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Aust N Z J Public Health 2019 Apr 17. Epub 2019 Apr 17.

Northern Territory Centre for Disease Control, Northern Territory.

Objectives: We report a cluster of acute rheumatic fever (ARF) cases and the public health response in a high-burden Australian setting.

Methods: The public health unit was notified of an increase in ARF cases in a remote Australian Aboriginal community. A multi-disciplinary group coordinated the response. Read More

Depress Anxiety 2019 Apr 16. Epub 2019 Apr 16.

Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.

Background: Recent findings suggest an association between attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Thus, we evaluated the clinical associated features of ADHD in a large sample of adult OCD patients.

Methods: A cross-sectional study including 955 adult patients with OCD from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (C-TOC). Read More

Zhongguo Zhong Yao Za Zhi 2019 Jan;44(2):388-400

Guang'anmen Hospital,China Academy of Chinese Medical Sciences Beijing 100053,China.

Mufangji Decoction is a famous herbal formula from Synopsis of Golden Chamber. However,it is easy to be misunderstood due to so its unique compatability. The syndromes treated by Mufangji Decoction included the following aspects:(1) in terms of modern medicine,it could be used to treat acute and chronic heart failure,heart failure aggravated by lung infection,chronic obstructive pulmonary disease acute episode,pulmonary heart disease,bilateral pleural effusion,acute attack of gout,rheumatic fever,rheumatoid arthritis,and rheumatoid arthritis;(2) in terms of symptoms,it could be used to treat asthma,chest tightness,wheeze impacting prostration and dyspnea impacting sitting posture; gastric distention; dark face,cyanotic,and mitral valvular face; edema of head and extremities; dry mouth,thirsty,unwilling to wear thick clothes,intolerance of heat,and irritable; fatigue,shortness of breath,poor appetite,constipation,less urine,yellow color,poor response to diuretics,and diuretic resistance; fast heart rate,which is hard to be controlled by Western medicine and has no response to Zhenwu Decoction; dark red tongue,dry tongue with yellow fur,rapid pulse,or deep tight pulse. Read More

J Antimicrob Chemother 2019 Apr 15. Epub 2019 Apr 15.

Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.

Background: Benzathine benzylpenicillin G (BPG) is recommended as secondary prophylaxis to prevent recurrence of acute rheumatic fever and subsequent rheumatic heart disease (RHD). Following intramuscular injection, BPG is hydrolysed to benzylpenicillin. Little is known of the pharmacokinetics of benzylpenicillin following BPG in populations at risk of RHD. Read More

QJM 2019 Apr 9. Epub 2019 Apr 9.

Division of Cardiology, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center 2-8-29 Musashidai, Fuchu, Tokyo, Japan.

Clin Rheumatol 2019 Apr 8. Epub 2019 Apr 8.

Section of Rheumatology, Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, CT, USA.

In 50% of patients, chikungunya fever (CHIKF) is followed by arthritic pain that is often chronic, painful, and disabling. To better define the spectrum of pain and disability in chronic CHIK arthritis (CCA), we evaluated 35 consecutive CCA patients seen in a Brazilian rheumatology clinic, using a pain Visual Analog Scale and the Health Assessment Questionnaire Disability Index. In our patients, pain and disability levels were of the same magnitude as are seen in other serious rheumatic diseases. Read More

BMC Public Health 2019 Apr 5;19(1):385. Epub 2019 Apr 5.

Waikato District Health Board, Pembroke Street, Private Bag 3200, Hamilton, 3240, New Zealand.

Background: Acute rheumatic fever in New Zealand persists and is a barometer of equity as its burden almost exclusively falls on Māori and Pacific Island populations. The primary objective of this study is to determine whether an incentive programme will result in increased secondary prophylaxis injections over a one-year period compared to a baseline period prior to the intervention.

Methods: The evaluation used a multiple baseline study to determine whether an incentive consisting of a mobile phone and monthly "top-up" (for data/calls) resulted in increased injections, increased texts/calls with nurses, reduced number of visits to get a successful injection, less medicine wasted, and increased nurse satisfaction. Read More

Pediatr Rheumatol Online J 2019 Apr 2;17(1):12. Epub 2019 Apr 2.

