This study summarizes the clinical findings of 15 children with recurrent pericarditis. Recurrent pericarditis most often followed closure of an atrial septal defect after age 6. Patients experienced 2 to 30 recurrences over 4 to 16 years of follow up. While recurrences tended to become milder over time, some patients still experienced active disease years later despite various treatment attempts. The course was unpredictable and often chronic regardless of underlying cause or therapy.
This document summarizes a webinar on interstitial lung diseases (ILDs) given by Dr. Alireza Bagheri. It discusses various topics related to ILDs including pathogenesis, patterns seen on imaging, treatments for nonspecific interstitial pneumonia (NSIP), progressive fibrosing ILDs, defining disease progression, burden of progressive fibrosing ILDs, antifibrotic clinical trials, and more. It provides details from several studies on prognosis of ILD subtypes, defining meaningful changes in pulmonary function tests, and the INBUILD trial of nintedanib in progressive fibrosing ILDs.
1) The study evaluated the effectiveness of indomethacin therapy for patent ductus arteriosus (PDA) in 41 full-term infants with birth weights over 2500g.
2) Indomethacin was administered intravenously in doses of 0.2-0.25 mg/kg every 12-24 hours. 25 infants (61%) responded positively to the treatment, either showing complete ductal closure or improved symptoms.
3) The remaining 16 infants (39%) did not respond to indomethacin therapy and most required surgical ligation of the ductus arteriosus. No severe adverse reactions occurred in any infants from the indomethacin treatment.
Thrombosis in children with bt shunts, glenns and fontansgisa_legal
Children with congenital heart disease are at high risk of thromboembolic complications following common cardiac surgeries like the Blalock-Taussig shunt, Glenn procedure, and Fontan procedure. Thrombosis is a known risk for each of these procedures but prevention and treatment strategies have not been well established. A large randomized controlled trial is currently underway to determine the optimal antithrombotic prophylaxis, such as aspirin or anticoagulation, following Fontan surgery. Better evidence is needed regarding thrombosis risks, prevention, and management for each type of surgery to improve outcomes for children with congenital heart disease.
This study reviewed 86 patients who underwent pericardiectomy for chronic constrictive pericarditis (CCP) at a single center from 2010-2014. Preoperatively, most patients were in NYHA class II or III. Tuberculosis was the cause of CCP in 32.6% of patients. The overall mortality rate was 2.3%. Postoperatively, 90.6% of surviving patients were in NYHA class I or II. The results showed pericardiectomy to be an effective treatment for CCP, with tuberculosis remaining a common cause in India.
This study investigated the risks of stroke, bleeding, and thromboembolism in patients with atrial fibrillation and chronic kidney disease. The study used Danish national registries to identify over 132,000 patients hospitalized for atrial fibrillation between 1997-2008. Patients with non-end stage chronic kidney disease had a 49% higher risk of stroke or thromboembolism compared to those without renal disease. Patients requiring dialysis had an 83% higher risk. Warfarin reduced these risks for both groups of patients with chronic kidney disease but increased bleeding risk. Thus, chronic kidney disease increases the risks of stroke and bleeding in atrial fibrillation patients, and warfarin decreases stroke risk but increases
Prevalência e MI por CC na Europa de 2000 a 2005gisa_legal
This document summarizes a study examining the prevalence of congenital heart defects (CHD) in Europe between 2000-2005 using data from 29 population-based registries covering over 3 million births. The study found an average total CHD prevalence of 8.0 per 1000 births, with live birth prevalence of 7.2 per 1000. Non-chromosomal CHD prevalence was 7.0 per 1000 births, of which 3.6% were perinatal deaths, 20% were prenatally diagnosed, and 5.6% were terminations of pregnancy. Severe non-chromosomal CHD occurred in 2.0 per 1000 births, with higher rates of perinatal death, prenatal diagnosis, and termination.
The guideline addresses treatment of venous thromboembolic disease (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). For patients without cancer, non-vitamin K oral anticoagulants (NOACs) are preferred over vitamin K antagonists (VKAs) for long-term anticoagulation based on similar efficacy and lower bleeding risk with NOACs. For cancer-associated VTE, low-molecular-weight heparin is preferred over VKAs or NOACs. The guideline also addresses treatment of subsegmental PE and use of aspirin for extended treatment after stopping anticoagulants.
Elevated Tissue Doppler E/E' on Index Admission Can Help Identify Patients at...crimsonpublishersOJCHD
Readmissions for congestive Heart Failure (CHF) are a major healthcare problem that contributes significantly to the overall healthcare expenditure. About 24% of patients are readmitted to the hospital within 30 days of discharge. We investigated whether a non-invasive estimate of left atrial filling pressure, an elevated ratio of early trans mitral flow velocity to early diastolic mitral annular velocity (E/E'), during the index admission for CHF could independently predict 30 day readmission.
This document summarizes a webinar on interstitial lung diseases (ILDs) given by Dr. Alireza Bagheri. It discusses various topics related to ILDs including pathogenesis, patterns seen on imaging, treatments for nonspecific interstitial pneumonia (NSIP), progressive fibrosing ILDs, defining disease progression, burden of progressive fibrosing ILDs, antifibrotic clinical trials, and more. It provides details from several studies on prognosis of ILD subtypes, defining meaningful changes in pulmonary function tests, and the INBUILD trial of nintedanib in progressive fibrosing ILDs.
1) The study evaluated the effectiveness of indomethacin therapy for patent ductus arteriosus (PDA) in 41 full-term infants with birth weights over 2500g.
2) Indomethacin was administered intravenously in doses of 0.2-0.25 mg/kg every 12-24 hours. 25 infants (61%) responded positively to the treatment, either showing complete ductal closure or improved symptoms.
3) The remaining 16 infants (39%) did not respond to indomethacin therapy and most required surgical ligation of the ductus arteriosus. No severe adverse reactions occurred in any infants from the indomethacin treatment.
Thrombosis in children with bt shunts, glenns and fontansgisa_legal
Children with congenital heart disease are at high risk of thromboembolic complications following common cardiac surgeries like the Blalock-Taussig shunt, Glenn procedure, and Fontan procedure. Thrombosis is a known risk for each of these procedures but prevention and treatment strategies have not been well established. A large randomized controlled trial is currently underway to determine the optimal antithrombotic prophylaxis, such as aspirin or anticoagulation, following Fontan surgery. Better evidence is needed regarding thrombosis risks, prevention, and management for each type of surgery to improve outcomes for children with congenital heart disease.
This study reviewed 86 patients who underwent pericardiectomy for chronic constrictive pericarditis (CCP) at a single center from 2010-2014. Preoperatively, most patients were in NYHA class II or III. Tuberculosis was the cause of CCP in 32.6% of patients. The overall mortality rate was 2.3%. Postoperatively, 90.6% of surviving patients were in NYHA class I or II. The results showed pericardiectomy to be an effective treatment for CCP, with tuberculosis remaining a common cause in India.
This study investigated the risks of stroke, bleeding, and thromboembolism in patients with atrial fibrillation and chronic kidney disease. The study used Danish national registries to identify over 132,000 patients hospitalized for atrial fibrillation between 1997-2008. Patients with non-end stage chronic kidney disease had a 49% higher risk of stroke or thromboembolism compared to those without renal disease. Patients requiring dialysis had an 83% higher risk. Warfarin reduced these risks for both groups of patients with chronic kidney disease but increased bleeding risk. Thus, chronic kidney disease increases the risks of stroke and bleeding in atrial fibrillation patients, and warfarin decreases stroke risk but increases
Prevalência e MI por CC na Europa de 2000 a 2005gisa_legal
This document summarizes a study examining the prevalence of congenital heart defects (CHD) in Europe between 2000-2005 using data from 29 population-based registries covering over 3 million births. The study found an average total CHD prevalence of 8.0 per 1000 births, with live birth prevalence of 7.2 per 1000. Non-chromosomal CHD prevalence was 7.0 per 1000 births, of which 3.6% were perinatal deaths, 20% were prenatally diagnosed, and 5.6% were terminations of pregnancy. Severe non-chromosomal CHD occurred in 2.0 per 1000 births, with higher rates of perinatal death, prenatal diagnosis, and termination.
