Publications by authors named "Miryan Cassandra"
Background: Rheumatic fever is a non-suppurative, inflammatory sequela of group A Streptococcus pharyngitis that can occur at two to four weeks after infection. Following an episode of rheumatic fever, there is a risk of developing rheumatic heart disease (RHD) later in life that carries significant risk of morbidity and mortality. RHD remains the largest global cause of cardiovascular disease in the young (age < 25 years).
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- Prolonged intramuscular injections of benzathine penicillin G (BPG) are essential for preventing group A streptococcal infections and reducing the risk of rheumatic fever and heart disease, but the pain from these injections may reduce patient compliance.
- * This systematic review and meta-analysis aimed to evaluate the effectiveness of local anaesthetics in reducing pain associated with BPG injections by analyzing randomised controlled trials comparing BPG alone to BPG with anaesthetics.
- * Out of 3958 records, eight trials with 489 patients were included, revealing that while patients reported high levels of immediate pain, some still experienced low-intensity pain 24 hours later.
Background: Early detection and diagnosis of acute rheumatic fever and rheumatic heart disease are key to preventing progression, and echocardiography has an important diagnostic role. Standard echocardiography might not be feasible in high-prevalence regions due to its high cost, complexity, and time requirement. Handheld echocardiography might be an easy-to-use, low-cost alternative, but its performance in screening for and diagnosing acute rheumatic fever and rheumatic heart disease needs further investigation.
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- - Secondary prevention with penicillin is crucial to avoiding repeat acute rheumatic fever and reducing the risk of rheumatic heart disease (RHD), though penicillin allergy reported by 10% of the population complicates this effort.
- - A comprehensive review of literature revealed no studies specifically addressing penicillin allergy testing in our initial context, but findings from other populations indicated low confirmed allergy rates and very limited severe reactions (less than 1-3 per 1000 treated).
- - Research on penicillin allergy delabeling showed that direct oral drug challenges resulted in fewer minor allergic reactions compared to skin testing, with no cases of anaphylaxis or fatalities; confirming or clearing penicillin allergies appears safe and has a low risk of adverse
Article Synopsis
- - Rheumatic Heart Disease (RHD) is a major cause of valvular heart disease globally, significantly impacting pregnancy outcomes, and echocardiography may play a key role in screening pregnant women for RHD in high-prevalence areas.
- - A review of 432 reports found 10 non-controlled studies involving 23,166 women, revealing RHD prevalence rates between 0.4% and 6.6% but with low certainty of evidence and high variability among studies.
- - While incorporating echocardiography in antenatal care might help detect RHD and other cardiac issues in asymptomatic pregnant women, more robust research is needed to validate its effectiveness compared to standard care.
Introduction: The incidence of cardiac implantable electronic device infections has increased significantly over the years and they are associated with significant morbidity and mortality. The epidemiology in the Central region of Portugal is not known.
Objective And Methods: To characterize cardiac implantable electronic device infections through a retrospective study of 3158 patients admitted to our center between January 2008 and September 2014 and to review the subject in the light of the current state of the art.
The authors describe a case of a rare complication occurring after cardiac surgery. Three weeks after aortic valve replacement a young male became hemodynamically unstable. The echocardiogram showed a large loculated hematoma compressing the right atrium.
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