array:21 [
  "pii" => "13108070"
  "issn" => "16954033"
  "doi" => "10.1157/13108069"
  "estado" => "S300"
  "fechaPublicacion" => "2007-07-01"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "An Pediatr (Barc). 2007;67:1-4"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 17098
    "formatos" => array:3 [
      "EPUB" => 112
      "HTML" => 16172
      "PDF" => 814
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "13108069"
      "issn" => "16954033"
      "doi" => "10.1157/13108069"
      "estado" => "S300"
      "fechaPublicacion" => "2007-07-01"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "fla"
      "cita" => "An Pediatr (Barc). 2007;67:1-4"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 37801
        "formatos" => array:3 [
          "EPUB" => 126
          "HTML" => 34939
          "PDF" => 2736
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Fiebre reumática aguda"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "1"
            "paginaFinal" => "4"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Acute rheumatic fever"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:6 [
            "identificador" => "fig1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier España"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "37v67n01-13108069fig01.jpg"
                "Alto" => 473
                "Ancho" => 408
                "Tamanyo" => 39780
              ]
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A Carceller-Blanchard"
            "autores" => array:1 [
              0 => array:2 [
                "Iniciales" => "A"
                "apellidos" => "Carceller-Blanchard"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "13108070"
          "doi" => "10.1157/13108069"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108070?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108069?idApp=UINPBA00005H"
      "url" => "/16954033/0000006700000001/v0_201404141729/13108069/v0_201404141729/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "13108072"
    "issn" => "16954033"
    "doi" => "10.1157/13108071"
    "estado" => "S300"
    "fechaPublicacion" => "2007-07-01"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "An Pediatr (Barc). 2007;67:5-10"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 10514
      "formatos" => array:3 [
        "EPUB" => 108
        "HTML" => 9722
        "PDF" => 684
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "titulo" => "Acute rheumatic fever: 27 year experience from the Montreal's Pediatric Tertiary Care Centers"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "5"
          "paginaFinal" => "10"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Fiebre reumática aguda: 27 años de experiencia en los hospitales pediátricos en Montreal"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A Carceller, B Tapiero, E Rubin, J Miró"
          "autores" => array:4 [
            0 => array:2 [
              "Iniciales" => "A"
              "apellidos" => "Carceller"
            ]
            1 => array:2 [
              "Iniciales" => "B"
              "apellidos" => "Tapiero"
            ]
            2 => array:2 [
              "Iniciales" => "E"
              "apellidos" => "Rubin"
            ]
            3 => array:2 [
              "Iniciales" => "J"
              "apellidos" => "Miró"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "13108071"
        "doi" => "10.1157/13108071"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108071?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108072?idApp=UINPBA00005H"
    "url" => "/16954033/0000006700000001/v0_201404141729/13108072/v0_201404141729/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "13108069"
    "issn" => "16954033"
    "doi" => "10.1157/13108069"
    "estado" => "S300"
    "fechaPublicacion" => "2007-07-01"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "An Pediatr (Barc). 2007;67:1-4"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 37801
      "formatos" => array:3 [
        "EPUB" => 126
        "HTML" => 34939
        "PDF" => 2736
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Fiebre reumática aguda"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "1"
          "paginaFinal" => "4"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Acute rheumatic fever"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:6 [
          "identificador" => "fig1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "37v67n01-13108069fig01.jpg"
              "Alto" => 473
              "Ancho" => 408
              "Tamanyo" => 39780
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A Carceller-Blanchard"
          "autores" => array:1 [
            0 => array:2 [
              "Iniciales" => "A"
              "apellidos" => "Carceller-Blanchard"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "13108070"
        "doi" => "10.1157/13108069"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108070?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108069?idApp=UINPBA00005H"
    "url" => "/16954033/0000006700000001/v0_201404141729/13108069/v0_201404141729/es/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "Acute rheumatic fever"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "1"
        "paginaFinal" => "4"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "A Carceller"
        "autores" => array:1 [
          0 => array:3 [
            "Iniciales" => "A"
            "apellidos" => "Carceller"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Pediatrics Department. CHU Sainte-Justine. Université de Montréal. Montreal. Canada."
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Fiebre reum&#225;tica aguda"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:6 [
        "identificador" => "fig1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "37v67n01-13108070fig01.jpg"
            "Alto" => 473
            "Ancho" => 408
            "Tamanyo" => 39718
          ]
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Unreliable legend related that Vitus&#39; intercession freed Emperor Diocletian&#39;s son of an evil spirit and cured from so called &#34;Saint Vitus Dance&#34;&#46; Probably if Vitus was born in our era&#44; he has never been saint&#44; because we know now&#44; chorea is able to resolve without treatment and without a miracle&#46; Saint Vitus &#40;died 303&#41; is the patron of children and invoked against Saint Vitus Dance or Sydenham&#39;s Chorea&#46;</p><p class="elsevierStylePara"><img src="37v67n01-13108070fig01.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">A case</span></p><p class="elsevierStylePara">1838&#46; Ten-year-old girl complained of general rheumatic symptoms&#59; pains in the limbs&#44; with puffiness and swelling of the wrists&#44; and some other joints&#46; Six days later&#44; she developed chorea&#58; her head was constantly tilting from one side of the bed to the other&#59; her lips closed and opened with a smacking sound&#44; and when she tried to put out her tongue it protruded in a forced grimace&#46; A rapid and irregular heart-beat led to suspect that the heart was also affected&#46; Sixteen days later&#44; the girl died&#46; After the autopsy&#44; Bright<span class="elsevierStyleSup">1</span> discovered that both the pericardium and the endocardium were involved&#46; Careful dissection of the brain failed to yield any perceptible abnormalities<span class="elsevierStyleSup">2</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Definition</span></p><p class="elsevierStylePara">Rheumatic Fever &#40;RF&#41; is a delayed and inflammatory disease non suppurative sequel of upper respiratory infection with group A <span class="elsevierStyleItalic">Streptococci</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">History</span></p><p class="elsevierStylePara">Acute migratory arthritis of children appeared in the time of Hippocrates&#44; a physician born in 460 BC on the island of Cos&#44; Greece&#46; The term chorea derived from a Greek word &#34;khoreia&#34; which means &#34;dancing&#34;&#46; It was introduced by Paracelsus &#40;1493-1541&#41; to describe hysterical movements of religious fanatics during the Middle Age&#46; The concept of Rheumatic Fever evolved from manifestations known in the 17<span class="elsevierStyleSup">th</span> Century as &#180;&#180;Rheumatism&#180;&#180; and it was described first by Guillaume Du Baillou in France &#40;1538&#41; and by Thomas Sydenham in England &#40;1686&#41;<span class="elsevierStyleSup">3</span>&#46; Sydenham used the designation St&#46; Vitus&#39; dance to describe chorea<span class="elsevierStyleSup">4</span>&#46; In 1761 Morgagni &#40;in Italy&#41; described the valvular lesions&#46; Joseph-Ir&#233;n&#233;e Itard&#44; a Parisian medical student probably was in 1824&#44; the first to study this disease&#59; he sustained a twenty-four-page thesis for graduation from medical school entitled &#34;Considerations sur le Rhumatisme de Coeur&#34;<span class="elsevierStyleSup">5</span>&#46; Richard Bright in 1838&#44; a prominent London physician called attention in his Lecture at the College of Physicians in London&#44; to the association of chorea with diseases of pericardium and he was the first to associate all the anomalies with rheumatic fever<span class="elsevierStyleSup">2</span>&#46; Dr James Kingston Fowler&#44; who was serving as house physician at King&#39;s College Hospital in 1874&#44; contracted a rheumatic fever and he was the first to report tonsillitis as a common precursor of rheumatic fever in collaboration with Walter Butler Cheadle<span class="elsevierStyleSup">6</span>&#46; It is in 1904 that Aschoff described the cardiac nodules&#46; In 1928 in New York&#44; F Swift introduced the hypothesis that rheumatic fever results from the development of hypersensitivity to <span class="elsevierStyleItalic">Streptococci</span> and is only in 1932 that Edgar W Todd evidenced to support the hypothesis of an immune pathogenesis of rheumatic fever with the discovery of antistreptolysins<span class="elsevierStyleSup">4</span>&#46; In 1944&#44; T Duckett Jones gave the first lecture about RF&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Epidemiology</span></p><p class="elsevierStylePara">The frequency of the RF was 100-200 cases per 100&#44;000 in the US population in 1900 and 50 per 100&#44;000 in 1940&#46; Until the early 1980&#39;s there was a decline to about 0&#46;5 per 100&#44;000 with a localized outbreaks<span class="elsevierStyleSup">7-14</span>&#46; In Europe&#44; there have been similar declines and it has become a rare disease&#46; Although&#44; in undeveloping countries&#44; RF still endemic and remains the major cause of acquired heart disease in young adults&#46;</p><p class="elsevierStylePara">Factors relating to the decrease in RF were still unknown<span class="elsevierStyleSup">15</span>&#46; Over the past Century&#44; living conditions and crowding were improved in most countries&#44; contributing to the declining of the disease&#46; We don&#39;t know if virulence of group A <span class="elsevierStyleItalic">Streptococci</span> is declining or if human resistance to these bacteria is increasing&#46; Of course&#44; penicillin treatment has contributed to declining mortality and morbidity due to streptococcal infections&#44; including RF&#44; but the reasons for the decline before penicillin were not apparent<span class="elsevierStyleSup">16</span>&#46; The