Detection and management of latent rheumatic heart disease: a narrative review.

Rheumatic heart disease (RHD) is a public health concern in many developing nations around the world. Early detection of latent or subclinical RHD can help in reversing mild lesions, retarding disease progression, reducing morbidity and mortality, and improving the quality of life of patients. Echocardiography is the gold-standard method for screening and confirming latent RHD cases. The rates and determinants of progression of latent RHD cases as assessed by echocardiography have been found to be variable through studies. Even though latent RHD has a slow rate of progression, the rate of progression of its subtype, 'definite' RHD, is substantial. A brief training of nonexpert operators on the use of handheld echocardiography with a simplified protocol is an important strategy to scale up the screening program to detect latent cases. Newer advancements in screening, such as deep-learning digital stethoscopes and telehealth services, have provided an opportunity to expand screening programs even in resource-constrained settings. Newer studies have established the efficacy and safety profile of secondary antibiotic prophylaxis in latent RHD. The concerned authorities in endemic regions of the world should work on improving the availability and accessibility of antibiotic prophylaxis.

Depression in Iraqi hemodialysis patients.

INTRODUCTION: Affective disorders, particularly depression, are the commonest and probably the most important psychopathological complication of end stage renal disease (ESRD). Depression has the potential to alter adversely the medical outcome of ESRD patients and the psychological stress can affect patient's adherence to medication regimen. In Iraq as well as many other Arab countries, the true prevalence of depression among ESRD patients is unknown. The objective of this study was to determine the prevalence of depression among a cohort of Iraqi hemodialysis (HD) patients and relate it to their socio-demographic characteristics. METHODS: We recruited patients from two HD centers in Baghdad, excluding patients with history of depression or other psychiatric disorders prior to the initiation of HD. The Arabic version of diagnostic and statistical manual of mental disorders fourth edition (DSM-IV) was used to diagnose depression. Beck's Depression Inventory was used to grade its severity. Clinical and laboratory data of the study group were documented and related to the diagnosis of depression. RESULTS: Seventy-five Iraqi patients on maintenance HD were included in the study. Patients' duration on HD ranged from six months to five years. The prevalence of depression among this cohort of HD patients was 80%. The prevalence of severe, moderate and mild depression was 25%, 50% and 25% respectively. The mean depression score was 17.1. Female gender, unemployment, and marital status had statistically significant associations with depression. CONCLUSION: Depression is common in this group of Iraqi HD patients and its prevalence is comparable to the results of similar studies in other societies.