Médecins Sans Frontières-Operational Centre Brussels, Italy Mission, Rome, Italy.

Background: Rheumatic heart disease (RHD) is a chronic condition responsible of congestive heart failure, stroke and arrhythmia. Almost eradicated in high-income countries (HIC), it persists in low- and middle-income countries. The purpose of the study was to assess the feasibility and meaningfulness of ultrasound-based RHD screening among the population of unaccompanied foreign minors in Italy and determine the burden of asymptomatic RHD among this discrete population. Read More

Immunol Med 2018 Mar 3;41(1):43-45. Epub 2018 Apr 3.

a Department of Pediatrics , Yamaguchi University Graduate School of Medicine , Ube , Japan.

Acute rheumatic fever (ARF), caused by group A β-hemolytic streptococcus infection, is characterized by inflammation affecting several organs. There are few reports on magnetic resonance imaging (MRI) findings in patients with ARF. An 8-year-old Japanese boy presented with a prolonged fever of unknown cause and swelling of his right hand. Read More

Neuro Endocrinol Lett 2019 Mar;39(8):544-549

North London Postgraduate Medical School, London, UK.

Background: Infective endocarditis (IE) is still a significant cause of mortality in European hospitals, despite of the fact, that large nationwide studies were performed in last twenty years and pathogens are well known. The aim of the study was to assess risk factors, mortality, etiology and proportion of elderly patients within a longitudinal nation wide survey of infectious endocarditis in Slovakia.

Patients And Methods: Etiology, risk factors and outcome of 1003 cases of infective endocarditis (IE) in Slovakia over the last 33 years have been assessed. Read More

Rev Neurol (Paris) 2019 Apr 26;175(4):207-216. Epub 2019 Mar 26.

20, rue de Chartres, 28160 Brou, France. Electronic address:

Adolphe Gubler (1821-1879) is a typical example of a 19th century hospital physician in Paris. Head of a medical unit at Beaujon hospital in 1855, he was nominated to the treatment and pharmacognosia Chair in 1868. He trained many students who became his disciples and remained very close to him. Read More

Am J Trop Med Hyg 2019 Mar 25. Epub 2019 Mar 25.

Royal Darwin Hospital, Darwin, Australia.

This study aimed to identify recurrent acute rheumatic fever (ARF) episodes which occurred despite adherence to prophylactic benzathine penicillin G (BPG). Data from Australia's Northern Territory were analyzed; ARF recurrences between 2012 and 2017 diagnosed while the person was prescribed BPG were identified. Days at risk (DAR)-median and interquartile range-preceding ARF onset were calculated. Read More

Viruses 2019 Mar 22;11(3). Epub 2019 Mar 22.

Section of Rheumatology, Allery and Immunology, Yale University School of Medicine, New Haven, CT 06510, USA.

Chikungunya fever (CHIKF) is an emerging viral infection that has spread widely, along with its vectors, throughout the tropics and beyond, causing explosive epidemics of acute illness and persistent disabling arthritis. The rheumatic symptoms associated with chikungunya virus (CHIKV) infection include polyarthralgia, polyarthritis, morning stiffness, joint edema, and erythema. Chronic CHIK arthritis (CCA) often causes severe pain and associated disability. Read More

Aust N Z J Public Health 2019 Mar 25. Epub 2019 Mar 25.

Paediatrics: Child & Youth Health, University of Auckland, New Zealand.

Objective: Rheumatic fever (RF) recurrence prevention requires secondary prophylaxis for at least ten years. However, recurrences of rheumatic fever (RRF) persist disproportionately affecting Māori and Pacific youth. Reasons for recurrence rates are not well understood and commonly attributed to patient non-adherence. Read More

BMJ 2019 Mar 21;364:l1085. Epub 2019 Mar 21.

Royal Bolton Hospital, Bolton, UK.

Rev Soc Bras Med Trop 2019 Mar 14;52:e20180041. Epub 2019 Mar 14.

Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.

