Consensus guidelines on pediatric acute rheumatic fever and rheumatic heart disease

JUSTIFICATION: Acute rheumatic fever and rheumatic chronic valvular heart disease is an important preventable cause of morbidity and mortality in suburban and rural India. Its diagnosis is based on clinical criteria. These criteria need verification and revision in the Indian context. Furthermore, there are glaring differences in management protocols available in literature. These facts prompted Indian Academy of Pediatrics to review the management of rheumatic fever. PROCESS: Management of Rheumatic fever was reviewed and recommendation was formulated at national consultative meeting on 20th May 2007 at New Delhi. OBJECTIVES: To formulate uniform guidelines on management of acute rheumatic fever and rheumatic heart disease in the Indian context. Guidelines were formulated for the management of streptococcal pharyngitis, acute rheumatic fever and its cardiac complication as well as secondary prophylaxis for recurrent episodes. RECOMMENDATIONS: (1) Streptococcal eradication with appropriate antibiotics (Benzathine penicillin single dose or penicillin V oral or azithromycin). (2) Diagnosis of rheumatic fever based on Jones criteria. (3) Control inflammatory process with aspirin with or without steroids (total duration of treatment of 12 weeks). (4) Treatment of chorea according to severity (therapy to continue for 2-3 weeks after clinical improvement). (5) Protocol for managing cardiac complication like valvular heart disease, congestive heart failure and atrial fibrillation. (6) Secondary prophylaxis with benzathine penicillin and management of anaphylaxis.     

Probiotics in health and disease in the pediatric patient

Probiotics are truly a timeless concept. Initially standard components of the human diet, potentially beneficial bacteria and yeast have been eliminated systematically through modern methods of preparing and preserving foods. Although the concept of probiotics is not new, the science of probiotics is in its infancy. Only recently have techniques been developed to identify, culture, and produce the probiotics that are suitable for medical use consistently. Furthermore, the potential uses for these organisms may extend far beyond what originally was thought. In no way should probiotics be thought of as a panacea for the diseases described earlier; however, when used appropriately, they represent a potentially beneficial adjunct to other proved therapies and have the added benefit of providing a stabilizing influence on the delicate balance between the ecosystem that consists of the human and its flora.     

中美儿童风湿性疾病现状分析

儿童风湿病学是一门发展中的学科。与美国相比,我国的临床和科研水平都相对滞后。建立规范的儿童风湿病管理体系,加强专科队伍建设,增加科研资金投入,以及重视儿童风湿病基础教学,转换医学模式,提倡多学科协作,对提高我国现阶段儿童风湿病诊治能力,促进学科发展至关重要。     

Cytomegalovirus infection in pediatric rheumatic diseases: a review

Human cytomegalovirus (HCMV) is familiar to pediatric rheumatologists mainly as a cause of opportunistic disease in pharmacologically immune suppressed patients. However, HCMV also has a variety of immuno-modulatory effects, through which it may influence the course of rheumatic conditions. In this article we discuss the interplay between HCMV and the immune system, and review the clinical manifestations, diagnosis, and treatment of HCMV infection in children with rheumatic disease.     

Immunologic and immunogenetic studies in rheumatic fever and rheumatic heart disease

In order to evaluate all the important limbs of the immune system in the same patient population with rheumatic fever (RF) and rheumatic heart disease (RHD) cellular and humoral immune parameters as well as the immunogenetic profile in 265 North Indian patients with RHD were evaluated. They were studied for class in HLA antigens and 165 of them were also evaluated for the class II (DR locus) antigen profile. Data obtained was compared with 400 and 134 healthy controls respectively of the same ethnicity. Humoral immune parameters (Serum immunoglobulins IgG, IgA; Serum complement fractions C3, C4, C3d; circulating immune complexes and B lymphocyte numbers) and cellular immune parameters (total leucocyte and lymphocyte counts; T lymphocyte sub-populations-CD4, CD8 counts; lymphocyte migration inhibition to an extracellular streptococcal antigen, streptolysin ’O’) were studied in 23 patients with RF, 21 patients with “inactive” RHD and 20 normal controls. Patients of RHD were noted to have an increased frequency of DR3 (P < 0.001; Relative risk = 2.3) and a decreased frequency of DR2 (P < 0.001; Relative risk = 0.3) as compared to the controls. Patients of RF had evidence of an altered regulatory T cell function (Increased CD4/CD8 ratio) and decreased cell mediated immunity to streptolysin ‘0’. An increased humoral immune response (increased B cell counts, elevated serum IgG, circulating immune complexes and C3d) was noted in patients of RF as well as “inactive” RHD. An integrated pathogenetic model with immune response associated antigens of the DR locus influencing selection of cardiac cross-reactive antigens by the antigen processing macrophages, an altered regulatory T cell function with decreased suppressor T cell activity leading to an abnormal immune response is proposed to explain the pathogenesis of RF.     

关注我国儿童风湿性疾病进展

随着医学科学的不断进步,在成人风湿病专业发展的影响下,越来越多的国内儿科医师开始关注儿童风湿性疾病.尤其近20年以来,在临床诊疗、基础研究方面,我国儿童风湿病领域取得了一定的成绩,但是与发达国家相比仍然存在差距.     

Evolution in pediatric health care

Background: There is disturbing evidence of escalating chronic disease among children – a phenomenon that is extracting a heavy toll from individuals, families, and health‐care systems. Methods: This review was prepared by assessing medical and scientific literature available from Medline, as well as by reviewing numerous books, conference proceedings, and government publications. Results: Knowledge translation in medical science, the process whereby new research is incorporated into clinical practice, remains lethargic. Nutritional and environmental factors have recently been recognized as common determinants of modern illness, and various diagnostic techniques in molecular medicine are now available to facilitate diagnosis of disease etiology. Conclusions: A re‐evaluation of the current pediatric clinical paradigm is required in light of emerging research from fields such as epigenetics, molecular medicine and environmental health. Education about these branches of medical science should be integrated into pediatric medical education, and important research information from these disciplines should be incorporated into public health care and clinical practice relating to children.     

高分辨率CT在儿童风湿病相关肺病中的应用进展

儿童风湿病是一种侵犯全身结缔组织的多系统疾病,肺是其侵犯的重要靶器官之一.高分辨率CT(HRCT)因其高空间分辨率等优点,在儿童风湿病相关肺病中应用日趋广泛.该文综述了HRCT在儿童风湿病相关肺病的应用,包括其检查方法、正常及基本病变的HRCT表现,并着重介绍了儿童常见的风湿病肺部累及的HRCT表现特征.