Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150101SERUM LEVELS OF TUMOR NECROSIS FACTOR ALPHA (TNF-α) IN TYPE 1 DIABETIC CHILDREN AS APREDICTOR OF METABOLIC CONTROL123912609984210.21608/azjp.2015.99842ENMohammed Abd El-Monem MattarHosny Mohammed El-MasryMostafa Abd El-Azeem HassanAbd El-Monem Mohammed HassanKotb Abbas MetwallyMohammed Sayed AllamJournal Article20200701<strong><em>Background</em></strong><em>: Type 1 diabetes mellitus (T1DM) is the most common metabolic disease in childhood. In the course of diabetes, the main clinical problem to be faced is the development of micro- and macro-angiopathies. It has been suggested that hyperglycemia may lead to the activation of proinflammatory cytokines tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-12 (IL-12)]that are crucial for development and progression of microangiopathy. <strong> </strong>TNF-α production is thought to play a role in the generation of microvascular complications associated with diabetes. In addition to triggering acute and chronic inflammation, TNF-α regulates glucose and lipid metabolism and inhibits insulin production in pancreatic beta cells. </em>
<strong><em>Aim of the study:</em></strong><em> To estimate the tumor necrosis factor alpha (TNF-α) levels as one of immunologic markers of microangiopathies in children with type 1 DM.</em>
<em>and the correlation of its level with other inflammatory markers as CRP and ESR as well as with other important factors as microalbuminuria and Glycosylated hemo-globin (Hb A1c).</em>
<strong><em> Patients and methods:</em></strong><em> The study was a cross-sectional study included 60 children with T1DM recruited from the regular attendants of the Diabetes Clinic, Children's Hospital, Assiut University. They were 28 males (46.7%) and 32 females (53.3%), Their ages ranged between 1-16 years with a mean </em><em>±</em><em> SD 9.46 </em><em>±</em><em> 4.09 years. T1DM, was defined in accordance with the criteria of the American Diabetes Association<strong> (ADA 2007)</strong> All patients were on regular insulin treatment in dose of (0.99 </em><em>±</em><em> 0.28 unit/kg/day).The control group consisted of 20 apparently healthy children of matched age, sex and nutritional status. </em>
<strong><em>Results:</em></strong><em> Our results demonstrated that; there were significant differences between type 1 diabetic patients with normal and abnormal TNF-α regarding mean levels of blood urea , serum lipid profile (total cholesterol, triglycerides , LDL & HDL ) , HbA1c concentrations and mean levels of inflammatory markers and microalbuminuria. While, there was no significant difference regarding CBC and serum creatinine between both groups. Also there was a significant difference between diabetic patients with abnormal TNF group and diabetic patients with normal TNF group regarding weight and body mass index (BMI). While there was no significant difference between both groups regarding age, height, systolic as well as diastolic blood pressure measurements, duration of diabetes and insulin dose. </em>Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150101NEONATAL READMISSION FOLLOWING EARLY DISCHARGE FROM NEONATAL INTENSIVE CARE UNIT IN AL GALAA TEACHING HOSPITAL126112759984510.21608/azjp.2015.99845ENWafaa M AminHany W G MichaelSalwa K HanafyReham S Abd ElhamidJournal Article20200701<strong>Objectives :</strong> The purpose of our study was to characterize early rehospitalization (within 2 weeks ) among infants early discharged ( within 4 days ) from the NICU.
<strong>Subjects & Methods: </strong>This is a retrospective case study where we recruited all newborns admitted to our regional neonatal care unit at AL Galaa Teaching Hospital over a 6 months period from 1<sup>st</sup> January 2012 to 30<sup>th</sup> June 2012. Neonates discharged from the NICU within 4ds age were assigned into two groups according to whether readmitted (within 14 ds) after discharge have occurred (group I), or no readmission took place (group II). Group II cases were considered as control group when studying factors underlying and prognosis of newborn readmission.
