Search

Background: Ventricular septal deformity (VSD) and Atrial septal deformity (ASD) are the most common congenital heart disease (CHD). This study intended to help improving morbidity and mortality of pediatrics patient with Ventricular septal defect and ASDs, through achieving the following objectives; assessment the role of diameter of defect, child age, measurement of serum l.carnitine and phospholipids in early spontaneous closure of atrial septal defects and ventricular septal defects. Patients and Methods: This was a cohort study was carried out at Pediatric Cardiology Unit of Zagazig University hospitals during the period from October 2019 to October 2020 Included 30 children up to 2 years of age were following for ASD or VSD. The patients were categorized into 2 groups: Group I; comprised 20 patients with ASD. Group II; comprised 10 patients with VSD were observed for 12 months with successive 2-dimensional echocardiography. All patients were subjected to full history and examination with special focus on cardiac manifestations, follow up echocardiography at 3 and 6 months viewing extent of the deformities which compared to preceding echocardiographic reports. Laboratory investigations was done with detection of Lcarnitine and phospholipids levels. Results: There was statistically significant higher total phospholipid among ASD patients with natural closure than regression to = 3 mm and than residual >3 mm (p-value = 0.001) with no statistically significant difference regarding L. Carnitine (p-value = 0.1). There was statistically significant higher L. Carnitine among the VSD patients with regression to = 3 mm than residual >3 mm (p-value =0.01) with no statistically significant difference regarding total phospholipid (p-value =0.1). Age at diagnosis, defect size, total phospholipids and L-Carnitine were the statistically significant predictor factors for spontaneous closure of ASD and VSD among the studied group. Conclusion: Age at diagnosis, defect size, total phospholipids and L-Carnitine were the statistically significant predictor factors for spontaneous closure of ASD and VSD among the studied group. [ABSTRACT FROM AUTHOR]

Background: Arrhythmias occur often in the early postoperative period, where hemodynamic variations are normal, rendering the patient unstable and can lead to low c ardiac output and cardiac arrest unless treated and resolved in a timely manner. The aim of this study was to analyze the possible causes and risk factors of early arrhythmias to determine the outcome of patients and prevention of arrhythmias after congenital cardiac surgery in pediatrics. Methods: This Prospective observational study was conducted in the pediatric cardiothoracic intensive care unit (ICU) and pediatric cardiology unit of Zagazig university, the target sample included 24 patients <18-years of both sexes who underwent cardiac operation with or without cardiopulmonary bypass (CPB) between January to July 2020. All patients underwent echocardiographic examination before and after surgery. Children were monitored in the early postoperative period (72h) for the detection of any rhythm abnormality and followed until they were discharged from hospital. Results: This study showed that early arrhythmias occurred after open heart surgery and all presented in the first 72 hours. The most common type of arrhythmias encountered in this study were JET (12.5%) in three cases diagnosed as ASD, VSD and TOF, SVT (4.2%) in one case of PDA+VSD.electrolyte disturbance one of causes of increase chance of arrhythmias occurrence in postoperative period in our study. Conclusions: Early Postoperative arrhythmias are still a frequent complication in the early period of congenital cardiac surgery in pediatric patients, especially junctional ectopic tachycardia. Hemodynamically significant arrhythmia could be lethal in patients with severe underlying heart diseases. [ABSTRACT FROM AUTHOR]

