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All Journal Journal of Health and Nutrition Research Sciences of Pharmacy Frontiers on Healthcare Research
Kino Kino
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Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Health Professions Medicine & Pharmacology Nursing Public Health

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Coexistence of Infective Endocarditis and Recurrent Acute Rheumatic Fever: A Case Report Kino, Kino; Hariyanto, Didik; Fernando, Harben; Fahlevi, Indra
Frontiers on Healthcare Research Vol. 2 No. 2 (2025)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v2.n2.p29-34.2025

Abstract

Background: Infective endocarditis (IE) and recurrent acute rheumatic fever (ARF) are two serious cardiovascular conditions frequently associated with rheumatic heart disease (RHD). Their coexistence complicates diagnosis and management due to overlapping clinical features such as fever, migratory arthritis, and valvular dysfunction. This case report aims to elucidate the clinical presentation, diagnostic challenges, and treatment strategies in a pediatric patient with coexisting IE and recurrent ARF.   Methods: A detailed clinical case study was conducted involving a 10-year-old boy with a history of RHD presenting with joint pain and intermittent fever. Diagnostic evaluations included physical examination, laboratory investigations (including blood cultures and antistreptolysin O titers), and serial transthoracic echocardiography. Therapeutic interventions combined targeted intravenous antibiotics, corticosteroids, and secondary prophylaxis with benzathine penicillin G. Multidisciplinary consultations were employed to optimize management. Results: The patient exhibited echocardiographic evidence of mitral valve vegetations along with severe mitral regurgitation. Blood cultures remained negative, likely due to prior antibiotic exposure. Elevated antistreptolysin O titers confirmed recent streptococcal infection supporting recurrent ARF diagnosis. Clinical improvement was observed with symptom resolution and reduction in vegetation size on follow-up echocardiography. Multimodal therapy was well-tolerated, preventing further complications. Conclusion: This case highlights the diagnostic complexity and therapeutic balancing act required in managing coexisting IE and recurrent ARF in children with RHD. Early recognition through comprehensive evaluation and integrated treatment combining antimicrobial and immunomodulatory approaches can improve outcomes. Continued vigilance and multidisciplinary care are essential for preventing morbidity in this high-risk population.
Activin A and Heart Function in Severe Preeclampsia: Insights From Global Longitudinal Strain Sriyanti, Roza; Permatasari, Ressy; Kino, Kino
Journal of Health and Nutrition Research Vol. 4 No. 3 (2025)
Publisher : Media Publikasi Cendekia Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56303/jhnresearch.v4i3.605

Abstract

Preeclampsia, a serious pregnancy complication affecting 2–5% of women globally, is a leading cause of maternal and fetal mortality. Its prevalence in Indonesia ranges from 0.8–7% depending on parity. Associated with long-term cardiovascular risks, recent research suggests that elevated maternal activin A levels may play a causal role in linking severe preeclampsia to subsequent cardiovascular complications, particularly through mechanisms involving cellular damage, including to the heart. The aim of this study was to assess the correlation between Activin A circulating level and cardiac ventricular function as assessed by cardiac global longitudinal strain (GLS) in severe preeclampsia. A cross-sectional study was conducted at M. Djamil Hospital, Padang, West Sumatera, Indonesia with a total of 31 patients with severe preeclampsia. The Enzyme-Linked Immunosorbent Assay (ELISA) as used to determine the level of Activin A in the blood serum. Ventricular function was assessed from the global longitudinal strain using echocardiographic evaluation. The mean level of Activin A was 2.97 ± 1.91 ng/mL. From the echocardiographic evaluation, the mean cardiac GLS value was 18.01 ± 3.27%.  The correlation between activin A levels and cardiac ventricular function was analyzed using Pearson's correlation test, which showed a strong negative correlation (r = -0.718, p < 0.001). This indicates that higher activin A levels are significantly associated with lower GLS values, demonstrating worse ventricular function.
Management of Iodine Contrast Media Related Anaphylactic Shock following Renal Arteriography: A Rare Case Report Kino, Kino; Karmia, Rofila Dita; Harun, Harnavi
Sciences of Pharmacy Volume 5 Issue 1
Publisher : ETFLIN Publishing House

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58920/sciphar0501429

Abstract

Background, anaphylactic shock (AS) caused by iodinated contrast media (ICM) is a rare but potentially life-threatening immediate hypersensitivity reaction. Despite widespread use of ICM in diagnostic imaging, data on ICM-related AS are limited, particularly in Indonesia. Early recognition and timely intervention are crucial to reduce morbidity and mortality. Case presentation, a 28-year-old female underwent renal arteriography with iodixanol. Within 5 minutes of contrast administration, she developed a generalized pruritic rash, dyspnea, vomiting, hypotension, and unstable cardiac parameters. Clinical presentation confirmed iodixanol-induced anaphylactic shock. Management, initial management included intramuscular epinephrine, rapid intravenous fluids, intravenous antihistamines and corticosteroids, and norepinephrine infusion. The patient’s hemodynamic status stabilized, and she was monitored in the CVCU for 48 hours. Outcome and conclusion, the patient recovered fully without complications. This case emphasizes the importance of rapid recognition and prompt pharmacologic intervention in ICM-induced anaphylaxis, while highlighting the value of thorough allergy documentation and preventive counseling.
Recurrent Acute Rheumatic Fever with Severe Rheumatic Mitral Stenosis in 11-years-old Patient: A Case Report Kino, Kino; Hariyanto, Didik; Fernando, Harben; Risani, Puti
Frontiers on Healthcare Research Vol. 3 No. 1 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n1.p33-38.2026

Abstract

Background: Acute Rheumatic Fever (ARF) was an immune-mediated complication of Group A Streptococcus (GAS) infection that could progress to Rheumatic Heart Disease (RHD) through repeated or untreated episodes. While RHD typically developed over years, yet some children in endemic settings can develop severe multivalvular disease rapidly, likely due to unrecognized/subclinical ARF and inadequate secondary prophylaxis. This case adds to the literature by illustrating severe rheumatic mitral stenosis at a young age with clinical features suggestive of recurrent ARF despite no documented prior ARF, emphasizing rapid progression could occur in endemic settings. Case report: An 11-year-old male presented with exertional dyspnea and intermittent joint pain without swelling or redness. There was no previously documented ARF episode. Serology showed positive anti-streptolysin O (ASO) supporting recent streptococcal exposure. Echocardiography demonstrated severe mitral stenosis, moderate mitral regurgitation, moderate aortic regurgitation, moderate aortic stenosis, and severe tricuspid regurgitation with high probability of pulmonary hypertension. Diagnosis of recurrent ARF with severe RHD was established using the modified Jones criteria, supported by echocardiographic evidence of multivalvular involvement. Initial management was adjusted for penicillin allergy and included azithromycin, corticosteroids, beta-blockers, diuretics, and nutritional rehabilitation, followed by erythromycin for secondary prophylaxis. Conclusion: This case highlighted the possibility of rapid progression to severe RHD in children due to subclinical ARF. Early diagnosis, routine echocardiography, strict adherence to secondary prophylaxis, and patient education were vital to prevent long-term complications, including heart failure and surgical interventions.
Co-Authors Didik Hariyanto Fahlevi, Indra Fernando, Harben Harun Harnavi Karmia, Rofila Dita Permatasari, Ressy Risani, Puti Sriyanti, Roza