Rheumatic heart disease (RHD) remains a major cause of preventable death and disability in children and young adults. Despite significant advances in medical technology and increased understanding of disease mechanisms, RHD continues to be a serious public health problem throughout the world, especially in low- and middle-income countries. Echocardiographic screening has played a key role in improving the accuracy of diagnosing RHD and has highlighted the disease burden. Read More

BMC Rheumatol 2019 28;3. Epub 2019 Feb 28.

1Clinic of Rheumatology, University of Magdeburg, Sophie-von-Boetticher-Strasse 1, 39245 Vogelsang-Gommern, Germany.

Background: Signs and symptoms establish the diagnosis of adult onset Still's disease (AOSD) as well as of systemic onset juvenile idiopathic arthritis (sJIA). The published data regarding the importance of IL-18 as a marker for diagnosis and disease activity so far are conflicting. The aim of this study was to clarify the role of IL-18 as a diagnostic and disease activity marker in AOSD and sJIA. Read More

Arthritis Res Ther 2019 Mar 14;21(1):75. Epub 2019 Mar 14.

Departamento de Reumatologia, Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brazil.

Background: The 17DD-yellow fever (YF) vaccine induces a long-lasting protective immunity, resulting from humoral and cellular immunological memory. The treatment of rheumatoid arthritis (RA) patients with disease-modifying anti-rheumatic drugs (DMARD) may affect pre-existing 17DD-vaccine protective immunity and increase the risk of acquiring YF infection. Our goal was to determine whether DMARD would affect the duration of YF-specific protective immunity in RA patients. Read More

Epidemiol Infect 2019 Jan;147:e79

School of Population and Global Health, University of Western Australia,Crawley, WA,Australia.

Acute rheumatic fever (ARF), an auto-immune response to a group A Streptococcus infection and precursor to rheumatic heart disease (RHD), remains endemic in many socio-economically disadvantaged settings. A Global Resolution on ARF and RHD was recently adopted at the 71st World Health Assembly where governments committed to improving efforts to prevent and control ARF and RHD. To inform these efforts, the objectives of this study were to examine associations between childhood ARF in the UK between 1958 and 1969 and a range of environmental and social factors. Read More

Ann Thorac Cardiovasc Surg 2019 Mar 12. Epub 2019 Mar 12.

Ho Chi Minh Heart Institute, Ho Chi Minh, Vietnam.

Purpose: We want to share our experience of Sorin Bicarbon prosthesis (SBP) after 19 years follow-up.

Methods: Retrospective study of 1377 patients who had replaced with SBP from May 1998 to December 2008 at Ho Chi Minh Heart Institute, Viet Nam.

Results: Male patients was 42%, mean age was 40. Read More

Emerg Microbes Infect 2019 ;8(1):70-79

a Institute of Health and Biomedical Innovation, School of Biomedical Sciences , Queensland University of Technology , Brisbane , QLD , Australia.

Chikungunya virus (CHIKV) is a mosquito-borne pathogen that causes an acute febrile syndrome and severe, debilitating rheumatic disorders in humans that may persist for months. CHIKV's presence in Asia dates from at least 1954, but its epidemiological profile in the region remains poorly understood. We systematically reviewed CHIKV emergence, epidemiology, clinical features, atypical manifestations and distribution of virus genotypes, in 47 countries from South East Asia (SEA) and the Western Pacific Region (WPR) during the period 1954-2017. Read More

North Clin Istanb 2018 13;5(4):329-333. Epub 2018 Aug 13.

Department of Pediatrics, Kecioren Training and Research Hospital, Ankara, Turkey.

Objective: Rheumatic heart disease (RHD) is still a major cause of morbidity and mortality in developing countries. The aim of the present study was to investigate asymptomatic RHD cases diagnosed by echocardiography without any acute rheumatic fever (ARF) history and to present the follow-up results.

Methods: Children who had been admitted to the pediatric cardiology department between 2011 and 2017 for various reasons (e. Read More

Case Rep Pediatr 2019 31;2019:5163213. Epub 2019 Jan 31.

Pediatric Gastroenterology Division, Children's Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.

