Acute Rheumatic Fever is an inflammatory disease that can occur following a Group A Streptococcal (GAS) infection, such as strep throat. It typically involves a latent period of 1-5 weeks between the initial GAS infection and onset of symptoms. Symptoms can include migratory polyarthritis, carditis (inflammation of the heart), chorea, erythema marginatum, and subcutaneous nodules. Treatment involves antibiotics to treat the initial GAS infection, anti-inflammatory drugs like aspirin to treat arthritis and carditis, and long-term antibiotic prophylaxis to prevent recurrent episodes of Acute Rheumatic Fever.
Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs' anatomic structure.
Some of the types of interstitial lung disease include:
Interstitial pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.
Idiopathic pulmonary fibrosis : A chronic, progressive form of fibrosis (scarring) of the interstitium. Its cause is unknown.
Nonspecific interstitial pneumonitis: Interstitial lung disease that's often present with autoimmune conditions (such as rheumatoid arthritis or scleroderma).
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.
Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs' anatomic structure.
Some of the types of interstitial lung disease include:
Interstitial pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.
Idiopathic pulmonary fibrosis : A chronic, progressive form of fibrosis (scarring) of the interstitium. Its cause is unknown.
Nonspecific interstitial pneumonitis: Interstitial lung disease that's often present with autoimmune conditions (such as rheumatoid arthritis or scleroderma).
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.
Acute rheumatic fever-definition,pathophysiology,clinical presentation and ma...onlinefreelancer1
A detailed approach to ACUTE RHEUMATIC FEVER,based on Harrison Principles of internal medicine and Braunwald Textbook of Cardiology.Useful for post graduate seminars.
Acute rheumatic fever is an auto immune disease, triggered by infection with specific strains of Streptococcus pyogenes, i.e. group A Streptococcus (GAS)
It affects the various organs like heart, joints, blood vessels , brain and connective tissues
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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2. The initial illness is usually characterized by a sore
throat (pharyngitis) that may be followed, within
approximately 1 to 5 weeks, by the sudden (acute)
onset of rheumatic fever.
"latent period."
ARF is an inflammatory disease following group A
streptococcal infection (i.e., sequelae) multiple
tissues and organs (joints, skin, subcutaneous
tissues, heart, and brain).
3.
4. Diagrammatic structure of the group A
beta hemolytic streptococcus
Capsule
Cell wall
Protein antigens
Group carbohydrate
Peptidoglycan
Cyto.membrane
Cytoplasm
……………………………………………
……...
Antigen of outer
protein cell wall
of GABHS
induces antibody
response in
victim which
result in
autoimmune
damage to heart
valves,
sub cutaneous
tissue,tendons,
joints & basal
ganglia of brain
5. Evidence of AUTOIMMUNITY
INDUCED BY STREPT. ANTIGENS
Gamma-globulins in sarcolemma
of myofibrils
Circulating ab. to heart tissue.
No strept. can be found in
lesions.
6. Not all of the serotypes of group A streptococci
can cause rheumatic fever. The rheumatogenic
serotypes are thought to include 1, 3, 5, 6, 14,
18, 19, and 24.
Pharyngitis- produced by GABHS can lead to-
acute rheumatic fever , rheumatic heart disease
& post strept. Glomerulonepritis
Skin infection- produced by GABHS leads to
post streptococcal glomerulo nephritis only.
Group A Beta Hemolytic Streptococcus
7. INCIDENCE
20 to 50 per 100,000 /year during the period of 1940 to
1960 and declined to 1/100,000/year in 1970s.
100/100,000/year of ARF/RHD among the younger age
group of the socially disadvantaged population.
THE ATTACK RATE
(INCIDENCE OF ARF IN PTS WITH STREPT. PHARYNGITIS)
3% OF UNTREATED PATIENTS
5-50% IN PTS WITH PREVIOUS ATTACKS
EPIDEMIOLOGY
SOCIO-ECONOMIC STATUS
OUT BREAKS OF STREPT PHARYNGITIS
9. •On pathological examination, the valves are thickened
and display rows of small vegetations along their apposing
surfaces
•Inflammation of the valves consists of oedema and
mononuclear cell infiltration of the valvular tissue and the
chordae tendineae in the acute phase; fibrosis and
calcification occur with maintenance of the inflammatory
process.