incidence and prevalence of this disease steadily have declined as has mortality in the past decade<span class="elsevierStyleSup">17-19</span>&#46; Factors that have contributed to the decrease in the incidence of acute rheumatic fever &#40;ARF&#41; may include changes in the host&#44; the environment or the pathogen<span class="elsevierStyleSup">17</span>&#46;</p><p class="elsevierStylePara">RF usually appears between 5 and 18 years old patients and it is rare before the age of 3 years&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Pathogenesis</span></p><p class="elsevierStylePara">Despite epidemiological and clinical research&#44; the precise pathogenesis of RF remains unknown<span class="elsevierStyleSup">20</span>&#46; Socio-economic factors have little importance in RF occurrence&#46; Some authors currently favour the theory that ARF is an autoimmune disorder after an immunologic cross-reaction response to the antecedent streptococcal infection<span class="elsevierStyleSup">21</span>&#46;</p><p class="elsevierStylePara">Group A <span class="elsevierStyleItalic">Streptococci</span> vary in their rheumatogenic potential&#46; Strains causing clusters or epidemics usually belong to certain serotypes 1&#44; 3&#44; 5&#44; 6&#44; 18&#44; 19&#44; 24 and are often heavily encapsulated as evidenced by their growth as mucoid colonies on blood agar plates&#46; Approximately 3 &#37; of untreated patients could to develop ARF<span class="elsevierStyleSup">21</span>&#46;</p><p class="elsevierStylePara">Rheumatogenic <span class="elsevierStyleItalic">Streptococci</span> adhere to pharyngeal cells<span class="elsevierStyleSup">22</span>&#46; The absorbed products of streptococcal degradation act as antigens and have molecular mimicry with different human tissues&#46; They are identified by the macrophages and presented to the T cell receptors producing cytokines which activates B cells to become immunoglobulin&#46; Antibodies to the <span class="elsevierStyleItalic">Streptococci</span> may cross-react with heart&#44; brain and&#47;or joint tissue resulting in carditis&#44; chorea or arthritis&#46; Components of the streptococcal cell wall and of the cell membrane contain epitopes that share antigenic determinants with certain constituents of the human tissues&#46; The hyaluronic acid and the N-Acetyl glucosamine in capsule react with the hyaluronic acid of joint tissue&#46; M-Protein&#44; the group A carbohydrate and the N-Acetyl glucosamine in cell wall react with tropomyosine&#44; myosine and glycoprotein of the heart&#46; Lipoproteins in Protoplasm react with neuronal tissue and affect basal ganglia regions of the caudate and putamen&#46; This <span class="elsevierStyleItalic"> humoral reaction</span> clears without sequel&#46; Persistent rheumatic heart disease&#44; as Aschoff body&#44; is a result of <span class="elsevierStyleItalic">cellular reaction</span>  and is the persistence of T cell activity in valve tissue<span class="elsevierStyleSup">23&#44;24</span>&#46;</p><p class="elsevierStylePara">Although&#44; several observations show that more than one member is affected in the same family&#44; only small percentage of individuals experienced streptococcal infection&#44; some individuals developing recurrent attacks or</p><p class="elsevierStylePara">exhibiting specific HLA antigen&#59; all these factors suggest that RF may be modulated by the specific genetic constitution of the host<span class="elsevierStyleSup">23</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Clinical expression</span></p><p class="elsevierStylePara">The diagnosis of RF is based on clinical criteria and may be difficult to establish it given the current rarity of the disease and the absence of any pathognomonic laboratory tests&#46;</p><p class="elsevierStylePara">The migratory polyarthritis with fever was the initial sign of RF in the past in approximately 75 &#37; of patients&#44; actually is really less frequently seen&#46; Knees&#44; ankles&#44; elbows and wrists are the most commonly affected joints&#59; arthritis improves without treatment in 1 to 3 days and it has a dramatic response to salicylates<span class="elsevierStyleSup">25</span>&#46; Recent international studies documented monoarticular arthritis as a presenting sign in ARF<span class="elsevierStyleSup">26</span>&#46; Although in 2000&#44; the Jones Criteria Working Group<span class="elsevierStyleSup">27</span> acknowledged the importance of monoarticular arthritis among people in undeveloped countries&#44; this diagnosis has not been universally accepted as major criteria in developed countries&#46; The Workshop<span class="elsevierStyleSup">27</span> did not address the potential need for antibiotic prophylaxis in patients with post streptococcal reactive arthritis who did not fulfill the Jones Criteria&#46;</p><p class="elsevierStylePara">Carditis&#44; the most serious manifestation of RF occurs within 3 weeks after Group A streptococcal infection&#46; It is a pancarditis&#58; Endocarditis that is almost always present&#44; mitral regurgitation is the most common pathology in RF associated or not to the aortic regurgitation&#59; Myocardial disease with atrioventricular conduction disorders or with congestive heart failure and Pericarditis who is rare &#40;&#60; 5 &#37;&#41;&#46; Cardiac involvement is seen in about 50 &#37; of patients with ARF and with the help of echocardiography in about 70 &#37;&#46; The use of Doppler-echocardiography should be used as an adjunctive technique to confirm clinical auscultatory findings&#59; although&#44; it should not be used as a major or minor criterion for establishing the diagnosis of carditis associated with ARF<span class="elsevierStyleSup">27</span>&#46; Clinical research is needed to determine the prognostic implications of subclinical valvular regurgitation&#46;</p><p class="elsevierStylePara">Sydenham&#39;s Chorea is a delayed manifestation of RF &#40;occurs 1 to 6 months&#41; after a Group A streptococcal infection&#46; Resulting from an autoimmune attack on the CNS&#44; sera from patients with chorea contain antibodies that cross-react with basal ganglia neurons&#46; Pathophysiology of Sydenham Chorea can be divided into four areas&#58; <span class="elsevierStyleItalic">Neuroanatomy</span> with basal ganglia regions of the caudate&#44; putamen and subthalamic nucleus dysfunction&#59; <span class="elsevierStyleItalic">Neurochemistry</span> with imbalance among the dopaminergic&#44; cholinergic and the inhibitory gamma aminobutyric acid systems&#59; <span class="elsevierStyleItalic"> Immunology</span> with production of antineuronal antibodies and inflammatory cytokines and <span class="elsevierStyleItalic">Genetics</span> as RF frequently appeared in multiple members of a family<span class="elsevierStyleSup">28</span>&#46; This disorder is characterized by sudden non-voluntary</p><p class="elsevierStylePara">arrhythmic and clonic purposeless mouvements&#46; Sometimes&#44; children present hypotonia&#44; gait disturbance&#44; incoordination&#44; loss of fine motor control&#44; facial grimacing&#44; gross fasciculations of the tongue&#44; and speech abnormalities with dysarthria&#44; explosive speech and emotional labilities&#46; Chorea is a clinic diagnostic due to the lower frequency of others positive results of the laboratory and may present without any other major or minor features of RF&#46; She was frequently seen in the 1950&#39;s and her incidence declined substantially to 10-30 &#37;&#46; Neuro-imaging as increased signal in the caudate and putamen nucleus have been reported in patients with Sydenham&#39;s chorea&#46; Chorea resolves in 2 to 3 months&#44; the treatment of Sydenham&#39;s Chorea is purely symptomatic and different drugs are used in her treatment although a few studies strongly support their efficacy&#46; Susan Swedo<span class="elsevierStyleSup">29</span> was the first to describe the paediatric auto-immune neuropsychiatric disorders associated with <span class="elsevierStyleItalic"> Streptococcus</span> &#40;PANDAS&#41; as different diagnosis from Syndenham&#39;s chorea&#46;</p><p class="elsevierStylePara">Transient erythema marginatum occurs to less than 2 &#37; of patients&#59; it consists of erythematous serpiginous&#44; macular lesions with pale central clearing on the trunk and extremities&#46; Subcutaneous nodules occur in less than 1 &#37; of cases and they resolve within one month without long-term sequelae&#46; They are firm&#44; non-tender&#44; varying in size from a few millimetres to 1-2 cm of diameter&#44; over bony prominences and in tendon sheaths<span class="elsevierStyleSup">30</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Criteria</span></p><p class="elsevierStylePara">Criteria are used at the acute stage of the disease&#46; The first criteria were established by Jones<span class="elsevierStyleSup">31</span> in 1940 and there were some updates&#44; the last one in 1992<span class="elsevierStyleSup">25&#44;32-34</span>&#46; In 2000&#44; the American Heart Association agreed that there were insufficient data to support a revision of the Jones Criteria and reaffirmed the guidelines iterated in the 1992 statement<span class="elsevierStyleSup">27</span>&#46;</p><p class="elsevierStylePara">The diagnosis of RF is highly suggested when two major criteria or one major and two minor criteria are fulfilled in a patient with previous streptococcal infection diagnosed by positive culture of throat and&#47;or elevated or rising streptococcal antibody titter&#46;</p><p class="elsevierStylePara">Major criteria are polyarthritis&#44; carditis&#44; chorea&#44; erythema marginatum and subcutaneous nodules&#46; Minor criteria are fever&#44; arthralgia&#44; elevated erythrocyte sedimentation rate &#40;ESR&#41; or C-reactive protein &#40;CRP&#41; and prolonged PR interval on the electrocardiogram&#46;</p><p class="elsevierStylePara">RF is now a rare disease in most of Europe and North America&#44; making its diagnosis more difficult to establish&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Diagnosis</span></p><p class="elsevierStylePara">Positive throat culture of Group A Streptococcal infection is infrequently found and the absence of a positive culture does not exclude the diagnosis of RF<span class="elsevierStyleSup">35&#44;36</span>&#46; Antistreptolysin O antibody &#40;ASO&#41; and anti-DNase B are of limited diagnostic value because 20 &#37; of cases presented without raised antibody levels<span class="elsevierStyleSup">30</span>&#46; The ESR or CRP should be measured and usually they are increased&#46; Chorea could be present as isolated manifestation&#44; frequently when a patient presents&#44; acute phase reactant levels may have normalized&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Outcome</span></p><p class="elsevierStylePara">Deaths are related to heart failure and it is really rare in industrialized countries&#46; Prophylaxis prevents recurrences&#46; Relapses are more frequent in the first 3 years after a first episode of RF&#46; Patients with residual valve disease must be followed by echocardiography every 6 months for the first 2 years after first episode of RF&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Treatment</span></p><p class="elsevierStylePara">The therapeutic management of the ARF need to treat the inflammatory process&#44; to eradicate the <span class="elsevierStyleItalic">Streptococcus</span> and