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Background Rheumatic fever continues to be a major public health problem in the developing world, being responsible for many morbidities and mortalities. Were it not for its serious effects on the cardiovascular system, and to some extent on the central nervous system, the disease might no t have significant consequences. The central nervous system involvement is explained with Sydenham chorea in which case the patient manifests with purposeless and choreiform movements aggravated by stress. Apart from this movement disorder the patient will also demonstrate emotional liability and motor manifestations. It is seen more commonly in children and young adolescent girls. It usually manifests as an isolated phenomenon called pure chorea, without evidence of active rheumatic fever; the other rare form of which is a type of acute rheumatic fever. Clinical description This case report is about a nine-year-old female child presenting with two weeks of complaint of abnormal purposeless, non-rhythmic movement of extremities and the face, with failure to communicate. At presentation, she had non-pruritic skin lesions that had appeared a day prior to admission. The skin lesions were circular, red in color, and painless, involving the abdomen, and lower chest anteriorly, and extending to all extremities and the back. Two months previously she had a history of sore throat and treatment with unspecified P.O. medication. Antistreptolysin O (ASO) antibody was 430 Todd units/mL and the erythrocyte sedimentation rate was 58 mm/h. Echocardiography study revealed carditis (no evidence of chronicity) with moderate to severe MR, mild TR, no pulmonary hypertension, good biventricular function, and no pericardial effusion. Conclusion In this case report, we would like to show the central nervous system manifestation of rheumatic fever called Sydenham chorea seen together with erythema marginatum and other features of rheumatic fever.

Worldwide, congenital heart disease is the principal heart diseases in children and constitutes one of the major causes of infant mortality, particularly in developing countries. Infants and children with congenital heart disease exhibit a range of delays in weight gain and growth. In some instances, the delay can be relatively mild, whereas in other cases, cause the failure to thrive.OBJECTIVESTo determine the nutritional status and associated factors of pediatric patients with congenital heart disease.MATERIAL AND METHODSA cross sectional analytical study was done over a period of 6months (Feb to Jul 2020). A total of 228 subjects with congenital heart disease that come to the cardiac center during the study period where included until the calculated sample size was attained. Data was collected from patient card and care givers of the children included in the study after obtaining their informed consent using data inquiry sheet. Data was then analyzed using Statistical Package for Social Sciences (SPSS) for windows version 25.0. Data is presented using tables and text form. Odds Ratio with 95% Confidence Interval (CI) was used to determine the effect of the independent variables on the outcome variable and P-value less than 0.05 was considered statistically significant.RESULTSA total of 228 children from age 3month to 17yrs with mean age of 4.7 years (SD=3.8 years) were included in the study. Most of the subjects had acyanotic heart disease accounting for 87.7%. The overall prevalence of wasting, underweight and stunting were 41.3%, 49.1% and 43% respectively. Among this children with congenital heart disease those with PAH were found more likely have wasting compared to those without PAH with an odds of 1.9 (95% CI: 1.0-3.4) and also greater chance of being stunted with an odds of 1.9 (95% CI: 1.0-3.4). children above 5years of age were 2.3 times more likely to be underweight.CONCLUSIONMalnutrition is a major problem of patients with CHD. Pulmonary hypertension and older age are associated with increased risk of undernutrition.

Background: Rheumatic heart disease (RHD) remains the leading cardiovascular disease in Ethiopian children and adults. Early treatment of bacterial sore throat is important in primary prevention of acute rheumatic fever (ARF). In Ethiopian population knowledge about RHD and its prevention strategies is expected to be limited but few studies have been done. Methods: To determine awareness of RHD prevention in the community in Northern Ethiopia a descriptive cross-sectional study was conducted in three districts of Tigray, Northern Ethiopia. Using structured questionnaire, adults > 18 years selected by systematic random sampling were interviewed. Findings: A total of 1298 participants were included, 1004 (77·4%) were from rural areas, 978 (75·3%) were female and 823 (60·1%) had no formal education. Only 34 (2·6%) of the participants responded that the cause of sore throat is due to bacteria or virus and 6·2 % knew that there is a relation between sore throat and heart disease. Of the respondents, 43·3% would take children with sore throat to traditional healers, 71·6% had history of uvulectomy in their children or themselves. Only 7·8% answered that penicillin injection is useful in children with sore throat as primary prophylaxis and 8·1% answered that regular penicillin injection is useful as secondary prevention in RHD. Interpretation: These results can help understand the beliefs and practices about sore throat in Northern Ethiopia. We conclude that the community awareness on the cause and the link between bacterial pharyngitis and ARF/RHD is almost non-existent. Funding: Klinikpartnerschaften, Germany, supported the study. Declaration of Interest: None. Ethical Approval: An ethical approval for this study was obtained from Mekelle University Ethical Review Committee of the College of Health Sciences, Northern Ethiopia. A letter of permission was issued from the Tigray Regional Health Bureau and the district health authorities. Verbal informed consent from the household heads was obtained.