Naveed Akhtar, Masood Sadiq, Faizul Hassan Rizvi, Haseena Chagani, Asad Hafeez, Adnan Gul, Madeeha Hina.
Pakistan cardiac society guidelines for prevention of rheumatic fever and rheumatic heart disease.
Pak Paed J Jan ;35(3):162-8.

Rheumatic fever (RF) is an inflammatory disease mediated by humoral and cellular auto-immune response that occurs as delayed sequelae of group A beta-hemolytic streptococcal infection of the throat1. It affects the connective tissue particularly in the heart, joints, skin and nervous system2. Rheumatic Heart Disease (RHD) is a crippling disease and is the most common cardiovascular disease in children and young adults and remains a major public problem in developing countries3. Poor housing conditions and over-crowding remain major contributing factors in facilitating the spread of group A beta-hemolytic streptococci4. RF and RHD cannot be separated from each other from epidemiological point of view. Recent data from Pakistan has shown a very high prevalence of RHD in both urban and rural population. In a large cross-sectional survey, conducted on more than 25000 urban school going children from inner Lahore using echocardiography to confirm the cardiac lesion, has estimated a prevalence of 22/10005. A study from Rahim Yar Khan from a rural area showed a prevalence rate of 5.7/1000. Less than 20% of the patients were aware of their diagnosis and only 8% were taking rheumatic fever prophylaxis6. Programs ensuring intense secondary prophylaxis and primary prevention, have attained relevant decrease in mortality, prevalence, incidence, hospital admission and severity of RF/RHD in the developing world7. The Scientific Council of Pakistan cardiac Society has extensively reviewed the current evidence based data on Rheumatic Fever to update the guidelines for Pakistan. The main objective of these guidelines is to identify and present the best evidence for practice of ARF diagnosis and prophylaxis

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