Inclusion of echocardiographic evidence of carditis and possibly arthralgia as major criteria would improve case detection.

Aims-To describe the pattern of hypothermia and cold stress after delivery among a normal neonatal population in Nepal; to provide practical advice for improving thermal care in a resource limited maternity hospital. Methods-The principal government funded maternity hospital in Kathmandu, Nepal, with an annual delivery rate of 15 000 (constituting 400/o of all Kathmandu Valley deliveries), severe resource limitations (annual budget £250 000), and a cold winter climate provided the setting. Thirty five healthy term neonates not requiring special care were enrolled for study within 90 minutes ofbirth. Continuous ambulatory temperature monitoring, using microthermistor skin probes for forehead and axilla, a flexible rectal probe, and a black ball probe placed next to the infant for ambient temperature, was carried out. All probes were connected to a compact battery powered Squirrel Memory Logger, giving a temperature reading to 0.2°C at five minute intervals for 24 hours. Severity and duration of hypothermia, using cutoff values of core temperature less than 36°C, 34°C, and 32°C; and cold stress, using cutoff values of skin-core (forehead-axilla) temperature difference greater than 3°C and 4°Cwere the main outcome measures.Results-Twenty four hour mean ambient temperatures were generally lower than the WHO recommended level of 25°C (median 22.3°C, range 15.1-27.5°C). Postnatal hypothermia was prolonged, with axillary core temperatures only reaching 36°C after a mean of 6.4 hours (range 0 -21.1; SD 4.6).There was persistent and increasing cold stress over the first 24 hours with the core-skin (axi11ary-forehead) temperature gap exceeding 3°C for more than half of the first 24 hours. Conclusions-Continuous ambulatory recording identifies weak links in the "warm chain" for neonates. The severity and duration of thermal problems was greater than expected even in a hospital setting where some of the WHO recommendations had already been implemented. (Arch Dis Child 1996;75:F42-F45)

Backgrounds and Aims: Rheumatic heart disease is the commonest acquired heart disease in children of developing world presenting earlier and with a more severe valvular lesion. This study was conducted to assess the clinical and demographic profile, pattern of valvular involvement and management modalities among children with rheumatic heart disease.Methods: This was a hospital-based observational study, performed at Shahid Gangalal National Heart Center where all children less than 15 years of age with confirmed echocardiographic diagnosis of rheumatic heart disease from June 2015 to May 2016 were evaluated and relevant data were recorded.Results: Two hundred and eleven children were diagnosed with rheumatic heart disease. The mean age was 11.9 ± 2.2 years with (100) 47.4% male and (111) 52.6% female. The median duration of symptoms among new cases was 1 year (interquartile range of 0.5 to 2 years). The most common symptom was dyspnea present in (187) 88.6% children followed by palpitation (34.5%). Mitral valve was most commonly affected in (141) 96.5% while isolated aortic valve involvement was seen in (8) 3.5%. Isolated mitral regurgitation was the most common lesion present in 118 (55.9%) children, while 50 (23.7%) children had combination of mitral and aortic regurgitation. Mitral valve was significantly more commonly affected in females and aortic valve commonly affected in males (p= 0.003).Conclusions: Rheumatic heart disease although declining in developed countries, remains to be the commonest acquired heart disease in developing and underdeveloped countries. Efforts are needed to improve primary and secondary preventive measures.Nepalese Heart Journal 2016; 13(2): 33-36

Background Studies evaluating potential differences in normal cardiac dimensions and body mass indices of various ethnic populations using 2D echocardiography have reported variations based on gender and ethnicity. Currently, accepted echocardiographic reference values are from US studies, and the limited information is available on Nepalese population. The purpose of this study was to derive population-based reference values for two-dimensional (2D) guided M-mode echocardiographic dimensions and left ventricular mass of adult Nepalese that can be applied in epidemiologic studies, clinical trials and clinical practice. Methods 97 individuals were randomly selected, out of 502 staffs working in our hospital, who were over 18 years of age and were free of cardiovascular disease. Subjects underwent M-mode and 2D echocardiogram with color Doppler study. Reference values were derived for end-diastolic and end-systolic left ventricular internal dimensions, left ventricular wall thickness, left atrial dimension, aorta, LV mass. Measurements were described by mean, standard deviation and 95% reference range. Results Echocardiographic measurements were within standard normal limits. The measurements of aorta, left atrium, inter-ventricular septum, left ventricle in systole and diastole, left posterior wall and left ventricular mass, adjusted or not for body surface area, were significantly higher in males. Several echocardiographic measurements, adjusted or not for anthropometric measurements, had different mean and range than the reference limits in US-based studies. Conclusion The means and range for the measurements of left atrium volume, left ventricular diastolic dimension and left ventricular mass found in this survey were lower than those indicated by the international literature and accepted as normal limits. The results of this study strongly indicate the need for a larger scale study to further establish ethnic-specific and gender-specific echocardiographic reference values for the Nepalese population. DOI: http://dx.doi.org/10.3126/njh.v9i1.8339 Nepalese Heart Journal Vol.9(1) 2012 pp.3-6

Surgical intervention is warranted irrespective of age and helps correct and control hypertension better; however, significant numbers of patients still require antihypertensive medication and regular monitoring. Intervention using an interposition tube graft may affect the prevalence of hypertension.

Lipoblastoma is a rare benign tumour of infancy originating from white foetal adipose tissue. Most commonly located in the extremities, intrathoracic and mediastinal involvement of this tumour is rare, and an intracardiac location is even rarer, with only one reported case. Herein, we present a 2-month old asymptomatic boy diagnosed with an echogenic mass in the left ventricular outflow tract. The patient underwent surgical excision and histopathological evaluation revealed a lipoblastoma.

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Subclinical carditis occurred only in the first-episode patients, which requires further evaluation for clinical significance. Because all deaths occurred in recurrent RF group (P = 0.02), secondary prophylaxis and management of sore throat need re-emphasis.