Deewakar Sharma

Clinical, laboratory and echocardiographic profile of acute rheumatic fever in Nepali children

Abstract Background: Acute rheumatic fever (RF) is a common, preventable health problem in developing countries. Sporadic outbreaks and the prevalence in some indigenous populations have renewed interest in RF in developed countries also. Aims: To describe the clinical, laboratory and echocardiographic features, outcome and value of echocardiography in detecting valvular disease in RF. Methods: A prospective, cross-sectional study was conducted over 2 years. Patients under 14 years admitted to the cardiology unit of Kanti Childrens Hospital, Kathmandu with RF using the Jones criteria were recruited consecutively. Results: The median age (range) of the 51 patients was 11 (5–14) years, the male:female ratio was 1.6:1 and 39% had a history of a sore throat. Clinical and laboratory features detected were as follows: carditis 92%, arthritis 33%, chorea 8%, subcutaneous nodules 4%, fever 51%, arthralgia 37%, elevated antistreptolysin O titre 94%, elevated CRP 78%, prolonged PR interval 45%, pericardial effusion 22% and cardiac failure 28%. In total, 36 patients (71%) complained of joint pains. A murmur on auscultation was significantly associated with underlying diseased valves confirmed by echocardiography (p=0.001). A murmur was audible in 78.4% and diseased valves were confirmed by echocardiography in 88.2%. The mitral valve was the most commonly involved valve (82%) and mitral regurgitation the commonest lesion (24%). A thickened mitral valve predicted carditis (p=0.007). Five (10%) patients died. Conclusion: Inclusion of echocardiographic evidence of carditis and possibly arthralgia as major criteria would improve case detection.

Prevalence of Metabolic Syndrome in a Suburban Community of Nepal

In context of rapidly rising prevalence of cardiovascular disease and risk factors in the developing world it has become important to study the scenario in its various aspects. This study conducted between March and July, 2007 in a suburban Nepali population deals with prevalence of metabolic syndrome according to the recently modified criteria for Asians. Altogether 150 subjects were randomly selected. The main component of the survey included administration of predetermined questionnaire, physical examination which included waist circumference measurement, height, weight, blood pressure measurement (twice), 12-lead ECG and fasting blood sample for lipid profile and glucose level. Prevalence of metabolic syndrome in our study according to the recent criteria developed by AHA/NHBLI is 12.4%. Significant Proportion of subjects diagnosed as having metabolic syndrome was not obese by traditional criteria but had increased waist circumference. Elevated triglyceride level was the most common component among subjects with metabolic syndrome was not obese by traditional criteria but had increased waist circumference. Elevated triglyceride level was the most common component among subjects with metabolic syndrome. Prevalence of metabolic syndrome syndrome in a suburban Nepali community seems to be significant. Thus, it is time for the developing countries to realize that the prevention of non-communicable diseases should also receive as much attention as that of nutritional and communicable diseases.