n = 21 subjects) and those with an ejection fraction less than or equal to 30 (n = 23) with respect to demographics, co-morbidities, and outcomes (maternal, pregnancy, fetal, ultrasound, and baby). There was no evidence of any differences in the demographics. From among the co-morbidities, there was a statistically higher rate of dilated cardiomyopathy and lower rate of rheumatic heart disease in those with a lower ejection fraction. Also, women with a lower ejection fraction tended to deliver through a means other than simple vaginal delivery. There was a significant association (p = 0.0296) indicating that individuals with a lower ejection fraction tended to have a lower gestational age at delivery. The information on whether the pregnancy resulted in a live birth was available for all but one of the mothers. Across all the mothers, 32 (74%) resulted in a live birth and 11 did not. The percentage of pregnancies resulting in a live birth in the group for which the ejection fraction was greater than 30 was 90% and that in the group for which the ejection fraction was less than or equal to 30 was 59% (p = 0.0339). From among the ultrasound and baby outcomes, only the rate of the babies being discharged alive differed statistically between the two ejection fraction groups, with those mothers having a lower ejection fraction experiencing fewer babies being discharged alive (p = 0.0310). Conclusions: In conclusion, women with a low ejection fraction are at an increased risk of maternal-fetal complications. In our study, the lower the EF (≤30) the worse were the fetal and neonatal outcomes; however, in terms of the maternal outcomes, it was the same whether the EF was low or ultra-low. Yet, these groups of patients need to be counseled about the facts of poor obstetrical outcomes with an emphasis on preconceptual counseling. Full article

Anesthesiology, the medical specialty that deals with the management of vital functions in patients undergoing surgery, has played an important role in the successful development of cardiac interventions worldwide. Tracing the historical roots of cardiac anesthesia and critical care from its inception in the late 1950s, a paradigm shift in perioperative care has been driven by a better understanding of the mechanisms of organ dysfunction in stressful conditions and technological advances regarding surgical approach, patient monitoring, and organ protection. Although progress in cardiac anesthesia and critical care lagged a little behind in Caribbean territories, successful achievements have been accomplished over the last forty years. Compared with Western countries, the greater prevalence of obesity, diabetes mellitus, and hypertension as well as specific diseases such as cardiac amyloidosis, sickle cell anemia, rheumatic heart disease, and tropical infections may reduce a patient’s physiologic reserve and increase the operative risk among the multi-ethnic population living in the French West Indies and Guiana. So far, cardiac anesthesiologists at the University Hospital of Martinique have demonstrated their abilities in implementing evidence-based clinical care processes and adaptating to efficiently working in a complex environment interacting with multiple partners. Attracting specialized physicians in dedicated cardiac surgical centers and the creation of a regional health network supported by governmental authorities, insurance companies, and charitable organizations are necessary to solve the unmet needs for invasive cardiac treatments in the Caribbean region. Full article

Systemic sclerosis (SSc) is an immuno-inflammatory rheumatic disease that can affect both the skin and internal organs through fibrosis. Pulmonary arterial hypertension (PAH) is one of the most severe secondary complications. Structural changes in the vascular bed lead to increased pressures in the pulmonary circulation, severely impacting the right heart and significantly affecting mortality. The gold standard for diagnosing PAH is right heart catheterization (RHC), an invasive method for measuring cardiac pressure. Due to the high risk of complications, procedural difficulties, and significant costs, non-invasive screening for SSc-PAH has garnered significant interest. Echocardiography is likely the most important screening tool, providing structural and functional information about the right heart through measurements that have proven their utility over time. In addition to imagistic investigations, serum biomarkers aid in identifying patients at risk for PAH and can provide prognostic information. Currently, well-known serum biomarkers (NT-proBNP, uric acid) are used in screening; however, in recent years, researchers have highlighted new biomarkers that can enhance diagnostic accuracy for SSc patients. Pulmonary involvement can also be assessed through pulmonary function tests, which, using established thresholds, can provide additional information and help select patients requiring RHC. In conclusion, given the invasiveness of RHC, non-invasive screening methods are particularly important for SSc patients. Full article