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Related Concept Videos

Rheumatic Heart Disease III: Medical Management01:21

Rheumatic Heart Disease III: Medical Management

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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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Rheumatic Heart Disease I: Introduction01:23

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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Rheumatic Heart Disease IV: Nursing Management01:20

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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies01:22

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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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This lesson will focus on the different treatment options for managing tonsillitis, which typically depend on the cause and severity.
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Tonsillitis is inflammation of the tonsils, which are two lymphoid tissue masses at the back of the throat. This condition can cause discomfort and irritation in the throat.
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First Presentation Acute Rheumatic Fever is Preventable in a Community Setting: A School-based Intervention.

Diana Lennon1, Philippa Anderson, Melissa Kerdemilidis

  • 1From the *Department of Pediatrics, University of Auckland, †Division of Pediatric Infectious Diseases, Starship Children's Hospital, Auckland District Health Board, ‡Division of Child Health, Kids First Public Health Nursing, Kidz First Community, and §Division of Population Health, Counties Manukau District Health Board, Auckland, New Zealand; ¶Division of Funding and Planning, Canterbury and West Coast District Health Board, Christchurch, New Zealand; ‖Invercargill Medical Centre, Invercargill, New Zealand; **National Hauora Coalition, and ††Division of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.

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Summary
This summary is machine-generated.

School-based sore throat clinics effectively reduced acute rheumatic fever (ARF) rates in children by treating group A streptococcal (GAS) pharyngitis. This initiative also lowered GAS prevalence, demonstrating a successful community prevention strategy.

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Area of Science:

  • Public Health
  • Infectious Disease Prevention
  • Pediatric Cardiology

Background:

  • Limited evidence exists for community-based programs aimed at preventing initial acute rheumatic fever (ARF) cases through timely treatment of group A streptococcal (GAS) pharyngitis.
  • Acute rheumatic fever remains a significant public health concern, particularly in certain pediatric populations, necessitating effective prevention strategies.

Purpose of the Study:

  • To evaluate the impact of implementing a school-based sore throat clinic program on the incidence of first-time ARF presentations among school-aged children.
  • To assess changes in pharyngeal group A streptococcal (GAS) prevalence following the introduction of the intervention.

Main Methods:

  • A school-based sore throat clinic program was introduced in Auckland, New Zealand, covering approximately 25,000 students aged 5-13 years across 61 schools from 2010-2016.
  • Culture-proven GAS pharyngitis cases identified by nurses and lay workers were treated with amoxicillin. ARF incidence was determined using a population-based register, and pharyngeal GAS prevalence was monitored annually in a subset of students.
  • A generalized linear mixed model was employed to analyze ARF rate changes before and after the staggered implementation of the school clinics.

Main Results:

  • Following the introduction of school clinics, ARF rates in 5-13 year olds decreased by 58%, from 88 to 37 per 100,000 children within two years.
  • Statistical analysis revealed no significant change in ARF rates before the clinic's introduction (P = 0.88), but a significant decline after its implementation (P = 0.008).
  • Pharyngeal GAS prevalence decreased significantly from 22.4% pre-intervention to 11.9% and 11.4% in the subsequent one to two years (P = 0.005).

Conclusions:

  • School-based management of group A streptococcal pharyngitis, utilizing oral amoxicillin, led to a significant reduction in acute rheumatic fever incidence.
  • The observed decline in ARF rates was concurrent with a decrease in pharyngeal GAS prevalence, supporting the program's effectiveness in disease prevention.