•Myocarditis is characterised by infiltration of
mononuclear cells, vasculitis and degenerative changes of
the interstitial connective tissue.
•The pathognomonic lesion is the Aschoff body in the
proliferative stage, present in 30 to 40 per cent of biopsies
of patients with acute RF
18. Jones Criteria (Revised) for Guidance in the
Diagnosis of Rheumatic Fever*
Major Manifestation Minor
Manifestations
Supporting Evidence
of Streptococal Infection
Clinical LaboratoryCarditis
Polyarthritis
Chorea
Erythema Marginatum
Subcutaneous Nodules
Previous
rheumatic
fever or
rheumatic
heart disease
Arthralgia
Fever
Acute phase
reactants:
Erythrocyte
sedimentation
rate,
C-reactive
protein,
leukocytosis
Prolonged P-
R interval
Increased Titer of Anti-
Streptococcal Antibodies ASO
(anti-streptolysin O),
others
Positive Throat Culture
for Group A Streptococcus
Recent Scarlet Fever
*The presence of two major criteria, or of one major and two minor criteria,
indicates a high probability of acute rheumatic fever, if supported by evidence of
Group A streptococcal nfection.
Recommendations of the American Heart Association
19. Pitfalls in diagnosis
John’s criteria is only a guideline
Problems with over diagnosis
A minor illness is misdiagnosed as ARF unnecessarily
therapy
cardiac neurotic
Problems with under diagnosis
another disease treatment for a non existent disease
No long term prophylaxis
20. ARTHRITIS
most common
IN 70% OF CASES
ACUTE MIGRATORY ASYMMETRIC
POLYARTHRITIS
USUALLY LARGE JOINTS
Involved joint is swollen and exquisitely
painful and tender.
RESOLVES WITHIN 1-3 WEEKS
RESPONDS QUICKLY TO SALICYLATES,
this may be taken as a therapeutic test
LEAVES NO PERMENANT DAMAGE
21. PANCARDITIS
IN 50% OF CASES
MOST SERIOUS CAUSE OF MORBIDITY AND MORTALITY
MAY BE THE ONLY MANIFESTATION OF ARF
LEAVES PERMENANT DAMAGE
Rheumatic carditis is pancarditis and endocardium is almost always
involved. Hence without murmur carditis cannot be diagnosed.
MYOCARDITIS:
TACHYCARDIA,ARRHYTHMIAS,A-V BLOCKS, CARDIOMEGALY, CHF
ENDOCARDITIS:
MR,AR,TR,PR (STENOTIC LESIONS ONLY AFTER MONTHS OR YEARS)
With severe cardiac failure and pericardial effusion murmur may not
be audible but in such cases the patient is usually very ill.
PERICARDITIS:DRY OR WITH EFFUSION.NEVER ALONE.
22. Chest radiograph of an 8 year old patient with acute carditis
before treatment
24. Two-dimensional
color flow
Doppler image of
the left
ventricular inflow
of a patient with
mitral
regurgitation in
the four-chamber
view (top panel)
and two-
dimensional
parasternal long-
axis view (lower
panel), showing
lack of apposition
of the leaflets of
the mitral valve
during systole
(arrow)
25. Two-dimensional parasternal long-axis view of a patient with mitral
stenosis, showing thickened valve cusps (arrow), with poor leaflet
separation in diastole. Left atrium is enlarged, with a thrombus in the
posterior aspect of it. Aortic valve is also stenotic
26. UNCOMMON (<10%), but most specific
SMALL (0.5-2 cm.)
PAINLESS FIRM DISCRETE AND FREELY
MOBILE
ON EXTENSOR TENDONS OF JOINTS
OCCASIONALLY ON SCALP AND SPINE
The subcutaneous nodules tend to appear after
the first weeks of the disease course and
usually disappear within a week or two.
Subcutaneous
nodules
28. Sydenham's chorea most frequently occurs
in children or adolescents between the ages
of 5 to 15.
Affects females approximately twice as
frequently as males, particularly in the years
around puberty. As a result, some
researchers suggest that sex hormones
(e.g., the female hormone estrogen) may
play some role in the development of the
syndrome.
