Rheumatic Fever

This research aims to evaluate the feasibility, sustainability, and public health impact of a district-based program for secondary prevention of Rheumatic Heart Disease (RHD) in Uganda. It is a non-randomized study testing the implementation of decentralized RHD preventive services, overseen by the Uganda Ministry of Health and District Health Offices in partnership with a technical quality assurance team. The study uses the RE-AIM framework to measure program reach, effectiveness, adoption, implementation, and maintenance while also estimating cost-effectiveness and budget impact. The study involves the ADUNU program, which integrates echocardiographic screening for RHD in children and young adults through community and facility-based testing. The program also includes registry-based secondary prophylaxis injections of Benzathine penicillin G (BPG) administered at local health centers (HCIII and HCIV) in the participating districts. This approach is designed to improve access to care and maintain patients linked to treatment. Participants and healthcare providers residing or working in the involved districts will engage with the program over several years. Researchers will assess the proportion of persons reached, enrolled, retained, and adherent to treatment at multiple time points up to five years. They will also evaluate program adoption and implementation at organizational, provider, and patient levels through surveys and interviews, alongside a cost analysis of the program at three years. The study ensures ongoing monitoring of adherence and outcomes to understand the program's public health impact.

Researchers are evaluating the need for antibiotic prevention in patients with chronic liver disease who have gastric varices and are treated with elective endoscopic injection of cyanoacrylate (GVO). Gastric varices can cause serious bleeding with a high chance of rebleeding and mortality. While endoscopic injection of tissue glue is effective in stopping acute bleeding, it still carries risks of rebleeding and infection, which are important concerns for patients with weakened immune systems due to liver conditions. The study compares two groups: one receiving an antibiotic called ertapenem injected intravenously before the endoscopic cyanoacrylate injection, and the other not receiving this antibiotic before the procedure. The trial is randomized and aims to clarify whether giving this antibiotic can help prevent infections and complications after GVO treatment. The treatment is delivered during an elective endoscopic procedure to manage gastric varices. Participants will be monitored for three years to evaluate key outcomes such as the prevention of sepsis, rebleeding rates, refractory bacterial infections, and mortality. Assessments will include tracking infections and bleeding events over time. The study is designed to provide long-term data on the benefits and risks of using antibiotic prophylaxis in this patient group, with ongoing safety monitoring throughout the follow-up period.

Researchers are evaluating whether AI-enabled, nurse-led treatment planning can match or improve the quality of clinical reasoning and management compared to standard physician-led care in adults aged 18 years and older. The study focuses on patients in rural and semi-urban India presenting with hypertension, diabetes mellitus, fever, breathlessness, or musculoskeletal pain. It aims to determine if nurse consultations supported by a large language model (LLM) achieve clinical quality scores that are not worse than those of physician consultations and to assess patient acceptance and satisfaction with AI-assisted nurse care. Participants receive two consultations during the same visit: one led by a nurse using an AI-based clinical decision support tool and one by a physician providing standard care. The nurse-led consultation involves routine history taking and clinical assessment, with interaction through a digital interface to the LLM for assistance in diagnosis, reasoning, and treatment planning. The physician consultation follows usual clinical practice without AI support. The study compares these two approaches in a randomized order within each participant. Throughout the study visit, both consultations are audio recorded for blinded clinical quality evaluation. After the nurse + LLM consultation, participants complete an exit survey measuring communication, trust, and satisfaction. Researchers also gather nurse-reported feedback on acceptability and feasibility through interviews after nurses complete at least 10 AI-assisted consultations. The main outcome measured is the clinical quality of the consultations immediately after both visits, with additional assessments of patient experience and nurse perspectives over up to nine months.

Researchers are investigating genetic factors that may contribute to human disorders of inflammation, including conditions like VEXAS syndrome and other autoinflammatory diseases. This exploratory natural history study aims to better understand these diseases by identifying genetic causes, examining immune system features, and describing clinical characteristics through medical record review. Participants include those with known or suspected autoinflammatory diseases, their family members, and healthy volunteers. Samples such as blood, saliva, hair, nails, or cheek swabs may be collected for genetic and immunologic studies. Some participants might also undergo skin biopsies. The study is observational and involves no treatment interventions. During the study, researchers will collect biological samples and review medical histories to discover genetic variants linked to inflammatory diseases. The main outcomes measured are the numbers of newly identified genetic changes that may cause or increase susceptibility to these disorders. Participation involves providing samples, consenting to medical record review, and may include follow-up over several years to monitor findings.

This research evaluates the accuracy and consistency of an AI platform called OpenGenome that analyzes free-text symptom descriptions submitted voluntarily by adults. The study collects anonymous symptom data and matches it with real biomedical literature from PubMed and ClinicalTrials.gov to generate structured biological signal reports. It aims to assess how well the extracted signals align with sources, how confidence scores correlate with dataset size and symptom specificity, and the distribution of biological signals across a large population. Adults aged 18 or older can submit free-text symptom descriptions via the OpenGenome platform, which then uses an AI-assisted method to extract primary and secondary biological signals grounded in biomedical evidence. For each submission, the system retrieves up to 16 relevant sources and provides a confidence score and signal strength. No treatment or intervention is given, and no participant contact occurs during the observational registry. Participants are involved by voluntarily submitting symptom descriptions online through the platform, with all data anonymized at collection. The study continuously monitors the internal signal-source concordance rate over 12 months. There are no in-person visits or direct assessments, ensuring privacy and minimal burden. This ongoing data collection helps researchers understand the platform's accuracy and signal calibration in a broad anonymous population.

