Background Chronic lung diseases (CLD) in children such as bronchiectasis and interstitial lung disease represent a major public health problem with limited therapeutic options. These patients develop pulmonary hypertension (and core-pulmonale in severe cases) because of the recurrent hypoxia and chronic inflammation; which results in right heart enlargement and ventricular hypertrophy. The early identification and convenient treatment of diastolic dysfunction can prevent further complications of the disease including diastolic heart failure and death. We aim to demonstrate the usefulness of tissue Doppler imaging echocardiography (TDI) in the detection of subtle myocardial affection in interstitial lung disease and bronchiectasis as subgroups of (CLD) in children. We studied echocardiographic parameters of 40 pediatric patients with chronic lung disease using conventional M mode and tissue Doppler imaging and compared them with 40 healthy controls of matching age and sex distribution. Results Myocardial performance index (MPI) showed that 28 subjects had abnormal right ventricular (RV) MPI (10 with severe affection ≥ 0.6) and 21 subjects had abnormal LV MPI (11 severe affections ≥ 0.6). Thirty percent (30%) of the cases had affected lateral E/E' and 47.5% had affected septal E/E' when compared to controls. Grades of diastolic dysfunction were: 0, 1, 2, 3 in 18, 15, 6, and 1 patients, respectively. MPI LV and MPI RV showed statistically higher values in patients compared to controls (P < 0.001). Conclusion This study proved that TDI can accurately detect subtle myocardial dysfunction in pediatric CLD patients.

Objective: Early identification of sickle nephropathy via renal doppler sonography among sickle cell disease patients so as to help in early diagnosis and interventions to prevent progression to end-stage renal disease. Methods: 45 SCD children were included along with 45 healthy control children. Renal doppler sonography (PI and RI) was performed to all subjects. Doppler indices (Resistance Index and pulsatility index) were of value to assess reno-vascular changes in SCD. Laboratory investigations were done: Hb electrophoresis, complete blood picture with blood indices, reticulocytic count, liver enzymes (ALT and AST), HCV serology, serum ferritin and lactate dehydrogenese (LDH). Results: The study group consisted of 45 SCD patients, 27 (60%) males with mean age 12 years (± 3 years). By performing renal doppler sonography, it was found that all study group had significantly higher doppler indices (Resistivity index and pulsatility index) compared to the control group. Results of renal doppler sonography revealed, Main renal pulsatility index was positively correlated with main renal resistance index (r=0.454, p=0.002). Conclusion: Roc curve showed that Main Renal Artery Pulsatility index and resistance index index could act as a predictor for sickle cell nephropathy with high sensitivity values. Otherwise, renal doppler indices didn’t show statistically significant correlation with the other studied variables.

Background. Left ventricular hypertrophy (LVH) is common in hemodialysis (HD) patients. It predicts poor prognosis. Several inhibitors regulate Wnt canonical pathways like Dickkopf-related protein-1 (Dkk-1) and sclerostin. Objectives. To investigate the relationship between serum sclerostin, Dkk-1, left ventricular mass (LVM), and LVM index (LVMI) in HD patients. Methods. This is a cross-sectional study including 65 HD patients in our HD unit. Patients were divided into two groups according to LVMI (group 1 with LVMI < 125 gm/m2 (N = 29) and group 2 with LVMI > 125 gm/m2 (N = 36)). Echocardiographic evaluation of the LVM, aortic, and mitral valves calcification (AVC and MVC) was done. Serum levels of sclerostin and Dkk-1 and patients’ clinical and biochemical data were recorded. Results. Group 2 showed significantly higher age, blood pressure, AVC, and MVC and significantly lower hemoglobin, sclerostin, and Dkk-1 levels. LVM and LVMI had a significant linear negative correlation to both serum sclerostin and Dkk-1 (r = −0.329 and −0.257, P = 0.01 and 0.046 for LVM; r = −0.427 and −0.324, P = 0.001 and 0.012 for LVMI, resp.). Serum Dkk-1 was an independent negative indicator for LVM and LVMI in multiple regression analyses ( P = 0.003 and 0.041 with 95% CI = −0.963 to −0.204 and −0.478 to −0.010, resp.). Conclusion. Serum sclerostin and Dkk-1 were significantly lower in HD patients with increased LVMI > 125 gm/m2, and both had a significant linear negative correlation with LVM and LVMI. Dkk-1 was a significant negative independent indicator for LVM and LVMI in HD patients.