to continue for long term prophylaxis&#46;</p><p class="elsevierStylePara">An anti-inflammatory treatment are required if severe carditis is present&#58; prednisolone 2 mg&#47;kg&#47;day and less than 80 mg&#47;day&#44; given in 1 dose&#47;day for 3-4 weeks decreasing over 6-8 weeks and followed by aspirin who is started 1 week before termination of steroids&#46; The dose of aspirin is 80-100 mg&#47;kg&#47;day&#44; 4 doses&#47;day during 4-8 weeks&#59; decreasing over the following 4 weeks&#46; In mild to moderate carditis&#44; corticosteroids are not essential and we can treat with aspirin directly&#46;</p><p class="elsevierStylePara">Patients need to receive penicillin for ten days to eradicate <span class="elsevierStyleItalic">Streptococcus</span>&#46;</p><p class="elsevierStylePara">The prophylaxis consisted to receive intramuscular penicillin benzathine given every 28 days&#44; if bodyweight is less than 27 kg the dose is 600&#44;000 international units &#40;IU&#41;&#44; if bodyweight is more than 27 kg&#44; the dose is 1&#46;200&#44;000 IU&#46; In the cases where intramuscular penicillin is not safe&#44; we can give 250 mg twice per os of Penicillin V and in the case of allergy to penicillin we can use erythromycin 250 mg twice per os&#46;</p><p class="elsevierStylePara">All children who have suffered cardiac sequelae must be thoroughly instructed on risk prevention of bacterial endocarditis &#40;AMH&#41;<span class="elsevierStyleSup">37</span>&#46;</p><p class="elsevierStylePara">In conclusion&#58;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">1&#46;</span>Although the acute rheumatic fever has become a rare disease in industrialized countries&#44; it remains prevalent&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">2&#46;</span>In 2000&#44; the American Heart Association agreed that there were insufficient data to support a revision of the Jones Criteria and reaffirmed the guidelines iterated in the 1992 statement&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">3&#46;</span>In pediatrics&#44; Criteria are a guide but should not replace clinical judgment&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> Acknowledge</span></p><p class="elsevierStylePara">The author would like to thank Mrs Ana Maria C&#46; Blanchard for her English expertise&#46;</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleBold"> Correspondence&#58;</span> Ana Carceller MD&#46;<br></br> Department of Pediatrics&#46; CHU Sainte-Justine&#46;<br></br> 3175 C&#244;te Ste-Catherine&#46; Montr&#233;al&#46; Qu&#233;bec H3T 1C5&#46; Canada&#46;<br></br> E-mail&#58; <a href="mailto&#58;ana&#95;carceller&#64;ssss&#46;gouv&#46;qc&#46;ca" class="elsevierStyleCrossRefs"> ana&#95;carceller&#64;ssss&#46;gouv&#46;qc&#46;ca</a></p>"
    "pdfFichero" => "37v67n01a13108070pdf001.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => array:6 [
        "identificador" => "fig1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "37v67n01-13108070fig01.jpg"
            "Alto" => 473
            "Ancho" => 408
            "Tamanyo" => 39718
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Cases of spasmodic disease accompanying affections of the pericardium&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Richard Bright&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Medico-Chirurgical Transactions"
                        "fecha" => "1839"
                        "volumen" => "22"
                        "paginaInicial" => "1"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20895675"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "referenciaCompleta" => "Rheumatic fever in America and Britain. A biological, epidemiological and medical history. New Jersey: Rutgers University Press; 1999. p. 17-52."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rheumatic fever in America and Britain&#46; A biological&#44; epidemiological and medical history&#46; New Jersey&#58; Rutgers University Press&#59; 1999&#46; p&#46; 17-52&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "English PC&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "A 45-year perspective on the Streptococcus and rheumatic fever&#46; In&#58; Edward H&#44; editor&#46; Kass Lecture in Infectious Disease History&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Denny FW&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "1994"
                        "volumen" => "19"
                        "paginaInicial" => "1110"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7888542"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "referenciaCompleta" => "Primer on the rheumatic diseases. Published by the Arthritis Foundation. 10th ed. Atlanta, Georgia; 1993. p. 1-2."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Primer on the rheumatic diseases&#46; Published by the Arthritis Foundation&#46; 10th ed&#46; Atlanta&#44; Georgia&#59; 1993&#46; p&#46; 1-2&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Schumacher HR"
                            1 => "Klippel JH"
                            2 => "Koopman WJ&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "referenciaCompleta" => "Considérations sur le rhumatisme du Coeur, thèse présentée et soutenue à la Faculté de Médecine de Paris, le 13 juillet 1824, pour obtenir le grade de docteur en médicine."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Consid&#233;rations sur le rhumatisme du Coeur&#44; th&#232;se pr&#233;sent&#233;e et soutenue &#224; la Facult&#233; de M&#233;decine de Paris&#44; le 13 juillet 1824&#44; pour obtenir le grade de docteur en m&#233;dicine&#46;"
                      "idioma" => "fr"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Joseph-Ir&#233;n&#233;e Itard&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Fowler&#46; On the association of the throat with Acute Rheumatism&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Sir James K&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1880"
                        "volumen" => "116"
                        "paginaInicial" => "933"
                        "paginaFinal" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resurgence of Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Hosier DM"
                            1 => "Craenen J"
                            2 => "Teske DW"
                            3 => "Wheller JJ&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Dis Child"
                        "fecha" => "1987"
                        "volumen" => "141"
                        "paginaInicial" => "730"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3591761"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Outbreak of acute rheumatic fever in Northeast Ohio&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Congeni B"
                            1 => "Rizzo C"
                            2 => "Congeni J"
                            3 => "Sreenivasan VV&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1987"
                        "volumen" => "111"
                        "paginaInicial" => "176"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3302191"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Acute Rheumatic Fever in Western Pennsylvania and the Tri-State area&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Wald ER"
                            1 => "Dashefsky B"
                            2 => "Feidt C"
                            3 => "Chiponis D"
                            4 => "Byers C&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1987"
                        "volumen" => "80"
                        "paginaInicial" => "371"
                        "paginaFinal" => "4"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3627888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Sydenham&#39;s Chorea in Western Pennsylvania&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Zomorrodi A"
                            1 => "Wald ER&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2005-1573"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2006"
                        "volumen" => "117"
                        "paginaInicial" => "e675"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16533893"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1063458411000690"
                          "estado" => "S300"
                          "issn" => "10634584"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resurgence of acute rheumatic fever in the intermountain area of the United States&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Veasy LG"
                            1 => "Wiedmeier SE"
                            2 => "Orsmond GS"
                            3 => "Ruttenberg HD"
                            4 => "Boucek MM"
                            5 => "Roth SJ"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198702193160801"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1987"
                        "volumen" => "316"
                        "paginaInicial" => "421"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3807984"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Acute rheumatic fever in adult&#58; A resurgence in the Hasidic Jewish Community&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Feuer J"
                            1 => "Spiera H&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "The J of Rheumatolog"
                        "fecha" => "1997"
                        "volumen" => "24"
                        "paginaInicial" => "337"
                        "paginaFinal" => "40"
                        "itemHostRev" => array:3 [
                          "pii" => "S1063458412007273"
                          "estado" => "S300"
                          "issn" => "10634584"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Epidemic Streptococcal Disease among Army Trainees&#44; July 1989 through June 1991&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Gunzenhauser JD"
                            1 => "Longfield JN"
                            2 => "Brundage JF"
                            3 => "Kaplan EL"
                            4 => "Miller RN"
                            5 => "Brandt CA&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1995"
                        "volumen" => "172"
                        "paginaInicial" => "124"
                        "paginaFinal" => "31"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7797902"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The virtual disappearance of rheumatic fever in the United States&#58; lessons in the rise and fall of disease&#46; T&#46; Duckett Jones Memorial Lecture&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Gordis L&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1985"
                        "volumen" => "72"
                        "paginaInicial" => "1155"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4064266"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Comprehensive Review of Morbidity and Mortality Trends for Rheumatic Fever&#44; Streptococcal Disease and Scarlet Fever&#58; The decline of Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Quinn RW&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Infect Dis"
                        "fecha" => "1989"
                        "volumen" => "11"
                        "paginaInicial" => "928"
