Subtle Myocardial Dysfunction and Fibrosis in Children with Rheumatic Heart Disease: Insight from 3D Echocardiography, 3D Speckle Tracking and Cardiac Magnetic Resonance Imaging.

Rheumatic heart disease (RHD) is a major cause of morbidity and mortality in developing countries, so early diagnosis and treatment can reduce morbidity and mortality resulting from subsequent valvular damage. The aim of this study was to detect subtle myocardial dysfunction among children with RHD with preserved left ventricular systolic function. This is a cross-sectional case-control study that was conducted on 30 children with RHD (who had valvular affection of any degree and were not in activity) compared to 23 healthy children. After history taking and cardiac examination, 2D echocardiography, tissue Doppler imaging, 3D-echocardiography and 3D speckle tracking echocardiography were done to both groups, whereas cardiac magnetic resonance imaging was done only to the patient group. The 3D-derived left ventricular end-diastolic volume and sphericity index among patients were significantly increased when compared to controls [131.5 (101.5 to 173.7) vs. 69 (58 to 92), P = 0.001, and 0.46 (0.36 to 0.59) vs. 0.33 (0.29 to 0.38), P = 0.001, respectively]. The 3D-derived ejection fraction and longitudinal strain did not differ significantly among both groups. The 3D-derived global circumferential strain was higher in patients when compared to controls [- 14 (- 16 to - 10) vs. - 11(- 13 to - 10), P = 0.04]. None of the examined patients demonstrated late enhancement myocardial fibrosis. In children with RHD and preserved systolic function, subtle systolic dysfunction could not be detected using conventional and novel non-conventional methods. This may indicate that the myocardial affection during the acute stage of rheumatic carditis is minimal with almost complete resolution.

Antioxidant, anti-inflammatory and hepatoprotective effects of silymarin on hepatic dysfunction induced by sodium nitrite.

PURPOSE: Sodium nitrite, a food additive that is used as a color fixative and preservative for meats and fish, has been reported to have adverse health effects due to increased oxidative stress that could be harmful to different organs including the liver. Meanwhile, silymarin protects against hepatotoxicity caused by a variety of agents, on account of its antioxidative and anti-inflammatory effects. We therefore examined the impact of dietary silymarin on sodium nitrite-induced liver damage in rats. METHODS: Fifty adult male Sprague-Dawley rats received 80 mg/kg sodium nitrite in the presence or absence of silymarin (10 and 25 mg/kg). Hepatic proinflammatory cytokines (TNF-α and IL-1ß), hepatic fibrosis marker (MCP-1 and TGF-ß1), mitochondrial activity marker (cytochrome C oxidase) and c-reactive protein (CRP) levels were measured. Hepatic apoptosis was assessed through determination of caspase-3 activity and DNA fragmentation. RESULTS: We found that oral sodium nitrite enhanced oxidative stress with subsequent increases in TNF-α (2-fold), IL-1ß (4-fold), MCP-1 (4-fold), TGF-ß1 (3-fold) and CRP (4-fold). In addition, sodium nitrite brings about reduced cytochrome C oxidase and enhanced caspase-3 activity and DNA fragmentation. Daily treatment with silymarin markedly ameliorated all these effects. CONCLUSIONS: Silymarin ameliorated the impairment of hepatic function in rats that had ingested sodium nitrite. Silymarn possesses antioxidant, anti-inflammatory, antifibrotic and anti-apoptotic effects.

Ultrasound assessment of normal splenic length and spleen-to-kidney ratio in children.

Splenic lengths in 184 normal Jordanian children were measured through the hilum by ultrasound and compared with data from Hong Kong and the United States of America. The spleen to left kidney ratio was calculated to determine whether it was constant and to establish a ratio above which splenomegaly can be diagnosed. Up to age 15 years, little variation in splenic length was observed, but over 15 years splenic length was slightly lower in Jordanian males. Spleen to left kidney ratio was constant at around 1; splenomegaly is highly probable in ratios > or = 1.25.

Ultrasound assessment of normal splenic length and spleen-to-kidney ratio in children

Splenic lengths in 184 normal Jordanian children were measured through the hilum by ultrasound and compared with data from Hong Kong and the United States of America. The spleen to left kidney ratio was calculated to determine whether it was constant and to establish a ratio above which splenomegaly can be diagnosed. Up to age 15 years, little variation in splenic length was observed, but over 15 years splenic length was slightly lower in Jordanian males. Spleen to left kidney ratio was constant at around 1; splenomegaly is highly probable in ratios > / = 1.25

Nephrocalcinosis and Bartter's Syndrome.

We report a case of a child with symptoms and signs of Bartter's syndrome and nephrocalcinosis. This report discusses the manifestations and management of this rare disease at a very early age.