The guideline addresses treatment of venous thromboembolic disease (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). For patients without cancer, non-vitamin K oral anticoagulants (NOACs) are preferred over vitamin K antagonists (VKAs) for long-term anticoagulation based on similar efficacy and lower bleeding risk with NOACs. For cancer-associated VTE, low-molecular-weight heparin is preferred over VKAs or NOACs. The guideline also addresses treatment of subsegmental PE and use of aspirin for extended treatment after stopping anticoagulants.
Elevated Tissue Doppler E/E' on Index Admission Can Help Identify Patients at...crimsonpublishersOJCHD
Readmissions for congestive Heart Failure (CHF) are a major healthcare problem that contributes significantly to the overall healthcare expenditure. About 24% of patients are readmitted to the hospital within 30 days of discharge. We investigated whether a non-invasive estimate of left atrial filling pressure, an elevated ratio of early trans mitral flow velocity to early diastolic mitral annular velocity (E/E'), during the index admission for CHF could independently predict 30 day readmission.
Avaliação cardiológica de crianças com suspeita cardíacagisa_legal
This document reports on the experience of a public pediatric cardiology outpatient clinic in Brazil that evaluated 2,675 children under age 15 referred for suspected heart disease over 39 months. The main reasons for referral were murmur (70%), chest pain (9%), suspected arrhythmia (9%), and breathlessness (5%). A final diagnosis found most cases were normal, including 83% of murmur cases, 98% of chest pain cases, 97% of arrhythmia cases, and 94% of breathlessness cases. Overall, 14% of children were considered abnormal and 1% required therapeutic procedures. The high rate of innocent murmurs referred underscores the need for improved cardiac evaluation training for local pediatricians to better distinguish normal from abnormal
A New Electrocardiographic Marker of Sudden Death in Brugada Syndrome The S-W...Marina Mercurio
This study analyzed electrocardiographic (ECG) data from 347 patients with Brugada syndrome to identify markers that predict risk of ventricular fibrillation or sudden cardiac death. During follow-up, 32 patients (9.2%) experienced ventricular fibrillation or sudden cardiac death. The presence of a wide and/or large S-wave in lead I of the ECG was found to be a powerful predictor of these life-threatening arrhythmias. Electroanatomic mapping in 12 patients found conduction delays in the right ventricular outflow tract, particularly in those with an S-wave in lead I. The duration of the S-wave in lead I over 40 ms was an independent predictor of ventricular fibrillation or
This study evaluated 70 patients with oral clefts to describe their clinical, electrocardiographic, and echocardiographic cardiovascular findings. Sixty percent of patients were male, and most had cleft lip and palate. Forty-four percent had comorbidities. Family history of risk for metabolic syndrome was present in 49% of patients, and one patient was diagnosed with rheumatic heart disease. Electrocardiograms found one case of atrioventricular block, and echocardiograms were abnormal in 36% of patients, including 5 cases of mitral valve prolapse. The findings indicate patients with oral clefts may be prone to acquired heart disease, so cardiovascular follow-up is necessary.
The document summarizes a meta-analysis of 6 randomized controlled trials examining the effectiveness of aspirin plus heparin vs aspirin alone in reducing myocardial infarction and death in patients with unstable angina. The meta-analysis found that treatment with aspirin plus heparin was associated with a 33% reduction in the risk of myocardial infarction or death compared to aspirin alone. No statistically significant heterogeneity was found among the individual study findings. The evidence suggests that most patients with unstable angina should be treated with both aspirin and heparin.
1) The document discusses a study examining the effect of enhanced external counterpulsation (EECP) therapy on subsequent emergency department visits and hospitalizations in patients with severe angina and left ventricular dysfunction.
2) The study included 450 patients who underwent EECP therapy for refractory angina and had a left ventricular ejection fraction of 40% or less.
3) The results showed that despite the patients' high risk profile, they experienced a substantial reduction in all-cause emergency department visits and hospitalization rates in the 6 months following EECP therapy compared to the 6 months prior to treatment.
Clinical Profile and Outcome of Children Admitted with Acute Encephalitis Syn...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document discusses the use of aspirin for the primary prevention of cardiovascular disease in patients with diabetes. While aspirin is proven to be effective for secondary prevention, its benefits for primary prevention in patients without a history of vascular disease are unclear based on previous studies which have been underpowered. The document describes two recent clinical trials, POPADAD and JPAD, which also did not provide definitive evidence due to low event rates. It encourages participation in the ongoing ASCEND trial, which aims to recruit 10,000 patients, in order to help resolve the uncertainty around aspirin's role in primary prevention for patients with diabetes.
Probing into arrhythmias in type 2 diabetics ijar feb 2015Sachin Adukia
This study examined arrhythmias in 50 patients with type 2 diabetes. The most common arrhythmia was sinus tachycardia (38%), followed by complete heart block (12%). Over half of patients (54%) had a prolonged QTc interval, with the majority (16 patients) also showing signs of cardiac autonomic neuropathy. Poor glycemic control correlated with a higher incidence of arrhythmias like sinus tachycardia, ventricular premature complexes, atrial fibrillation, and complete heart block. The presence of comorbidities like hypertension and ischemic heart disease also increased the risk of arrhythmias. All patients responded well to standard treatment for their arrhythmias.
Prognostic value of noninvasive testing after orthotopic cardiac transplantationPatrick P Verhoeven
1) The study evaluated the prognostic value of routine noninvasive testing (stress thallium-201 imaging, echocardiography, radionuclide angiography) one year after cardiac transplantation.
2) Survival rates were high, with 81% surviving 5 years after transplantation. Stress thallium-201 imaging and echocardiography were predictive of survival, but radionuclide angiography was not.
3) By multivariate analysis, stress thallium-201 imaging was the only significant predictor of survival after transplantation.
This study analyzed the causes of stroke in 50 young patients aged 15-35 years at a tertiary hospital in Pakistan. The most common cause of stroke was infective meningitis (34%), predominantly tuberculosis meningitis. The second most common cause was cardioembolism (20%), mainly due to valvular heart disease. Other major causes included hypertension (14%), pregnancy-related conditions (12%), and systemic lupus erythematosus (4%). Infective meningitis, particularly tuberculosis, was found to be the leading cause of stroke in young patients in this study.
This study evaluated the efficacy of colchicine in preventing in-stent restenosis in 90 patients undergoing percutaneous coronary intervention with bare-metal stents. Patients were divided into 3 groups: those receiving a bare-metal stent plus colchicine, bare-metal stent alone, or a drug-eluting stent. After 6 months of follow up, the rates of in-stent restenosis and target vessel revascularization were significantly lower in patients receiving colchicine plus bare-metal stent compared to bare-metal stent alone. There was no difference in stent thrombosis rates between groups. The study suggests that colchicine may be useful for reducing restenosis and need for repeat procedures when
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The purpose of the study is to provide information about the database of 1421 adult patients with acute ischemic stroke (IS) developing ≤ 48 hours before admitting, research methods, study protocol, and clinical predictors of the evolving stroke course (EIS).
Methods and Materials: EIS outlined as an increase of NIHSS ≥ 2 points within seven days or in-hospital lethal outcome. Clinical, demographic, instrumental, laboratory data acquisition, as well as the IS course variant and the functional outcome assessment, were carried out prospectively. Statistical analyses were performed using R V.3.2.5 statistical package software and IBM SPSS Statistics 26.0.