The relationship of inflammatory bowel disease (IBD) and chronic recurrent multifocal osteomyelitis (CRMO) is understood as extraintestinal rheumatic manifestations. CRMO is a chronic, relapsing, inflammatory, noninfectious disorder of the skeletal system of unknown origin. The disease course is not always recurrent. Read More

J Ayurveda Integr Med 2019 Feb 26. Epub 2019 Feb 26.

Department of Indian Systems of Medicine, Kerala, India. Electronic address:

Kabhatika Hridroga (valvular heart disease) embodies a significant part of cardiovascular disease. There are many causes for valvular heart disease of which, the rheumatic fever is an important one. This study is a case report of a patient awaiting mitral valve transplant for valvular heart disease (i. Read More

Curr Cardiol Rep 2019 Feb 28;21(3):14. Epub 2019 Feb 28.

The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Purpose Of Review: This review provides an update on rheumatic mitral stenosis. Acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection, is the major etiology for mitral stenosis (MS).

Recent Findings: While the incidence of acute RF in the Western world had substantially declined over the past five decades, this trend is reversing due to immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher. Read More

Ann Lab Med 2019 Jul;39(4):345-357

Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK.

The platelet-to-lymphocyte ratio (PLR) has emerged as an informative marker revealing shifts in platelet and lymphocyte counts due to acute inflammatory and prothrombotic states. PLR has been extensively examined in neoplastic diseases accompanied by immune suppression and thrombosis, which can be predicted by combined blood cell counts and their ratios. Several large observational studies have demonstrated the value of shifts in PLR in evaluating the severity of systemic inflammation and predicting infections and other comorbidities, in inflammatory rheumatic diseases. Read More

Case Rep Med 2019 16;2019:4674875. Epub 2019 Jan 16.

Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.

Introduction: Streptococcal pharyngitis has been historically complicated with systemic involvement manifesting as acute rheumatic fever, which is a serious condition that can lead to permanent damage to heart valves. A recent association between streptococcal pharyngitis and nonrheumatic heart disease is emerging in literature. We present a case of nonrheumatic streptococcal myocarditis diagnosed using cardiac MRI. Read More

Arch Med Sci Atheroscler Dis 2018 15;3:e142-e155. Epub 2018 Dec 15.

Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Introduction: A role for ficolin (FCN) 2 gene polymorphisms in the pathogenesis of recurrent severe streptococcal infections and rheumatic carditis has been suggested. The aim of the study was to evaluate a possible relationship between single nucleotide polymorphisms located at positions -602 and -4 of the FCN2 gene and FCN2 serum levels and risk of development of rheumatic fever (RF) and rheumatic heart disease (RHD).

Material And Methods: Seventy-seven Caucasian Egyptian patients with RF were recruited with a control group of 43 healthy subjects. Read More

Arch Med Sci Atheroscler Dis 2018 28;3:e80-e82. Epub 2018 Jun 28.

Department of Pediatrics, Shanghai Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China.

Anat Histol Embryol 2019 May 17;48(3):201-206. Epub 2019 Feb 17.

Department of Veterinary Sciences, University of Turin, Grugliasco, Turin, Italy.

Anitschkow cells (AC) are a peculiar type of stromal cells observed in myocardium, cardiac valves and coronary vessels wall whose origin, characterization and role remain controversial. In human heart, they represent a histological hallmark of Aschoff nodules in rheumatic fever, but they have also been observed in other myocardial pathologies. Firstly, they have been considered a myocyte-derived cells, but light microscopy, immunohistochemical and ultrastructural studies pointed out that a macrophagic/histiocytic origin cannot be excluded. Read More

mSphere 2019 02 13;4(1). Epub 2019 Feb 13.

Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia

Group A (GAS) is a major cause of global infection-related morbidity and mortality. A modern controlled human infection model (CHIM) of GAS pharyngitis can accelerate vaccine development and pathogenesis research. A robust rationale for strain selection is central to meeting ethical, scientific, and regulatory requirements. Read More

BMJ Case Rep 2019 Feb 6;12(2). Epub 2019 Feb 6.

