CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
246
AFRICA
1495: COMPARATIVE EFFECTIVENESS AMONG DIFFER-
ENT IMMUNOGLOBULIN FOR KAWASAKI DISEASE
Ming-Chih Lin
1,2,3
, Mei-Shu Lai
2
, Yun-Ching Fu
1,3
, Sheng-Ling Jan
1,3
1
Taichung Veterans General Hospital, Taichung, Taiwan
2
School of Medicine, National Yang-Ming University, Taipei, Taiwan
3
Institute of Epidemiology and Preventive Medicine, National Taiwan
University, Taiwan
Background:
Kawasaki disease is the leading cause of acquired
heart disease among children in most industrialised countries. Using
immunoglobulin to treat Kawasaki disease, only a few studies have
ever evaluated the comparative effectiveness among immunoglobulin
from different manufacturing processes. Moreover, those studies
were limited by small case numbers and lack of longitudinal follow
up. The aim of this study was to evaluate the comparative effective-
ness of immunoglobulin from different manufacturing processes.
Methods:
The data come from the National Health Insurance
Research Database of Taiwan. From 1997 to 2008, patients who
were admitted with the diagnosis of Kawasaki disease and receiv-
ing immunoglogulin therapies for the first time were enrolled in the
research cohort. The immunogloblulin manufacturing process was
divided into
β
-propiolactonation, acidification and containing IgA.
The comparative effectiveness was evaluated by portion of treatment
failure, acute aneurysm formation, chronic aneurysm formation and
recurrence.
Results:
Totally 3 830 children were enrolled in the cohort. For treat-
ment failure,
β
-propiolactonation had a relative risk of 1.45 (95% CI:
1.08–1.94). However, acidification and containing IgA were non-
significant. For acute aneurysms, acidification had a relative risk of
1.49 (95% CI: 1.17–1.90), but
β
-propiolactonation and containing
IgA were non-significant. For chronic aneurysm,
β
-propiolactonation
had a relative risk of 1.44 (95% CI: 1.18–1.76) and acidification
could protect it, with a relative risk of 0.82 (95% CI: 0.69–0.97).
Containing IgA was non-significant. For recurrence, all three factors
were non-significant.
Conclusions:
This is the first and largest longitudinal study evaluat-
ing immunoglobulin effectiveness.
β
-propiolactonation immuno-
globulin had higher risks for treatment failure and chronic coronary
aneurysm. Acidification may increase the risk for acute coronary
aneurysm. Further prospective studies may be needed to elucidate
the real causal relationship between manufacturing process and
outcomes.
1496: EPIDEMIOLOGY OF GROUP A STREPTOCOCCAL
PHARYNGITIS INTHEVANGUARD COMMUNITY DEMON-
STRATION SITE, SOUTH AFRICA
Mark Engel
1
, Ronald Gounden
1
, Andrew Whitelaw
1,2
, Dylan Barth
1
,
Karen Cohen
1
, Gary Maartens
1
, Jim Dale
3
, Bongani Mayosi
1
1
University of Cape Town, South Africa
2
National Health Laboratory Services, Douth Africa
3
University of Tennessee, USA
Background
: Incidence rates of group A streptococcal (GAS) swab-
positive pharyngitis from 3.9–95/100 child-years have been reported.
However, data from South Africa are scant and an understanding
of the incidence of GAS pharyngitis among children within a local
context is an important component of any acute rheumatic fever
and rheumatic heart disease (RHD) control programme. Treating
all symptomatic GAS sore throats in susceptible individuals in the
community with a course of oral or parenteral penicillin presents the
opportunity for primary intervention of RHD. The primary aim of
this study was to determine the crude incidence rate of GAS phar-
yngitis-associated disease burden among children with sore throat.
Methods
: We conducted a prospective, clinic-based study from
2008–2012. Following enrolment, participants with pharyngitis, aged
5–15 years were examined physically, before rendering a throat-swab
specimen for microbiological culture. SA census data were used to
estimate crude incidence rates.
Results
: We enrolled 840 participants with a mean age of 8.17 years,
presenting with pharyngitis as a symptom. GAS was positive in 181
patients (21.6%). The crude incidence of pharyngitis and GAS phar-
yngitis was estimated to be 837 and 180.4 cases/10
5
per year, respec-
tively. A significantly higher incidence of GAS pharyngitis was
observed in the younger age group (IRR 2.265, 95% CI: 1.61–3.21),
a trend seen throughout each year of the study period.
Discussion
: This is the first community-based prospective incidence
study of GAS-positive pharyngitis in Africa. While it is likely that
our prevalence and incidence rates are an underestimate, our data
nevertheless confirm that the complaint of GAS pharyngitis is
common, particularly among younger children. Our data call atten-
tion to the need for vigilance as to the correct management of sore
throat.
1497: ISOLATION OF THE RIGHT INNOMINATE ARTERY
WITH RETROGRADE FLOW INTO THE PULMONARY
ARTERY
Keng Yean Wong, Ching Kit Chen, Tze Liang Choo, Min Yu Tan,
Teng Hong Tan
Cardiology Service, KKWomen’s and Children’s Hospital, Singapore
Isolation of the innominate artery is a rare congenital vascular defect.
It is often associated with connection to the pulmonary artery. The
majority of patients described have right aortic arch and isolation of
the left innominate artery. A literature review by J Manner
et al.
in
1997 showed only one of 16 patients had an isolated right innominate
artery. We present a patient with a left aortic arch and isolation of the
right innominate artery.
Case report:
The patient is a six-year-old girl, diagnosed at birth
with a large ventricular septal defect and pulmonary hypertension
and 22q11 deletion. She had surgical repair of the VSD at three
months of age. Postoperative echocardiogram showed no residual
ventricular septal defect but the presence of a small patent ductus
arteriosus. A cardiac catheterisation was done with the intention
to close the duct. The angiogram showed a left aortic arch with
absent right innominate artery. The left carotid, left vertebral and left
subclavian arteries were seen. There was no patent ductus arteriosus
seen in the usual position. Retrograde flow following the aortogram
shows the right innominate artery draining via a duct into the main
pulmonary artery. Surgical correction is considered in view of the
arterio-venous steal. Manner
et al.
proposed that the pathogenesis of
this condition is related to derangement of the embryonic aortopul-
monary septation due to abnormal migration of neural crest cells.
Conclusion:
Isolated right innominate artery is a very rare condition.
This was seen in an asymptomatic patient with chromosome 22q11
deletion, unsuspected at the time of surgical repair of VSD, and can
be a challenge diagnose.
1501: EVALUATION OF CARDIAC FUNCTION USING
SPECKLE-TRACKING ECHOCARDIOGRAPHY AND
TISSUE DOPPLER IMAGING IN THALASSAEMIA MAJOR
PATIENTS
Jacqueline Ellero
2
, Sudeepthi Singarayar
1
, Owen Jones
1
, Christoph
Camphausen
1, 2
1
Cardiology Department, Sydney Children’s Hospital, Randwick,
Australia
2
School of Women’s & Children’s Health, University of New South
Wales, Australia
Background:
Speckle-tracking echocardiography (STE) and tissue
Doppler imaging (TDI) are new techniques available for objectively
quantifying the movement of individual cardiac segments. Increasing
data suggest that STE and TDI provide reliable estimates of cardiac
contractility and provide more detail than conventional echocardiog-
raphy (CE).
Objective:
To clarify the value of STE and TDI in the early detection
of myocardial dysfunction in chronically transfused thalassaemia
major patients.