                        "paginaFinal" => "53"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2690288"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The return of rheumatic fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Stollerman GH&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hosp Pract"
                        "fecha" => "1988"
                        "volumen" => "23"
                        "paginaInicial" => "100"
                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Changing epidemiology of acute rheumatic fever in the United States&#46; Editorial&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Lee GM"
                            1 => "Wessels MR&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "CID"
                        "fecha" => "2006"
                        "volumen" => "42"
                        "paginaInicial" => "448"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rheumatic Fever in the Eighties&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Markowitz M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Clin of North Am"
                        "fecha" => "1986"
                        "volumen" => "33"
                        "paginaInicial" => "1141"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The epidemiology and prevention of Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Rammelkamp CH"
                            1 => "Wannamaker LW"
                            2 => "Denny FW&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bull of the NY Ac of Med"
                        "fecha" => "1997"
                        "volumen" => "74"
                        "paginaInicial" => "119"
                        "paginaFinal" => "36"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Antecedent streptococcal infection in acute rheumatic fever&#46;"
                      "idioma" => "ro"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Kaplan EL"
                            1 => "Bisno AL&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/506944"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2006"
                        "volumen" => "43"
                        "paginaInicial" => "690"
                        "paginaFinal" => "2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16912940"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Update on complications of Group A Streptococcal Infections&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Ayoub EM"
                            1 => "Ahmed S&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Problems in Pediatrics"
                        "fecha" => "1997"
                        "volumen" => "27"
                        "paginaInicial" => "90"
                        "paginaFinal" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Host factors in rheumatic fever and heart disease&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Williams RC Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hosp Pract (Off Ed)"
                        "fecha" => "1982"
                        "volumen" => "17"
                        "paginaInicial" => "125"
                        "paginaFinal" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Immunologic and clinical correlations in rheumatic fever and rheumatic heart disease&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Veasy LG"
                            1 => "Hill HR&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "1997"
                        "volumen" => "16"
                        "paginaInicial" => "400"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9109143"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Group A streptococcal infections and acute rheumatic fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Bisno AL&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199109123251106"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1991"
                        "volumen" => "325"
                        "paginaInicial" => "783"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1870652"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Guideliness for the diagnosis of rheumatic fever&#46; Jones Criteria&#44; 1992 update&#46; Special Writing Group of the Committee on Rheumatic Fever&#44; Endocarditis and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Dajani AS"
                            1 => "Ayoub E"
                            2 => "Bierman FZ"
                            3 => "Bizno AL"
                            4 => "Denny FW"
                            5 => "Durack DJ&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1992"
                        "volumen" => "268"
                        "paginaInicial" => "2069"
                        "paginaFinal" => "73"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1404745"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rheumatic fever presenting as monoarticular arthritis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Harlan GA"
                            1 => "Tani LY"
                            2 => "Byington CL&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Infect Dis J"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "743"
                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Jones Criteria working group&#46; Proceedings of the Jones Criteria Workshop&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Ferrieri P&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2002"
                        "volumen" => "106"
                        "paginaInicial" => "2521"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12417554"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Sydenham&#39;s Chorea&#46;"
                      "idioma" => "da"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Marqu&#233;s-D&#237;as MJ"
                            1 => "Mercadante MT"
                            2 => "Tucker D"
                            3 => "Lombroso P&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Psychiatric Clin North Am"
                        "fecha" => "1997"
                        "volumen" => "20"
                        "paginaInicial" => "809"
                        "paginaFinal" => "19"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections&#58; Clinical description of the first 50 cases&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Swedo SE"
                            1 => "Leonard HL"
                            2 => "Garvey M"
                            3 => "Mittleman B"
                            4 => "Allen AJ"
                            5 => "Perlmutter S"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1176/ajp.155.2.264"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Psychiatry"
                        "fecha" => "1998"
                        "volumen" => "155"
                        "paginaInicial" => "264"
                        "paginaFinal" => "71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9464208"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Acute rheumatic fever&#58; Clinical aspects and insights into pathogenesis and prevention&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Guzman-Cottrill JA"
                            1 => "Jaggi P"
                            2 => "Shulman ST&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin and Applied Immunol Reviews"
                        "fecha" => "2004"
                        "volumen" => "4"
                        "paginaInicial" => "263"
                        "paginaFinal" => "76"
                        "itemHostRev" => array:3 [
                          "pii" => "S1063458412009338"
                          "estado" => "S300"
                          "issn" => "10634584"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Diagnosis of rheumatic fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Jones TD&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1944"
                        "volumen" => "126"
                        "paginaInicial" => "481"
                        "paginaFinal" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Guideline maintenance and revision&#46; 50 years of the Jones Criteria for Diagnosis of Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Shiffman RN&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pediatr Adolesc Med"
                        "fecha" => "1995"
                        "volumen" => "149"
                        "paginaInicial" => "727"
                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7795761"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "T&#46; Duckett Jones and his Criteria for the Diagnosis of Acute Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Shulman ST&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Annals"
                        "fecha" => "1999"
                        "volumen" => "28"
                        "paginaInicial" => "9"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rheumatic fever&#58; Keeping up with the Jones Criteria&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Forster J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Contem Pediatr"
                        "fecha" => "1993"
                        "volumen" => "10"
                        "paginaInicial" => "51"
                        "paginaFinal" => "60"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The diagnosis of Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Mirkinson L&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Rev"
                        "fecha" => "1998"
                        "volumen" => "19"
                        "paginaInicial" => "310"
                        "paginaFinal" => "1"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Acute rheumatic fever&#58; Diagnosis and treatment&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Alsaeid K"
                            1 => "Majeed HA&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Annals"
                        "fecha" => "1998"
                        "volumen" => "27"
                        "paginaInicial" => "295"
                        "paginaFinal" => "300"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Prevention of bacterial endocarditis&#46; Recommendations by the American Heart Association&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Dajani AS"
                            1 => "Taubert KA"
                            2 => "Wilson W"
                            3 => "Bolger AF"
                            4 => "Bayer A"
                            5 => "Ferrieri P"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1997"
                        "volumen" => "277"
                        "paginaInicial" => "1794"
                        "paginaFinal" => "801"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9178793"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/16954033/0000006700000001/v0_201404141729/13108070/v0_201404141729/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14281"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/16954033/0000006700000001/v0_201404141729/13108070/v0_201404141729/en/37v67n01a13108070pdf001.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108070?idApp=UINPBA00005H"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Acute rheumatic fever
Fiebre reumática aguda
A. Carcellera
a Pediatrics Department. CHU Sainte-Justine. Université de Montréal. Montreal. Canada.