In cardiovascular disorders, the myocardium may be subjected to the breakdown and remodeling of collagen by metalloproteinase‑9 (MMP‑9). We hypothesized that the serum MMP‑9 concentration may be elevated in pediatric patients with rheumatic heart disease (RHD) and heart failure (HF), and its level can be correlated with the HF severity. Thus, in the present study, we aimed to evaluate the sensitivity and accuracy of MMP‑9 to predict HF in children with RHD and to determine its effectiveness as an indicator of the degree of HF. This study included 98 consecutive children admitted to the Department of Pediatrics, Zagazig University Hospital, Al Sharqia Governorate, Egypt with newly diagnosed RHD. Their ages ranged from 8.5 to 16 years. Fifty‑eight children had RHD without HF while 40 children were complicated with HF which was diagnosed clinically and by echocardiography. A total of 44 healthy children were enrolled as a control group. MMP‑9 serum levels were estimated by enzyme‑linked immunosor‑ bent assay. The serum MMP‑9 concentration was higher in the RHD without HF and RHD with HF groups than this level noted in the control (P<0.001). MMP‑9 was a significant predictor of HF; area under the curve (AUC)=0.85 [95% confidence interval (CI), 0.76‑0.94]. At the level of 386.9 ng/ml, MMP‑9 detected HF with a sensitivity 95% (95% CI, 83.08‑99.39), specificity 74.14% (95% CI, 60.96‑84.74), positive predictive value 71.70% (95% CI, 61.96‑79.75), negative predictive value 95.56% (95% CI, 84.67‑98.82) and accuracy 82.65% (95% CI, 73.69‑89.56). In addition, MMP‑9 showed a significant nega‑ tive correlation with ejection fraction and fractional shortening (P=0.01 and P=0.02, respectively). In conclusion; MMP‑9 may be an independent sensitive marker with which to detect HF in children with RHD and it can predict the prognoses of these patients as it correlates with the severity of HF. Further studies considering MMP‑9 in the detection of ‘silent’ RHD in school aged children and asymptomatic HF in children with known RHD especially in rural areas, are highly recommended. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular complications represent the main determinant of survival in ß-thalassemia patients, with particular pattern of cardiovascular affection inß-thalassemia major (ß-TM) and ß-thalassemia intermedia (ß-TI). Serum cystatin C is a well-known predictor of nephropathy but it has emerged as a strong predictor to cardiovascular dysfunction. Objective: We assessedcystatin C levels in children and adolescents with ß-TM and ß-TI and its relation to echocardiography parameters and carotid intima media thickness (CIMT) as a marker of subclinical cardiovascular dysfunction. Methods: Case control study on 60 patients with ß-TM, 30 patients with ß-TI and 60 age- and sex-matched controls focusing on hematological profile, serum ferritin, urinary albumin-creatinine ratio (UACR), serum cystatin C, echocardiography and CIMT. Results: UACR, serum cystatin C and CIMT were significantly higher in ß-TM and ß-TIgroups compared to control (P < 0.001). Cardiac left ventricle (LV) systolic dysfunction was more prominent in patients with ß-TM (30%) versus (13.33%) in ß-TI, while significantly higher pulmonary pressure in those with ß-TI(73.3%) compared to (43.3%) of ß-TM. Significantly higher cystatin C levels were observed in ß-TM and ß-TI patients with nephropathy, LV systolic dysfunction or pulmonary hypertension than those without. Cystatin C levels were positively correlated with CIMT in both ß-TM and ß-TI groups. Thecystatin C cutoff values for detection of the risk of cardiovascular complications were assessed. Conclusions: Cystatin C appears to be a promising a marker for subclinical cardiovascular dysfunction in ß-TM and ß-TI patients. [ABSTRACT FROM AUTHOR]

Background: Heart failure is defined as a clinical and pathophysiologic syndrome results from ventricular dysfunction, volume, or pressure overload, alone or both. Galectin-3 is a novel biomarker that mediates fibrosis in many organs like the heart that interest in galactin3 as a potential heart failure biomarker that reflects ongoing ventricular remodeling. Objective: To see if galectin-3 acts as a biomarker of heart failure in congenital heart disease and evaluate if there is a correlation between galectin-3 and severity of HF detected by Ross classification and echocardiogram. Patients and Methods: The present study included 38 cases with HF due to CHD admitted to PICU and pediatric department at Zagazig University Hospital from July 2018 to July 2019. Patients were selected to exclude heart failure other than congenital heart disease. Results: Galectin-3 level was significantly higher in children with CHD than age and sex-matched healthy children. There were statistically significant positive correlations between Galectin 3 and ROSS so higher Galectin-3 levels were associated with measures of HF severity. The level was significantly elevated in children with HF in comparison to those without HF, with a significant correlation with the disease severity. Galectin 3 had sensitivity 80%, specificity 100%, PPV 100% and PPN 71.4%. Conclusion: Galectin-3 has short term prognosis and can be used as a tool to help in HF diagnosis in children as a marker of disease severity (positive correlation between Ross classification and galectin-3 serum level was proved) and staging patients with acute HF due to congenital heart diseases. [ABSTRACT FROM AUTHOR]

