The present study aims to determine the limitations of traditional Jones criteria during the first episode of acute rheu- matic fever (ARF) at the initial referral hospital, in a cohort of patients below 18 years old who had undergone mitral valve repair in National Heart Institute (IJN) from 2011 to 2016. Carditis followed by fever and joint involvement were the most frequent manifestations at first diagnosis. Of the 50 patients, only seven (14%) fulfilled the traditional Jones criteria for the diagnosis of the first episode of ARF. When compulsory evidence of a previous group A Beta he- molytic streptococcus (GABHS) was disregarded, this figure rose to 54%. Therefore, strict adherence to Jones criteria with absolute documentation of GABHS will lead to underdiagnoses of ARF. The application of echocardiographic diagnostic criteria of rheumatic heart disease (RHD) needs to be emphasized to allow early diagnosis and adminis- tration of secondary prophylaxis to prevent progression to severe valvular disease.
Background:
Prevention of hypothermia in patients undergoing major posterior approach spinal surgery can be difficult, as a
large body surface is exposed to the cold environment of the operating theatre. We compared the efficacy of a
new under-body forced-air warming blanket with that of a resistive heating blanket in preventing hypothermia.
Methods:
Sixty patients undergoing major posterior approach spinal surgery lasting for more than 2 hours were randomly
assigned to warming with a full under-body forced-air warming blanket or three segments of resistive heating
blankets, both set at 42°C. The ambient temperature was kept near 20°C. Nasopharyngeal, rectal and axillary
temperatures were measured at regular intervals. Changes in core temperature (average of nasopharyngeal
and rectal) over time were compared by the independent t-test.
Results:
The characteristics of the patients were comparable. The baseline core temperature was 36.36 ±0.38°C in the
forced-air group and 36.27 ± 0.46°C in the resistive heating group. During the first hour, the core temperature
decreased similarly from baseline in both groups. From 100 minutes after induction until the end of the surgery,
core temperature rose in both groups. At the end of surgery, the core temperature was increased by 0.08
± 0.09°C from baseline in the forced-air group but decreased by 0.40 ±0.04°C from baseline in the resistive
heating group. The difference in the change of the core temperature, at the end of the surgery, between the
two groups is statistically significant (P