We aimed to examine the relationship between epicardial fat thickness (EFT) measured by echocardiography and cardiovascular functional parameters in children with type 1 diabetes mellitus (T1DM). The study included 50 type 1 diabetic children and 50 healthy subjects matched by sex, age, and body mass index. In addition to laboratory tests, all participants underwent transthoracic echocardiography for EFT, cardiac dimensions and left ventricular functions, and ultrasonographic examination for brachial artery fow-mediated dilation (FMD) response and carotid intima-media thickness (CIMT). Multivariate linear regression was used to analyze the relationship between EFT and CIMT, FMD, lateral mitral E' velocity, and mitral E/E' ratio. EFT was signifcantly increased in diabetic children compared with controls (P<0.001). In comparison with controls diabetic children had signifcantly increased mitral A, decreased lateral mitral E', decreased mitral E/A ratio, decreased lateral mitral E'/A' ratio, and increased mitral E/E' ratio (P<0.001). FMD response was signifcantly lower in diabetic group versus controls (P<0.001) and CIMT was signifcantly increased in diabetics versus controls (P=0.03). EFT was negatively correlated with lateral mitral E' velocity (r= −0.613, P<0.001), positively correlated with mitral E/E' ratio (r=0.60, P<0.001), positively correlated with CIMT (r=0.881, P<0.001), and negatively correlated with FMD (r= −0.533, P<0.001). By multivariate regression analysis, the EFT was independently and positively associated with CIMT mean and E/E' mean and negatively associated with FMD mean and E' mean. The cut-of point for EFT as predictor of endothelial dysfunction was 6.95 mm. Our fndings suggest that children with T1DM have subclinical LV diastolic and vascular endothelial dysfunctions associated with increased EFT.

This study aimed to assess the role of serum midkine (MK) as a biomarker for early detection of diabetic nephropathy in children with type 1 diabetes mellitus (T1DM) before microalbuminuria emerges.

Methods:

A total of 120 children with T1DM, comprising 60 microalbuminuric patients (Group 1), 60 normoalbuminuric patients (Group 2), and 60 healthy participants as a control group (Group 3) were included. Detailed medical history, clinical examination, and laboratory assessment of high-sensitivity C-reactive protein (hs-CRP), hemoglobin A1c percentage (HbA1c%), lipid profile, urinary albumin to creatinine ratio (ACR), serum MK and estimated glomerular filtration rate based on serum creatinine were performed in all participants.

Results:

Both Group 1 and Group 2 had significantly higher serum MK compared to controls (p< 0.001). Additionally, significantly higher MK concentrations were present in Group …

Down syndrome (DS) is the most common genetic disorder in live-born infants. Children with DS are at increased risk of numerous endocrinal comorbidities. The information contained in this article will provide pediatricians with a narrative overview of different presentations, diagnoses, and management recommendations of various endocrinal disorders in children with DS. We systematically searched PubMed, Embase, Google Scholar, MEDLINE, EBSCO, and Science Direct, and potentially relevant articles were identified and retrieved from electronic and print journals.

Hormone resistance is defined as a reduced or absence of target tissues responsiveness to a hormone, where the presentation is related to either a relative lack or excess of hormones. Various disorders of hormone resistance were encountered including, Laron syndrome, nephrogenic diabetes insipidus, thyroid hormone resistance syndrome, pseudohypoparathyroidism, insulin resistance, familial glucocorticoid deficiency, pseudohypoaldosteronism, X linked hypophosphatemic rickets and androgen insensitivity syndrome. The article gives a summary that presents, in concentrated form, what the primary care physicians need to know about recognition, clinical presentation, diagnosis, and management of various hormone resistance in children.

Background: For transcatheter aortic valve implantation (TAVI), accurate determination of valve size is crucial.
Multidetector Computed Tomography (MDCT) is considered gold standard, however sometimes there are conflicting measurements or aortic annulus is ambiguous between 2 prosthesis sizes. In such cases balloon sizing can serve in selecting valve size.

Methods: 110 patients were prospectively enrolled. Aortic annular diameter was measured by 2D TEE. Balloon sizing was done with balloons equal or 1 mm smaller than TEE measurements. Supra-aortic angiography was performed during balloon inflation. Contrast regurgitation and balloon movement indicated annulus size underestimation, balloon wasting indicated annulus size overestimation. Valve size selection was based on balloon sizing. Agreement between 2D TEE and balloon measurements was calculated. Inhospital outcomes related to valve sizing and routine predilation were determined.
Results: TEE was correctly sizing the valve in 81% of patients, oversizing in 17% and undersizing in only 2% compared with balloon sizing. Agreement between 2D TEE and balloon sizing measurement yielded a K value of 0.71. Hemodynamic instability after balloon sizing was observed in 2 patients, valve embolization occurred in one patient, no case of aortic rupture or coronary occlusion was detected. Two patients needed a second valve. Stroke rate was 0.9%, inhospital mortality was 1.8%. At hospital discharge, rate of significant PVL (≥ grade II) was 3.4% and pacemaker implantation rate was 6.4%.
Conclusions: Balloon sizing based on 2D TEE annular measurements represents an appropriate approach for selecting valve size with favorable outcomes.

Objectives: To describe and to validate a new technique for crossing stenotic aortic valves (AV).

Background: Current techniques for crossing the AV may be time-consuming and hazardous.

Methods: One hundred consecutive patients with severe aortic stenosis treated by transfemoral TAVI were prospectively selected to have an initial attempt of 5 min to cross the AV with a novel pigtail/J-wire technique before switching to the conventional Amplatz ®/straight wire approach. For the pigtail/J-wire technique, the catheter is placed 3–4 cm above the AV and turned anteriorly in the 30° RAO view. A J-wire pushed out of the pigtail-catheter will reach the anterior wall of the ascending aorta, forming a u-shaped curve above the AV. The height of the pigtail catheter determines the width of the curve, rotation will help to find an orientation, where the vertex of the curved J-wire easily passes the AV. We analyzed the primary success rate within 5 min and the mean crossing time required.

Results: Patients were 83.5 ± 5.5 years of age and predominantly male (62%). Primary success rate was 86%, AV crossing took 48.2 ± 34.6 s without complications. Fourteen failed cases were successfully managed with AL1- (6) and both, AL1- and AL2-catheters (8), respectively

Conclusions: The pigtail/J-wire technique for AV crossing is safe, simple and fast. Primary placement of a pigtail catheter into the left ventricle at a success rate of 86% facilitates TAVI procedures.