Background: One of the most prevalent congenital deformities in infants is congenital heart disease (CHD) that has high rates of morbidity and mortality. To enhance patient clinical outcomes, it is vital to investigate CHD pathophysiology. Cardiovascular illness has been linked to TGF-1 signaling disruptions. Aim of the Study: The forecasting of CHD susceptibility in the Egyptian population is our aim. Patients and methods: This case-control study was conducted at the Pediatric Cardiology Unit at the Zagazig Children Hospital, Faculty of Medicine, Zagazig University, with 60 CHD patients and 60 healthy controls of similar age and sex. Single nucleotide polymorphisms (SNPs) that are genotyped include: The TGFB1 rs1800471 and rs1982073 analysis were carried out using restriction fragment length polymorphism (RFLP PCR). Results: The CT and TT genotypes of rs1982073 were significantly more prevalent in the CHD group compared to controls. The C allele was only identified in 65 (54%) of the CHD cases and the T allele in 55 (46%) of them, whereas the C allele was present in 94 (78%) of the control participants and the T allele in 26 (22%) of them. There was a significant difference between CHD cases and controls in terms of the T allele of rs1982073, which was higher in CHD cases compared to controls. Conclusion: The current study shows a link between the TGFB1 gene variant rs1982073 and the incidence of congenital cardiac disease in Egyptian communities. [ABSTRACT FROM AUTHOR]

Background: Along with decreased sympatho-adrenal flow, catestatin has a number of cardiovascular effects. Reduced plasma catestatin levels could be a sign of a predisposition to develop metabolic and hypertensive diseases. Aim and objectives: To assess the function of catestatin in cardiometabolic risk assessment among diabetic children. Subjects and methods: This case-control study was carried out on 108 children at Pediatrics Department, Zagazig University Hospital. Children were divided into 2 groups: (Group A): Case group 54 children with diabetes, (Group B): Control group 54 apparent healthy children at same sex and age. Every infant was subjected to serum catestatin concentrations measurement using ELISA Kit. Result: Median Catestatin in diabetic group was 8.35 ng/ml (6.16 - 17.41) while that for Control group was 11.19 ng/dl(7.42 -16.56), the difference was statistically significant (p< 0.05). Conclusion: Serum Catestatin was related to diabetes and it cannot be considered as a good biomarker of cardio metabolic risk among diabetic children. Further larger scale studies are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Introduction: Rotavirus is the major cause of acute gastroenteritis (AGE) in infants and young children all over the world. The objective of the study was to compare different methods for detecting rotavirus and to assess the burden of rotavirus as a causative agent for AGE in children younger than five. Methods: This case control study included 65 children with AGE and 35 healthy control children. They were chosen from the Pediatric Department of Zagazig University Hospitals from October 2014 to March 2015. Stool samples were obtained and assayed for rotavirus by the immunochromatography test (ICT), enzyme linked immunosorbent assay (ELISA) and quantitative real time RT-PCR (qr RT-PCR). Results: Fifty out of the 65 patients (76.9%) were positive for qr RT-PCR. Forty-five (69.2%) and 44 (67.7%) were positive for ICT and ELISA, respectively. There was a significant association between the severity of the disease as determined by the Vesikari score and rotavirus infection. Conclusion: This study demonstrated that ICT is a useful method for the rapid screening of group A rotavirus in fecal specimens, because it is rapid, inexpensive, easy to perform, and requires very little equipment. In addition, this study highlights the substantial health burden of rotavirus AGE among children less than five. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is the foremost cause of child death worldwide. M-ficolin is encoded by the FCN1 gene and represents a novel link between innate and adaptive immunity., Objectives: To investigate the FCN1 -144 C/A (rs10117466) polymorphism as a potential marker for pneumonia severity and adverse outcome namely complications or mortality in the under-five Egyptian children., Methods: This was a prospective multicenter study that included 620 children hospitalized with World Health Organization-defined severe pneumonia and 620 matched healthy control children. Polymorphism rs10117466 of the FCN1 gene promoter was analyzed by PCR-SSP, while serum M-ficolin levels were assessed by ELISA., Results: The FCN1 A/A genotype and A allele at the -144 position were more frequently observed in patients compared to the control children (43.4% vs 27.6%; odds ratio [OR]: 1.62; [95% confidence interval {CI}: 1.18-2.2]; for the A/A genotype) and (60.8% vs 52.5%; OR: 1.4; [95% CI: 1.19-1.65]; for the A allele); P < .01. The FCN1 -144 A/A homozygous patients had significantly higher serum M-ficolin concentrations (mean: 1844 ± 396 ng/mL) compared with those carrying the C/C or C/A genotype (mean: 857 ± 278 and 1073 ± 323 ng/mL, respectively; P = .002). FCN1 -144 A/A genotype was an independent risk factor for adverse outcomes in children with severe pneumonia (adjusted OR = 4.85, [95% CI: 2.96-10.25]; P = .01)., Conclusion: The FCN1 A/A genotype at the -144 position was associated with high M-ficolin serum levels and possibly contributes to enhanced inflammatory response resulting in the adverse outcome of pneumonia in the under-five Egyptian children., (© 2020 Wiley Periodicals, Inc.)