Read
26497
Times
was read the article
4111
Total PDF
22386
Total HTML
Share statistics
 array:21 [
  "pii" => "13108070"
  "issn" => "16954033"
  "doi" => "10.1157/13108069"
  "estado" => "S300"
  "fechaPublicacion" => "2007-07-01"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "An Pediatr &#40;Barc&#41;. 2007;67:1-4"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 17098
    "formatos" => array:3 [
      "EPUB" => 112
      "HTML" => 16172
      "PDF" => 814
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "13108069"
      "issn" => "16954033"
      "doi" => "10.1157/13108069"
      "estado" => "S300"
      "fechaPublicacion" => "2007-07-01"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "fla"
      "cita" => "An Pediatr &#40;Barc&#41;. 2007;67:1-4"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 37801
        "formatos" => array:3 [
          "EPUB" => 126
          "HTML" => 34939
          "PDF" => 2736
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Fiebre reum&#225;tica aguda"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "1"
            "paginaFinal" => "4"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Acute rheumatic fever"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:6 [
            "identificador" => "fig1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier Espa&#241;a"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "37v67n01-13108069fig01.jpg"
                "Alto" => 473
                "Ancho" => 408
                "Tamanyo" => 39780
              ]
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A Carceller-Blanchard"
            "autores" => array:1 [
              0 => array:2 [
                "Iniciales" => "A"
                "apellidos" => "Carceller-Blanchard"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "13108070"
          "doi" => "10.1157/13108069"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108070?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108069?idApp=UINPBA00005H"
      "url" => "/16954033/0000006700000001/v0_201404141729/13108069/v0_201404141729/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "13108072"
    "issn" => "16954033"
    "doi" => "10.1157/13108071"
    "estado" => "S300"
    "fechaPublicacion" => "2007-07-01"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2007;67:5-10"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 10514
      "formatos" => array:3 [
        "EPUB" => 108
        "HTML" => 9722
        "PDF" => 684
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "titulo" => "Acute rheumatic fever&#58; 27 year experience from the Montreal&#39;s Pediatric Tertiary Care Centers"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "5"
          "paginaFinal" => "10"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Fiebre reum&#225;tica aguda&#58; 27 a&#241;os de experiencia en los hospitales pedi&#225;tricos en Montreal"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A Carceller, B Tapiero, E Rubin, J Mir&#243;"
          "autores" => array:4 [
            0 => array:2 [
              "Iniciales" => "A"
              "apellidos" => "Carceller"
            ]
            1 => array:2 [
              "Iniciales" => "B"
              "apellidos" => "Tapiero"
            ]
            2 => array:2 [
              "Iniciales" => "E"
              "apellidos" => "Rubin"
            ]
            3 => array:2 [
              "Iniciales" => "J"
              "apellidos" => "Mir&#243;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "13108071"
        "doi" => "10.1157/13108071"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108071?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108072?idApp=UINPBA00005H"
    "url" => "/16954033/0000006700000001/v0_201404141729/13108072/v0_201404141729/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "13108069"
    "issn" => "16954033"
    "doi" => "10.1157/13108069"
    "estado" => "S300"
    "fechaPublicacion" => "2007-07-01"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2007;67:1-4"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 37801
      "formatos" => array:3 [
        "EPUB" => 126
        "HTML" => 34939
        "PDF" => 2736
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Fiebre reum&#225;tica aguda"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "1"
          "paginaFinal" => "4"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Acute rheumatic fever"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:6 [
          "identificador" => "fig1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "37v67n01-13108069fig01.jpg"
              "Alto" => 473
              "Ancho" => 408
              "Tamanyo" => 39780
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A Carceller-Blanchard"
          "autores" => array:1 [
            0 => array:2 [
              "Iniciales" => "A"
              "apellidos" => "Carceller-Blanchard"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "13108070"
        "doi" => "10.1157/13108069"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108070?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108069?idApp=UINPBA00005H"
    "url" => "/16954033/0000006700000001/v0_201404141729/13108069/v0_201404141729/es/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "Acute rheumatic fever"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "1"
        "paginaFinal" => "4"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "A Carceller"
        "autores" => array:1 [
          0 => array:3 [
            "Iniciales" => "A"
            "apellidos" => "Carceller"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Pediatrics Department. CHU Sainte-Justine. Université de Montréal. Montreal. Canada."
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Fiebre reum&#225;tica aguda"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:6 [
        "identificador" => "fig1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "37v67n01-13108070fig01.jpg"
            "Alto" => 473
            "Ancho" => 408
            "Tamanyo" => 39718
          ]
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Unreliable legend related that Vitus&#39; intercession freed Emperor Diocletian&#39;s son of an evil spirit and cured from so called &#34;Saint Vitus Dance&#34;&#46; Probably if Vitus was born in our era&#44; he has never been saint&#44; because we know now&#44; chorea is able to resolve without treatment and without a miracle&#46; Saint Vitus &#40;died 303&#41; is the patron of children and invoked against Saint Vitus Dance or Sydenham&#39;s Chorea&#46;</p><p class="elsevierStylePara"><img src="37v67n01-13108070fig01.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">A case</span></p><p class="elsevierStylePara">1838&#46; Ten-year-old girl complained of general rheumatic symptoms&#59; pains in the limbs&#44; with puffiness and swelling of the wrists&#44; and some other joints&#46; Six days later&#44; she developed chorea&#58; her head was constantly tilting from one side of the bed to the other&#59; her lips closed and opened with a smacking sound&#44; and when she tried to put out her tongue it protruded in a forced grimace&#46; A rapid and irregular heart-beat led to suspect that the heart was also affected&#46; Sixteen days later&#44; the girl died&#46; After the autopsy&#44; Bright<span class="elsevierStyleSup">1</span> discovered that both the pericardium and the endocardium were involved&#46; Careful dissection of the brain failed to yield any perceptible abnormalities<span class="elsevierStyleSup">2</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Definition</span></p><p class="elsevierStylePara">Rheumatic Fever &#40;RF&#41; is a delayed and inflammatory disease non suppurative sequel of upper respiratory infection with group A <span class="elsevierStyleItalic">Streptococci</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">History</span></p><p class="elsevierStylePara">Acute migratory arthritis of children appeared in the time of Hippocrates&#44; a physician born in 460 BC on the island of Cos&#44; Greece&#46; The term chorea derived from a Greek word &#34;khoreia&#34; which means &#34;dancing&#34;&#46; It was introduced by Paracelsus &#40;1493-1541&#41; to describe hysterical movements of religious fanatics during the Middle Age&#46; The concept of Rheumatic Fever evolved from manifestations known in the 17<span class="elsevierStyleSup">th</span> Century as &#180;&#180;Rheumatism&#180;&#180; and it was described first by Guillaume Du Baillou in France &#40;1538&#41; and by Thomas Sydenham in England &#40;1686&#41;<span class="elsevierStyleSup">3</span>&#46; Sydenham used the designation St&#46; Vitus&#39; dance to describe chorea<span class="elsevierStyleSup">4</span>&#46; In 1761 Morgagni &#40;in Italy&#41; described the valvular lesions&#46; Joseph-Ir&#233;n&#233;e Itard&#44; a Parisian medical student probably was in 1824&#44; the first to study this disease&#59; he sustained a twenty-four-page thesis for graduation from medical school entitled &#34;Considerations sur le Rhumatisme de Coeur&#34;<span class="elsevierStyleSup">5</span>&#46; Richard Bright in 1838&#44; a prominent London physician called attention in his Lecture at the College of Physicians in London&#44; to the association of chorea with diseases of pericardium and he was the first to associate all the anomalies with rheumatic fever<span class="elsevierStyleSup">2</span>&#46; Dr James Kingston Fowler&#44; who was serving as house physician at King&#39;s College Hospital in 1874&#44; contracted a rheumatic fever and he was the first to report tonsillitis as a common precursor of rheumatic fever in collaboration with Walter Butler Cheadle<span class="elsevierStyleSup">6</span>&#46; It is in 1904 that Aschoff described the cardiac nodules&#46; In 1928 in New York&#44; F Swift introduced the hypothesis that rheumatic fever results from the development of hypersensitivity to <span class="elsevierStyleItalic">Streptococci</span> and is only in 1932 that Edgar W Todd evidenced to support the hypothesis of an immune pathogenesis of rheumatic fever with the discovery of antistreptolysins<span class="elsevierStyleSup">4</span>&#46; In 1944&#44; T Duckett Jones gave the first lecture about RF&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Epidemiology</span></p><p class="elsevierStylePara">The frequency of the RF was 100-200 cases per 100&#44;000 in the US population in 1900 and 50 per 100&#44;000 in 1940&#46; Until the early 1980&#39;s there was a decline to about 0&#46;5 per 100&#44;000 with a localized outbreaks<span class="elsevierStyleSup">7-14</span>&#46; In Europe&#44; there have been similar declines and it has become a rare disease&#46; Although&#44; in undeveloping countries&#44; RF still endemic and remains the major cause of acquired heart disease in young adults&#46;</p><p class="elsevierStylePara">Factors relating to the decrease in RF were still unknown<span class="elsevierStyleSup">15</span>&#46; Over the past Century&#44; living conditions and crowding were improved in most countries&#44; contributing to the declining of the disease&#46; We don&#39;t know if virulence of group A <span class="elsevierStyleItalic">Streptococci</span> is declining or if human resistance to these bacteria is increasing&#46; Of course&#44; penicillin treatment has contributed to declining mortality and morbidity due to streptococcal infections&#44; including RF&#44; but the reasons for the decline before penicillin were not apparent<span class="elsevierStyleSup">16</span>&#46; The incidence and prevalence of this disease steadily have declined as has mortality in the past decade<span class="elsevierStyleSup">17-19</span>&#46; Factors that have contributed to the decrease in the incidence of acute rheumatic fever &#40;ARF&#41; may include changes in the host&#44; the environment or the pathogen<span class="elsevierStyleSup">17</span>&#46;</p><p class="elsevierStylePara">RF usually appears between 5 and 18 years old patients and it is rare before the age of 3 years&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Pathogenesis</span></p><p class="elsevierStylePara">Despite epidemiological and clinical research&#44; the precise pathogenesis of RF remains unknown<span