Clinical Outcomes in 3343 Children and Adults with Rheumatic Heart Disease from 14 Low and Middle Income Countries: 2-Year Follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY study)

Background: There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease or information on their predictors. We report the 2-year follow-up of individuals with rheumatic heart disease from 14 low- and middle-income countries in Africa and Asia. Methods: Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive heart failure, stroke or transient ischemic attack, recurrent acute rheumatic fever, and infective endocarditis. Results: Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18–40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80–3.11), congestive heart failure (HR, 2.16; 95% CI, 1.70–2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32–2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10–1.78), and older age (HR, 1.02; 95% CI, 1.01–1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54–0.85) and female sex (HR, 0.65; 95% CI, 0.52–0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle–income countries had significantly higher age- and sex-adjusted mortality than patients from upper-middle–income countries. Valve surgery was significantly more common in upper-middle–income than in lower-middle– or low-income countries. Conclusions: Patients with clinical rheumatic heart disease have high mortality and morbidity despite being young; those from low- and lower-middle–income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and the treatment of clinical rheumatic heart disease are required to improve outcomes. </jats:sec

EFFECT OF CATHA EDULIS (KHAT) EXTRACT ON COLOR STABILITY OF ACRYLIC RESIN DENTURE TEETH: AN IN-VITRO STUDY

Background and aim: Long-term denture tooth color stability for patients is an important criterion in choosing the types of dental materials to use as one of the main concerns in treatment. Discoloration of denture teeth may result in patient dissatisfaction and an additional expense for their replacement. In Yemen, khat (Catha Edulis) chewing habit may affect the color of acrylic denture teeth. The aim of this study was to assess the effect of khat extract on color stability of reinforced acrylic resin denture teeth. Materials and Methods: Experimental design carried to 3 brands of reinforced acrylic resin teeth from three manufacturers, Vitapan, FX-Anterior and Shanghai-SND were evaluated 40 specimens (maxillary central incisors) of each brand were selected systematically and grouped into A, B and C respectively. All samples were stored in distilled water (DW) at 37 °C for 24 hours after which baseline colorimetric measurements were recorded by colorimeter. All the specimens were immersed for 24 hours daily and kept in an incubator at 37°C for 30 days. The KH was changed every 24 hours. Colorimeter was used for color change testing of each specimen after 10, 20 and 30 days on CIE L* a* b*. Then the collected data was analyzed using SPSS version 23. Results: The results of this study shows that there was a significant effect of KH on acrylic teeth (p&lt;0.001). Also, a significant interaction between the three brands acrylic teeth and KH was found (p&lt;0.05). The effect of time on acrylic teeth color stability was statistically significant (p&lt;0.05). The brands teeth specimens at 10, 20 and 30 days in KH revealed more significantly color change than DW (p&lt;0.05). Conclusions: The khat homogenate (KH) causes discoloration on the 3 brands of reinforced acrylic teeth and the discoloration increases with the passage of time. The change of discoloration is acceptable clinically except in SND teeth. Vitapin teeth has more color stable compared to FX teeth and SND teeth.                         Peer Review History: Received: 12 February 2023; Revised: 13 March; Accepted: 25 April 2023, Available online: 15 May 2023 Academic Editor: Prof. Dr. Gorkem Dulger, Duzce University, Turkey, [email protected] Received file:                             Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Khaled A AL-Haddad,Orthodontics, Pedodontics and Prevention Department Faculty of Dentistry, Sana'a University, Yemen, [email protected] Dr.  Masoomeh S Ghahfarokhi, University of Benin, Nigeria, [email protected]

PREVALENCE OF SIGNS OF TEMPOROMANDIBULAR DISORDERS IN HEALTHY ASYMPTOMATIC COMPLETELY EDENTULOUS INDIVIDUALS AND THE EFFECT OF DENTURE ON TEMPOROMANDIBULAR DISORDERS

Background and objectives: Temporomandibular disorders (TMD) are a multi-factorial issue characterized by signs and symptoms that eventually restrict or may impede an edentulous patient’s physiological activity. The current study aimed to ascertain the prevalence of TMD among edentulous individuals, and their association with risk factors such as gender, age, educational level, habitual Khat chewing, economical status, duration of edentulousness, the age, and vertical dimension of occlusion (OVD) of the present dentures. Materials and Methods: This study involved a thorough evaluation of 400 edentulous Yemeni patients who were undergoing prosthetic treatment at the Faculty of Dentistry Sana'a University and the University of Sciences and Technology, 114 with denture and 286 without denture. This evaluation of TMD signs and symptoms was performed using the Helkimo index. The outcomes were analyzed by correlating the research variables and the prevalence of signs and symptoms of TMD using chi-squared tests. Results: The study’s findings showed that signs and symptoms of TMD were 82.5% and 55.3% among complete denture wearers and 80.4% and 49.0% among non-denture wearers, respectively. Furthermore, the most frequent sign and symptom was the joint sounds. This study revealed a statistically significant association between the prevalence of TMD symptoms and patient gender and between TMD signs and symptoms and OVD in denture wearers. Conclusion: The current study supports the need to evaluate the potential impact of TMD on completely edentulous individuals and to take caution while receiving dental therapy and prosthetic rehabilitation.                        Peer Review History: Received: 6 January 2023; Revised: 11 February; Accepted: 5 March 2023, Available online: 15 March 2023 Academic Editor: Dr. DANIYAN Oluwatoyin Michael, Obafemi Awolowo University, ILE-IFE, Nigeria, [email protected] Received file:                             Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Alfonso Alexander Aguileral, University of Veracruz,  Mexico, [email protected] Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, [email protected] Similar Articles: HISTOLOGIC AND RADIOGRAPHIC STUDY OF PATHOLOGIC CHANGE IN COMPLETE IMPACTED THIRD MOLARS DENTAL FOLLICLE

Seven key actions to eradicate rheumatic heart disease in Africa: the Addis Ababa communiqué

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a ‘roadmap’ of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa. Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseases (NCD), (4) decentralise technical expertise and technology for diagnosing and managing ARF and RHD (including ultrasound of the heart), (5) establish national and regional centres of excellence for essential cardiac surgery for the treatment of affected patients and training of cardiovascular practitioners of the future, (6) initiate national multi-sectoral RHD programmes within NCD control programmes of affected countries, and (7) foster international partnerships with multinational organsations for resource mobilisation, monitoring and evaluation of the programme to end RHD in Africa. This Addis Ababa communiqué has since been endorsed by African Union heads of state, and plans are underway to implement the roadmap in order to end ARF and RHD in Africa in our lifetime

Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study)

AIMS: Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. METHODS AND RESULTS: This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12–51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries. CONCLUSION: Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level