CHOREA
29. LONG LATENT PERIOD: 1 to 6 months
In most patientsacutely
sudden, aimless, irregular, involuntary, jerky
movements
A significant deterioration in handwriting (in school-aged
children)
Slight or significant difficulties dressing, feeding, and walking
Slurred, slowed speech (dysarthria)
disappear with sleep and may increase with stress,
fatigue, excitement, or other factors.
Bilateral (20% hemichorea)
emotional or behavioral abnormalities
spontaneously resolve within approximately 3 to 6 months
However, in some instances, there may be residual signs of
chorea and behavioral abnormalities, which may wax and
wane over a year or more
30. RARE (5-10%)
MACULAR NONPRURITIC RASH WITH A
SERPIGINOUS ERYTHEMATOUS BORDER
SURROUNDING NORMAL LOOKING SKIN
BEGINS AS RED OR PINK MACULES THAT FADE
CENTRALLY
ON TRUNK & PROXIMAL EXTREMITIES
NEVER FACE AND HANDS
ABOUT 1INCH IN DIAMETER
This skin rash tends to appear early in the disease
course, may persist or recur when other
symptoms have subsided, and usually only affects
patients with carditis.
31. Erythema marginatum on the trunk, showing erythematous lesions
with pale centers and rounded or serpiginous margins
32.
33. LABORATORY STUDIES
ISOLATION OF STREPT.
(THROAT CULTURES)
Throat culture render positive
results in approximately 25 % of
children of ARF probably related
to early antibiotic administration.
-VE(75% OF PTS.)
FALSE +VE: Positive throat culture
need not indicate infection because
positive throat culture may occur in
carrier state as in many school going
children.
34. STREPTOCOCCAL AB. TESTS
ANTIGEN
EXTRACELLULAR PRODUCT
• SREPTOLYSIN-O
• SREPTOKINASE
• HYALURONIDASE
• DEOXYRIBONUCLEASE -N
• NICOTINAMIDE ADENINE
DINUCLEOTIDASE
• ALL OF THE ABOVE
CELLULAR COMPONENT
• TYPE-SPECIFIC M PROTEIN
• GROUP-SPECIFIC POLYSACCHARIDE
TEST
ANTI-STREPTOLYSIN-0
ANTI-STREPTOKINASE
ANTI-HYALURONIDASE
ANTI-DNAse B
ANTI-NADase
STREPTOZYME
TYPE-SPECIFIC AB.
ANTI-A CARBOHYDRATE
35. positive ASOT occur only in 80 % of
streptococcal throat infection. However
sensitivity may be increased to 95 % if
AHT and anti DN ase B are also tested.
37. DIFFERENTIAL DIAGNOSIS
POLYARTHRITIS
JUVENILE RHEUMATOID: usually involves small joints of the
fingers and here the swelling is disproportionate to the symptom
and usually the manifestation takes a longer time to subsides
and residual deformity is common.
‘Growing pains’ of children is mistaken for arthritis. But the
symptom is not over the joints, pain is severe at night and the
child is well during the day time.
SLE
MIXED COLLAGEN DSE.
POST-INFECTIOUS REACTIVE
INFECTIVE
SERUM SICKNESS
38. D.D. of CARDITIS
Innocent murmurs: The common mistake is
misinterpreting the innocent basal ejection systolic murmur
or left parasternal systolic murmur (Still’s) as evidence of
carditis since they are misinterpreted for mitral
regurgitation. Still’s murmur is vibratory in quality, usually
late systolic unlike the systolic murmur of carditis which is
usually pansystolic or occupies most of systole. The quality
is also different from Still’s murmur. Isolated ejection
systolic murmurs shall never be taken as evidence of
carditis.
Tachycardia associated with fever and anxiety may be
misinterpreted as evidence of myocarditis. This can be
avoided if one pays attention to sleeping pulse rate.
