Background Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of type 1 diabetes mellitus (T1DM) that has increased during the COVID-19 pandemic. This study will not only shed light on such life-threatening complications but also be a step to increase the awareness of healthcare providers about such complications in the upcoming pandemic waves and increased dependence on telemedicine. Thus, we aimed to further investigate the increase of DKA in pediatrics. Methods PubMed, Web of Science, and Scopus were broadly searched for studies assessing the incidence of DKA in pediatrics during the COVID-19 pandemic. Results Our study included 24 papers with a total of 124,597 children with diabetes. A statistically significant increase occurred in the risk of DKA among newly diagnosed T1DM patients during the pandemic (RR 1.41; 95% CI 1.19, 1.67; p < 0.01; I 2 = 86%), especially in the severe form of DKA (RR 1.66: 95% CI 1.3, 2.11) when compared to before. Conclusion DKA in newly diagnosed children with T1DM has increased during the pandemic and presented with a severe form. This may reflect that COVID-19 may have contributed not only to the development but also the severity of DKA. Impact Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) that has increased during the COVID-19 pandemic. Our study included 25 papers with a total of 124,597 children with diabetes. A statistically significant increase occurred in the risk of DKA among newly diagnosed T1DM patients during the pandemic. Our findings reflect that COVID-19 may have an altered presentation in T1DM and can be related to DKA severity.

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Blood culture-negative infective endocarditis (BCNIE) poses a significant challenge in determining the best antibiotic regimen for this life-threatening infection, which should be treated with as specific and effective a regimen as feasible. The goal of this study was to determine the prevalence of BCNIE among definite infective endocarditis (IE) cases and to study the impact of a molecular and serological diagnostic approach in defining the microbiological origin of BCNIE. This study included 94 definite IE cases. Serum and blood samples from BCNIE patients were tested using serological, broad-range PCR, and sequencing assays. Valve tissue sections obtained from 42 operated patients were subjected to culture and molecular studies. BCNIE accounted for 63 (67%) of the cases. Of these cases, blood PCR followed by sequencing could diagnose 11 cases. Zoonotic infective endocarditis was detected in 7 (11%) patients by serology and PCR (four Brucella, two Bartonella, and one Coxiella). Sequencing of valve PCR bands revealed 30 positive cases. Therefore, the percentage of BCNIE with unidentified etiology was reduced from 67% to 27.7% through a combination of all diagnostic procedures utilized in our study. Blood and valve PCR and sequencing assays are valuable techniques for the etiological diagnosis of BCNIE, especially in cases with previous antibiotic therapy. However, these tests should be used as part of a larger diagnostic strategy that includes serology, microscopy, and valve culture. The use of an automated blood culture system, and proper blood culture collection before ordering antibiotics, will guide IE etiological diagnosis.

Background: Chronic kidney disease (CKD) is a common disease in clinical practice and increases the risk for acute coronary syndrome, and there are little data about the relationship between the elevation of troponin T levels and morbidity and mortality outcomes in CKD patients. The aim of the work: is to estimate the appropriate highlysensitive troponin T average value in CKD patients who presented with acute coronary syndrome and its relation to the outcome. Patients and methods: The study included 60 patients who were sub-divided into two groups, First group: 30 patients with CKD and ACS as the study group, the second group: 30 patients with ACS without evidence of CKD as a control group. Measurement of the highly sensitive troponin T level after 1-3 hours of the onset of chest pain and calculation of the estimated glomerular filtration rate (eGFR) was done. Results: The mean levels of the highly sensitive troponin T levels were significantly higher in patients with CKD and ACS with p value less than 0.05 and there was significant statistical difference between mean of HS Trop T of patients with ACS and complications and those without (4.3 ± 1.1 vs. 2.1± 0.9 ng/ml; P= 0.03). Also mean of HS Trop T of patients with ACS that were died was significantly higher than those were improved (2.91± 0.6 vs. 3.1 ± 0.9; P = 0.02) Conclusion: There is direct negative correlation between the levels of highly sensitive troponin T and estimated glomerular filtration rate, but there is direct relation between the higher level of highly sensitive troponin T and mortality and morbidity rates in patients with ACS and CKD. The specificity of the highly sensitive troponin T decreases with the decreased estimated GFR in ACS and CKD patients resulting in higher level of highly sensitive troponin T required for the diagnosis of NSTE-ACS.