Background: Coronavirus disease of 2019 (COVID-19) infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) among children is mostly a mild disease yet it may cause life threatening direct histopathological lung injury and indirect immune dysregulation with hyperimmune response that causes multi inflammatory disease. Aim of work: to study the clinical presentation, indication of admission to pediatric intensive care unit (PICU), complications and outcome in children with COVID-19 infection. Material and Methods: Our prospective observational study included children with COVID-19 admitted to PICU of Fayoum University Hospital, Egypt between January and March 2021. Results:The study included 35 children admitted with severe SARS-Cov-2, diagnosed by CT chest and positive antibodies against SARS-CoV-2, of them 20 (57.1%) were males and 15 (42.9%) females. Their mean ± SD age was 9 ± 8 months (range: 1 month to 10 years). The symptoms were heterogeneous; with fever 29 (82.9%) and cough 29 (82.9%) being the most frequent. The indication of admission to PICU was respiratory failure in 29 patients (80%), pediatric multisystem inflammatory syndrome -temporally associated with SARS-CoV-2 (PMIS-TS) in 5 (14.2%); 3 shocked, 2 of them with Kawasaki-like syndrome and 1 patient with liver cell failure (2.9%). The frequencies of lymphopenia and thrombocytopenia were (80% and 29.4%, respectively). Inflammatory markers, D-dimer, and cardiac enzymes were elevated in 28 (80%) patients. Complications included myocarditis in 8 (22.9%) cases and vascular thrombosis in 4 (11.4%). Intravenous immunoglobulin was prescribed exclusively for myocarditis, 31 (88.6%) of the patients received steroids and 19 (54.2%) received anticoagulants. Eight (22.9%) died; 6 with respiratory failure, 1 with liver cell failure and 1 with PMIS-TS and shock. Four (11.4%) patients were discharged with impaired cardiac function following myocarditis. Thrombocytopenia was found in 7 cases (29.4%) and was associated with mortality among the patients studied (p=0.014). Conclusion:Severe COVID-19 in children presented with pulmonary and non-pulmonary affection. It was complicated by serious complications as myocarditis and vascular thrombosis. PMIS-TS clinically manifested as Kawasaki's disease and/or shock syndrome. Thrombocytopenia was a risk factor of mortality in the studied patients.

Introduction: Cardiac affection in patients with nephrotic syndrome (NS) may be attributable to malnutrition and activated inflammatory state. Myocardial performance index (MPI) is more sensitive than the classic echocardiographic parameters, particularly in showing subclinical myocardial function compromise. Aim of the study: Tto compare the findings of conventional echocardiography and tissue Doppler imaging in children with NS. Methods: This study was conducted at the outpatient Nephrology Clinic and the Cardiology Unit of Pediatric Department at Fayoum University Hospital. It included 30 patients with primary nephrotic syndrome (PNS) compared with 30 apparently healthy subjects, age-and gender-matched to the diseased group. Participants were subjected to full history taking, thorough clinical examination, anthropometric measurements, and laboratory studies. Conventional echocardiography and tissue Doppler imaging were used for evaluation of ventricular hemodynamics. Results: Conventional echocardiography did not reveal any significant differences between the patients and control subjects. Tissue Doppler imaging showed significant differences in some parameters. The right ventricular (RV) and left ventricular (LV) MPI were high in 30% and 20% of PNS patients, respectively. Both LV and RV dysfunctions were significantly associated with longer duration of disease and treatment as well as higher percentage of relapse, steroid resistance, and intake of immunosuppressives. Conclusion:Both LV and RV dysfunctions may occur in children with PNS. Both conditions were significantly associated with disease duration, treatment duration, relapse, steroid resistance, and administration of immunosuppressive drugs. Tissue Doppler echocardiography is recommended for follow-up of NS patients, particularly those with long disease duration and/or prescribed immunosuppressive drugs.

The aim of this study was to study the repolarization patterns in pediatric patients with cyanotic and acyanotic congenital heart diseases as prolonged QT indicates a myocardium at risk of ventricular arrhythmia. A cross-sectional case-control study included 50 patients with acyanotic congenital heart diseases and 50 patients with cyanotic congenital heart diseases who presented to Catheterization Unit of Cairo University Pediatric Hospital between March 2013 and June 2014. We included 50 healthy children as a control. For all the patients' measurement of oxygen saturation, echocardiography and 12-lead electrocardiogram (ECG) were done and the corrected QT (QTc) was measured. The mean QTc was significantly higher in acyanotic congenital heart diseases with volume overload than in control: 0.426 versus 0.4 s (p = 0.009). Increased left ventricular end-diastolic dimension was significantly associated with QTc prolongation (p = 0.01). Early repolarization was higher in congenital heart diseases (18 % in acyanotic patient, 48 % in cyanotic patients) than in control 6 %. Decreased oxygen saturation was significantly associated with early repolarization (p = 0.01). Prolonged QTc was higher in acyanotic congenital heart diseases with volume overload and increased left ventricular end diastolic dimension was a significant association. Decreased oxygen saturation was a significant association.