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{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T05:35:02Z","timestamp":1623303302043},"reference-count":46,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2005,4,18]],"date-time":"2005-04-18T00:00:00Z","timestamp":1113782400000},"content-version":"unspecified","delay-in-days":807,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2003,2]]},"abstract":"<jats:p>We designed a multi-hospital prospective study of children less than 12 years to determine the comparative clinical profile, severity of carditis, and outcome on follow up of patients suffering an initial and recurrent episodes of acute rheumatic fever. The study extended over a period of 3 years, with diagnosis based on the Jones criteria. We included 161 children in the study, 57 having only one episode and 104 with recurrent episodes. Those seen in the first episode were differentiated from those with recurrent episodes on the basis of the history. The severity of carditis was graded by clinical and echocardiographic means. In those suffering their first episode, carditis was significantly less frequent (61.4%) compared to those having recurrent episodes (96.2%). Arthritis was more marked in the first episode (61.4%) compared to recurrent episodes (36.5%). Chorea was also significantly higher in the first episode (15.8%) compared to recurrent episodes (3.8%). Sub-cutaneous nodules were more-or-less the same in those suffering the first (7%) as opposed to recurrent episodes (5.8%), but Erythema marginatum was more marked during the first episode (3.5%), being rare in recurrent episodes at 0.9%. Fever was recorded in approximately the same numbers in first (45.6%) and recurrent episodes (48.1%). Arthralgia, in contrast, was less frequent in first (21.1%) compared to recurrent episodes (32.7%). A history of sore throat was significantly increased amongst those suffering the first episode (54.4%) compared to recurrent episodes (21.2%). When we compared the severity of carditis in the first versus recurrent episodes, at the start of study mild carditis was found in 29.8% versus 10.6%, moderate carditis in 26.3% versus 53.8%, and severe carditis in 5.3% versus 31.8% of cases, respectively. At the end of study, 30.3% of patients suffering their first episode were completely cured of carditis, and all others showed significant improvement compared to those with recurrent episodes, where only 6.8% were cured, little improvement or deterioration being noted in the remainder of the patients. We conclude that the clinical profile of acute rheumatic fever, especially that of carditis, is milder in those suffering their first attack compared to those with recurrent episodes.<\/jats:p>","DOI":"10.1017\/s1047951103000064","type":"journal-article","created":{"date-parts":[[2005,4,18]],"date-time":"2005-04-18T11:49:54Z","timestamp":1113824994000},"page":"28-35","source":"Crossref","is-referenced-by-count":11,"title":["Clinical profile of acute rheumatic fever in Pakistan"],"prefix":"10.1017","volume":"13","author":[{"given":"Hasina Suleman","family":"Chagani","sequence":"first","affiliation":[]},{"given":"Kalimuddin","family":"Aziz","sequence":"additional","affiliation":[]}],"member":"56","published-online":{"date-parts":[[2005,4,18]]},"reference":[{"key":"S1047951103000064_ref010","doi-asserted-by":"crossref","unstructured":"Alan L , Bisno . Group A streptococcal infection and acute rheumatic fever. 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Elsevier, New York, 1979, pp 183\u2013203."},{"key":"S1047951103000064_ref045","doi-asserted-by":"crossref","unstructured":"Markowitz M . Eradication of rheumatic fever. An unfulfilled hope. Circulation 1970; 41: 1077\u20131084.","DOI":"10.1161\/01.CIR.41.6.1077"},{"key":"S1047951103000064_ref005","unstructured":"Haig-Brown C . Tonsillitis in adolescent, Bailliere Tendoll and Cox, London 1886."},{"key":"S1047951103000064_ref017","unstructured":"Levine LI , Chapman SS , Guerra V , Cooper J , Krause RM . Studies on the transmission within the families of group A hemolytic streptococci. J Lab Clin Med 1966; 67: 483\u2013494."},{"key":"S1047951103000064_ref028","doi-asserted-by":"crossref","unstructured":"Ehmke DA , Stehbens JA , Young L . Two studies of compliance with daily prophylaxis in rheumatic fever patients in Iowa. Am J Public Health 1980; 70: 1189\u20131193.","DOI":"10.2105\/AJPH.70.11.1189"},{"key":"S1047951103000064_ref021","doi-asserted-by":"crossref","unstructured":"Ward C . The reappraisal of the clinical features in acute and chronic rheumatic heart disease. Etiology implications. Am Heart J 1979; 98: 298\u2013306.","DOI":"10.1016\/0002-8703(79)90040-1"},{"key":"S1047951103000064_ref009","doi-asserted-by":"crossref","unstructured":"Sanyal SK , Thaper MK , Ahmed SA , Hooja V , Tewari P . The initial attack of acute rheumatic fever during childhood in North India. A prospective study of the clinical profile. Circulation 1974; 49: 7\u201312.","DOI":"10.1161\/01.CIR.49.1.7"},{"key":"S1047951103000064_ref016","unstructured":"Strasser T . Rheumatic fever and rheumatic heart disease in the 1970's. WHO Chron. 