Department of General Surgery, University Hospital Crosshouse, Kilmarnock, Scotland.

Tonsillitis is an extremely common condition, usually it is self-limiting, of viral origin, and managed conservatively in general practice. Rarely patients require inpatient management, usually when bacterial infection is present or when the cause is virulent organisms such as Epstein Barr virus. Complications can be divided into non-suppurative; sepsis, scarlet fever, rheumatic fever, glomerulonephritis and Lemierres disease, and suppurative; quinsy, parapharyngeal abscess and retropharyngeal abscess, respectively. Read More

Hellenic J Cardiol 2019 Jan 31. Epub 2019 Jan 31.

Department of Paediatrics, "Karamandaneion"General Paediatric Hospital Patras.

Ter Arkh 2018 Nov;90(11):79-89

N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia.

Borreliosis after sucking ticks is an acute problem in the world. People do not go to doctors after that often, which leads to the development of various complications. Thrombosis of veins of various localization can be one of them. Read More

Case Rep Pediatr 2018 30;2018:8762482. Epub 2018 Dec 30.

Department of Pediatrics, University of Hawaii, John A. Burns School of Medicine, Kapi'olani Medical Center for Women and Children, Honolulu, HI 96826, USA.

The presence of rheumatic heart disease (RHD) and systemic lupus erythematosus (SLE) has rarely been described in one patient. This report describes an adolescent Polynesian male with RHD who developed SLE years later. Initially, he fulfilled modified Jones criteria for rheumatic fever with aortic insufficiency, transient arthritis, elevated streptococcal titers, and a high erythrocyte sedimentation rate with a negative antinuclear antibody (ANA). Read More

BMC Microbiol 2019 Jan 28;19(1):24. Epub 2019 Jan 28.

Department of Microbiology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8501, Japan.

Background: Group A Streptococcus (GAS) is a major human pathogen, which is associated with a wide spectrum of invasive diseases, such as pharyngitis, scarlet fever, rheumatic fever, and streptococcal toxic shock syndrome (STSS). It is hypothesized that differences in GAS pathogenicity are related to the acquisition of diverse bacteriophages (phages). Nevertheless, the GAS genome also harbors clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated (cas) genes, which play an important role in eliminating foreign DNA, including those of phages. Read More

Rev Endocr Metab Disord 2018 12;19(4):363-395

Institute of Diabetes ''Gerhardt Katsch'', Karlsburg, Germany.

The immune system is closely intertwined with the endocrine system. Many effects of medications used for various clinical endocrine conditions such as the metabolic syndrome, hypercholesterolemia, diabetes mellitus, hypertension, Graves' disease and others also have an impact on the immune system. Some drugs including statins, metformin, angiotensin converting enzyme and proprotein-convertase-subtilisin-kexin type-9 (PCSK9) inhibitors and sex hormones are known to have immunomodulatory properties. Read More

Lancet 2019 01;393(10168):275

Department of Ophthalmology, Mohamed VI University Hospital of Marrakesh, Marrakesh, Morocco.

Int J Med Inform 2019 Mar 27;123:68-75. Epub 2018 Dec 27.

İstanbul University, Informatics Department, İstanbul, Turkey.

Background: Acute rheumatic fever (ARF) is an important disease that is frequently seen in Turkey, it is necessary to develop solutions to cure the disease. It is believed that new data analysis methods may be applied to this disease, and this may be useful to discover previously unrecognized patterns. Data mining of existing records and data repositories may improve knowledge on the diagnosis and management of ARF. Read More

Acta Reumatol Port 2018 Oct-Dec;43(4):318-320

Centro Hospitalar São João.

Macrophage activation syndrome (MAS) is a rare life-threatening condition that involves excessive activation of inflammatory cells and overproduction of different cytokines. It is characterized by persistent fever, hepatosplenomegaly, cytopenias and coagulopathy. Other prominent features are hyperferritinemia and findings of activated macrophages in haemopoietic organs, often associated with multi-organ impairment. Read More

BMJ Case Rep 2019 Jan 10;12(1). Epub 2019 Jan 10.