Results: The incidence of EIS reached 30.0%. The average age of patients with EIS was 72.6±10.2 years, compare the age of patients without EIS - 68.1±11.3 years; p = 0.005. Female sex increased the odds of EIS (OR, 1.36; 95% CI 1.08-1.73). Total anterior carotid stroke (OR, 7.78; 95% CI 5.91-10.23), the initial NIHSS score > 14 points (OR, 3.74; 95% CI 2.83-4.94), and the right anterior circulation was also associated with EIS (OR, 1.30; 95% CI 1.02-1.66). The odds of EIS were significantly higher in the presence of diabetes mellitus (OR, 1.29; 95% CI 1.01-1.66), cerebral artery stenosis ≥ 70% (OR, 1.96; 95% CI 1.30-2.93), atrial fibrillation (OR, 1.89; 95% CI 1.51-2.39), congestive heart failure (OR, 1.90; 95% CI 1.51-2.39), and peripheral artery disease (OR, 1.69; 95% CI 1.27-2.25). Respiratory (OR, 2.82; 95% CI 2.22-3.59), gastrointestinal (OR, 1.34; 95% CI 1.05-1.70), and urologic diseases (OR, 2.10; 95% CI 1.65-2.66), stroke-associated infection (OR, 3.47; 95% CI 2.09-5.76), and gradual development of initial IS symptoms before admitting increased the odds of progression of the neurological deficit during treatment (OR, 2.37; 95% CI 1.78-3.15)were associated with the evolving clinical course of IS. The patients with the EIS compared with patients without EIS, showed higher serum levels of glucose (p < 0.001), urea (p = 0.001), creatinine (p < 0.001), sodium (p = 0.025), and direct bilirubin (p = 0.015). Potassium level in EIS group was lower than in the group without EIS (p < 0.001). In patients with EIS, a higher amount of RBC (p = 0.030) and WBC (p < 0.001) was found.
Conclusion: The in-hospital database contains information about EIS by the bases subtypes of IS, patient demography, cardiovascular risk factors, comorbid pathology, clinical and laboratory tests, instrumental methods of examination, medications, the severity of neurological deficit, and post-stroke outcome.
This study analyzed 231 patients with aneurysmal subarachnoid hemorrhage (SAH) from 25 Mexican hospitals to describe clinical characteristics, risk factors, and outcomes. Hypertension was the main risk factor associated with SAH. Most aneurysms (92%) were located in the anterior circulation and 15% of patients had multiple aneurysms. The median hospital stay was 23 days. Invasive treatments like clipping or coiling were performed in 69% of patients. The in-hospital mortality rate was 20% due to neurological causes. 25% of patients were discharged with significant neurological impairment.
This document provides information about the 7th International Conference on Biotechnology, Bioinformatics, Bio Medical Sciences and Stem Cell Applications that was held from November 11-12, 2016 at the Nanyang Technological University in Singapore. It lists the conference venue and contact information. It also provides details about the plenary speaker, Yoshiko Yamaguchi, and includes the abstract of a study presented on hypertension in Sohag City, Egypt.
(1) This study evaluated 103 patients with Staphylococcus aureus bacteremia using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) to determine the diagnostic value of each test for detecting infective endocarditis (IE). (2) TEE was more sensitive than TTE at detecting IE, with a sensitivity of 100% compared to 32% for TTE. (3) TEE identified IE in patients where TTE was negative or indeterminate, and was better able to detect small vegetations and complications like abscesses that TTE could not.
The document describes a conference on biotechnology, bioinformatics, biomedical sciences and stem cell applications taking place from November 11-12, 2016 in Singapore. It provides the conference schedule, list of speakers, and abstracts of papers being presented on topics related to diabetes, hypertension, cardiovascular disease, cognitive functions and thrombogenesis. The conference will bring together researchers from various universities and institutions in Asia to present and discuss their work in healthcare, life sciences and stem cell applications.
This document summarizes information about pulmonary arterial hypertension (PAH) in patients with connective tissue diseases (CTDs). It discusses several key points:
- PAH is most prevalent in systemic sclerosis (SSc), occurring in up to 9% of patients. Survival is worse for PAH associated with SSc compared to idiopathic PAH.
- Early detection of PAH in SSc is important and can be aided by annual screening with echocardiography, pulmonary function tests, and biomarkers like BNP/NT-proBNP. Stress echocardiography may also help predict PAH.
- The DETECT study developed a validated two-step algorithm using non-invasive tests to identify PAH in high
This document discusses acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in resource-limited settings. It presents a case study of a 12-year-old girl diagnosed with ARF in The Gambia. Key challenges in diagnosis and management of ARF and RHD in these settings include limited access to investigations like echocardiography and lack of specialists. The Jones criteria for diagnosing ARF may be too insensitive for high-prevalence areas. Management involves bed rest, antibiotics, aspirin, and follow-up care, though access can be limited. RHD is a major cause of heart disease worldwide and often presents with severe disease due to limited care access.
This study evaluated D-dimer levels in 80 patients with chronic atrial fibrillation to determine if D-dimer could diagnose left atrial appendage thrombus. The patients underwent transesophageal echocardiography and were divided into two groups: those with thrombus and those without. All patients in the thrombus group had elevated D-dimer levels, while only 28.5% of patients without thrombus had elevated levels. After 3 months of anticoagulation therapy, D-dimer levels decreased significantly in the thrombus group and thrombus resolved in 77.8% of patients. The study concludes that D-dimer has 100% sensitivity and 71.4% specificity for diagnosing left
This systematic review analyzed four studies that evaluated patients presenting with supraventricular tachycardia (SVT) and elevated troponin levels who underwent coronary angiography. The studies found that:
1) A significant proportion of patients with SVT and elevated troponins were found to have no significant coronary artery disease based on angiography results.
2) Three of the four studies, involving higher risk patients, found that troponin elevation was not associated with coronary artery disease.
3) One study of 27 lower risk patients found 6 had previously undiagnosed coronary artery disease.
However, the review noted limitations including the small number of older retrospective studies and lack of recent U.
Clinical profile of paediatric patients with rheumatic heart disease at moi t...Alexander Decker
This document summarizes a study on the clinical profile of pediatric patients with rheumatic heart disease at Moi Teaching and Referral Hospital in Eldoret, Kenya. The study found that the most common symptoms in new patients were dyspnea, easy fatigability, palpitations, cough and orthopnea. The most common signs were systolic murmurs, thrills and tachycardia. Most new patients presented with severe disease in NYHA class 3 or 4. Mitral regurgitation alone or combined with aortic regurgitation were the most common valve lesions. The results suggest that most new patients have advanced valvular disease and complications due to late presentation, highlighting the need for early detection
Clinical profile of paediatric patients with rheumatic heart disease at moi t...Alexander Decker
This document summarizes a study on the clinical profile of pediatric patients with rheumatic heart disease at Moi Teaching and Referral Hospital in Eldoret, Kenya. The study found that 84 pediatric patients had rheumatic heart disease, with more female patients than male. New patients most commonly presented with dyspnea, easy fatigability, and palpitations. Signs like systolic murmurs and tachycardia were also common in new patients. Most new patients were in NYHA classes 3 and 4, indicating severe valvular disease and late presentation. The study recommends emphasis on early detection and prevention of rheumatic heart disease.