class="elsevierStyleSup">20</span>&#46; Socio-economic factors have little importance in RF occurrence&#46; Some authors currently favour the theory that ARF is an autoimmune disorder after an immunologic cross-reaction response to the antecedent streptococcal infection<span class="elsevierStyleSup">21</span>&#46;</p><p class="elsevierStylePara">Group A <span class="elsevierStyleItalic">Streptococci</span> vary in their rheumatogenic potential&#46; Strains causing clusters or epidemics usually belong to certain serotypes 1&#44; 3&#44; 5&#44; 6&#44; 18&#44; 19&#44; 24 and are often heavily encapsulated as evidenced by their growth as mucoid colonies on blood agar plates&#46; Approximately 3 &#37; of untreated patients could to develop ARF<span class="elsevierStyleSup">21</span>&#46;</p><p class="elsevierStylePara">Rheumatogenic <span class="elsevierStyleItalic">Streptococci</span> adhere to pharyngeal cells<span class="elsevierStyleSup">22</span>&#46; The absorbed products of streptococcal degradation act as antigens and have molecular mimicry with different human tissues&#46; They are identified by the macrophages and presented to the T cell receptors producing cytokines which activates B cells to become immunoglobulin&#46; Antibodies to the <span class="elsevierStyleItalic">Streptococci</span> may cross-react with heart&#44; brain and&#47;or joint tissue resulting in carditis&#44; chorea or arthritis&#46; Components of the streptococcal cell wall and of the cell membrane contain epitopes that share antigenic determinants with certain constituents of the human tissues&#46; The hyaluronic acid and the N-Acetyl glucosamine in capsule react with the hyaluronic acid of joint tissue&#46; M-Protein&#44; the group A carbohydrate and the N-Acetyl glucosamine in cell wall react with tropomyosine&#44; myosine and glycoprotein of the heart&#46; Lipoproteins in Protoplasm react with neuronal tissue and affect basal ganglia regions of the caudate and putamen&#46; This <span class="elsevierStyleItalic"> humoral reaction</span> clears without sequel&#46; Persistent rheumatic heart disease&#44; as Aschoff body&#44; is a result of <span class="elsevierStyleItalic">cellular reaction</span>  and is the persistence of T cell activity in valve tissue<span class="elsevierStyleSup">23&#44;24</span>&#46;</p><p class="elsevierStylePara">Although&#44; several observations show that more than one member is affected in the same family&#44; only small percentage of individuals experienced streptococcal infection&#44; some individuals developing recurrent attacks or</p><p class="elsevierStylePara">exhibiting specific HLA antigen&#59; all these factors suggest that RF may be modulated by the specific genetic constitution of the host<span class="elsevierStyleSup">23</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Clinical expression</span></p><p class="elsevierStylePara">The diagnosis of RF is based on clinical criteria and may be difficult to establish it given the current rarity of the disease and the absence of any pathognomonic laboratory tests&#46;</p><p class="elsevierStylePara">The migratory polyarthritis with fever was the initial sign of RF in the past in approximately 75 &#37; of patients&#44; actually is really less frequently seen&#46; Knees&#44; ankles&#44; elbows and wrists are the most commonly affected joints&#59; arthritis improves without treatment in 1 to 3 days and it has a dramatic response to salicylates<span class="elsevierStyleSup">25</span>&#46; Recent international studies documented monoarticular arthritis as a presenting sign in ARF<span class="elsevierStyleSup">26</span>&#46; Although in 2000&#44; the Jones Criteria Working Group<span class="elsevierStyleSup">27</span> acknowledged the importance of monoarticular arthritis among people in undeveloped countries&#44; this diagnosis has not been universally accepted as major criteria in developed countries&#46; The Workshop<span class="elsevierStyleSup">27</span> did not address the potential need for antibiotic prophylaxis in patients with post streptococcal reactive arthritis who did not fulfill the Jones Criteria&#46;</p><p class="elsevierStylePara">Carditis&#44; the most serious manifestation of RF occurs within 3 weeks after Group A streptococcal infection&#46; It is a pancarditis&#58; Endocarditis that is almost always present&#44; mitral regurgitation is the most common pathology in RF associated or not to the aortic regurgitation&#59; Myocardial disease with atrioventricular conduction disorders or with congestive heart failure and Pericarditis who is rare &#40;&#60; 5 &#37;&#41;&#46; Cardiac involvement is seen in about 50 &#37; of patients with ARF and with the help of echocardiography in about 70 &#37;&#46; The use of Doppler-echocardiography should be used as an adjunctive technique to confirm clinical auscultatory findings&#59; although&#44; it should not be used as a major or minor criterion for establishing the diagnosis of carditis associated with ARF<span class="elsevierStyleSup">27</span>&#46; Clinical research is needed to determine the prognostic implications of subclinical valvular regurgitation&#46;</p><p class="elsevierStylePara">Sydenham&#39;s Chorea is a delayed manifestation of RF &#40;occurs 1 to 6 months&#41; after a Group A streptococcal infection&#46; Resulting from an autoimmune attack on the CNS&#44; sera from patients with chorea contain antibodies that cross-react with basal ganglia neurons&#46; Pathophysiology of Sydenham Chorea can be divided into four areas&#58; <span class="elsevierStyleItalic">Neuroanatomy</span> with basal ganglia regions of the caudate&#44; putamen and subthalamic nucleus dysfunction&#59; <span class="elsevierStyleItalic">Neurochemistry</span> with imbalance among the dopaminergic&#44; cholinergic and the inhibitory gamma aminobutyric acid systems&#59; <span class="elsevierStyleItalic"> Immunology</span> with production of antineuronal antibodies and inflammatory cytokines and <span class="elsevierStyleItalic">Genetics</span> as RF frequently appeared in multiple members of a family<span class="elsevierStyleSup">28</span>&#46; This disorder is characterized by sudden non-voluntary</p><p class="elsevierStylePara">arrhythmic and clonic purposeless mouvements&#46; Sometimes&#44; children present hypotonia&#44; gait disturbance&#44; incoordination&#44; loss of fine motor control&#44; facial grimacing&#44; gross fasciculations of the tongue&#44; and speech abnormalities with dysarthria&#44; explosive speech and emotional labilities&#46; Chorea is a clinic diagnostic due to the lower frequency of others positive results of the laboratory and may present without any other major or minor features of RF&#46; She was frequently seen in the 1950&#39;s and her incidence declined substantially to 10-30 &#37;&#46; Neuro-imaging as increased signal in the caudate and putamen nucleus have been reported in patients with Sydenham&#39;s chorea&#46; Chorea resolves in 2 to 3 months&#44; the treatment of Sydenham&#39;s Chorea is purely symptomatic and different drugs are used in her treatment although a few studies strongly support their efficacy&#46; Susan Swedo<span class="elsevierStyleSup">29</span> was the first to describe the paediatric auto-immune neuropsychiatric disorders associated with <span class="elsevierStyleItalic"> Streptococcus</span> &#40;PANDAS&#41; as different diagnosis from Syndenham&#39;s chorea&#46;</p><p class="elsevierStylePara">Transient erythema marginatum occurs to less than 2 &#37; of patients&#59; it consists of erythematous serpiginous&#44; macular lesions with pale central clearing on the trunk and extremities&#46; Subcutaneous nodules occur in less than 1 &#37; of cases and they resolve within one month without long-term sequelae&#46; They are firm&#44; non-tender&#44; varying in size from a few millimetres to 1-2 cm of diameter&#44; over bony prominences and in tendon sheaths<span class="elsevierStyleSup">30</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Criteria</span></p><p class="elsevierStylePara">Criteria are used at the acute stage of the disease&#46; The first criteria were established by Jones<span class="elsevierStyleSup">31</span> in 1940 and there were some updates&#44; the last one in 1992<span class="elsevierStyleSup">25&#44;32-34</span>&#46; In 2000&#44; the American Heart Association agreed that there were insufficient data to support a revision of the Jones Criteria and reaffirmed the guidelines iterated in the 1992 statement<span class="elsevierStyleSup">27</span>&#46;</p><p class="elsevierStylePara">The diagnosis of RF is highly suggested when two major criteria or one major and two minor criteria are fulfilled in a patient with previous streptococcal infection diagnosed by positive culture of throat and&#47;or elevated or rising streptococcal antibody titter&#46;</p><p class="elsevierStylePara">Major criteria are polyarthritis&#44; carditis&#44; chorea&#44; erythema marginatum and subcutaneous nodules&#46; Minor criteria are fever&#44; arthralgia&#44; elevated erythrocyte sedimentation rate &#40;ESR&#41; or C-reactive protein &#40;CRP&#41; and prolonged PR interval on the electrocardiogram&#46;</p><p class="elsevierStylePara">RF is now a rare disease in most of Europe and North America&#44; making its diagnosis more difficult to establish&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Diagnosis</span></p><p class="elsevierStylePara">Positive throat culture of Group A Streptococcal infection is infrequently found and the absence of a positive culture does not exclude the diagnosis of RF<span class="elsevierStyleSup">35&#44;36</span>&#46; Antistreptolysin O antibody &#40;ASO&#41; and anti-DNase B are of limited diagnostic value because 20 &#37; of cases presented without raised antibody levels<span class="elsevierStyleSup">30</span>&#46; The ESR or CRP should be measured and usually they are increased&#46; Chorea could be present as isolated manifestation&#44; frequently when a patient presents&#44; acute phase reactant levels may have normalized&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Outcome</span></p><p class="elsevierStylePara">Deaths are related to heart failure and it is really rare in industrialized countries&#46; Prophylaxis prevents recurrences&#46; Relapses are more frequent in the first 3 years after a first episode of RF&#46; Patients with residual valve disease must be followed by echocardiography every 6 months for the first 2 years after first episode of RF&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Treatment</span></p><p class="elsevierStylePara">The therapeutic management of the ARF need to treat the inflammatory process&#44; to eradicate the <span class="elsevierStyleItalic">Streptococcus</span> and to continue for long term prophylaxis&#46;</p><p class="elsevierStylePara">An anti-inflammatory treatment are required if severe carditis is present&#58; prednisolone 2 mg&#47;kg&#47;day and less than 80 mg&#47;day&#44; given in 1 dose&#47;day for 3-4 weeks decreasing over 6-8 weeks and followed by aspirin who is started 1 week before termination of steroids&#46; The dose of aspirin is 80-100 mg&#47;kg&#47;day&#44; 4 doses&#47;day during 4-8 weeks&#59; decreasing over the following 4 weeks&#46; In mild to moderate carditis&#44; corticosteroids are not essential and we can treat with aspirin directly&#46;</p><p class="elsevierStylePara">Patients need to receive penicillin for ten days to eradicate <span class="elsevierStyleItalic">Streptococcus</span>&#46;</p><p class="elsevierStylePara">The prophylaxis consisted to receive intramuscular penicillin benzathine given every 28 days&#44; if bodyweight is less than 27 kg the dose is 600&#44;000 international units &#40;IU&#41;&#44; if bodyweight is more than 27 kg&#44; the dose is 1&#46;200&#44;000 IU&#46; In the cases where intramuscular penicillin is not safe&#44; we can give 250 mg twice per os of Penicillin V and in the case of allergy to penicillin we can use erythromycin 250 mg twice per os&#46;</p><p class="elsevierStylePara">All children who have suffered cardiac sequelae must be thoroughly instructed on risk prevention of bacterial endocarditis &#40;AMH&#41;<span class="elsevierStyleSup">37</span>&#46;</p><p class="elsevierStylePara">In conclusion&#58;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">1&#46;</span>Although the acute rheumatic fever has become a rare disease in industrialized countries&#44; it remains prevalent&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">2&#46;</span>In 2000&#44; the American Heart Association agreed that there were insufficient data to support a revision of the Jones Criteria and reaffirmed the guidelines iterated in the 1992 statement&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">3&#46;</span>In pediatrics&#44; Criteria are a guide but should not replace clinical judgment&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> Acknowledge</span></p><p class="elsevierStylePara">The author would like to thank Mrs Ana Maria C&#46; Blanchard for her English expertise&#46;</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleBold"> Correspondence&#58;</span> Ana Carceller MD&#46;<br></br> Department of Pediatrics&#46; CHU Sainte-Justine&#46;<br></br> 3175 C&#244;te Ste-Catherine&#46; Montr&#233;al&#46; Qu&#233;bec H3T 1C5&#46; Canada&#46;<br></br> E-mail&#58; <a href="mailto&#58;ana&#95;carceller&#64;ssss&#46;gouv&#46;qc&#46;ca" class="elsevierStyleCrossRefs"> ana&#95;carceller&#64;ssss&#46;gouv&#46;qc&#46;ca</a></p>"
