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Background: COVID-19 leads to severe overwhelming inflammation in some patients mediated by various cytokines (cytokine storm) that usually leads to severe illness accompanied by cardiovascular manifestations. Growth differentiation factor-15 is a cytokine induced by stress and is associated with inflammatory processes in the lung and heart. This study aimed to measure the level of serum growth differentiation factor (GDF-15) in children with COVID-19 and to correlate it with the disease severity, cardiac affection, and the outcome of COVID-19., Methods: A cross-sectional study was conducted on 144 children; 72 children diagnosed with COVID-19, and 72 healthy children. The severity of COVID-19 was assessed clinically, laboratory, and radiologically. Echocardiography was done within 48 h of admission for COVID-19 patients. Serum GDF-15 was measured by ELISA for both patients and controls., Results: Serum GDF-15 level was significantly higher in patients with COVID-19 than in controls (p < 0.01). In COVID-19 patients with severe clinical grading, those who were hospitalized in the PICU, and those who died, serum GDF-15 levels were greater. individuals with cardiac manifestations exhibited significantly higher serum GDF-15 levels than individuals without them. In children with COVID-19, increased GDF-15 was correlated to poorer ejection fraction and higher INR using multivariate linear regression analysis., Conclusion: Serum GDF-15 is a promising biomarker of COVID-19, it can be used as a predictor of cardiac manifestations in children with COVID-19 and severe disease., (© 2023. The Author(s).)

Background: Thrombosis and embolism are possible complications in coronavirus disease 2019 (COVID)-19-positive pediatric patients. Although the risk is lesser in children than it is in adults, it does exist during acute infection and multi-inflammatory syndrome in children. Biomarkers such asd-dimer, prothrombin time, and fibrinogen degradation products are ineffective at detecting disease severity. Homocysteine (Hcy) is a prothrombotic factor that has been reported to be higher in adult COVID-19 patients, leading to speculation that it could be used as a biomarker for disease severity., Purpose: To detect the correlation between serum total homocysteine (tHcy) level and the severity of COVID-19 in pediatrics., Methods: A cross-sectional study was conducted on 40 children with COVID-19 and 40 healthy control subjects. Serum tHcy was measured by enzyme-linked immunosorbent assay and correlated with the clinical, laboratory, and radiological parameters of the patients., Results: The median serum tHcy level in COVID-19 patients was 27.5 (interquartile range [IQR]: 23-31.75) μmol/L, while that in the controls was 1.8 (IQR: 1.6-1.875) μmol/L. There was a statistically significant increase in the tHcy level in cases compared to controls (p < 0.001). There was a statistically significant positive correlation between serum tHcy and d-dimer, ferritin, alanine transaminase, aspartate transaminase, blood urea nitrogen, and a highly significant positive correlation between tHcy and COVID-19 reporting and data system score, pediatric intensive care unit admission, and the disease severity classification., Conclusion: Hcy could be a biomarker of importance in predicting the severity of COVID-19 in pediatrics., (© 2022 Wiley Periodicals LLC.)

Objective: To report and describe cases of children presenting with coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in children (MIS-C) with new-onset type 1 diabetes mellitus (T1DM) in severe diabetic ketoacidosis (DKA)., Research Design and Methods: This prospective observational study was conducted to characterize children with COVID-19-related MIS-C and new-onset T1DM who were in DKA. MIS-C was diagnosed if Centers for Disease Control and Prevention and World Health Organization criteria were fulfilled., Results: Six cases were identified. The patients were critically ill and in nonfluid responsive shock (combined hypovolemic and cardiogenic or distributive shock). All had cardiac involvement. One patient had a Kawasaki shock-like presentation. All needed aggressive treatment with careful monitoring of fluid balance (because of associated cardiac dysfunction), early institution of vasoactive/inotropic supports, and use of methylprednisolone and intravenous immunoglobulins. The latter are better administered after DKA resolution to avoid undue volume overload and fluid shifts while the patients are in DKA., Conclusions: Awareness of MIS-C coexistence with DKA at T1DM onset is crucial for rapid proper management., (© 2022 by the American Diabetes Association.)