Echocardiographic abnormalities in children with sickle cell disease

Sickle cell disease [SCD] is an inherited disorder associated with significant morbidity, characterized by the presence of abnormal hemoglobin within the red blood cells. The cardiovascular system is stressed by chronic anemia, small pulmonary artery occlusions and myocardial hemosiderosis that cause multiple anatomical and functional changes. Anatomical and functional assessment of the heart through M mode, 2 dimension and doppler echocardiography in pediatric patients with sickle cell anemia [SCA]. Twenty-five children with SCA [mean age 10 +/- 3.4 years], 14 males and 11 females were prospectively studied in a comparison with 25 ages and sex matched healthy children. All of them underwent clinical and laboratory evaluation, M mode, 2 dimension and doppler echocardiography. Patients with SCD had higher left ventricular end diastolic dimension, left atrial dimension, stroke volume and left ventricular mass. Mild pulmonary hypertension with mean pulmonary artery systolic pressure [PASP] 30 +/- 5.40 mmHg. Chamber dilatation, left ventricular hypertrophy with increased left ventricular mass associated with left ventricular diastolic dysfunction secondary to chronic anemia with volume overload and sickle cell cardiomyopathy confirm the evidence of the literature in characterizing a sickle cell disease in pediatrics

Different modalities in early diagnosis of acute appendicitis in children

Acute appendicitis [AA] is a common surgical problem that is associated with an acute-phase reaction. Previous studies have shown that cytokines and acute-phase proteins are activated and may serve as indicators for the severity of appendicitis. During inflammation, enterochromaffin cells in the appendix secrete serotonin, and 5-hydroxy indole acetic acid [5-HIAA]; a serotonin metabolite excreted in urine, has been found to be elevated in patients presenting with acute appendicitis. As there is no reliable single laboratory marker to assist in diagnosis of acute appendicitis so the aim of this study was to compare diagnostic values of different serum inflammatory markers in acute appendicitis in children. A total of 90 children were admitted in the emergency unit with suspected acute appendicitis. Fourteen children were excluded as they were diagnosed with pneumonia [4], urinary tract infection [3], tonsillopharyngitis [5] and gastroenteritis [2]. According to required treatment, patients were divided into two groups. One group comprised 46 children with acute appendicitis who had surgical intervention while the other group comprised 30 children with non-specific abdominal pain. All patients were subjected to history, clinical examination, abdominal ultrasound, white cell count, C- reactive protein, interleukin-6 and urinary 5-hydroxy indole acetic acid. Ultrasonography and urinary 5-HIAA showed the highest diagnostic accuracy [91.1% and 87.8% respectively], followed by serum IL-6 concentration [70%], white blood cell count [67.8%], clinical signs [66.7%], and serum C-reactive protein concentration [61%]. Ultrasonography and 5-HIAA achieved also the highest specificity [90.9%] and positive [91.1% and 90.7%] and negative [88.9% and 85.1%] predictive values, whereas clinical signs showed the highest sensitivity [91.3%] followed by ultrasonography [89.1%] and urinary 5-HIAA [84.8%]. Combination of ultrasonography and urinary 5-HIAA increase the diagnostic accuracy of acute appendicitis and provide surgeons with complementary information in discerning the necessity for urgent operation