Fiebre reumática aguda: 27 años de experiencia en los hospitales pediátricos en Montreal
Bibliographic record
Abstract
Revisar la epidemiología, las características clínicas y la evolución de una cohorte de niños, durante 27 años, con fiebre reumática aguda en Montreal (Canadá). Las historias clínicas de niños menores de 18 años hospitalizados y diagnosticados de fiebre reumática en Montreal, entre enero de 1979 y diciembre de 2005, fueron revisadas. De las 134 historias seleccionadas, 36 niños eran seguidos por fiebre reumática crónica, los 98 pacientes restantes (51 % de sexo femenino) cumplían los criterios diagnósticos de fiebre reumática aguda y fueron incluidos en el análisis. La edad media en el momento del diagnóstico era de 10,1 ± 3,0 años (intervalo: 3-17). Durante los 27 años del período de estudio, hubo una incidencia media de 3,6 pacientes por año sin picos de incidencia, sin embargo dos tercios de los casos se presentaron en los últimos 15 años. El 49 % de los pacientes habían nacido en Canadá y no nativos (NCnN), el resto eran nativos nacidos en Canadá (NCN) o nacidos en el extranjero (NE). La carditis fue diagnosticada en el 73 % de los pacientes y la corea de Sydenham en el 49 %. De los niños NCnN, el 39 % presentaban carditis comparativamente al 61 % de los niños de otro origen (p = 0,003). Sin embargo, la corea fue el modo de presentación en el 69 % de los niños NCnN frente al 31% en niños de otro origen (p < 0,001). No hubo ninguna mortalidad, a pesar de que el 2% presentaron recidiva durante el período de estudio y el 6,1 % con secuela cardíaca severa requirieron recambios valvulares. La fiebre reumática aguda en Montreal, a pesar de ser una enfermedad rara, ha presentado una incidencia constante en los últimos 27 años, la presentación clínica depende del origen étnico. To examine the epidemiology, clinical characteristics and outcomes in a cohort of children with acute rheumatic fever (RF) over the past 27 years in Montreal. The medical records of patients younger than 18 years of age hospitalized and diagnosed with RF in Montreal between January 1979 and December 2005 were reviewed. Among the initial 134 charts selected, 36 children were already followed-up for chronic RF and the remaining 98 patients (51 % females) who fulfilled the Jones criteria for acute RF were included in the analysis. The mean age at diagnosis was 10.1 ± 3.0 years (range: 3-17). Over the 27-year study period, there was a mean incidence of 3.6 patients/year without peaks, but onset occurred in the last 15 years in almost two-thirds of the patients. Forty-nine percent of the patients were Canadian-born non-aboriginal (CbnA) and the remaining patients were Canadian-born aboriginal (CbA) or foreign-born (Fb). Carditis was diagnosed in 73 % of the patients and Sydenham's chorea in 49 %. Of the CbnA children, 39 % had carditis compared with 61 % of children from other ethnic groups (P = 0.003). However, the form of presentation was chorea in 69 % of CbnA children vs. 31 % of children from other ethnic groups (P < 0.001). No deaths were attributable to acute RF although 2% of the patients relapsed during the study period. Severe cardiac sequelae requiring valve replacements occurred in 6.1%. The incidence of acute RF in Montreal was low but consistent over the 27-year study period. Clinical presentation varied depending on ethnicity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".