Avaliação cardiológica de crianças com suspeita cardíacagisa_legal
This document reports on the experience of a public pediatric cardiology outpatient clinic in Brazil that evaluated 2,675 children under age 15 referred for suspected heart disease over 39 months. The main reasons for referral were murmur (70%), chest pain (9%), suspected arrhythmia (9%), and breathlessness (5%). A final diagnosis found most cases were normal, including 83% of murmur cases, 98% of chest pain cases, 97% of arrhythmia cases, and 94% of breathlessness cases. Overall, 14% of children were considered abnormal and 1% required therapeutic procedures. The high rate of innocent murmurs referred underscores the need for improved cardiac evaluation training for local pediatricians to better distinguish normal from abnormal
A New Electrocardiographic Marker of Sudden Death in Brugada Syndrome The S-W...Marina Mercurio
This study analyzed electrocardiographic (ECG) data from 347 patients with Brugada syndrome to identify markers that predict risk of ventricular fibrillation or sudden cardiac death. During follow-up, 32 patients (9.2%) experienced ventricular fibrillation or sudden cardiac death. The presence of a wide and/or large S-wave in lead I of the ECG was found to be a powerful predictor of these life-threatening arrhythmias. Electroanatomic mapping in 12 patients found conduction delays in the right ventricular outflow tract, particularly in those with an S-wave in lead I. The duration of the S-wave in lead I over 40 ms was an independent predictor of ventricular fibrillation or
This study evaluated 70 patients with oral clefts to describe their clinical, electrocardiographic, and echocardiographic cardiovascular findings. Sixty percent of patients were male, and most had cleft lip and palate. Forty-four percent had comorbidities. Family history of risk for metabolic syndrome was present in 49% of patients, and one patient was diagnosed with rheumatic heart disease. Electrocardiograms found one case of atrioventricular block, and echocardiograms were abnormal in 36% of patients, including 5 cases of mitral valve prolapse. The findings indicate patients with oral clefts may be prone to acquired heart disease, so cardiovascular follow-up is necessary.
The document summarizes a meta-analysis of 6 randomized controlled trials examining the effectiveness of aspirin plus heparin vs aspirin alone in reducing myocardial infarction and death in patients with unstable angina. The meta-analysis found that treatment with aspirin plus heparin was associated with a 33% reduction in the risk of myocardial infarction or death compared to aspirin alone. No statistically significant heterogeneity was found among the individual study findings. The evidence suggests that most patients with unstable angina should be treated with both aspirin and heparin.
1) The document discusses a study examining the effect of enhanced external counterpulsation (EECP) therapy on subsequent emergency department visits and hospitalizations in patients with severe angina and left ventricular dysfunction.
2) The study included 450 patients who underwent EECP therapy for refractory angina and had a left ventricular ejection fraction of 40% or less.
3) The results showed that despite the patients' high risk profile, they experienced a substantial reduction in all-cause emergency department visits and hospitalization rates in the 6 months following EECP therapy compared to the 6 months prior to treatment.
Clinical Profile and Outcome of Children Admitted with Acute Encephalitis Syn...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document discusses the use of aspirin for the primary prevention of cardiovascular disease in patients with diabetes. While aspirin is proven to be effective for secondary prevention, its benefits for primary prevention in patients without a history of vascular disease are unclear based on previous studies which have been underpowered. The document describes two recent clinical trials, POPADAD and JPAD, which also did not provide definitive evidence due to low event rates. It encourages participation in the ongoing ASCEND trial, which aims to recruit 10,000 patients, in order to help resolve the uncertainty around aspirin's role in primary prevention for patients with diabetes.
Probing into arrhythmias in type 2 diabetics ijar feb 2015Sachin Adukia
This study examined arrhythmias in 50 patients with type 2 diabetes. The most common arrhythmia was sinus tachycardia (38%), followed by complete heart block (12%). Over half of patients (54%) had a prolonged QTc interval, with the majority (16 patients) also showing signs of cardiac autonomic neuropathy. Poor glycemic control correlated with a higher incidence of arrhythmias like sinus tachycardia, ventricular premature complexes, atrial fibrillation, and complete heart block. The presence of comorbidities like hypertension and ischemic heart disease also increased the risk of arrhythmias. All patients responded well to standard treatment for their arrhythmias.
Prognostic value of noninvasive testing after orthotopic cardiac transplantationPatrick P Verhoeven
1) The study evaluated the prognostic value of routine noninvasive testing (stress thallium-201 imaging, echocardiography, radionuclide angiography) one year after cardiac transplantation.
2) Survival rates were high, with 81% surviving 5 years after transplantation. Stress thallium-201 imaging and echocardiography were predictive of survival, but radionuclide angiography was not.
3) By multivariate analysis, stress thallium-201 imaging was the only significant predictor of survival after transplantation.
This study analyzed the causes of stroke in 50 young patients aged 15-35 years at a tertiary hospital in Pakistan. The most common cause of stroke was infective meningitis (34%), predominantly tuberculosis meningitis. The second most common cause was cardioembolism (20%), mainly due to valvular heart disease. Other major causes included hypertension (14%), pregnancy-related conditions (12%), and systemic lupus erythematosus (4%). Infective meningitis, particularly tuberculosis, was found to be the leading cause of stroke in young patients in this study.
This study evaluated the efficacy of colchicine in preventing in-stent restenosis in 90 patients undergoing percutaneous coronary intervention with bare-metal stents. Patients were divided into 3 groups: those receiving a bare-metal stent plus colchicine, bare-metal stent alone, or a drug-eluting stent. After 6 months of follow up, the rates of in-stent restenosis and target vessel revascularization were significantly lower in patients receiving colchicine plus bare-metal stent compared to bare-metal stent alone. There was no difference in stent thrombosis rates between groups. The study suggests that colchicine may be useful for reducing restenosis and need for repeat procedures when
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The purpose of the study is to provide information about the database of 1421 adult patients with acute ischemic stroke (IS) developing ≤ 48 hours before admitting, research methods, study protocol, and clinical predictors of the evolving stroke course (EIS).
Methods and Materials: EIS outlined as an increase of NIHSS ≥ 2 points within seven days or in-hospital lethal outcome. Clinical, demographic, instrumental, laboratory data acquisition, as well as the IS course variant and the functional outcome assessment, were carried out prospectively. Statistical analyses were performed using R V.3.2.5 statistical package software and IBM SPSS Statistics 26.0.
Results: The incidence of EIS reached 30.0%. The average age of patients with EIS was 72.6±10.2 years, compare the age of patients without EIS - 68.1±11.3 years; p = 0.005. Female sex increased the odds of EIS (OR, 1.36; 95% CI 1.08-1.73). Total anterior carotid stroke (OR, 7.78; 95% CI 5.91-10.23), the initial NIHSS score > 14 points (OR, 3.74; 95% CI 2.83-4.94), and the right anterior circulation was also associated with EIS (OR, 1.30; 95% CI 1.02-1.66). The odds of EIS were significantly higher in the presence of diabetes mellitus (OR, 1.29; 95% CI 1.01-1.66), cerebral artery stenosis ≥ 70% (OR, 1.96; 95% CI 1.30-2.93), atrial fibrillation (OR, 1.89; 95% CI 1.51-2.39), congestive heart failure (OR, 1.90; 95% CI 1.51-2.39), and peripheral artery disease (OR, 1.69; 95% CI 1.27-2.25). Respiratory (OR, 2.82; 95% CI 2.22-3.59), gastrointestinal (OR, 1.34; 95% CI 1.05-1.70), and urologic diseases (OR, 2.10; 95% CI 1.65-2.66), stroke-associated infection (OR, 3.47; 95% CI 2.09-5.76), and gradual development of initial IS symptoms before admitting increased the odds of progression of the neurological deficit during treatment (OR, 2.37; 95% CI 1.78-3.15)were associated with the evolving clinical course of IS. The patients with the EIS compared with patients without EIS, showed higher serum levels of glucose (p < 0.001), urea (p = 0.001), creatinine (p < 0.001), sodium (p = 0.025), and direct bilirubin (p = 0.015). Potassium level in EIS group was lower than in the group without EIS (p < 0.001). In patients with EIS, a higher amount of RBC (p = 0.030) and WBC (p < 0.001) was found.