INFECTIVE ENDOCARDITIS
COLLAGEN DSE.(SLE,KAWASAKI)
VIRAL MYOCARDITIS/pericarditis
39. Treatment
Step I - primary prevention
(eradication of streptococci)
Step II - anti inflammatory treatment
(aspirin,steroids)
Step III- supportive management &
management of complications
Step IV- secondary prevention
(prevention of recurrent attacks)
40. STEP I: Primary Prevention of Rheumatic Fever
(Treatment of Streptococcal Tonsillopharyngitis)
Agent Dose Mode Duration
Benzathine penicillin G 600 000 U for patients< IM Once
27 kg (60 lb)
1 200 000 U for patients >27 kg
or
Penicillin V Children: 250 mg 2-3 times daily Oral 10 d
(phenoxymethyl penicillin) Adolescents and adults:
500 mg 2-3 times daily
For individuals allergic to penicillin
Erythromycin: 20-40 mg/kg/d 2-4 times daily Oral 10 d
(maximum 1 g/d)
Recommendations of American Heart Association
41. Arthritis only Aspirin 75-100
mg/kg/day,give as 4
divided doses for 6
weeks
(Attain a blood level 20-
30 mg/dl)
Carditis Prednisolone 2-2.5
mg/kg/day, give as two
divided doses for 2
weeks
Taper over 2 weeks &
while tapering add
Aspirin 75 mg/kg/day
for 2 weeks.
Continue aspirin alone
100 mg/kg/day for
another 4 weeks
Step II: Anti inflammatory treatment
Clinical condition Drugs
42. Bed rest
Treatment of congestive cardiac
failure: -digitalis,diuretics, ACEI
Treatment of chorea:
-diazepam or haloperidol
Rest to joints & supportive splinting
3.Step III: Supportive management &
management of complications
43. STEP IV : Secondary Prevention of Rheumatic Fever
(Prevention of Recurrent Attacks)
Agent Dose Mode
Benzathine penicillin G 1 200 000 U every 4 weeks* Intramuscular
or
Penicillin V 250 mg twice daily Oral
or
Sulfadiazine 0.5 g once daily for patients 27 kg (60 lb Oral
1.0 g once daily for patients >27 kg (60 lb)
For individuals allergic to penicillin and sulfadiazine
Erythromycin 250 mg twice daily Oral
*In high-risk situations, administration every 3 weeks is justified and
recommended
Recommendations of American Heart Association
44. Duration of Secondary Rheumatic Fever
Prophylaxis
Category Duration
Rheumatic fever with carditis and At least 10 y since last
residual heart disease episode and at least until
(persistent valvar disease*) age 40 y, sometimes lifelong
prophylaxis
Rheumatic fever with carditis 10 y or well into adulthood,
but no residual heart disease whichever is longer
(no valvar disease*)
Rheumatic fever without carditis 5 y or until age 21 y,
whichever is longer
*Clinical or echocardiographic evidence.
Recommendations of American Heart Association
45. For those who receive salicylate
therapy, blood levels and liver
function must be regularly
monitored (i.e., with blood and
urine tests) to help reduce the
possibility of salicylate toxicity, a
condition that may be
characterized by headache, rapid
breathing
(tachypnea), vomiting, irritability,
reduced levels of sugar in the
blood (hypoglycemia), and/or
other findings.
46. SYDENHAM’S CHOREA
PHYSICAL & MENTAL REST
As Sydenham's chorea may spontaneously
resolve or not cause significant functional
impairment, many experts indicate that
treatment should be avoided unless
associated chorea is functionally disabling
or associated with potentially violent
flailing motions of the limbs that may
result in self-injury.
47. First-line therapy with anticonvulsant
medication: valproate sodium
(Depakene®) may be beneficial
Carbamazepine has also been suggested
as a first-line treatment for Sydenham’s
chorea.
48. Dopamine antagonists are usually reserved for
those patients who fail to respond to valproate or
who present with severe forms (i.e., chorea
paralytica).
Haloperidol (initial dose of 0.5 to 1mg/kg/day,
maximum, 5mg/day)
If fails, the next steps may include
immunomodulatory treatment, steroids, IV IgG,
or plasmapheresis.
Treatment is usually maintained for 8-12
weeks.
49. ARF IS THE MOST COMMON CAUSE OF
ACQUIRED HEART DISEASE IN CHILDREN
AND YOUNG ADULTS.
DIAGNOSIS OF ARF SHOULD DEPEND ON
CLINICAL,LABORATORY & IMAGING
INVESTIGATIONS.
TREATMENT OF CARDITIS WITH
SALICYLATES , STEROIDS.
LONG-TERM PROPHYLAXIS WITH LONG
ACTING PCN. IS HIGHLY RECOMMENDED.