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Prevevaalelenncece ooff

Pr

RRhheeuumat

maticic He

Heart

art DDiisseaeasese

iinn Sch

Schooool-l-CChhiildldrreenn ooff SShhiimla

mla

SSuupeperrvviisosorr

Dr. An

::Dr.

Anuuppaamm PPaarash

rashaarr

Co-su-supperervvisisoorr ::DDr.r. Re

Co

Rennuu

PPrese

resennted

ted by:

by:

VVai aibbhhavav shshaarma rma

(045588))

(04

VViikkran

rantt SShharma

arma

((04045599))

VViikkran rantt ThThaku akurr (0(0464600))

VViinneet eetBhBhard ardwwaj aj (0(0464611))

VViirat rat KKuunnttal alamam (0(0464633))

VViiren rendderer CChau hauhhanan (0(0446644))

We aarree Grate

We

Gratefufull toto

Dr. A.

Dr.

A. K.

K. Bhardw

Bhardwajaj

Prof

&& He

Headad

De

Dept.

pt. ofof CComommmununityity MMedic

ediciinene

Dr. AnAnmmol

Dr.

ol Gup

Guptata

As

Assoc.

soc. Prof

Prof

DDept.

ept. ofof Com

Commmuni

unityty MMeeddicicininee

Dr. AnAnupam

Dr.

upam Par

Parasashar

har

As

Asst.

st. PProf

rofeessssoror

Dr. Renu

Dr.

Renu

De

Dept.

pt. ofof CComommmununityity MMedic

ediciinene

De

Dept

ofof CCoommmmununityity Me

Medicine

dicine

Mrs. Veena

Mrs.

Veena ShShararmmaa

Principal

Pr

incipal

Mod Modeell PuPubl blicic Schoo School,l, SaSanj njaauli uli..

And

And all

all tthehe sstud

tudents

ents wwhhoo parti

particciipated

pated inin tthis

his sstudy

tudy..

Wh

Whyy RRHDHD ????

WWee ddoo nnoott iinnhheerit

rit He

Heaaltlthh && HHapapppininess

ess frofromm oourur

AAnncecestostorrss bubutt wwee bboorrrrooww itit frofromm oourur FFuututurree

ggeneneerarattioionns…s…

ØCripp

Cripplinlingg oourur Futu

Futurere ggeenera

neratiotionn

ØCCat atchcheses tthhemem yyoouunngg

Ø iinnci ciddeenncece amamoonngg FFememal aleses

Wh R R HD HD ?? ?? “ “ W W e e d d o

ØAAlready

lready LLooww SSexex Rat

Ratiioo

Ø RRHHDD CCoonst

nstitituutteses 3030-3-35%5% ooff hhosp

ospiittaall aadmdmiissi

ssioonn dduuee ttoo CVCVDD

ØPPrerevavallenencece lowlow bbut

ut SSiiggni

niffiicacant

nt MMoorbrbiiddiittyy && Mor

Morttali

alittyy

ØSSchchooooll ggoin

oingg ChChiillddren

stittuutteses 2200-2-25%5% ooff tot

totaall ppopopuullaattiioonn ooff InInddiiaa..

ren con

consti

Ø AAvvera eraggee aagege at at tthhee ttiimmee ooff ddeaeatthh duduee ttoo RHRHDD iiss 3535 yyrrss..

WWhahatt are

we dedeaalilingng wwithith??

are we

RRHDHD Crip

Cripplin

pling,

-commmmuunnicicaable

ble ddise

isease

ase

g, nnoonn-co

reresusulltintingg ddueue toto dederarannggeded iimmmmununee rreespspononsese

toto aa ccoommmmuunnica

icabblele ddisea

iseasese GGABABHH

SStrep

treptotoccococccaall PPhaharyrynngitis

gitis..

aa chchildild wwhoho hahass ppaainin inin LLeegsgs iiss sosooonn ggooing

ing ttoo

bbeeccoome

me ShShoortrt ooff bbrreeaathth aass wwell…”

ell

-- HHipipppoocra

crates.

tes.

