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Introduction: to assess the role of epicardial fat thickness and irisin in early prediction of cardiac dysfunction in children and adolescents with type 1 diabetes mellitus and correlate them with echocardiographic parameters and lipid profile. Material and methods: Sixty-three type 1 diabetic children and adolescents were recruited from the Pediatric Diabetic Clinic, National Research Centre. Thirty-four healthy children, matched for age and sex, served as controls. All patients were insulin dependent with at least 3-year duration of the disease since diagnosis. Venous blood was withdrawn under complete aseptic precautions from fasting subjects; sera were collected for evaluation of glycated haemoglobin (HbA1C), lipid profile and irisin levels. Two-dimensional echocardiography was performed for measurement of interventricular septal thickness in diastole, left atrial diameter (LAD), aortic root diameter, mitral E and A wave, left ventricular internal dimension in diastole, percent fractional shortening (FS%), percent ejection fraction, left ventricular mass, and epicardial fat thickness. Patients were further divided into two groups according to their glycaemic control (< 7.00, ≥ 7.0) for comparison of echocardiographic parameters and irisin. Results: Echocardiographic study revealed a statistically significant increase in LAD, FS%, and epicardial fat thickness in patients compared to controls (p = 0.000, 0.014, and 0.000 respectively). Triglyceride and irisin levels were significantly increased in patients compared to controls (p = 0.012, 0.015 respectively). Epicardial fat thickness positively correlated with left atrial diameter (p = 0.009) and left ventricular mass (p = 0.000). Irisin was positively correlated with E/A ratio (p = 0.05). Conclusions: The findings of the present study probably indicate the beginning of a state of metabolically induced diastolic dysfunction. Echocardiography should be performed in type 1 diabetic patients on a regular basis for early detection of subclinical cardiac dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Familial Mediterranean fever (FMF) is an autosomal recessive disease. It is characterized by recurrent crises of fever and serosal inflammation. Although FMF patients are symptom free in between attacks, subclinical inflammation continues during the attack-free period. Such patients with inflammatory status have an increased risk of atherosclerotic cardiovascular complications. We attempted to elucidate the role of arterial wall thickening as a predictor of early atherosclerosis in children affected by FMF and to clarify the links between carotid intima media thickness and the markers of subclinical inflammation serum amyloid A (SAA), erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR)., Material and Methods: It is a case control study. The study comprised 45 Egyptian children diagnosed with FMF and 45 healthy children of matched age and sex who served as controls, without family history or clinical manifestations suggestive of FMF. Laboratory investigations included complete blood count, NLR, PLR, ESR, C-reactive protein and lipid profile. Serum amyloid A levels were determined in both groups using enzyme linked immunosorbent assay. Assessment of the common carotid artery intima media thickness (CIMT) in the FMF patients was carried out., Results: The level of SAA was significantly higher in patients than the control subjects with a mean value of 38.30 ng/ml and 23.43 ng/ml respectively ( p < 0.001). Our patients showed significantly higher PLR when compared to controls ( p < 0.001). The mean right and left carotid intima media thickness in patient and control groups showed a highly significant difference ( p = 0.005 and 0.036 respectively)., Conclusions: The mean carotid intima media thickness is higher in cases than the control group. Hence carotid intima media thickness may be used as a tool in the prediction of any atherosclerotic burden in those children., Competing Interests: The authors declare no conflict of interest.

Background: Empty sella (ES) may be associated with variable clinical conditions ranging from the occasional discovery of a clinically asymptomatic pouch within the sella turcica to severe intracranial hypertension and rhinorrhea. The need for replacement hormone therapy in ES, as in other syndromes that may cause hypopituitarism, must be assessed for every single hormone, including growth hormone (GH)., Aim: To determine whether or not the presence of ES could allow some changes in the GH responses of the isolated growth hormone deficiency (GHD) patients., Materials and Methods: We included a cohort of 59 short stature children and adolescents with isolated GHD. According to computed tomography finding, they were classified into 2 groups: Group 1 included 40 children with normal sella and 19 children with ES in Group 2. All patients received recombinant human growth hormone (rhGH) with a standard dose of 20 IU/m(2)/week., Results: The baseline results were not significantly different for all variables except weight standard deviation was smaller with statistical significant difference (P = 0.02). We identified no significant differences when comparing both groups, except for height standard deviation (HTSD) after the first year of therapy which revealed significant difference in favor of group 1. When comparing pre- and the two post-treatments HTSD results of the studied cases, all showed significant changes after GH therapy. The results of related variables pre-and post-treatment in both the groups showed significant improvement in all variables of the two groups of the study., Conclusion: Our study showed a similar stature outcome in the two treatment groups.

Background: Multiple factors affect the growth response to recombinant human growth hormone (rhGH) in children with idiopathic short stature (ISS)., Aim: To evaluate the growth responses of children with ISS treated with rhGH, aiming to identify the predictors of growth response., Materials and Methods: We studied 120 cases, 90 males (75%), with a mean age of 13.8±2.7 years and 30 females (25%), with a mean age of 12.3±2.5 years. All patients received rhGH with a standard dose of 20 IU/m(2)/week. The calculated dose per week was divided into six days and given subcutaneous at night., Results: A significant positive trend was detected in the delta changes of all anthropometric data. For the first year, the growth response was positively correlated to CA and BA delay and negatively correlated to height, weight and IGF-1 SDSs. For the second year, the growth response was correlated positively to first year growth velocity, BA, triceps skin fold thickness SDS and deviation from target height, and negatively correlated to weight, IGFBP3 SDS and target height SDS. For the third year, the growth response was positively correlated to five variables namely target height, 2(nd) year growth velocity, IGF-1 SDS, weight SDS and triceps skin fold thickness SDS. For the fourth year, growth response was positively correlated to 2(nd) and 3(rd) year growth velocity, BA, deviation from target height and weight/ height SDS., Conclusion: Our study showed multiplicity of predictors that is responsible for response in ISS children treated with rhGH, and BA was an important predictor.

Background and Objectives: Recombinant human growth hormone (rhGH) is approved for use in children with Turner's syndrome (TS) in most industrialized countries and is recommended in the recently issued guidelines. We determined the growth responses of girls who are treated with rhGH for TS, with an aim to identify the predictors of growth response., Materials and Methods: Fifty-six prepubertal girls with TS, documented by peripheral blood karyotype, were enrolled. All the patients received biosynthetic growth hormone therapy with a standard dose of 30 IU/m(2)/week. The calculated dose per week was divided for 6 days and given subcutaneously at night., Results: This study showed that rhGH therapy provides satisfactory auxological results. Bone age delay is to be considered as a predictive factor which may negatively influence the effect of rhGH therapy on final height. The growth velocity in the preceding year is the most important predictor of rhGH therapy response., Conclusion: These observations help us to guide rhGH prescription, to reduce the risks and costs.