Cleveland Clinic - Fairview Hospital, Cleveland, Ohio, USA.

Myocardial calcification is a rare and life-threatening condition. It has been associated with a myriad of causes, including ischaemic heart disease, cardiac surgery, rheumatic fever, and myocarditis. However, this entity is less well recognised in the setting of toxic shock syndrome. Read More

Clin Exp Rheumatol 2019 Jan 3. Epub 2019 Jan 3.

Rheumatology Research Center, Department of Medicine, and Department of Medicine B, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Objectives: Group A streptococcal (GAS) tonsillitis is reported as an uncommon cause of acute non-rheumatic fever (non-RF) myocarditis. The aim of this research was to study the occurrence, diagnosis, management and prognosis of this condition.

Methods: We conducted a retrospective computerised search through medical records of patients admitted to our tertiary medical center between 1998-2016 with the diagnosis of either acute rheumatic fever or non-RF streptococcal myocarditis based on criteria we developed and review the relevant literature from 1973-2016. Read More

Front Immunol 2018 18;9:3009. Epub 2018 Dec 18.

Molecular Immunopathology Laboratory, Department of Medical Pathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil.

Rheumatic fever (RF) and its subsequent progression to rheumatic heart disease (RHD) are chronic inflammatory disorders prevalent in children and adolescents in underdeveloped countries, and a contributing factor for high morbidity and mortality rates worldwide. Their primary cause is oropharynx infection by , whose acetylated residues are recognized by ficolin-1. This is the only membrane-bound, as well as soluble activator molecule of the complement lectin pathway (LP). Read More

Rheumatol Int 2019 Mar 3;39(3):431-440. Epub 2019 Jan 3.

Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Pediatric Rheumatology is an emerging specialty in Turkey with increasing number of available centers and specialists all over the country. In this paper, we sought to provide an overview on pediatric rheumatology service in our country, as well as to assess the principle published literature from Turkey in this field. A systematic literature search has been performed to achieve the significance and the impact of this manuscript. Read More

Indian Heart J 2018 Dec 30;70 Suppl 3:S74-S81. Epub 2018 May 30.

CUNY School of Public Health University, New York, USA.

Background: The lack of surveillance system is a major barrier in prevention and control of rheumatic fever/rheumatic heart disease (RF/RHD). Efficacy of school-based surveillance was evaluated for detection of acute pharyngitis and RF/RHD in Shimla district, HP.

Methods: The schools in district Shimla were randomly assigned to intervention and controlled arm (442 vs. Read More

Indian Heart J 2018 Dec 19;70 Suppl 3:S68-S73. Epub 2018 May 19.

IGMC, Shimla, HP, India.

Objective: To report the prevalence, risk factors and consequences of atrial fibrillation (AF) in patients of rheumatic heart disease (RHD).

Methods: The Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry database of 1918 patients was analyzed. AF was diagnosed with 12-lead ECG recording at entry in to the registry. Read More

Indian Heart J 2018 Nov - Dec;70(6):907-910. Epub 2018 Jan 8.

All India Institute of Medical Sciences, Bhubaneswar, India. Electronic address:

A significant socioeconomic inequality is the main barrier to achieve primordial prevention of rheumatic heart disease (RHD) in the developing countries. An effective vaccine with affordable cost against Streptococcus yet to be identified. The subclinical nature of rheumatic fever (RF) is the main hurdle for effective primary prevention of RHD. Read More

BMJ Case Rep 2018 Dec 19;11(1). Epub 2018 Dec 19.

Department of Obstetrics and Gynecology, Philippine General Hospital, Manila, Metro Manila, Philippines.

A 20-year-old primigravid experienced sudden stiffening of the neck, upper and lower extremities and trunk associated with joint pains. She was generally well before hospital admission with no history of attacks, except for her inflammatory bowel disease that was treated more than a year ago. During physical examination, the patient manifested neck flexion deviated to the right, deviation of the eyes downward and to the right, spooning of the upper extremities, exhibition of milkmaid's grip, extension of both lower extremities and jerky speech. Read More