{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:11:59Z","timestamp":1788966719700,"version":"build-2803163510"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Studies in adults with chronic rheumatic heart disease (RHD) suggest persistence of elevated inflammatory markers, indicating a potential role of ongoing inflammation in disease chronicity. However, similar data in the pediatric population are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A cross-sectional observational study was conducted in the Division of Pediatric Cardiology at a tertiary care hospital in North India from August 2022 to February 2024. Forty-three patients with RHD &lt;18 years were enrolled. Comprehensive history taking and clinical examinations were conducted. Blood samples were collected to evaluate C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, interleukin-6 (IL-6), IL-17, and tumor necrosis factor alpha (TNF-\u03b1) levels. Inflammatory marker levels were compared with American College of Cardiology (ACC) valvular heart disease (VHD) stage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Mean age of participants was 13.14 \u00b1 3.17 years. Mean duration of disease was 3.23 \u00b1 1.98 years. The CRP was elevated in 37.2% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 16) patients. IL-6, IL-17, and TNF-\u03b1 were elevated in all patients. IL-6 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.036) and IL-17 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.008) showed significant association with ACC VHD stage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Pediatric RHD patients exhibit elevated blood inflammatory markers in the absence of acute rheumatic fever. Targeting this chronic inflammation could potentially slow progression of RHD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/apc.apc_100_26","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:21:24Z","timestamp":1788949284000},"page":"527-533","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Recurrence to persistence: Inflammatory markers in pediatric rheumatic heart disease"],"prefix":"10.4103","volume":"19","author":[{"given":"Lalan","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Pediatrics, ABVIMS and Dr RML Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakshi","family":"Sachdeva","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, ABVIMS and Dr RML Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dheeraj Deo","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, ABVIMS and Dr RML Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, ABVIMS and Dr RML Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neera","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, ABVIMS and Dr RML Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal Kumar","family":"Vishwakarma","sequence":"additional","affiliation":[{"name":"Institute of Pharmacy, Deen Dayal Upadhyay Gorakhpur University, Gorakhpur, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harlokesh Narayan","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, All India Institute of Medial Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimisha","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, ABVIMS and Dr RML Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"R1-20260909","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/jpc.12808","article-title":"Historical aspects of rheumatic fever","volume":"51","author":"Steer","year":"2015","journal-title":"J Paediatr Child Health"},{"key":"R2-20260909","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/S0140-6736(11)61171-9","article-title":"Rheumatic heart disease","volume":"379","author":"Marijon","year":"2012","journal-title":"Lancet"},{"key":"R3-20260909","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.ihj.2021.02.009","article-title":"Detecting sub-clinical disease activity in patients with chronic rheumatic valvular heart disease","volume":"73","author":"Singal","year":"2021","journal-title":"Indian Heart J"},{"key":"R4-20260909","first-page":"329","article-title":"Subclinical rheumatic heart disease: A single center experience","volume":"5","author":"Kayali","year":"2018","journal-title":"North Clin Istanb"},{"key":"R5-20260909","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1001\/archpedi.1984.02140420007003","article-title":"Recurrences of acute rheumatic fever. 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