The absence of predictors for bacterial infection in more than 70% of bacterial AOM suggests that empirical antibiotic treatment should be advised for the young infants with AOM even when afebrile and with normal laboratory profile. A low diagnostic rate of AOM by the paediatrician emphasizes the need for improvement in examination skills and instrumentation to allow a thorough ear evaluation in children of a very young age.

Background: Hyperglycaemia and hyperinsulinaemia, hallmarks of the postprandial state, have been associated with increased oxidative stress contributing to vascular injury. The development of cardiovascular disease is a main complication of diabetes mellitus. Heat sock protein 60 is over-expressed after cells exposure to stressful conditions that include oxidative stress like diabetes as well as cardiovascular diseases. The association between serum heat sock protein 60 levels and development of diabetic complications is unknown. Objectives: evaluate the potential value of serum heat sock protein 60 level in the development of cardiovascular complications in Egyptian patients with type 2 diabetes mellitus. Patients and methods: Heat sock protein 60 in 18 diabetic control patients and 62 diabetic patients with different risks to cardiovascular disease was determined using AssayMax Human heat sock protein 60 ELISA kit. All groups were age and sex matched. Results: Heat sock protein 60 concentrations were significantly higher in diabetic patients with diferent risks to cardiovascular disease compared to diabetic control group (P<0.05). Moreover, its level showed higher sensitivity and area under the curve compared to common traditional markers (ratio 1 & ratio 2) of cardiovascular disease. Conclusion: Our results showed that presence of Heat sock protein 60 in diabetic patients was associated with the development of cardiovascular disease complications. Heat sock protein 60 showed superiority in sensitivity compared to other traditional biochemical parameters so could serve as an early marker for diagnosis of diabetic cardiovascular disease complications.

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