Prognostic value of cardiac troponin I and left ventricular geometry in pediatric chronic hemodialysis: a one year follow up study

Increase in left ventricular mass index [LVMI] is associated with an increase in the incident risk of fatal and nonfatal cardiovascular events in chronic renal failure [CRF]. Cardiac troponin I [cTnl] has been shown to be specific for myocardial damage in chronic dialysis patients. To assess LVMI and cTnI in pediatric patients with CRF on chronic hemodialysis [HD] and to determine their relation to dialytic hypotensive episodes as well as mortality over a period of one year. A prospective follow up study was conducted on 30 pediatric patients with CRF on chronic regular HD with a mean age [10.3 +/- 3.04 years]. Cases were subjected to clinical evaluation, 2-D, M-mode, pulsed and color Doppler echocardiography. Calculation of left ventricular mass [LVM] and LVMI were done. Assessment of cTnI using one-step serum immunoassay test was performed. Cases were clinically followed up for 1 year for dialytic hypotensive episodes and mortality. LVMI was increased in 20 cases [66.7%]. Concentric hypertrophy was present in 13 patients and eccentric hypertrophy was detected in 7 patients. Another six cases had concentric remodeling. All cases were negative for cTnl. There was a statistically significant difference between CRF patients with LVH and those with normal LVM as regards pH, HCO3 and left ventricular posterior wall thickness [LVPW] [p<0.05]. A positive correlation markedly approaching significance was found between fractional shortening [FS] and body mass index [BMI] [r=0.35. p=0.05]. Mortality was 10% and hypotensive episodes occurred in 13.3% of the cases. The positive predictive value of LVMI to mortality was 28.6%, negative predictive value 95.7% with 81.5% specificity and 66.7 +/- sensitivity. Low FS was an excellent predictor of mortality in the studied cases with positive predictive value 100 +/- , and negative predictive value 96.4% with 100% specificity and 66.7% sensitivity. Normal cardiac Troponin I does not preclude cardiovascular risk in chronic hemodialysis patients. Increased LVMI and low FS are useful predictors of mortality in chronic pediatric hemodialysis patients

Thalassemia intermedia and prevalence of anti-hepatitis C antibodies and other hepatitis markers

This study aimed to find out the prevalence of anti-hepatitis C virus antibodies [anti-HCVAb] and hepatitis B virus [HBV] markers in children with TI and their relation with age, sex, the number of blood units transfused and ferritin level in addition to determining the infection's effects or liver functions. Twenty-eight patients [13 males and 15 females] suffering from TI with a mean age 11.7 +/- 4.9 years were compared with 15 healthy children of the same age and sex. Complete blood count, hemoglobin electrophoresis, liver and kidney functions tests and ferritin level were done in addition to assessment of anti-hepatitis C antibodies [anti-HCVAb], hepatitis B surface antibodies [anti-HBcAb] by ELISA technique. In conclusion, HCV infection might be the cause of morbidity among the occasionally blood transfused thalassemia inter- media patients, even with their low rate of transfusion and even after the introduction of procedures to screen blood products for HCV. Egyptian blood donors should be effectively screened for anti-HCV and individuals who have a history of drug abuse should be deferred from donating the blood. This and stringent infection-control measures are necessary steps to limit the spread of HCV, HBV and perhaps other viruses to patients

Prevalence of cytomegalovirus and Epstein Barr virus in patients with juvenile rheumatoid arthritis and childhood systemic lupus erythematosus

The aim of this study was to investigate the possible role of cytomegalovirus [CMV] and Epstein-Barr virus [EBV] infections in the pathogenesis of juvenile rheumatoid arthritis [JRA] and childhood systemic lupus erythematosus [SLE]. The study included 31 JRA patients, 29 childhood onset SLE patients and 21 age and sex matched healthy controls. It was concluded that the prevalence of CMV and EBV is high in pediatric patients with JRA and SLE. These findings supported the hypothesis that these viral infections may be involved in the pathogenesis of autoimmune rheumatic diseases of childhood