1978; 32: 18\u201325."},{"key":"S1047951103000064_ref019","doi-asserted-by":"crossref","unstructured":"Bland EF , Jones TD . Rheumatic fever and rheumatic heart disease. A twenty-year report on 1000 patients followed since childhood. 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Chicago, 1991."},{"key":"S1047951103000064_ref039","unstructured":"Talbot R . Pockets of rheumatic fever in developed world. XI World Congress of Cardiology. Manila 1990."},{"key":"S1047951103000064_ref040","doi-asserted-by":"crossref","unstructured":"Taranta A , Markowitz M . Rheumatic fever. A guide to its recognition, prevention and cure, with special reference to developing countries. M.T.P. Press Ltd., Boston, 1981.","DOI":"10.1007\/978-94-015-7171-5"},{"key":"S1047951103000064_ref032","unstructured":"Intersociety commission for heart disease and resources. Rheumatic fever and rheumatic heart disease study group. Prevention of rheumatic fever and rheumatic heart disease. Circulation 1970; 41: A1\u201315."},{"key":"S1047951103000064_ref014","unstructured":"Rahimtoola RJ , Shafqat H , Ramzan A . Acute rheumatic fever and rheumatic carditis in children. Pak Heart J 1980; 3: 2\u20139."},{"key":"S1047951103000064_ref011","doi-asserted-by":"crossref","unstructured":"Gharib R . Acute rheumatic fever in Shiraz, Iran. It's prevalence and characteristics in two socio-economic groups. Am J Dis Child 1969: 118: 694\u2013699.","DOI":"10.1001\/archpedi.1969.02100040696005"},{"key":"S1047951103000064_ref008","unstructured":"Padmavati S . Rheumatic fever and rheumatic heart disease in developing countries. Bull. WHO 1979; 56: 543\u2013550."},{"key":"S1047951103000064_ref033","doi-asserted-by":"crossref","unstructured":"Spagnuolo M , Pasternack B , Taranta A . Risk of rheumatic fever recurrences after streptococcal infections. Prospective study of clinical and social factors. N Engl J Med 1971; 285: 641\u2013647.","DOI":"10.1056\/NEJM197109162851201"},{"key":"S1047951103000064_ref038","unstructured":"Meyer RJ , Haggerty RJ . Streptococcal infections in families. Factors altering individual susceptibility. Pediatrics 1962; 29: 539\u2013549."},{"key":"S1047951103000064_ref023","doi-asserted-by":"crossref","unstructured":"Feinstein AR , Spagnuolo M . The clinical patterns of acute rheumatic fever; A reappraisal. Medicine 1962; 41: 279\u2013305.","DOI":"10.1097\/00005792-196212000-00001"},{"key":"S1047951103000064_ref018","unstructured":"Shanks RA . Collagen and connective tissue diseases. In: Forfar JA , Arneil CC (eds) Textbook of Pediatrics. Churchill Livingstone, Edinburgh, 1978: 1501\u20131515."},{"key":"S1047951103000064_ref027","unstructured":"Billoo AG , Abbasi AS , Sultana S , Desa L , Syed SA . Prophylaxis against recurrence of rheumatic fever. Pak Heart J 1968; 1: 8\u201314."},{"key":"S1047951103000064_ref034","unstructured":"Syed SA . Rheumatic heart disease. Pak Heart J 1972; 5: 14\u201316."},{"key":"S1047951103000064_ref044","unstructured":"Community control of rheumatic heart disease in developing countries-II. Strategies for prevention and control. WHO Chron 1980; 34: 389\u2013395."},{"key":"S1047951103000064_ref006","unstructured":"Joshi MK , Kandoth PW , Barve RJ , Kamat JR . Rheumatic fever: Clinical profile of 339 cases with long term follow-up. Indian pediatr 1983; 20: 849\u2013853."},{"key":"S1047951103000064_ref030","unstructured":"Koshi G , Benjamin V , Cherian G . Rheumatic fever and rheumatic heart disease in rural south Indian children. Bull WHO 1981; 59: 599\u2013603."},{"key":"S1047951103000064_ref015","doi-asserted-by":"crossref","unstructured":"Robinson RD , Sultana S , Abbasi AS et al. Acute rheumatic fever in Karachi, Pakistan. Am J Cardiol 1966; 8: 548\u2013551.","DOI":"10.1016\/0002-9149(66)90009-9"}],"container-title":["Cardiology in the Young"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1047951103000064","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T22:32:57Z","timestamp":1586212377000},"score":1,"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,2]]},"references-count":46,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2003,2]]}},"alternative-id":["S1047951103000064"],"URL":"http:\/\/dx.doi.org\/10.1017\/s1047951103000064","relation":{},"ISSN":["1047-9511","1467-1107"],"issn-type":[{"value":"1047-9511","type":"print"},{"value":"1467-1107","type":"electronic"}],"subject":["Cardiology and Cardiovascular Medicine","General Medicine","Pediatrics, Perinatology, and Child Health"],"published":{"date-parts":[[2003,2]]}}}
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