Subtle Myocardial Dysfunction and Fibrosis in Children with Rheumatic Heart Disease: Insight from 3D Echocardiography, 3D Speckle Tracking and Cardiac Magnetic Resonance Imaging.

Rheumatic heart disease (RHD) is a major cause of morbidity and mortality in developing countries, so early diagnosis and treatment can reduce morbidity and mortality resulting from subsequent valvular damage. The aim of this study was to detect subtle myocardial dysfunction among children with RHD with preserved left ventricular systolic function. This is a cross-sectional case-control study that was conducted on 30 children with RHD (who had valvular affection of any degree and were not in activity) compared to 23 healthy children. After history taking and cardiac examination, 2D echocardiography, tissue Doppler imaging, 3D-echocardiography and 3D speckle tracking echocardiography were done to both groups, whereas cardiac magnetic resonance imaging was done only to the patient group. The 3D-derived left ventricular end-diastolic volume and sphericity index among patients were significantly increased when compared to controls [131.5 (101.5 to 173.7) vs. 69 (58 to 92), P = 0.001, and 0.46 (0.36 to 0.59) vs. 0.33 (0.29 to 0.38), P = 0.001, respectively]. The 3D-derived ejection fraction and longitudinal strain did not differ significantly among both groups. The 3D-derived global circumferential strain was higher in patients when compared to controls [- 14 (- 16 to - 10) vs. - 11(- 13 to - 10), P = 0.04]. None of the examined patients demonstrated late enhancement myocardial fibrosis. In children with RHD and preserved systolic function, subtle systolic dysfunction could not be detected using conventional and novel non-conventional methods. This may indicate that the myocardial affection during the acute stage of rheumatic carditis is minimal with almost complete resolution.

Use of Kato and nucleopore techniques for qualitative diagnosis of schistosomiasis.

A comparison on qualitative basis, is attempted between merthiolate-iodine-formaldehyde concentration (MIFC) and Kato thick smear techniques for diagnosis of schistosome eggs in stools. As well, the centrifugation-sedimentation method was compared with the Nucleopore filtration technique for schistosome eggs in urine. Using MIFC and Kato techniques, 149 out of 185 subjects were found to have Schistosoma mansoni infection, 41 of them were diagnosed by Kato alone, while no case was solely MIFC positive. The sensitivity of MIFC compared to kato was 72.3% and both techniques were 100% specific. For diagnosis of S. haematobium infection, 78 out of 103 subjects were positive by centrifugation- sedimentation and/or Nucleopore techniques. 42 of them were diagnosed by Nucleopore alone and none was positive by centrifugation- sedimentation only. The sensitivity of the latter technique was 46.2% and both techniques were 100% specific. The study demonstrates that Kato thick smear and Nucleopore filtration are highly sensitive techniques that can be used for routine qualitative diagnosis of schistosomiasis. Under field conditions, they are qualitatively and quantitatively useful. The Kato technique besides its high sensitivity is very cheap. The only limitation for the Nucleopore technique is its relative high expenses.