Objective:The aim of this study was to investigate the relationship between C-reactive protein and erythrocyte sedimentation rate and neutrophil-to-lymphocyte, platelet-to-lymphocyte, and monocyte-to-lymphocyte ratios in acute rheumatic fever in children.Method:In this retrospective study, 182 patients with acute rheumatic fever and 173 controls were included. Complete blood count parameters, and neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios were recorded for all the patients underwent transthoracic echocardiography.Results:Neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios were significantly higher in patients with rheumatic heart disease than patients without cardiac involvement (p < 0.05). C-reactive protein and erythrocyte sedimentation rate levels were found to have a positive correlation with neutrophil-to-lymphocyte (r = 0.228, p = 0.001; r = 0.355, p = 0.001), platelet-to-lymphocyte (r = 0.227, p = 0.01; r = 0.149, p = 0.005), and monocyte-to-lymphocyte ratios (r = 0.117, p = 0.005; r = 0.107, p = 0.044). Cardiac involvement was present in 152 (83.5%) of the patients. Neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios were significantly higher in patients with rheumatic heart disease than patients without cardiac involvement (p < 0.05). Patients with carditis were grouped according to mitral, aortic, or both valve involvement but there was no significant difference between the groups with respect to neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios. In addition, neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios were significantly higher in patients with Sydenham’s chorea than without chorea (p < 0.05).Conclusion:Neutrophil-to-lymphocyte, platelet-to-lymphocyte, and monocyte-to-lymphocyte ratios may help make the diagnosis of acute rheumatic fever and its prognosis by serial measurements in follow-up but none of them tell us the severity of carditis. Also, this is the first study showing the positive correlation between Sydenham’s chorea and neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios. Further studies are needed to confirm this hypothesis, as this is the first study in the literature on this topic.

MicroRNAs (miRNAs) are fine regulators of gene expression which participate in the regulation of almost every phase of cell physiology, including development of immune cells and adjustment of immune response. In the studies with in vitro/in vivo model systems, specific miRNAs are revealed to have various roles in cardiovascular development and physiological functions. Furthermore, some studies have been done to understand the role of miRNAs about myocarditis, heart failure and coronary artery diseases. miRNAs crucial role in the pathogenesis of other rheumatic diseases have been investigated, however rheumatic carditis was not studied. The aim of this study is to assess values of miRNAs in children with rheumatic carditis and compare them with healthy children. This study included 36 children with rheumatic carditis (mean aged 12.1 ± 2.1 years) and age-gender matched 35 healthy controls (mean aged 11.1 ± 2.3 years). Conventional echocardiography was performed to all subjects. Using real-time polymerase chain reaction, the expression of some miRNAs (hsamiR-16-5p, hsa-miR-221-3p, hsa-miR-223-3p, hsa-miR-10a-5p, hsa-miR-24-3p, hsamiR-92a-3p, hsa-iR-320a, hsa-miR-21-5p, hsa-miR-155-5p, hsa-miR-132-3p, hsamiR-146a-5p, hsa-miR-499a-5p, hsa-miR-1, hsa-miR-125, hsa-miR-196a-5p, hsa-miR-130b-3p, hsa-miR-133b, hsa-miR150-5p,hsa-miR-204-5p, hsa-miR-203a) were analyzed. hsa-miR-16-5p(-1.46 fold, p < 0.01), hsa-miR-223-3p(-1.46 fold, p < 0.01), and hsa-miR-92a-3p(-1.27 fold, p < 0.05) expressions in the patients were lower than those of controls, whereas other examined miRNAs did not differently express between the groups. Results of the study demonstrated that significant downregulation of hsa-miR-16-5p, hsa-miR-223-3p and hsa-miR-92a-3p in children with rheumatic carditis. Since, this is the first study in children with rheumatic carditis, further studies are needed for lightening whether these miRNAs might be helpful as biomarkers.

Decrease in LVEDD and presence of PH are associated with poor prognosis. Also, PH was associated with mortality in CDH patients. Thus, outcome may be predicted on careful echocardiographic evaluation of the LV diameters and pulmonary pressure.

The study concluded that 2D-speckle tracking echocardiography method can determine cardiac involvement earlier than conventional echocardiography in children with chronic kidney disease having preserved ejection fraction.

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