C-Reactive protein as a marker of cardiac abnormalities in children on regular hemodialysis

End stage renal disease [ESRD] is a situation with a cardiovascular risk profile of unique severity; this study was designed to detect the cardiac abnormalities among children with ESRD and to evaluate the relation between inflammation as detected by CRP and these disorders. The present study was carried out on 60 children with ESRD on regular hemodialysis. [30 hypertensive, and 30 normo-tensive] and 30 apparently healthy age and sex matched children studied as a control group. All studied children were subjected to full history taking, thorough clinical examination and anthropometric measurements. Echocardiography, ECG and chest X-ray were also performed. Laboratory investigations included: Hb, S.alb, S.Ca, S.P, alkaline phophatase, lipid profile, kidney functions as well as CRP both by latex agglutination and ELISA for high sensitive detection. The results of the present study demonstrated echocardiographic changes in patients with end stage renal disease in the form of significant increase in inter-ventricular septal diameter [IVSD], posterior wall thickness [PWT], left ventricular mass index [LVMI], velocity of circumferential fiber shortening [vCFS], and isovolumetric relaxation time [IVRT], [P<0.001, P<0.001, P<0.01 and P<0.001 resespectively] as well as significant decrease of e/a ratio [P<0.001] as compared to the controls. Furthermore, there was significant increase of LVMI in hypertensives as compared to normotensives [P<0.001]. CRP measured by latex agglutination was significantly increased in patients as compared to controls [+ve in 17 patients, 13 were hypertensive and 4 were normotensive], it was correlated inversely with body mass index [P<0.05] and directly with LVMI [P<0.05]. The highly sensitive [hs] CRP was also significantly elevated in patients than controls [+ve in 21 patients, 12 were hypertensive and 9 were normotensive, with median of 31.35 micro g/ml and IQR of 33.028] [P<0.001], it was significantly higher in patients with cardiovascular events [P<0.001] and those with lowered e/a ratio[P<0.05] and the level was affected by S. Ca, S.p and CaXP products[P<0.01]. The only mortality during this study demonstrated high levels of conventional and [hs] CRP. LV hypertrophy and diastolic dysfunction are the main CV changes in children with ESRD. There is high prevalence of inflammation related mainly to the BMI and CaXp products but not to the usual lipid risk factors. This inflammation [as detected by conventional and [hs] CRP] can help in prediction of LV structural and functional abnormalities

Cardiovascular changes in patients with type I diabetes with and without autonomic dysfunction

Diabetic complications - either microvascular or macrovascular - represent a major cause of morbidity and mortality in diabetic patients[1]. Cardiovascular autonomic neuropathy is one of the complications of type I diabetes mellitus. It may lead to life discomfort or even it may be the direct cause of death in diabetic patients. Early detection of cardiovascular autonomic neuropathy is of major clinical interest that could lead to a more intensive supervision of diabetic patients.[2] Cardiovascular autonomic neuropathy induces different functional cardiac changes, especially a reduction in left ventricular contractility and changes in ventricular repolarization.[3] This study was designed to estimate the prevalence of cardiovascular autonomic neuropathy among a group of children with type I diabetes mellitus, to assess the cardiac function in the same group of patients by echocardiography and to relate the abnormalities to the duration of diabetes, glycemic control and other risk factors

Functional and structural cardiac abnormalities in cirrhotic patients with and without ascites

This study was done to clarify the nature of cardiac involvement in liver cirrhosis, the study comprised 40 patients with liver cirrhosis and 10 healthy control subjects. These patients were categorized under 3 groups: Patients with liver cirrhosis and tense ascites: This group comprised 20 patients [7 females [35%] and 13 males [65%] with age range from 40 to 70 years [mean = 55 +/- 8] [Group 1]. Patients with liver cirrhosis with no evidence of actual ascites at clinical and abdominal ultrasound examination but with history of clinically previous episodes of ascites. This group comprised 20 patients [5 females [25%] and 15 males [75%] with age range from 46 to 70 years [mean 55 +/- 5] [Group 2]. 10 healthy subjects [3 females [30%] and 7 males [70%]] with age range from 45 to 70 years [mean= 56 +/- 7], served as normal control for comparison [Group 3]. All patients were subjected to full history taking, full clinical examination, laboratory investigation [assessment of liver function, hepatitis marker, indirect haemaglutination [IHA] for bilharziasis, arterial blood gases], abdominal ultrasound, X ray chest and heart, electrocardiography, doppler echocardiography. The results showed that patients with liver cirrhosis with and without ascites showed increased prevalence of Q-Tc interval prolongation that correlate positively with the severity of liver cirrhosis and Child Pugh Score and was attributed to autonomic dysfunction, adrenergic hypertone, electrolyte imbalance and female gender. The study showed also irrespective of the ascites and the cause, patients with advanced liver cirrhosis had left ventricular diastolic dysfunction and wall thickness increase while the left ventricular systolic function still normal and impairment of left ventricular diastolic function correlates positively with the severity of liver disease and Child Pugh Score. The possible mechanisms responsible for the cardiac changes in liver cirrhosis include left ventricular overload induced by hyperdynamic circulation, impairment of B adrenergic receptors and its signal transudation pathway, abnormalities of circulating humoral factors and changes of cardiac plasma membrane physical properties

Cardiovascular anomalies in conjoined twins

Cardiovascular anomalies have been studied in two cases of conjoined twins. In case I, there was a single fused heart with 3 ventricles and 4 auricles. In case II, there were two ventricles and two auricles of which one was larger than the other. Both cases had separate arches of aorta for each of the pair. In both, persistance of sinus venosus was a feature. The truncus arteriosus was not differentiated in one of the pair, in case I. Two cases of conjoined female twins were received from the Mosul Obstetric Hospital. During labour, the head of one of the pair in Case I and lower abdomen with both legs in one of the pair in case II were severed to save the mothers. Both specimens were dissected to study the vital viscera and their anomalies. A variety of abnormal features were observed and the following is the account of such anomalies in the cardiovascular system. The other variations are being described in a separate communication