Uncontrolled type-1 diabetes (T1DM) can lead to dyslipidaemia and albuminuria, which may promote cardiovascular injuries. However, some lipidemic factors could be useful in predicting cardiac dysfunction. Seventy-eight adolescents under insulin treatment due to a 6-year history of T1DM and were retrospectively examined. Glycemia, lipidemia, and albuminuria were measured in addition to development of cardiovascular abnormalities Both girls and boys showed higher HbA1c and fasting blood glucose and 27.1% females and 33.3% males exhibited microalbuminuria though their plasma levels of total cholesterol (TC), triglycerides (TG), and low-density lipoproteins (LDL) and high-density lipoproteins (HDL lipoproteins were in the normal range. They exhibited a preserved systolic function, but 50% of females and 66.6% of males had developed diastolic failures. Interestingly, girls with diastolic dysfunction showed significantly lower concentrations of HDL and higher TC/HDL and TG/HDL ratios. In fact, low HDL levels (OR 0.93; 95% CI 0.88–0.99; p = 0.029) and high TC/HDL (OR 2.55; 95% CI 1.9–5.45; p = 0.016) and TG/HDL (OR 2.74; 95% CI 1.12–6.71; p = 0.028) ratios associated with the development of diastolic complications. The cut-off values for HDL, TC/HDL, and TG/HDL were 49 mg/dL, 3.0 and 1.85, respectively. HDL and TC/HDL and TG/HDL ratios may be useful for predicting diastolic dysfunction in girls with uncontrolled T1DM.

Objectives: To assess the role of Cardiotrophin-1 (CT-1) and echocardiography in early detection of subclinical Diabetic Cardiomyopathy (DCM) in children with type 1 Diabetes Mellitus (T1D). Methods: This case-control study included two groups of children and adolescents aged between 7 and 18. Group (1) included forty patients with T1D (duration > 5 years) regularly followed at the children's hospital of Cairo University, and Group (2) included forty age and sex-matched healthy subjects as a control group. The serum level of CT-1 was measured, and conventional echocardiography, tissue Doppler imaging (TDI), and 2D speckle tracking echocardiography were performed. Results: The level of CT-1 in the cases ranged from 11 to 1039.4 pg/ml with a median (IQR) of 19.4 (16.60–25.7) pg/ml, while its level in the control group ranged from 10.8 to 162.6 pg/ml with a median (IQR) of 20.2 (16.2–24.8) pg/ml. CT-1 levels showed no statistically significant difference between cases and controls. Patients had significantly higher mean left ventricle E/E′ ratio (p<0.001), lower mean 2D global longitudinal strain (GLS) of the left ventricle (LV) (p<0.001), and lower mean GLS of the right ventricle (RV) (p<0.001) compared to controls. Ofpatients with diabetes, 75 % had LV diastolic dysfunction, 85 % had RV diastolic dysfunction, 97.5 % had LV systolic dysfunction, and 100 % had RV systolic dysfunction. Conclusions: Non-conventional echocardiography is important for early perception of subclinical DCM in patients with T1D. CT-1 was not specific for early detection of DCM.

Background: Neonatal sepsis is a serious systemic infection that might be fatal. Early diagnosis is challenging. The c-reactive protein (CRP)/albumin ratio is a promising biomarker that may help with early diagnosis and timely management of sepsis.Aim of the work: to study the sensitivity and specificity of the CRP/albumin ratio as a diagnostic marker of neonatal sepsis in preterm newborns.Patients and Methods: in this case-control study CRP/albumin ratio was estimated in 154 preterm newborns admitted to Neonatal Intensive Care Units (NICUs) of Cairo University Children's Hospitals. They were divided into 2 groups. Group (I), the sepsis group “based on positive blood culture” (n=54), and group (II), a control group, with no clinical signs or laboratory evidence of sepsis (n=100).Results: The mean age of newborns in the sepsis group was 3 ± 2.5 days vs 4.5 ± 2.5 days for the control group. The sepsis group had a mean ± SD CRP/albumin ratio higher than that of the control group (18.5 ± 20 vs 0.6± 0.7, p= 0.00). 30 (55%) of those in the sepsis group died; they had a mean ± SD CRP/albumin ratio of 20± 21, vs 15 ± 17 for those who survived (p value=0.3). Neonatal Sepsis was best diagnosed by the CRP/albumin ratio above the cutoff value of 1.5 with 100 % sensitivity, 95% specificity, 91.5 % positive predictive value (PPV), 100 % negative predictive value (NPV), (area under the curve (AUC)= 0.99, and 95 % confidence interval (CI) 0.983 - 1), which was not different than that of CRP alone (p=0.800). CRP above the cutoff point of 4.3 showed 96.3 % sensitivity, 96% specificity, 92.9 % PPV, 98 % NPV, (AUC= 0.99 , 95 % CI 0.983 - 1). The I/T ratio (shift to the left) above the cutoff point of 0.2 showed 64.8% sensitivity, 100 % specificity, 100% PPV and 84% NPV (AUC= 0.94 , 95% CI 0.891 - 0.973).Conclusion: CRP/albumin ratio is a highly sensitive and specific early diagnostic biomarker for neonatal sepsis in premature newborns that has marginal superiority to the CRP in the diagnosis of neonatal bacterial sepsis. More studies are needed to validate the sensitivity and specificity of a score that combines both the CRP/ albumin ratio above 1.2 and the I/T ratio above 0.2 in predication of true positive cases and exclusion of the true negative cases.