    "pdfFichero" => "37v67n01a13108070pdf001.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => array:6 [
        "identificador" => "fig1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "37v67n01-13108070fig01.jpg"
            "Alto" => 473
            "Ancho" => 408
            "Tamanyo" => 39718
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Cases of spasmodic disease accompanying affections of the pericardium&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Richard Bright&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Medico-Chirurgical Transactions"
                        "fecha" => "1839"
                        "volumen" => "22"
                        "paginaInicial" => "1"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20895675"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "referenciaCompleta" => "Rheumatic fever in America and Britain. A biological, epidemiological and medical history. New Jersey: Rutgers University Press; 1999. p. 17-52."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rheumatic fever in America and Britain&#46; A biological&#44; epidemiological and medical history&#46; New Jersey&#58; Rutgers University Press&#59; 1999&#46; p&#46; 17-52&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "English PC&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "A 45-year perspective on the Streptococcus and rheumatic fever&#46; In&#58; Edward H&#44; editor&#46; Kass Lecture in Infectious Disease History&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Denny FW&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "1994"
                        "volumen" => "19"
                        "paginaInicial" => "1110"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7888542"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "referenciaCompleta" => "Primer on the rheumatic diseases. Published by the Arthritis Foundation. 10th ed. Atlanta, Georgia; 1993. p. 1-2."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Primer on the rheumatic diseases&#46; Published by the Arthritis Foundation&#46; 10th ed&#46; Atlanta&#44; Georgia&#59; 1993&#46; p&#46; 1-2&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Schumacher HR"
                            1 => "Klippel JH"
                            2 => "Koopman WJ&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "referenciaCompleta" => "Considérations sur le rhumatisme du Coeur, thèse présentée et soutenue à la Faculté de Médecine de Paris, le 13 juillet 1824, pour obtenir le grade de docteur en médicine."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Consid&#233;rations sur le rhumatisme du Coeur&#44; th&#232;se pr&#233;sent&#233;e et soutenue &#224; la Facult&#233; de M&#233;decine de Paris&#44; le 13 juillet 1824&#44; pour obtenir le grade de docteur en m&#233;dicine&#46;"
                      "idioma" => "fr"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Joseph-Ir&#233;n&#233;e Itard&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Fowler&#46; On the association of the throat with Acute Rheumatism&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Sir James K&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1880"
                        "volumen" => "116"
                        "paginaInicial" => "933"
                        "paginaFinal" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resurgence of Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Hosier DM"
                            1 => "Craenen J"
                            2 => "Teske DW"
                            3 => "Wheller JJ&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Dis Child"
                        "fecha" => "1987"
                        "volumen" => "141"
                        "paginaInicial" => "730"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3591761"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Outbreak of acute rheumatic fever in Northeast Ohio&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Congeni B"
                            1 => "Rizzo C"
                            2 => "Congeni J"
                            3 => "Sreenivasan VV&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1987"
                        "volumen" => "111"
                        "paginaInicial" => "176"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3302191"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Acute Rheumatic Fever in Western Pennsylvania and the Tri-State area&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Wald ER"
                            1 => "Dashefsky B"
                            2 => "Feidt C"
                            3 => "Chiponis D"
                            4 => "Byers C&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1987"
                        "volumen" => "80"
                        "paginaInicial" => "371"
                        "paginaFinal" => "4"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3627888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Sydenham&#39;s Chorea in Western Pennsylvania&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Zomorrodi A"
                            1 => "Wald ER&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2005-1573"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2006"
                        "volumen" => "117"
                        "paginaInicial" => "e675"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16533893"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1063458411000690"
                          "estado" => "S300"
                          "issn" => "10634584"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resurgence of acute rheumatic fever in the intermountain area of the United States&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Veasy LG"
                            1 => "Wiedmeier SE"
                            2 => "Orsmond GS"
                            3 => "Ruttenberg HD"
                            4 => "Boucek MM"
                            5 => "Roth SJ"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198702193160801"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1987"
                        "volumen" => "316"
                        "paginaInicial" => "421"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3807984"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Acute rheumatic fever in adult&#58; A resurgence in the Hasidic Jewish Community&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Feuer J"
                            1 => "Spiera H&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "The J of Rheumatolog"
                        "fecha" => "1997"
                        "volumen" => "24"
                        "paginaInicial" => "337"
                        "paginaFinal" => "40"
                        "itemHostRev" => array:3 [
                          "pii" => "S1063458412007273"
                          "estado" => "S300"
                          "issn" => "10634584"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Epidemic Streptococcal Disease among Army Trainees&#44; July 1989 through June 1991&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Gunzenhauser JD"
                            1 => "Longfield JN"
                            2 => "Brundage JF"
                            3 => "Kaplan EL"
                            4 => "Miller RN"
                            5 => "Brandt CA&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1995"
                        "volumen" => "172"
                        "paginaInicial" => "124"
                        "paginaFinal" => "31"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7797902"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The virtual disappearance of rheumatic fever in the United States&#58; lessons in the rise and fall of disease&#46; T&#46; Duckett Jones Memorial Lecture&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Gordis L&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1985"
                        "volumen" => "72"
                        "paginaInicial" => "1155"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4064266"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Comprehensive Review of Morbidity and Mortality Trends for Rheumatic Fever&#44; Streptococcal Disease and Scarlet Fever&#58; The decline of Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Quinn RW&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Infect Dis"
                        "fecha" => "1989"
                        "volumen" => "11"
                        "paginaInicial" => "928"
                        "paginaFinal" => "53"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2690288"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The return of rheumatic fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Stollerman GH&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hosp Pract"
                        "fecha" => "1988"
                        "volumen" => "23"
                        "paginaInicial" => "100"
                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Changing epidemiology of acute rheumatic fever in the United States&#46; Editorial&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Lee GM"
                            1 => "Wessels MR&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "CID"
                        "fecha" => "2006"
                        "volumen" => "42"
                        "paginaInicial" => "448"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rheumatic Fever in the Eighties&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Markowitz M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Clin of North Am"
                        "fecha" => "1986"
                        "volumen" => "33"
                        "paginaInicial" => "1141"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The epidemiology and prevention of Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Rammelkamp CH"
                            1 => "Wannamaker LW"
                            2 => "Denny FW&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bull of the NY Ac of Med"
                        "fecha" => "1997"
                        "volumen" => "74"
                        "paginaInicial" => "119"
                        "paginaFinal" => "36"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Antecedent streptococcal infection in acute rheumatic fever&#46;"
                      "idioma" => "ro"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Kaplan EL"
                            1 => "Bisno AL&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/506944"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2006"
                        "volumen" => "43"
                        "paginaInicial" => "690"
                        "paginaFinal" => "2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16912940"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Update on complications of Group A Streptococcal Infections&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Ayoub EM"
