Thesis (M.Sc.) - Cairo University - Faculty of Medicine- Department of Clinical and Chemical Pathology

Background: Rickets is a bone disease that is associated with decreased serum calcium and/or phosphate levels in the blood, leading primarily to widening and delay of mineralization of growth plates in bones. Nutritional rickets can be caused by deficiencies of vitamin D, calcium or phosphate attributable to nutritional or environmental causes. Cardiovascular involvement, namely cardiomyopathy, is an important complication in these patients. Early assessment of vitamin D status and heart functions allows the detection of subclinical myocardial involvement before proceeding to overt myocardial dysfunction. We aimed to study myocardial function in nutritional rickets patients using 3D Speckle Tracking Echocardiography and assessment of Brain Natriuretic Peptide level in patients{u2019} serum and correlating it to vitamin D status. Methodology: Thirty four patients with nutritional rickets, age ranged from 3 months to 12 years of both genders, were compared to thirty four healthy age and sex matched children. Cases and controls were subjected to clinical examination, laboratory assessment of vitamin D, BNP and routine investigations (total calcium, phosphorus, alkaline phosphatase, ionized calcium, sodium, potassium and albumin). 3D Speckle Tracking Echocardiography was also performed to children of both groups. Results: We found statistically significant differences between the two studied groups regarding vitamin D, total calcium and ionized calcium levels which were significantly lower in cases of nutritional rickets than control group (p-value was <0.001, 0.002 and <0.001 respectively). Alkaline phosphatase and BNP levels were significantly higher in cases of nutritional rickets than control group (p-value was <0.001 and 0.001 respectively).There was significant difference in 3D STE parameters between cases and controls. LV and RV GLS were significantly lower in cases of nutritional rickets than control group (p-value was <0.001 for both), denoting systolic dysfunction and LV and RV E/E{u2019} were significantly higher in cases of nutritional rickets than control group (p-value was <0.001 and 0.001 respectively), denoting diastolic dysfunction

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