Rheumatic heart disease (RHD) has a worldwide prevalence of 33 million cases and 270 000 deaths annually, making it the most common acquired heart disease in the world. There is a disparate global burden in developing countries. This case report aims to address the minimal RHD coverage by the international medical community. A Tahitian boy aged 10 years was diagnosed with advanced heart failure secondary to RHD at a local clinic. Previous, subtle symptoms of changes in handwriting and months of fever had gone unrecognised. Following a rapid referral to the nearest tertiary centre in New Zealand, urgent cardiac surgery took place. He returned home facing lifelong anticoagulation. This case highlights the RHD burden in Oceania, the limited access to paediatric cardiac services in countries where the RHD burden is greatest and the need for improved awareness of RHD by healthcare professionals, and the general public, in endemic areas.
Hydroxychloroquine (HCQ) suppresses an interleukin-1β-granulocyte-macrophage colony-stimulating factor cytokine axis, reported to be dysregulated in peripheral blood mononuclear cells of acute rheumatic fever patients ex vivo . We describe HCQ treatment for 2 patients with rheumatic carditis and a protracted inflammatory course. HCQ was associated with control of inflammatory markers, control of pericarditis in first patient and stabilization of progressive carditis in the second patient.
The familiar landscape of substance misuse in the UK is changing.Recently a briefing in the BJGP highlighted two newer misuse scenarios: legal highs and 'chemsex'. 1Another new misuse scenario generally escapes the attention of health professionals and others because it does not fit our concept of the term 'recreational drugs', since motivation for use is to enhance performance in exams or at work.However, so-called 'smart drugs' are prescription-only medicines; some being class B drugs.After becoming aware of this emerging issue the BMA Occupational Medicine Committee published a report. 2This editorial aims to distil the evidence most relevant for primary care specialists.
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