Conclusion: The in-hospital database contains information about EIS by the bases subtypes of IS, patient demography, cardiovascular risk factors, comorbid pathology, clinical and laboratory tests, instrumental methods of examination, medications, the severity of neurological deficit, and post-stroke outcome.
This study analyzed 231 patients with aneurysmal subarachnoid hemorrhage (SAH) from 25 Mexican hospitals to describe clinical characteristics, risk factors, and outcomes. Hypertension was the main risk factor associated with SAH. Most aneurysms (92%) were located in the anterior circulation and 15% of patients had multiple aneurysms. The median hospital stay was 23 days. Invasive treatments like clipping or coiling were performed in 69% of patients. The in-hospital mortality rate was 20% due to neurological causes. 25% of patients were discharged with significant neurological impairment.
This document provides information about the 7th International Conference on Biotechnology, Bioinformatics, Bio Medical Sciences and Stem Cell Applications that was held from November 11-12, 2016 at the Nanyang Technological University in Singapore. It lists the conference venue and contact information. It also provides details about the plenary speaker, Yoshiko Yamaguchi, and includes the abstract of a study presented on hypertension in Sohag City, Egypt.
(1) This study evaluated 103 patients with Staphylococcus aureus bacteremia using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) to determine the diagnostic value of each test for detecting infective endocarditis (IE). (2) TEE was more sensitive than TTE at detecting IE, with a sensitivity of 100% compared to 32% for TTE. (3) TEE identified IE in patients where TTE was negative or indeterminate, and was better able to detect small vegetations and complications like abscesses that TTE could not.
The document describes a conference on biotechnology, bioinformatics, biomedical sciences and stem cell applications taking place from November 11-12, 2016 in Singapore. It provides the conference schedule, list of speakers, and abstracts of papers being presented on topics related to diabetes, hypertension, cardiovascular disease, cognitive functions and thrombogenesis. The conference will bring together researchers from various universities and institutions in Asia to present and discuss their work in healthcare, life sciences and stem cell applications.
This document summarizes information about pulmonary arterial hypertension (PAH) in patients with connective tissue diseases (CTDs). It discusses several key points:
- PAH is most prevalent in systemic sclerosis (SSc), occurring in up to 9% of patients. Survival is worse for PAH associated with SSc compared to idiopathic PAH.
- Early detection of PAH in SSc is important and can be aided by annual screening with echocardiography, pulmonary function tests, and biomarkers like BNP/NT-proBNP. Stress echocardiography may also help predict PAH.
- The DETECT study developed a validated two-step algorithm using non-invasive tests to identify PAH in high
This document discusses acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in resource-limited settings. It presents a case study of a 12-year-old girl diagnosed with ARF in The Gambia. Key challenges in diagnosis and management of ARF and RHD in these settings include limited access to investigations like echocardiography and lack of specialists. The Jones criteria for diagnosing ARF may be too insensitive for high-prevalence areas. Management involves bed rest, antibiotics, aspirin, and follow-up care, though access can be limited. RHD is a major cause of heart disease worldwide and often presents with severe disease due to limited care access.
This study evaluated D-dimer levels in 80 patients with chronic atrial fibrillation to determine if D-dimer could diagnose left atrial appendage thrombus. The patients underwent transesophageal echocardiography and were divided into two groups: those with thrombus and those without. All patients in the thrombus group had elevated D-dimer levels, while only 28.5% of patients without thrombus had elevated levels. After 3 months of anticoagulation therapy, D-dimer levels decreased significantly in the thrombus group and thrombus resolved in 77.8% of patients. The study concludes that D-dimer has 100% sensitivity and 71.4% specificity for diagnosing left
This systematic review analyzed four studies that evaluated patients presenting with supraventricular tachycardia (SVT) and elevated troponin levels who underwent coronary angiography. The studies found that:
1) A significant proportion of patients with SVT and elevated troponins were found to have no significant coronary artery disease based on angiography results.
2) Three of the four studies, involving higher risk patients, found that troponin elevation was not associated with coronary artery disease.
3) One study of 27 lower risk patients found 6 had previously undiagnosed coronary artery disease.
However, the review noted limitations including the small number of older retrospective studies and lack of recent U.
Clinical profile of paediatric patients with rheumatic heart disease at moi t...Alexander Decker
This document summarizes a study on the clinical profile of pediatric patients with rheumatic heart disease at Moi Teaching and Referral Hospital in Eldoret, Kenya. The study found that the most common symptoms in new patients were dyspnea, easy fatigability, palpitations, cough and orthopnea. The most common signs were systolic murmurs, thrills and tachycardia. Most new patients presented with severe disease in NYHA class 3 or 4. Mitral regurgitation alone or combined with aortic regurgitation were the most common valve lesions. The results suggest that most new patients have advanced valvular disease and complications due to late presentation, highlighting the need for early detection
Clinical profile of paediatric patients with rheumatic heart disease at moi t...Alexander Decker
This document summarizes a study on the clinical profile of pediatric patients with rheumatic heart disease at Moi Teaching and Referral Hospital in Eldoret, Kenya. The study found that 84 pediatric patients had rheumatic heart disease, with more female patients than male. New patients most commonly presented with dyspnea, easy fatigability, and palpitations. Signs like systolic murmurs and tachycardia were also common in new patients. Most new patients were in NYHA classes 3 and 4, indicating severe valvular disease and late presentation. The study recommends emphasis on early detection and prevention of rheumatic heart disease.
This study compared the long-term (18-month) outcomes of supervised exercise (SE), stent revascularization (ST), and optimal medical therapy (OMT) for patients with claudication due to aortoiliac peripheral artery disease. 79 patients completed the 18-month follow-up assessment. The study found that both SE and ST resulted in significantly greater improvements in peak walking time and claudication onset time compared to OMT. SE and ST also provided durable improvements in quality of life measures up to 18 months. Both SE and ST had better long-term outcomes than OMT alone for treating claudication, demonstrating the durability of exercise interventions for peripheral artery disease.
This study examined seasonal variations in the onset of acute pancreatitis at a hospital in Islamabad, Pakistan from 2005-2006. The researchers found:
- There were 121 cases of acute pancreatitis included in the study, with slightly more male patients. The average age was 42.
- Gallstones and alcoholism were the leading risk factors, accounting for 39.7% and 12.4% of cases respectively.
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- Events occurring in October-December had a significantly higher mortality rate compared to other times of year.
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
This study reviewed the management of 1432 grown-up congenital heart disease patients over 10 years at a tertiary hospital in India. It found a early morbidity rate of 5.2% and identified previous sternotomy, emergency procedures, cross-clamp time over 45 minutes, and cyanotic disease as significant risk factors. Outcomes were generally good with a mortality rate of 1.4% and 86% follow-up completeness. However, the study was limited by its single center retrospective design and loss to follow-up of simpler cases.
This document summarizes several studies on outcomes for pediatric patients receiving continuous renal replacement therapy (CRRT) or dialysis for acute renal failure. The studies found that mortality rates for pediatric patients receiving CRRT ranged from 40-50%, with most deaths occurring within the first 3 weeks in the ICU. Higher degrees of fluid overload in patients at the time of CRRT initiation were associated with increased mortality in some studies. Outcomes for infants over 3kg were similar to older children. However, limitations included the retrospective and single-center nature of most studies as well as an inability to control for severity of illness.
