الفهرس 
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Abstract
Infection with Streptococcus pyogenes in the throat results in acute rheumatic fever. Heart failure and mortality may occur if rheumatic fever induces cardiac involvement, which can be caused by rheumatic heart disease. In many low-income countries, poverty and overcrowding in the house make acute rheumatic fever and rheumatic heart disease a public health threat. The diagnosis of RF requires two major or one major and two minor Jones criteria along with evidence of a preceding streptococcal infection. The major criteria are polyarthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules. The minor criteria are fever, arthralgia, elevated acute phase reactants, and a prolonged PR interval on the electrocardiogram Pediatric vitamin D insufficiency is a worldwide public health issue. Many studies have shown that vitamin D may have immunomodulatory and anti-inflammatory effects on viral and autoimmune illnesses. Children with autoimmune disorders have been shown to have low serum 25(OH)D levels in a few investigations. During the winter and spring months, incidences of GAS infection and ARF surge due to a lack of sunshine exposure, which lowers 25(OH)D levels. Additionally, children between the ages of 5 and 15 years old are quickly growing, which need a higher vitamin D intake. The current case control study was carried out at Tanta University Hospital’s pediatric cardiology unit. The analysis of vitamin D insufficiency in ARF and its influence on disease phenotypes as well as its relationship to serum immunoglobulin levels was the goal of this investigation. The patients were classified into two groups: group 1: 49 children subdivided into: group 1a: included 10 patients with rheumatic fever diagnosed by modified Jones criteria or rheumatic heart disease group 1b: 39 children (the brothers and sisters of rheumatic patients) included group 2: the control group included 40 healthy, age and sex matched children of ten families. All patients were subjected to complete history talking, Echocardiographic examination and laboratory investigations (Vit. D, ESR, ASOT, CRP, Ca, Ph, IgG, C3, C4). Summary of results • The mean age of the cases was (10.29± 3.21) while that of the control group was (9.6 ± 4.24) (p = 0,388). • The percentage of male among the study group was 51.0% and of female was 49.0%, while among control group the percentage of male was 52.5% and of female was 47.5%. • The mean weight of the cases was (30.10 ± 6.93) while that of control group was (28.93±9.01). • (30.6 %) of patients had positive family history of rheumatic disease while (69.4%) of patients had negative family history of rheumatic disease. • (24.5%) of cases have past history of URTI while (75.5%) of cases have negative past history of URTI. (7.5%) of control have past history of URTI while (92.5%) of control have negative past history of URTI. There is a significant difference between the cases and the control group regarding past history of upper respiratory tract infection. • The myalgia, Arthralgia,fever and murmers are the most common clinical presentations with the following percentage (26.5%) (24.5%), (18.4), (14.3%) respectively while headache is the least one (6.1%). • There was a statistically significant decrease between cases and controls regarding Ca level with, as Ca mean value was (8.92mg/dl) in cases, while it was (9.75 mg/dl) in control with P value 0.001* • There was statistically significant decrease between cases and controls regarding Vit D3 with, as Vit D3 mean value was (20.3ng/ml) in cases, while it was (43.7 ng/ml) in control. • There is statistically significant difference decrease between cases and controls regarding C4 with P value 0.001* • The ROC curve for serum Vit D level in study group shows the best cut off point of Vit D was 37 ng/ml with sensitivity (98%), specificity (80%). • The ROC curve for serum Ca level in study group shows the best cut off point of Ca was 9.5 mg/dl with sensitivity (73%), specificity (75%). • The ROC curve for serum C4 level in study group shows the best cut off point of C4 was 23 mg/dl with sensitivity (86%), specificity (68%).