Myocardial function using two dimension speckle-tracking echocardiography in children with celiac disease.

The prevalence of cardiac complications linked to celiac disease (CD) is on expanding. This study aimed to evaluate the cardiac function in children with CD using two dimensional speckle tracking echocardiography (2D-STE) to detect early myocardial dysfunction, if any. This cross-sectional study included 40 children with CD as the patient group and 40 healthy age- and sex-matched children served as the control group. High sensitive troponin T (Hs-troponin T), anti-tissue transglutaminase immunoglobulin A (tTG-IgA), hemoglobin, ferritin, albumin, and vitamin D levels were measured in all participants. Conventional, tissue Doppler imaging (TDI), and 2D-STE were performed for all included children. Conventional echocardiographic parameters showed no significant difference between the two groups. Left ventricular global longitudinal strain (LV GLS) obtained by 2D-STE was substantially lower in children with CD than the control group; however, myocardial performance index (MPI) obtained by TDI was significantly higher in children with CD. Hs-troponin T levels were comparable in both groups. LV GLS was positively correlated with hemoglobin, ferritin, and albumin level, but it was inversely correlated with the duration of the disease and anti tTG-IgA.    Conclusion: 2D-STE can detect subclinical early cardiac dysfunction in children with CD and this cardiac injury correlated to the duration and severity of the disease and some nutritional deficiency in these children. What is Known: • The prevalence of cardiac complications linked to celiac disease (CD) is on expanding. • Only one study evaluated cardiac function in children with CD using two dimensional speckle tracking echocardiography (2D-STE). What is New: • Our study found that 2D-STE can detect early subclinical cardiac dysfunction in children with CD. Cardiac injury in theses children correlated to the duration and severity of the disease, hemglobin, ferritin, and albumin levels.

Role of BAALC Gene in Prognosis of Acute Lymphoblastic Leukemia in Egyptian Children.

Acute lymphoblastic leukemia (ALL) is characterized by excess bone marrow lymphoblast cell production. Brain and Acute Leukemia Cytoplasmic gene (BAALC gene) is a recently identified gene on chromosome 8q22.3. The aim of this work was to study the role of BAALC gene in prognosis of ALL in Egyptian children. This study was conducted on 60 children with ALL who were admitted in Oncology Unit in the period from January 2012 to March 2015 including 36 males and 24 females with mean age of 8.74 ± 2.66 years. For all patients the following were done: Full history taking, thorough clinical examination and laboratory investigations including: complete blood count, LDH, bone marrow aspiration, cytochemistry, immunophenotyping, FISH technique for detection of t(12;21) and t(9;22) and assessment of BAALC gene expression by PCR in bone marrow aspirate mononuclear cells at diagnosis before chemotherapy. Positive BAALC gene expression was found in 36 patients (60%) and negative expression in 24 patients (40%). Positive BAALC gene expression group includes 14 males and 22 females with mean age at presentation of 8.45 ± 2.77 years while negative BAALC gene expression group includes 18 males and 6 females with mean age at presentation of 8.61 ± 2.44 years with no significant differences between positive and negative BAALC gene expression groups regarding age, sex, clinical presentations, WBCs and platelets counts, hemoglobin and LDH levels, peripheral blood and BM blast cell counts, immunophenotyping and chromosomal translocations including t(12;21) and t(9;22). There were significant differences in disease outcome between positive and negative BAALC gene expression groups with higher rate of relapse and death and lower rate of complete remission, disease free survival (DFS) and overall survival (OS) in positive BAALC gene expression group compared with negative group (p = 0.028). Multivariate analyses for overall survival and disease free survival shows significant role of BAALC gene expression in OS and DFS. BAALC expression might represent an additional prognostic marker in children with ALL and should be routinely assessed at diagnosis for better prognostic assessment.

Safety and Efficacy of Prophylactic Amiodarone in Preventing Early Junctional Ectopic Tachycardia (JET) in Children After Cardiac Surgery and Determination of Its Risk Factor.

Postoperative arrhythmia is a common complication after open heart surgery in children. JET is the most common and dangerous arrhythmia. We aimed to assess safety and efficacy of prophylactic amiodarone in preventing JET in children underwent cardiac surgery and to assess risk factors for JET among our patients. In total, 117 children who underwent cardiac surgery for CHD at Tanta University Hospital from October 2011 to April 2015 were divided in two groups; amiodarone group (65 patients) was given prophylactic amiodarone intraoperatively and placebo group (52 patients). Amiodarone is started as loading dose of 5 mg/kg IV in the operating room after induction of anesthesia and continued for 3 days as continuous infusion 10-15 µg/kg/min. Primary outcome and secondary outcomes of amiodarone administration were reported. We studied pre-, intra- and postoperative factors to determine risk factors for occurrence of JET among these children. Prophylactic amiodarone was found to significantly decrease incidence of postoperative JET from 28.9 % in placebo group to 9.2 % in amiodarone group, and symptomatic JET from 11.5 % in placebo group to 3.1 % in amiodarone group, and shorten postoperative intensive care unit and hospital stay without significant side effects. Risk factors for occurrence of JET were younger age, lower body weight, longer cardiopulmonary bypass, aortic cross-clamp time, hypokalemia, hypomagnesemia, acidosis and high dose of inotropes. JET was more associated with surgical repair of right ventricular outlet obstruction as in case of tetralogy of Fallot and pulmonary stenosis. Most of JET 15/21 (71.4 %) occurred in the first day postoperatively, and 6/21 occurred in the second day (28.6 %). Prophylactic amiodarone is safe and effective in preventing early JET in children after open heart surgery.