1) Intravenous thrombolysis (IVT) with alteplase remains the standard treatment for acute ischemic stroke within 4.5 hours of symptom onset. Pivotal clinical trials in 1995 and 2008 demonstrated that IVT can reduce disability and is safe, with about a 7% risk of symptomatic intracranial hemorrhage.
2) Real-world data from registries show that IVT results in functional independence for 40-45% of patients at 3 months, and is effective in patients over 80 years old. Faster treatment times are associated with better outcomes.
3) Current research aims to increase the number of patients treated by overcoming some contraindications to IVT, and to
Prognosis of pulmonary arterial hypertensiongisa_legal
1) The expected survival of patients with pulmonary arterial hypertension (PAH) varies based on the underlying cause, with idiopathic PAH having a median survival of 2.8 years based on historical studies.
2) Medical therapies like epoprostenol have improved survival rates, with studies showing 1, 2, and 3 year survival rates with epoprostenol between 63-87%, compared to 27-52% historically.
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Introduction: There is growing evidence that Obstructive Sleep Apnea (OSA) is a risk factor for Pulmonary Embolism (PE). This
association represents a major public health burden.Aims and Objectives: To investigate Computed Tomography Obstruction Index (CTOI) and the Right Ventricular (RV) to Left Ventricular (LV) diameter ratio with OSA severity. Materials and Methods: 46 Patients with (PE) were evaluated for OSA. Pulmonary Artery Obstruction Index (PAOI) and RV/ LV diameter ratio was measured by pulmonary angiography. Pulmonary Embolism Severity Index (PESI) was determined. Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) was performed for all patients. Based on the PAOI, patients divided into (< 15%, 15-50%, > 50%).
This study examined echocardiographic predictors of perinatal mortality in fetuses diagnosed with Ebstein's anomaly or tricuspid valve dysplasia. The study reviewed 21 fetuses between 2000-2008. Smaller right atrial size and absence of hydrops were associated with improved survival. Analysis of left ventricular function showed non-survivors had shorter combined contraction and relaxation times, though ejection times did not differ. Overall perinatal survival was 75% and survival to 3 months was 57-50% depending on whether terminations were included.
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This document summarizes a study examining heart defects in fetuses with Turner's syndrome. The study found that among 53 fetuses with a 45X karyotype:
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- The most common defects were coarctation of the aorta (45% of fetuses) and hypoplastic left heart syndrome (13% of fetuses).
- Termination of pregnancy occurred in 85% of fetuses, while spontaneous fetal loss occurred in 6 cases. Two fetuses with a mosaic karyotype survived to birth.
Stratified Management of Cardiac Surgery for Structural Heart Disease during ...semualkaira
We study pregnancy outcomes of cardiac surgery
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Stratified Management of Cardiac Surgery for Structural Heart Disease during ...semualkaira
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Pulmonary embolism (PE) is a relatively common cardiovascular disorder with potentially fatal consequences. While advances have been made in diagnosing PE, it remains difficult to diagnose due to non-specific symptoms and signs. Validated diagnostic algorithms using clinical probability assessments, D-dimer testing, and computed tomography pulmonary angiography (CTPA) imaging allow for efficient evaluation and management of patients with suspected PE. Risk stratification is important for determining appropriate treatment and monitoring for individual patients.
This literature review summarizes the clinical characteristics of myocardial stunning (neurogenic stunned myocardium or NSM) seen in patients after acute ischemic stroke. The review identified 7 case reports/series describing a total of 13 patients with NSM following stroke. Key findings include that NSM after stroke was more common in older females, with involvement of the left ventricle apex. Less than half of cases involved the insular cortex. Troponin levels and left ventricular dysfunction were typically mild. Most patients showed significant left ventricular recovery within 4 weeks, indicating a generally favorable prognosis. However, larger prospective studies are still needed.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
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According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
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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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Pericardite recorrente
1. doi:10.1016/S0735-1097(03)00778-2
2003;42;759-764J. Am. Coll. Cardiol.
Marja Raatikka, Pirkko M. Pelkonen, Jouko Karjalainen, and Eero V. Jokinen
Recurrent pericarditis in children and adolescents: Report of 15 cases
This information is current as of June 22, 2008
http://content.onlinejacc.org/cgi/content/full/42/4/759
located on the World Wide Web at:
The online version of this article, along with updated information and services, is
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3. had mild tamponade. The chest X-ray showed cardiac
enlargement in 14 patients and pleuritis and/or pneumonia
in 10 patients. The electrocardiogram was normal in 3
patients, showed either short-lasting T-wave or ST-
segment changes in 10 patients and low-voltage QRS
complexes in 1 patient. Increased serum creatine kinase-MB
levels were found in three children. The erythrocyte sedi-
mentation rate and C-reactive protein (CRP) values were
clearly elevated (Table 2), except in one patient who had
massive polyserositis.
RECURRENCES. In total, 15 patients had 149 recurrences
(mean 9.9, range 2 to 30) during follow-up (Table 1, Fig. 1).
The principal symptom during recurrences was pain,
similar to that during the initial attack. In only four
patients was pleuritis/pneumonia observed during recur-
rences. In general, with increasing time, recurrences
became less severe and the interval between attacks
became prolonged. This tendency to a milder course was
also seen in cardiologic and laboratory findings, as
summarized in Table 2. In two patients (Patients #3 and
#7), however, clinically mild recurrences gradually devel-
oped into monthly episodes of pericarditis, and in two
patients (Patients #5 and #8), recurrences regained the
initial intensity. None of the recurrences resulted in
tamponade or constrictive pericarditis.
The longest quiescence between attacks was 1 to 11
months (n ϭ 6) or 12 to 27 months (n ϭ 9). So far, seven
patients have been without further attacks for more than
four years, and these patients may probably be regarded as
cured of RP (Figs. 1 and 2). In this group, active disease,
calculated from the initial attack to the onset of the last
recurrence, lasted from 0.5 to 3.5 years (mean 1.9 years), and
they have been followed up for 4.0 to 11.1 years (mean 6.8
years) after the last recurrence. For those quiescent for Ͻ4
years, the active disease has varied from 3.2 to 15.5 years
(mean 6.7 years).
PERICARDIAL FLUID AND HISTOPATHOLOGY. In three pa-
tients, pericardial puncture or drainage was done during the
initial attack and in four during a recurrence without
complications. Pericardial fluid was clear on four occasions,
slightly cloudy once, and slightly bloody twice. Its protein
content was 48 g/l (measured once). The white cell count
varied from 11.4 to 19.5 ϫ109
/l (60% to 88% polymorpho-
nuclear cells and 12% to 40% mononuclear cells), corre-
sponding to the white cell findings in the blood. In all
samples, bacterial, tuberculous, and fungal cultures were
negative. Viral isolation yielded herpes simplex type 1 in one
sample; however, there was no increase in the viral antibody
titer. Pericardial biopsy displayed fibrosis and nonspecific
inflammation in two patients. Pericardiectomy was not
performed in any of the patients.
Preceding and associated conditions. OPEN-HEART
SURGERY. Open-heart surgery preceded RP in 7 (47%) of
15 patients. An operation was performed for an atrial septal
defect (ASD) in six patients and a ventricular septal defect
in one patient (Table 1). The proportion of ASD patients
(86%) among our postoperative patients with RP was 10
times higher than the 8.4% proportion of ASD operations
among Finnish pediatric cardiac operations in general (9).
Also, the average age at the ASD operation (9.9 years [range
6.3 to 15.7 years]) was higher than that at all ASD
operations (4.8 years) in Finland during the same period.