HHeaealthy

lthy InIndiv

divididuauall

Re Recove coveryry mos mostt ooff tthehe TTiime me
Re
Recove
coveryry mos
mostt ooff
tthehe TTiime
me
GA GA BHS BHS Pharyn Pharyn g g i i ti ti s s

GAGABHS

BHS Pharyn

Pharynggiititiss

Cross

Cross Rea

Reacti

ctingng AAnt

ntige

igensns

Cross Cross Rea Rea cti cti ng ng A A nt nt ige ige ns ns

Immune Re

Immune

Ressponse

ponse

 
Deran g g e e d d I I mmune Deran mmune
 

Deranggeedd IImmune

Deran

mmune

Respons

Responsee

Antibooddies

Antib

ies agai

againsnstt oowwnntitissssueue

H H ea ea lthy lthy In In div div id id ua ua l l

VVarariious

ous Manif

Manifeesstatation

tionss

Sym

Sympto

H H ea ea lthy lthy In In div div id id ua ua l l

ptommss

SSign ignss
SSign
ignss

AAims

ims && Ob

Objec

jectivtiveess

ToTo ddeetermi

terminnee ththee PPrev

revaalelencncee ofof RRHHDD

aammoonngg SSchchooool-ch

l-childre

ildrenn inin SShhimimla.

la.

ToTo SStutuddyy the

the rreelalation

tion ofof RRHHDD with

with

FFaacto

ctorsrs like

like Ag

Agee && SSeex.

x.

Ø((ToTo Lea

Learrnn Ho

Howw anan EpEpididemio

emiolog

logica

icall SStud

tudyy isis

ddoonene?? ))

Mod

Moduuss Op

Opeerarannddi

i

....

..

Sample

Sam

ple ssiizeze ooff 217

217

AAgege GGrrooupup 5-11

5-11 yyears

ears..

School

Scho

ol nnoott ccoovverereedd inin ongoing

ongoing sstudy

tudy

condu

conduct

cteded bbyy

DDepeptt..

ofof CComommmunit

unityy MMedi

edicciine,

ne,

IGIGMMC,

C, SShi

himmla.

la.

QQues

uestitiononnnaaiirere bas

baseded ssuurrvveyey wwasas ddone

one

QQues

uestitiononss wwere

ere CCllososee Ended

Ended QQues

uesttions

ions wwiithth

answwererss iinn YYES’

ans

ES oror NNO’

O..

Criteria

Crit

eria for

for Study

Study:: MModified

odified JJones

ones CCrriteri

iteriaa

ShShoortrt HHiisstory

tory,, CCrrititeeririaa BBase

asedd QQui

uickck EExamxam &&

DDet

etaile

ailedd CCVVSS Exam

Examiinnat

ation

ion wwasas don

done.

e.

Students

Students wwiithth popossiititiveve findings

findings for

for RHRHDD were

were

ttoo bebe furt

furthheerr evevaaluated

luated byby sspepeci

ciali

alisststs at

at IGIGMMCC..

Final Diagno

Final

Diagnosis

sis wwasas ttoo bebe mmade

ade only

only aft

afterer

EEchocardiograph

chocardiographyy and

and CCol

oloorr DDooppler

ppler..

MMododiifie

fiedd JJoonneses CCrriiteterriiaa

MMajo ajorr

M M od od i i fie J J o o n n es es C

MMiinnoror

üCCard arditis itis

** CClinlinicical

al FFinindin

dings: gs:
dings:
gs:

üPoPolylyararthr thriittisis ## AArrthralgia thralgia

üCChhororeeaa ## Feve Feverr

üErythem

Erythemaa Ma

Marrgin

ginaatutumm

ü

ss..c.

** LaLabb Fin

Findin

dings:

gs:

c. nonoduduleless ## EESRSR

## CCRPRP

## PProlo

rolongngeedd PPRR iinte

nterrvavall

Queeststioionnnnaire

Qu

aire

H/o

H/o RRececuurrrreenntt SSore

ore TThrhrooaatt

H/o CChheestst PaPainin

H/o

H/o Fever/

H/o

Fever/ BBododyy acaches/

hes/ CChills/

hills/ RRigigors

ors

H/o Palpitations

H/o

Palpitations (( ifif yes,

assess sesevveerrityity))

yes, assess

H/o

H/o Syncope

Syncope

H/o JoJoint

H/o

int PaPainin (( fle

fleeting

eting ttypypee))

H/o Penicillin

H/o

Penicillin Pro

Prophylaxis

phylaxis

H/o

H/o SOB

SOB

H/o abno

H/o

abnormrmal

al invo

involun

luntatarryy mmoovevemment

entss ooff limlimbb

H/o

H/o PND

PND// OOrrththopn

opnoea

oea

H/o CCoough

H/o

ugh// Hem

Hemoptysis

optysis

H/o Pain

H/o

Pain upp

upperer aabbdom

domenen

Obs

Obseerrvvat

atioionns…s…

OOuutt ooff 221717 stustuddeents nts

9911 Gir

Girlsls && 112266 BoBoyyss

RReecucurre

rrenntt SSore

ore ThThrrooaatt

CChheesstt PaPainin

PPaalpita lpitation tion

SSynynccoopepe

SSOOBB

CCoougughh

JoJoint

int PPain

ain

1166 (7(7.4.4%%))

88 (3(3.7.7%%))

44 (1(1.8.8%)

%)

77 (3(3.2.2%%))

1144 (5(5.1.1%)

%)

2233 (1(10.

