No abstract

The study aimed to evaluate mean platelet volume (MPV), platelet distribution width (PDW), and platecrit in children with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD), to assess the predictive value of these platelet activation markers for adverse outcomes, and to correlate their levels with various data in these patients. This prospective cohort study included 60 children with PAH-CHD as group I and 60 children with CHD and no PAH as group II. Another 60 healthy children of matched age and sex served as the control group. All included children were evaluated by echocardiography. MPV, PDW, and platecrit were also measured using an automated blood counter. All patients were followed up for death or readmission for 6 months. MPV, PDW, and platecrit were significantly higher in group I compared to group II and the control group and they correlated well with increasing severity of PAH. MPV, PDW, and platecrit positively correlated with right ventricular diameter and mean pulmonary artery pressure, however they correlated negatively with right ventricular systolic and diastolic function. The best cut-off of platelet activation markers levels to predict poor prognosis in group I was > 11.2 FL with 75% sensitivity and 96.6% specificity for MPV, > 12.7 FL with 75% sensitivity and 61.5% specificity for PDW, and > 0.505% with 75% sensitivity and 93.2% specificity for platecrit. MPV, PDW, and platecrit were elevated in children with PAH-CHD and found to be good predictive markers for poor prognosis in these children.

Background: Cyclosporin A (CsA) is an important drug regimen for difficult to treat nephrotic syndrome (NS) with few information known about its ototoxicity. Aims: Assessment the hearing status in children with difficult to treat idiopathic NS on CsA treatment. Material and Methods: This prospective cohort study included 2 groups: Group I: 15 children with steroid sensitive idiopathic nephrotic syndrome on steroids only as a line of treatment was used as comparing group to group II which included 15 children recently diagnosed difficult to treat NS starting CsA as steroids sparing drug, hearing functions were assessed using standard, high-frequency audiometry and transient otoacoustic emissions (TOAEs) at base line for both groups and after 6 months of CsA treatment for group II. Results: There was significant elevation of hearing threshold in extended high frequency (> 8 KHz) (subclinical hearing loss) after six months of CsA. There was positive correlation between Cyclosporin A trough level and elevated hearing threshold in pure tone audiometry and extended high frequency (> 8 KHz). There was insignificant difference between groups according to TOAEs. There was statistically significant positive correlation between extended high frequency range and serum trough CsA level in group II. Conclusions: CsA is a potential cause of hearing impairment in children with difficult to treat NS so all patients on CsA need routine audiological assessment especially with high serum CsA level and long duration.

Objectives: We aimed to evaluate neutrophil-to-lymphocyte ratio in children with acute heart failure due to dilated cardiomyopathy, to assess the predictive and prognostic values of neutrophil-to-lymphocyte ratio, and to correlate its levels with brain natriuretic peptide and other various data in these patients. Method: We included 50 children with acute heart failure due to dilated cardiomyopathy as the patient group. Fifty healthy children of matched age and sex served as the control group. Patients were evaluated clinically and by echocardiography. A complete blood count with differentiation to evaluate neutrophil-to-lymphocyte ratio was done, and the serum level of brain natriuretic peptide was also measured. All patients were followed up for death or readmission for a period of one year. Results: Neutrophil-to-lymphocyte ratio was significantly higher in patient group as compared to the control group. Neutrophil-to-lymphocyte ratio was significantly increased in patients with higher severity of heart failure. There was a significant increase in neutrophil-to-lymphocyte ratio in patients with bad prognoses compared to those with good prognoses. There was a significant positive correlation between neutrophil-to-lymphocyte ratio and both brain natriuretic peptide and clinical stage of heart failure while there was a significant negative correlation between neutrophil-to-lymphocyte ratio and left ventricular systolic function. The best cut-off of neutrophil-to-lymphocyte ratio to predict adverse outcomes in children with dilated cardiomyopathy was >3.6 with 87% sensitivity and 79% specificity. The cut-off of neutrophil-to-lymphocyte ratio to predict patients who will not respond to conventional treatment was ≥3.85 with 85% sensitivity and 100% specificity. Conclusion: Neutrophil-to-lymphocyte ratio is a cheap good predictive and prognostic biomarker in children with dilated cardiomyopathy.

Aim:This study aimed at assessing P-wave and QT interval dispersion in children with βthalassemia and to correlate them with various laboratory and echocardiographic data. Methodology: Subjects comprised of 30 children with β-thalassemia major as the patient group. 30 healthy children matched for age and sex served as the control group. All patients were evaluated clinically as well as by echocardiography and 12 leads ECG. The type of study is prospective case control study. Results: There was a statistically significant increase of Interventricular Septal end diastole (IVSd), Interventricular Septal end systole (IVSs), Left Ventricular Internal Diameter end diastole (LVIDd), Left Ventricular Internal Diameter end systole (LVIDs) and Left Ventricular Posterior Wall end diastole (LVPWd) in patients as compared to controls (Mean ±SD = 0.950±0.166, 0.863±0.103, 3.983±0.456, 2.947±0.535a nd 0.797±0.165 respectively) (P < 0.05). Moreover, there were a significant increase of LV mass (Mean ±SD = 107.267±26.736, P= 0.002) and LV mass index of the studied patients (Mean ±SD = 106.900±22.651, P = 0.005) compared to the controls. There were significant decrease of ejection fraction (EF%)( Mean ±SD = 60.373 ± 8.088, P = 0.032)and