Table 1. Basic Data on the 15 Patients With Recurrent Pericarditis
Patient
No. Gender
Age at Initial
Attack
(yrs)
Number of
Relapses
Type of
Heart Defect
Postoperative Interval
to Pericarditis
(months) Associated Conditions During Initial Attack
1 M 16.8 4 ASD 59 Pleuritis, scar irradiation, Rubinstein Taybi syndrome
2 F 10.8 6 VSD 1
3 M 8.4 30 ASD 7 Pneumonia, scarlatina
4 F 10.0 9 ASD 2 Pleuropneumonia
5 M 9.4 13 ASD 22 Pleuropneumonia, appendicectomy
6 M 6.5 2 ASD 3
7 F 15.8 26 ASD 3
8 M 15.5 14
9 M 12.5 10 Pneumonia
10 F 7.5 2 Pleuritis, ascites, thyroiditis
11 M 10.7 2
12 F 6.9 5 Pleuritis, colitis, mesalamine
13 M 15.0 15 Pleuritis
14 M 13.1 5 Pleuropneumonia
15 F 15.4 6 Pleuropneumonia, colitis, erythema-nodosum,
Noonan’s syndrome
ASD ϭ atrial septal defect; VSD ϭ ventricular septal defect.
Abbreviations and Acronyms
ASD ϭ atrial septal defect
CRP ϭ C-reactive protein
NSAID ϭ nonsteroidal anti-inflammatory drug
RP ϭ recurrent pericarditis
760 Raatikka et al. JACC Vol. 42, No. 4, 2003
Recurrent Pericarditis in Children August 20, 2003:759–64
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4. Calculated from the total number of ASD operations
performed during the study period, the risk of RP was 1.6%
and in those who had an operation at the age of six years or
older, 5%. Also, the patient with a ventricular septal defect
was operated on at an older age (9.8 years) than is usual.
Recurrent pericarditis appeared within two years after car-
diac surgery in six children (Table 1). In the patient with an
interval of five years, pericarditis was triggered by radiation
of the keloid thoracotomy scar.
OTHER ASSOCIATED CONDITIONS. The initial attack of
pericarditis was associated with colitis in two children
(Table 1). The disease was of short duration in one patient
(Patient #15), and in the other (Patient #12), ulcerative
colitis was treated with prednisolone and mesalamine. She
had five recurrences of pericarditis, but none after me-
salamine was discontinued. Patient #10 presented with
polyserositis and autoimmune thyroiditis and had a high
titer of antinuclear antibodies, but no definable connective
tissue disease has appeared during follow-up. We aimed at
exclusion of connective tissue diseases by immunologic
studies. Antinuclear antibodies were increased in 1 of 14
patients (Patient #10). Antibodies to extractable nuclear
antigen and to double-stranded deoxyribonucleic acid were
both normal in eight patients studied, as well as rheumatoid
factor in five patients. Serum immunoglobulin levels (n ϭ 9)
and complement components C3 and C4 (n ϭ 11) were
normal or increased. However, a family history revealed
systemic lupus erythematosus in two families and HLA
B27-positive spondyloarthropathy with carditis in one. The
sister of Patient #10 had autoimmune thyroiditis. The
grandfather of Patient #14 had had several episodes of
pericarditis of unknown etiology.
INFECTIONS IN ASSOCIATION OF THE INITIAL ATTACK AND
RECURRENCES. No microbiologic etiology could be estab-
lished for pleuritis or pneumonia found in 10 of 15 patients
during the initial attack. Blood cultures were obtained in 11
of 15 patients with negative results. Signs of upper respira-
tory tract infection were noted at presentation in four
patients, one of whom had had scarlatina and another had
undergone an appendectomy before the initial attack. An-
tibiotic treatment was administered to nine patients.
Upper respiratory tract infections were recorded in 29
recurrences of 9 patients. An attempt to specify the etiology
of these infections was done only occasionally: influenza A,
Figure 1. Follow-up times in each of the 15 patients. The open part of the bar shows the duration of active disease, and the solid part shows the follow-up
time after the last recurrence. Patient numbers correspond to those in Table 1.
Table 2. Clinical Findings During Initial Attack of Pericarditis and Recurrences
Pericarditis
No. of
Attacks
Fever
(% of Attacks)
ESR
(mm/h)*
CRP
(mg/l)*
ECG Changes
(Changes/No. of
Attacks Studied)
Pericardial Effusion
(Effusion/No. of
Attacks Studied)
Initial attack 15 80 60 (10–96) 150 (12–307) 77% (10/13) 100% (15/15)
Relapses 1–3 42 62 62 (4–120) 134 (10–340) 73% (19/26) 89% (34/38)
Relapses 4–6 32 50 46 (13–97) 71 (10–270) 42% (8/19) 59% (16/27)
Relapses 7–9 21 19 17 (7–47) 44 (10–153) 44% (4/9) 43% (3/7)
Relapses 10–15 28 7 39 (7–90) 104 (10–260) 50% (4/8) 42% (5/12)
*Data are presented as the mean value (range).
CRP ϭ C-reactive protein; ECG ϭ electrocardiographic; ESR ϭ erythrocyte sedimentation rate.
761JACC Vol. 42, No. 4, 2003 Raatikka et al.
August 20, 2003:759–64 Recurrent Pericarditis in Children
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5. influenza B, adenovirus, parainfluenza 2, and Mycoplasma
pneumoniae infection were all diagnosed once. Interestingly,
Patient #8 had two relapses triggered by influenza vaccina-
tion. In contrast to the initial pericardial attack, pleural
effusion or pulmonary infiltrate was seen only during nine
recurrences. Most recurrences did not have any obvious
triggering factor.
Comparison between postoperative and other cases.
There were no obvious differences in the nature or course of
RP between patients who had an operation for heart disease
and other patients. During the 4-year follow-up of all
patients, the number of recurrences was comparable in the
operated patients (mean 8.1 [range 2 to 26]) and the others
(mean 7.3 [range 2 to 14]). During the initial attack, CRP
was 67 to 307 mg/l (mean 153 mg/l) in the operated
patients and 12 to 295 mg/l (mean 146 mg/l) in the others.
Three of seven postoperative patients and four of eight other
patients were apparently cured of RP during follow-up.
Drug therapy. Four patients (Patients #1, #4, #6, and #9)
were treated with nonsteroidal anti-inflammatory drugs
(NSAIDs) only. The remaining 11 patients received corti-
costeroids, seven of them even during the initial attack. In
two patients, predniso(lo)ne was given as one- to two-week
courses. Long-term (more than two years) prednisolone,
mostly on alternate days, was given to four patients, and in
the rest, the regimen varied. Initially, CRP was 12 to 295
mg/l (mean 135 mg/l) in the group treated with corticoste-
roids and 96 to 307 mg/l (mean 201 mg/l) in the others,
suggesting that the initial attack may not have been less
severe in the group receiving no corticosteroids. During a
follow-up period of 4 years, available in all patients, the
number of recurrences was 2 to 26 (mean 8.3) in the group
treated with corticosteroids and 2 to 6 (mean 4.5) in those
not so treated. Remission of at least 4 years was achieved by
5 of 11 patients of the former group and 2 of 4 of the latter
group. Peroral methotrexate 10 to 15 mg/week in 4 patients
and 25 mg intramuscularly in 1 patient did not prevent
recurrences, neither did azathioprine 100 mg/day in 1
patient. One child (Patient #14) was receiving cyclosporine
A for 9 months and had two more recurrences during that
time, but has since been off treatment and well for 4.5 years.
Colchicine 0.5 to 2.0 mg/day was given to 4 patients
(Patients #3, #5, #7, and #8) who had relapsed despite
corticosteroid treatment. However, these patients had 3 to
10 recurrences (mean 5.8) during a period of 6 to 27 months
(mean 13.3 months) on colchicine. Before colchicine treat-
ment these patients had 4 to 15 attacks (mean 7.5) during a
period of 10 to 71 months (mean 35 months).