                            1 => "Ahmed S&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Problems in Pediatrics"
                        "fecha" => "1997"
                        "volumen" => "27"
                        "paginaInicial" => "90"
                        "paginaFinal" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Host factors in rheumatic fever and heart disease&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Williams RC Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hosp Pract (Off Ed)"
                        "fecha" => "1982"
                        "volumen" => "17"
                        "paginaInicial" => "125"
                        "paginaFinal" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Immunologic and clinical correlations in rheumatic fever and rheumatic heart disease&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Veasy LG"
                            1 => "Hill HR&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "1997"
                        "volumen" => "16"
                        "paginaInicial" => "400"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9109143"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Group A streptococcal infections and acute rheumatic fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Bisno AL&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199109123251106"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1991"
                        "volumen" => "325"
                        "paginaInicial" => "783"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1870652"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Guideliness for the diagnosis of rheumatic fever&#46; Jones Criteria&#44; 1992 update&#46; Special Writing Group of the Committee on Rheumatic Fever&#44; Endocarditis and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Dajani AS"
                            1 => "Ayoub E"
                            2 => "Bierman FZ"
                            3 => "Bizno AL"
                            4 => "Denny FW"
                            5 => "Durack DJ&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1992"
                        "volumen" => "268"
                        "paginaInicial" => "2069"
                        "paginaFinal" => "73"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1404745"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rheumatic fever presenting as monoarticular arthritis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Harlan GA"
                            1 => "Tani LY"
                            2 => "Byington CL&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Infect Dis J"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "743"
                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Jones Criteria working group&#46; Proceedings of the Jones Criteria Workshop&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Ferrieri P&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2002"
                        "volumen" => "106"
                        "paginaInicial" => "2521"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12417554"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Sydenham&#39;s Chorea&#46;"
                      "idioma" => "da"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Marqu&#233;s-D&#237;as MJ"
                            1 => "Mercadante MT"
                            2 => "Tucker D"
                            3 => "Lombroso P&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Psychiatric Clin North Am"
                        "fecha" => "1997"
                        "volumen" => "20"
                        "paginaInicial" => "809"
                        "paginaFinal" => "19"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections&#58; Clinical description of the first 50 cases&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Swedo SE"
                            1 => "Leonard HL"
                            2 => "Garvey M"
                            3 => "Mittleman B"
                            4 => "Allen AJ"
                            5 => "Perlmutter S"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1176/ajp.155.2.264"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Psychiatry"
                        "fecha" => "1998"
                        "volumen" => "155"
                        "paginaInicial" => "264"
                        "paginaFinal" => "71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9464208"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Acute rheumatic fever&#58; Clinical aspects and insights into pathogenesis and prevention&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Guzman-Cottrill JA"
                            1 => "Jaggi P"
                            2 => "Shulman ST&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin and Applied Immunol Reviews"
                        "fecha" => "2004"
                        "volumen" => "4"
                        "paginaInicial" => "263"
                        "paginaFinal" => "76"
                        "itemHostRev" => array:3 [
                          "pii" => "S1063458412009338"
                          "estado" => "S300"
                          "issn" => "10634584"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Diagnosis of rheumatic fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Jones TD&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1944"
                        "volumen" => "126"
                        "paginaInicial" => "481"
                        "paginaFinal" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Guideline maintenance and revision&#46; 50 years of the Jones Criteria for Diagnosis of Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Shiffman RN&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pediatr Adolesc Med"
                        "fecha" => "1995"
                        "volumen" => "149"
                        "paginaInicial" => "727"
                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7795761"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "T&#46; Duckett Jones and his Criteria for the Diagnosis of Acute Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Shulman ST&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Annals"
                        "fecha" => "1999"
                        "volumen" => "28"
                        "paginaInicial" => "9"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rheumatic fever&#58; Keeping up with the Jones Criteria&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Forster J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Contem Pediatr"
                        "fecha" => "1993"
                        "volumen" => "10"
                        "paginaInicial" => "51"
                        "paginaFinal" => "60"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The diagnosis of Rheumatic Fever&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Mirkinson L&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Rev"
                        "fecha" => "1998"
                        "volumen" => "19"
                        "paginaInicial" => "310"
                        "paginaFinal" => "1"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Acute rheumatic fever&#58; Diagnosis and treatment&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Alsaeid K"
                            1 => "Majeed HA&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Annals"
                        "fecha" => "1998"
                        "volumen" => "27"
                        "paginaInicial" => "295"
                        "paginaFinal" => "300"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Prevention of bacterial endocarditis&#46; Recommendations by the American Heart Association&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Dajani AS"
                            1 => "Taubert KA"
                            2 => "Wilson W"
                            3 => "Bolger AF"
                            4 => "Bayer A"
                            5 => "Ferrieri P"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1997"
                        "volumen" => "277"
                        "paginaInicial" => "1794"
                        "paginaFinal" => "801"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9178793"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/16954033/0000006700000001/v0_201404141729/13108070/v0_201404141729/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14281"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/16954033/0000006700000001/v0_201404141729/13108070/v0_201404141729/en/37v67n01a13108070pdf001.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13108070?idApp=UINPBA00005H"
]
Article information
ISSN: 16954033
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 16 23 39
2024 October 114 83 197
2024 September 124 122 246
2024 August 138 89 227
2024 July 98 78 176
2024 June 101 107 208
2024 May 107 142 249
2024 April 90 101 191
2024 March 82 87 169
2024 February 88 66 154
2024 January 90 56 146
2023 December 96 68 164
2023 November 122 96 218
2023 October 91 60 151
2023 September 87 58 145
2023 August 74 33 107
2023 July 78 40 118
2023 June 92 46 138
2023 May 109 37 146
2023 April 65 32 97
2023 March 81 39 120
2023 February 57 19 76
2023 January 53 34 87
2022 December 64 38 102
2022 November 78 42 120
2022 October 85 59 144
2022 September 94 63 157
2022 August 133 79 212
2022 July 88 58 146
2022 June 65 60 125
2022 May 126 61 187
2022 April 140 59 199
2022 March 228 107 335
2022 February 238 91 329
2022 January 147 70 217
2021 December 130 54 184
2021 November 126 65 191
2021 October 182 81 263
2021 September 68 54 122
2021 August 59 57 116
2021 July 68 50 118
2021 June 75 64 139
2021 May 120 61 181
2021 April 299 154 453
2021 March 190 39 229
2021 February 155 36 191
2021 January 128 22 150
2020 December 161 38 199
2020 November 127 36 163
2020 October 114 21 135
2020 September 100 16 116
2020 August 95 21 116
2020 July 72 28 100
2020 June 92 18 110
2020 May 97 22 119
2020 April 84 20 104
2020 March 83 26 109
2020 February 92 17 109
2020 January 75 10 85
2019 December 66 19 85
2019 November 49 14 63
2019 October 52 22 74
2019 September 30 17 47
2019 August 45 22 67
2019 July 49 12 61
2019 June 49 21 70
2019 May 77 30 107
2019 April 116 24 140
2019 March 41 20 61
2019 February 48 13 61
2019 January 55 19 74
2018 December 45 30 75
2018 November 50 27 77
2018 October 60 18 78
2018 September 32 8 40
2018 August 4 0 4
2018 July 2 0 2
2018 June 5 0 5
2018 May 13 0 13
2018 April 25 0 25
2018 March 22 0 22
2018 February 16 0 16
2018 January 12 0 12
2017 December 20 0 20
2017 November 25 0 25
2017 October 13 0 13
2017 September 20 0 20
2017 August 18 0 18
2017 July 17 1 18
2017 June 27 11 38
2017 May 21 13 34
2017 April 30 4 34
2017 March 11 1 12
2017 February 10 5 15
2017 January 9 2 11
2016 December 27 9 36
2016 November 28 7 35
2016 October 37 7 44
2016 September 39 5 44
2016 August 16 2 18
2016 July 12 7 19
2016 June 5 7 12
2016 May 5 11 16
2016 April 3 0 3
2016 March 2 0 2
2016 February 6 12 18
2016 January 8 0 8
2015 December 12 0 12
2015 November 5 10 15
2015 October 12 12 24
2015 September 3 5 8
2015 August 5 0 5
2015 July 42 11 53
2015 June 43 2 45
2015 May 23 1 24
2015 April 21 3 24
2015 March 37 2 39
2015 February 34 4 38
2015 January 36 0 36
2014 December 65 5 70
2014 November 42 1 43
2014 October 42 1 43
2014 September 46 4 50
2014 August 49 2 51
2014 July 70 3 73
2014 June 179 6 185
2014 May 360 13 373
2014 April 264 5 269
2014 March 306 13 319
2014 February 251 29 280
2014 January 202 19 221
2013 December 186 22 208
2013 November 333 36 369
2013 October 263 16 279
2013 September 346 44 390
2013 August 201 58 259
2013 July 184 23 207
2013 June 23 6 29
2013 May 24 2 26
2013 April 25 4 29
2013 March 15 5 20
2013 February 51 1 52
2013 January 29 1 30
2012 December 22 1 23
2012 November 35 2 37
2012 October 16 2 18
2012 September 2 2 4
2012 August 4 2 6
2007 June 10775 0 10775
Show all

Follow this link to access the full text of the article

Idiomas
Anales de Pediatría (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?