Researchers are exploring a new way to personalize treatment for autoimmune and autoinflammatory rheumatic diseases. This study aims to develop and use a special cell-based test that helps predict how well patients will respond to disease-modifying antirheumatic drugs (DMARDs). By identifying the best treatment for each person, the study hopes to improve treatment success, shorten the time to see benefits, and lower healthcare costs. The approach focuses on analyzing immune cells from patients to better understand their response to different therapies. The study includes several groups: newly diagnosed patients without prior treatment, patients already on immunomodulatory therapy, and healthy individuals for comparison. Blood samples are collected at different times depending on the group. Researchers use advanced laboratory methods to test immune cell responses to DMARDs outside the body, measuring specific immune signals and gene activity. Archived tissue samples are also studied to link immune profiles with disease features. This design allows detailed analysis of immune function related to treatment. Participants will provide blood samples and undergo clinical assessments over time, including baseline and follow-up visits at 6 and 12 weeks, with additional optional visits if disease worsens or treatment changes. The study measures changes in immune cell types and activity using the ex vivo assay and other tests. Data are stored securely, and the study will compare predicted responses with actual clinical outcomes to validate the test's usefulness. Participants' involvement may last up to a year, with ongoing monitoring and data collection to support personalized therapy development.

Researchers are evaluating a telemedicine system designed for continuous monitoring of body temperature in adults who have fever. This pilot study is nonrandomized and conducted at a single center, aiming to assess both the effectiveness and safety of the device. Up to 40 adults hospitalized for infections or other conditions causing temperature changes will participate, with no randomization or stratification of participants. The investigational device will be placed in the armpit area and connected to a mobile phone to continuously record temperature readings. Study staff will also manually measure skin temperature in the opposite armpit using a gallium thermometer every 30 to 60 minutes, increasing frequency if the temperature rises or if temperature-lowering drugs are administered. The device will stay in place for up to 72 hours, followed by an additional 72-hour monitoring period after removal to observe for any side effects. Participants will be monitored closely by research staff during device placement and after removal, with temperature checks and safety evaluations continuing throughout the six-day period. The main measurement is the correlation between the telemedicine device readings and standard thermometer measurements over 72 hours. Researchers will also track any adverse events related to the device or procedures during the entire monitoring period.

Juvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease in children that causes pain, joint swelling, and loss of function, which can reduce quality of life and lead to muscle weakness, limited motion, and walking difficulties. Researchers are evaluating the Dynamic Gait Index (DGI) as a new tool to assess walking ability in children with JIA, since current methods lack a functional walking test for this group. The study aims to determine whether the DGI is a reliable and valid measure for evaluating walking challenges in these children. The study includes two groups: children diagnosed with JIA and age-matched healthy volunteers. The DGI test measures walking on level ground, changing speed, head turns, pivot turns, jumping over obstacles, walking around obstacles, and climbing stairs. Each activity is scored to assess walking ability. Additional physical tests include the Timed Up and Go Test, walking speed measurement, Wong-Baker FACES Pain Scale for pain assessment, Pediatric Balance Scale, and Childhood Health Assessment Questionnaire. These tests will be conducted at the start and again two weeks later. Participants will undergo physical examinations involving several walking and balance tests. Researchers will measure outcomes such as the DGI score, walking speed, timed up and go performance, pain levels, and balance ability. These measurements will help evaluate the walking function and risks related to falls in children with JIA compared to healthy peers. The study will monitor participants over a two-week period after baseline testing to assess the consistency and reliability of the DGI for this purpose.

This research aims to explore how intravenous vitamin C infusion affects the occurrence of fever during labor in women who receive epidural pain relief. The study focuses on reducing fever-related impacts on both mothers and infants to improve their health outcomes and offers guidance for clinical preventive treatments. It is a phase 4 randomized controlled trial involving women experiencing labor complications and fever. Participants will receive epidural labor analgesia through a catheter placed in the lower spine, with an initial test dose followed by a continuous patient-controlled epidural analgesia pump. After the epidural anesthesia is started, participants are randomly assigned to receive either 1 g, 2 g, or 3 g of vitamin C intravenously, or a placebo of normal saline, all infused at a rate of 5 ml per minute. During the study, maternal temperature and fever status are monitored every two hours until delivery. Blood tests are taken before analgesia, when fever develops, and after delivery. Researchers will also assess pain levels, total analgesic use, delivery details, and newborn health immediately after birth. The study includes safety monitoring and records infant care needs, with participation lasting through labor and delivery.

This research aims to evaluate how effective a school-centered program is at preventing latent rheumatic heart disease among schoolchildren in Nepal. It also investigates how socioeconomic and environmental factors influence the development and progression of this disease. Rheumatic heart disease is a serious condition affecting many children worldwide, especially in regions where group A beta-hemolytic streptococcal (GAHBS) infections are common, which can lead to acute rheumatic fever and heart damage. The study involves implementing a dedicated school nurse program at Tulsi Secondary Boarding School, focusing on assessing, intervening, and following up on cases of GAHBS pharyngitis. This program also facilitates secondary antibiotic prevention for children identified with latent rheumatic heart disease through echocardiography screening. The program is designed to provide timely detection and treatment to reduce the disease burden through primary and secondary prevention efforts. Participants, children aged 5 to 16 years attending the school, will undergo echocardiography before the program starts and again two and four years after implementation to measure the prevalence of latent rheumatic heart disease. Researchers will collect sociodemographic information through interviews and monitor outcomes such as GAHBS pharyngitis, acute rheumatic fever, and adverse reactions to penicillin. This longitudinal approach aims to assess the program's impact on disease prevalence and identify factors related to disease progression over a four-year period.