Introduction: Diabetic cardiomyopathy (DCM) is a serious complication that frequently occurs in patients with type 1 diabetes (T1D) necessitating early diagnosis. The aim of the current study was to detect subclinical DCM in Egyptian children and adolescents with T1D and evaluate the effect of antioxidants on myocardial dysfunction.Material and methods: The current prospective observational cohort study included 81 T1D patients (9-20 years old) with diabetes duration > 4 years compared to 50 age and sex matched non-diabetic controls. Serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was assessed in addition to conventional echocardiography, tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). Patients with myocardial dysfunction were supplemented with vitamin E (α-tocopherol) as an antioxidant for 1 year, then follow up echocardiography was done.Results: NT-proBNP was elevated in 73 (90.1%) patients, 50.6% had left ventricular (LV) diastolic dysfunction, 14.8% had right ventricular (RV) diastolic dysfunction, 84% had LV systolic dysfunction and 91.4% had RV systolic dysfunction with statistically significant difference compared to controls. There was a significant negative correlation between LV global longitudinal strain (GLS) and NT-proBNP (p<0.001, r=-0.796). ROC curve analysis showed that NT-proBNP at a cut-off point ≥ 195 ng/ml detected LV systolic dysfunction function with 89.7% sensitivity and 84.6% specificity. Follow up after one year of α-tocopherol supplementation revealed significant improvement in LV systolic and diastolic functions as well as RV systolic dysfunction.Conclusions: NT-proBNP and non-conventional echocardiography were useful in early detection of subclinical cardiomyopathy in patients with T1D. Antioxidant treatment improved subclinical myocardial dysfunction in T1D patients.

Background: Early diagnosis of sepsis and its severity is essential for timely management to improve patient survival.Aim of the work: define prognostic indicators of mortality in children presenting with sepsis. Materials and Methods: A prospective observational cohort study included 45 children with sepsis admitted to the Pediatric Intensive Care Unit (PICU), Children Hospital, Cairo university. Studied predictors included clinical assessment, modified Sequential Organ Failure assessment m (SOFA) score calculation, age- adjusted quick Sequential Organ Failure assessment (qSOFA), Pediatric Risk of Mortality (PRISM) score and lab investigations, including reticulocyte distribution width (RDW).Results: The age of enrolled children with sepsis ranged between 0.16 - 5 years (median= 1 year), 27 (60 %) of them were males. Of them, 14 (31%) patients died. The mortality among them was predicted by the mSOFA above the cutoff point of 12 had 92% sensitivity, 96% specificity, 92% positive predictive value (PPV), and 96% negative predictive value (NPV) with area under the curve (AUC): 0.97, 95 % confidence interval (CI) 0.93 to 1, the PRISM III score above the cutoff point of 15 had 92% sensitivity, 90 %specificity, 81 % PPV, and 96% NPV with AUC: 0.96, 95 % CI 0.9 to 1, and the RDW above the cutoff point of 21 had 92% sensitivity, 66% specificity, 56% PPV, and 95% NPV with AUC: 0.86, 95 % CI 0.754 to 0.973. The age-adjusted qSOFA failed to predict mortality. Combining the RDW with these scores improved the mortality prediction as the combined RDW to the mSOFA above the cutoff point of 34 showed 100% sensitivity, 90 %specificity, 82 % PPV, and 100% NPV with AUC: 0.97, 95 % CI 0.93 to 1 and the combined RDW to the PRISM III score above the cutoff point of 41 had 92% sensitivity, 96 % specificity, 92 %, PPV, and 96% NPV with AUC: 0.98, 95 % CI 0.96 to 1.Conclusion: RDW combined with mSOFA score above the cutoff point of 34 and PRISM III score above the cutoff point of 41 were sensitive and specific predictors of mortality among children with sepsis. They may be used as indicators for timely referral of children with sepsis from the emergency ward to the PICU.

Background: In underdeveloped nations, neonatal sepsis (NS) is a leading cause of neonatal mortality and morbidity, however, its diagnosis is challenging. Objectives: This study aimed to evaluate the Neonatal Acute Physiology Perinatal Extension II (SNAPPE II) score as a predictor of neonatal mortality in NS. Patients and methods: This was a cross–sectional study, conducted on 150 neonates who were admitted to the neonatal intensive care unit (NICU) of the Pediatric hospitals, Cairo University and Ahmed Maher Teaching Hospital who were diagnosed with NS. Thorough history taking and clinical and laboratory data were recorded to calculate the SNAPPE II score. Results: The included patients had a mean gestational age of 35.4±3.4. The SNAPPE II score ranged from 0 to 54 with a median and IQR of 5 (0–28). Receiver operating characteristic analysis showed that the SNAPPE II score could be used as a predictive tool to discriminate the outcome at a cutoff level of greater than 30.5, with 87.1% sensitivity, 96.6% specificity, 96.2% positive predictive value and 88.2% negative predictive value with AUC = 0.98 and P value less than 0.001. Thirty-one (20.7%) of our patients died, they had statistically significant lower gestational age, lower weight, lower platelet count, and higher SNAPPE II scores with P values of 0.048, 0.001, less than 0.001, 0.015, and less than 0.001, respectively, they had greater scores regarding lowest mean airway pressure, lowest temperature, lowest PH, APGAR score, weight and small for gestational age with a P value less than 0.001. Conclusion: The SNAPPE II score can be used as a predictive tool of neonatal mortality due to NS.