DISCUSSION
Open-heart surgery as a background factor. Cardiac
surgery preceded RP in 47% of our patients, in contrast to
the findings in adult series where the proportion of postop-
erative cases varied from 13% (3) to 25% (10). The inci-
dence of post-pericardiotomy syndrome is higher in chil-
dren than in adults (11), which may explain the difference.
On the other hand, post-pericardiotomy syndrome occurs
far more often in older children than in infants (12). In
accordance, all seven postoperative patients had an opera-
tion at an older age than is usual for their defects. The
Registry for Cardiac Operations in Finnish Children al-
lowed us to calculate the risk of RP after ASD operation.
An unexpectedly high 5% risk was found among children
operated on after the age of six years. Altogether, RP seems
to be a disease affecting principally older children and
adolescents. The clinical picture, course, and prognosis of
RP were similar in the postoperative and other patients,
indicating that the character of the trigger is not of
importance for the subsequent nature of the disease.
Figure 2. Total number of patients (whole bar) and patients with active disease (open part of bar) in each follow-up year.
762 Raatikka et al. JACC Vol. 42, No. 4, 2003
Recurrent Pericarditis in Children August 20, 2003:759–64
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6. Associated conditions at the time of initial pericarditis.
Pneumonic infiltration or pleural effusion found in 67% of
our patients may reflect the same immune-mediated process
that inflamed the adjacent pericardium, as no microbiologic
etiology could be verified. In fact, pleuritis is an essential
feature in post-pericardiotomy syndrome (2). Pleuritis
and/or pulmonary infiltration were found both in operated
and nonoperated patients, reflecting the similar pathophys-
iologic mechanism of RP. Two patients had inflammatory
bowel disease, in which pericarditis may very rarely occur as
an extraintestinal manifestation (7). In one of these patients,
both the initial attack and the recurrences of pericarditis
were clearly associated with mesalamine treatment. This
observation stresses the causal role of 5-aminosalicylic acid
compounds in pericarditis, believed to be due to type IV
hypersensitivity reaction, as discussed in detail by Sentongo
and Piccoli (7).
Triggers of recurrences. Clinical documentation of respi-
ratory tract infections was found in patient records in 20% of
all relapses. Mycoplasma infection is among the infections
reported to cause RP (13), but appropriate antibiotic treat-
ment did not prevent further recurrences in our patient.
Interestingly, one patient had relapses repeatedly after
influenza vaccinations, as described previously in an adult
(14). Thus, if pericarditis occurs after influenza vaccination,
further influenza vaccinations should be avoided. It can be
speculated that epi-pericardial injury due to any of a variety
of insults may initiate an autoimmune process, which is
reactivated by microbe-induced immune stimulation. Per-
sistent T-cell activation may be induced by antigens intrin-
sic to the epi-pericardium and cross react with viral antigens
because of molecular mimicry. Coxsackie adenovirus recep-
tors and co-receptors have been described on cardiac cell
surfaces (15).
Genetic factors. Genetic factors may contribute to the
propensity to recurrences in pericarditis. Familial clustering
of RP has recently been described (16), and the grandfather
of one of our patients had RP. The clinical picture of RP
shares features of hereditary recurrent inflammatory disor-
ders, which are characterized by repeated attacks of fever
and organ-localized inflammation affecting mainly the ab-
domen, musculoskeletal system, and skin. In a recent series
of 394 patients with recurrent inflammatory syndrome, 2
patients had RP as the only sign of the disease (17).
Treatment. Controlling chest pain and pericardial effusion
during the attacks and preventing recurrences are the main
goals of therapy. We found no harm in our practice not to
restrict the physical activity of patients between the attacks
when clinical findings were normal. The NSAIDs are the
commonly used first-choice treatment, but the response is
often unsatisfactory, and most patients (11 of 15 in our
series) receive corticosteroids (1,4). Corticosteroids effec-
tively suppress pericardial pain and inflammation during
acute attacks. However, the efficacy of corticosteroids in
preventing relapses has been questioned, and warnings have
been issued about steroid dependence (6,10). Recurrences
occurred in our patients on corticosteroids, and, in fact, the
mean number of relapses in steroid-treated patients was
nearly twice that of those not so treated. Because of systemic
side effects, steroids were discontinued in two patients. The
subsequent relapses were not more frequent and were
successfully treated with NSAIDs only. As the disease
gradually tends to quiet down, it seems possible to avoid
corticosteroids during the later recurrences, even in patients
who initially required them because of intractable symp-
toms. This is especially important in patients with frequent
late recurrences and/or those at risk of steroid dependence,
but without clear-cut evidence of active inflammation, such
as an elevated CRP value. Although the mechanism of pain
in such cases is unknown (possibly due to low-grade
inflammation or so-called complex regional pain syndrome
[18]), pain should be treated with NSAIDs or pain killers
only. None of the other immunosuppressive drugs given to
seven patients prevented recurrences. Thus, we recommend
treatment of children with RP primarily with NSAIDs and
the use of corticosteroids only in those with severe symp-
toms and only temporarily, if possible. As RP is uncommon,
its treatment is challenging. In addition, there is a risk of
steroid dependence, so patients should be followed in
centers familiar with this disease.
Colchicine. Colchicine has recently been used in RP, with
good results in adults and subsequently in children (8,10),
and it has been recommended as the drug of choice in this
disease. In a international multicenter study, 51 patients
were treated with colchicine and only 7 patients (13.7%)
presented with new recurrences (10). Our experience is in
contrast to that study, as the response in all our four patients
was unsatisfactory. Colchicine is an effective drug in familial
Mediterranean fever, a disease prevalent in countries where
good results with colchicine have been obtained in RP.
Mediterranean fever has not been observed in the Finnish
population. The effectiveness of colchicine in RP has not
been tested in a double-blind, controlled manner. This
would be important because of the unpredictable natural
course of RP and the tendency of recurrences to settle down
(Fig. 2).
Prognosis. The course of RP was often long and unpre-
dictable, irrespective of the cause or triggering event. How-
ever, the activity of the disease seems to “burn out” gradually
(Figs. 1 and 2), independent of the type of drug treatment
used. In 7 of 15 patients, remission has lasted for over 4
years. The prognosis of RP may thus be somewhat better in
children than in adults, as only 9 of 31 patients followed by
Fowler and Harbin (3) stayed in remission for 2 years or
more. Mild tamponade was found only in one child. No
instance of constriction appeared.
Study limitations. Recurrent pericarditis is an uncommon
disease in children. The 15 cases of this series were
encountered during a 14-year-long period. Therefore, only
a retrospective analysis of the patients was possible.
Conclusions. The most frequent background for RP in
children was the closure of ASD after the age of six years.
763JACC Vol. 42, No. 4, 2003 Raatikka et al.
August 20, 2003:759–64 Recurrent Pericarditis in Children
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7. The course of RP was unpredictable and often chronic,
irrespective of the underlying cause and therapy given.
Colchicine or other immunosuppressive drugs did not
prevent relapses. Therefore, we prefer the use of NSAIDs in
the treatment of RP in children.
Acknowledgments
We thank Drs. T. Tikanoja, L. Nisula, A.-L. Noponen, A.
Westerlund, and H. Sairanen for the data on their patients.
Reprint requests and correspondence: Dr. Jouko Karjalainen,
Central Military Hospital, Box 50, 00301, Helsinki, Finland.
E-mail: jouko.karjalainen@pp.inet.fi.
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8. doi:10.1016/S0735-1097(03)00778-2
2003;42;759-764J. Am. Coll. Cardiol.
Marja Raatikka, Pirkko M. Pelkonen, Jouko Karjalainen, and Eero V. Jokinen
Recurrent pericarditis in children and adolescents: Report of 15 cases
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