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Posts Tagged ‘inclusion of echo criteria for rheumatic fever’

Rheumatic fever and RHD is still a major cause for  cardio vascular morbidity and mortality in India .It seems , improving quality of life  has little  impact on the incidence .(We could realise  this as  we sit in the cardiology OPD of a 200 year old hospital !) There is no country wide data on the true prevalence .  Our understanding of rheumatic heart disease is based on isolated  studies on localized populations .

Of late , cardiology   resources  in our country is diverted towards  much glamorous CAD the poor continue to  suffer with  RHD.

Just Imagine many   hospitals indulge in 1000s of PTCA every year  but hardly do  a  hand full of PTMCs.

How our cath  lab resources  are used   across the breadth and length of country needs some introspection (Currently , I believe we have about 750   labs ) .I think there should  be a binding legislation  in every cath lab .For every 10 PTCAs done   at least one PTMC must be done to heal the poor .( Like the Air-craft license  .You can’t fly only the lucrative metro sector is given only if IT  services less developed areas )

In this scenario ,  it is a pleasant  surprise  to find a  wonderful review article on RHD from the two pioneers ,  in lesser known medical journal IJMR  .

Review article rheumatic fever  Indian journal of medical researchEspecially heartening  is  the fact ,  it is a collective effort  from two  distant  regions of India ( Kochi from down south and  New Delhi In the north) . While politicians keep the divide , it is a great  work  of the authors , which  would help  youngsters  who  would like  to go on a national mission on eradication of RHD. .

Reference

http://www.icmr.nic.in/ijmr/2013/april/centenary%20review%20article.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840767/#CIT12

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RHD is the scourge of mankind . While a part of the world is suffering from glamorous  lifestyle disease ,a  significant  population (The country I live – India , included)  is suffering due to  “lack of any style” in their  life !  exposed to  primitive streptococcal infections  and end up in deadly destructive heart valve disease .

While , the  privileged  cardiologists make merry in cath labs  ,  a  few toil in the deep sub Sahara forests and the tropics  of Cambodia  to bring some sense and balance  to  cardiology literature.

Mankind will benefit  much more  these committed souls* than the pseudo-research that is happening world wide !

Of course ,  we should thank the NEJM to publish  such  precious articles !

The summary of this article goes something  like this

Echocardiography ,  if used widely in general population  ( more specifically in children)  can identify rheumatic fever early with high degree of precision .With penicillin prophylaxis we can reduce the RHD burden of our planet significantly.

The message may be simple, but in the modern world  people’s suffering  is not due to lack of  sophisticated health tools , but  “lack of common sense “

This article came in 2007, unfortunately it has not  generated the  desired  impact  among the cardiac care takers  .(While  a  mediocre ,  drug eluting stent can reach 1000 cath labs in 100 countries in a matter  of weeks!)

The World health organisation (WHO) is yet to formally adopt this new  echocardiographic criteria to diagnose Rheumatic fever .We expect  the WHO , to urgently formulate new guidelines for early detection of rheumatic fever .(It is better , we stop hanging on to Jones for over  half  century !)

Will the WHO be proactive ?

If a portable echo costing few thousand dolors can save  millions of life , let the WHO the bring an ordinance to supply  (liberally ) manpower and  machines  to  all those poor countries  which lack in basic health service , but infested with  free supply of  deadly land mines , outsourced arms and ammunition !

This study was performed in  Maputo Heart Institute  Mozambique , and Cambodia .

http://www.nejm.org/doi/full/10.1056/NEJMoa065085

http://circ.ahajournals.org/cgi/reprint/120/8/663

* Three cheers to Eloi Marijon, M.D., Phalla Ou, M.D., David S. Celermaje .

Chain of Hope

Travel online to Africa : A journey into human side of cardiology  . . .

The charity  that has adapted  Maputo Heart Institute  Mozambique

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