0.55%%))

55 (2.

(2.33%%))

Observations In Pies & Bars…

What ‘Pie’ Says…

Findingss onon GPGPEE

Finding

PPaallor llor 3399

on on GP GP E E … … Finding • P P a a llor

CCyayannosis osis 1177

on on GP GP E E … … Finding • P P a a llor

JaJauunndic dicee

on on GP GP E E … … Finding • P P a a llor

NNiill

CClulubbbbiningg NNiill

LLAAPP 1515

on on GP GP E E … … Finding • P P a a llor

JVJVPP

on on GP GP E E … … Finding • P P a a llor
on on GP GP E E … … Finding • P P a a llor

FFiindndiingngss oonn CVCVSS eexxaammina

inattiionon

Therere wwaass oonly

The

nly oonene ssigignnifificicanantt ffininddiinngg ooff

PPaarraaste

sterna

rnall HHeeaaveve aanndd PPaalpa

lpabblele PP22..

NNoo aannyy oothe

therr finfindin

dinggss spspececifi

ificcaallllyy ppooiinnting

ting

totowward

ardss PProb

robaabblele RRHDHD wa

wass dedetetecctteedd..

Preevvioiouuss SSttuuddieies…s…

Pr

IInndia

dia::

§ IICCMR

MR

2.1-1111/10

2.1-

/100000 ((avg

avg..

7/100000)0)

7/1

§ CCMC

MC Vellor

Velloree ((LLarges

argestt Stu

Studydy till

till date;

date; n=n=22,,229,829

9,829))

00.68/1

.68/1000000

HHima

imacchhal

al PPrarades

desh:

h:

§ 22.98/1

.98/1000000 inin Shim

Shimlala inin 19199494

§ 33.9/10

.9/100000 inin ShShimimlala inin 19195656

((Hig

that timtimee))

Highes

hestt ever

ever Inciden

Incidencece rreported

eported inin IIndi

ndiaa at

at that

§ 33.627

.627/10

/100000 inin Shim

Shimlala inin 199

19988

§ 11 ccasasee soso ffarar inin approx.

approx. 50500000 susurvrveeyed

yed

sstudent

tudents.s. (o(ongngoin

oingg stud

studyy;; DDept.

ept. ofof

CCoommmmununityity MMed.

ed. IIGMGMCC,, ShShimimlala.).)

TimTimee

ThThee Loo

Loopphhooles

les

InInaaddeqequuaatete sample

sample SSizizee ccoommbbine

inedd wwitithh

vveeryry loloww pprreevvaalen

lenccee..

SSeelelectio

ctionn BBiiaass

WWee aarere nnoott ExExppeertrt inin ththee FFiieeldld ccooncnceernrneed.

d.

CCoommpplian

lianccee ooff SSttuuddeenntt..

RReeliliaabbilit

ilityy ofof Hist

Histooryry giv

giveen.

n.

InInvveesstigtigaattiningg fafacciiliti

litieess iinnaaddeqequuaate.

te.

CClinic

linicaall fea

featutures

res nonott veveryry spspeecciific.

fic.

TThehe LLaasstt wwoorrddss

TeTeaachcheersrs wwere

ere rereccoommmmeenndededd ttoo reremmaainin

uultra

ltra vvigila

igilant

nt ffoorr ththee wwarn

arniningsgs ssyymmpto

ptommss

PPraracctticicaall susuggggeestion

stionss liklikee oopepenniningg ccerta

ertainin

wwinindodowwss for

for effec

effectivtivee ccrroossss vveennttilailatitioonn

wweerere aadvdvooccaatteedd..

ItIt wa

wass susuggggeeste

stedd tha

thatt aatt leleaasstt oonene ppaarerents

nts

teteaaccheherr mee

meetintingg mmuustst bbee hheelldd rreeggaarrddiningg

ininform

forminingg ththee ppaarreenntsts aabbououtt wwaarnin

rningg

symsympptotommss ooff ththee ddisiseeaase.

se.

CCoonntdtd

EEmmpphhasis

asis wwaass totolldd toto bbee llaaidid oonn ththoosese

cchhildre

ildrenn wwhhoo wwere

ere susuffffeeririnngg frofromm ppaalllloorr

aanndd ththeerree rorouutintinee chcheecckkupup wa

wass aaddvviisesedd..

THTHAANNKK YYOOUU !!!!