<strong>Results</strong>: A total of 350 newborns were recruited in this study, Group I were 40 neonates and group II were 310 neonates .The incidence of readmission among our study population was 11.4 % over the study period. Mean timing of readmission was 2.32 days following discharge, and mean duration of hospital stay after readmission was 6.5 days. There is statistically significant difference between two groups as regards the mode of delivery, apgar score, need for resuscitation ,gestational age and birth weight. But not maternal disease. The major cause of readmission was jaundice (40%) followed by sepsis (27.5%), feeding problems (12.5%) then respiratory problems (10%) and lastly convulsions and congenital heart diseases (5% each). The mean serum bilirubin was statistically significant higher in group I cases than group II. There was an inverse relationship between neonatal readmission rate and average length of hospital stay at birth.
<strong>Conclusion:</strong> Decreases in newborn length of stay may result in substantial increases in morbidity however timing of newborn discharge should be determined on individual basisAl-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150701STUDY OF SERUM CATHELICIDIN AND VITAMIN D LEVELS IN CHILDREN WITH TYPE 1 DIABETES MELLITUS127812879985310.21608/azjp.2015.99853ENSomaya M. Abd El-GhanyMohamed H. El-HefnawyAmal G. MohamedMona Y. IbrahimKhadija M. AliJournal Article20150701Cathelicidins are antimicrobial peptides that play a critical role in innate immune defense against invasive bacterial infections. Several studies have suggested the potential role of vitamin D in maintaining immune homeostasis and preventing the development of autoimmune processes e.g., diabetes mellitus. <strong>The aim of the present work</strong> was to study serum level of vitamin D and cathelicidin in a group of Egyptian children with type 1 diabetes mellitus and to know their relation to infection in those cases. <strong>It was conducted at</strong> Alzahraa University hospital on sixty children, aged 3-15 years of both sexes: forty of them known to have type 1 diabetes mellitus (type 1 DM) as defined by ADA, 2012 (twenty with acute bacterial infection and twenty without infection), and twenty were apparently healthy children age and sex matched taken as a control group. Patients were taken randomly from outpatient clinic of National Diabetes Institute during the period from January 2013 to June 2013. <strong>All studied children were subjected to </strong>careful history taking, thorough clinical examination and laboratory investigations including: CBC, CRP, measurement of serum 1,25(OH)2 vitamin D and serum cathelicidin levels by ELISA. For diabetic children fasting blood sugar, postprandial blood sugar and glycated hemoglobin (HbA1c) were also measured. <strong>Results revealed </strong>a significantly higher mean serum cathelicidin level in diabetic with infection when compared to controls (38.57±33.6 vs 18.67±25.07) while no significant difference was found between either diabetic without infection and controls or between diabetic with and without infection. The mean serum vitamin D levels in the diabetic patients (both with and without infection) were significantly lower than its mean serum level in controls (23.89±7.39 pg/ml and 24.49±5.37 versus 31.30±6.78 gp/ml respectively). Also, a significant positive correlation was found between serum cathelicidin and BMI while there was no significant correlation between serum cathelicidin or vitamin D and other studied parameters. <strong><em>In conclusion,</em></strong>serum cathelicidin level was significantly higher in diabetic children with acute bacterial infection when compared to controls, all studied diabetic children had significant lower mean serum vitamin D level in comparison to controls and a significant positive correlation was found between serum cathelicidin and BMI.Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150101IRON DIFFICIENCY ANEMIA AS A RISK FACTOR FOR LOWER RESPIRATORY TRACT INFECTIONS IN EGYPTIAN PRESCHOOL CHILDREN1288130210169310.21608/azjp.2015.101693ENEman M EL-HindawySeham M ZakiJournal Article20200708<strong>Background and Aim:</strong> Acute lower respiratory infection (ALRI) is one of the leading causes of illness and death in children below 5 years of age. Anemia is one of the most widespread public health problems, especially in developing countries[2]. We aim to study the relationship between anemia as a risk factor and acute lower respiratory tract infections in Egyptian preschool children aged 6 months to 6 years.
<strong>Subjects and methods:</strong> A case-control study was conducted on a total number of 172 infants and children aged 6 months to 6 years; in the period from January 2013 to December 2013, we recruited 86 cases hospitalized for lower respiratory tract infections in Children Hospital, Zagazig University comprising all newly diagnosed cases during the defined time period of the study (incident cases) to ascertain the temporal sequence of exposure and disease. 86 healthy controls without any respiratory problems, age and sex matched were selected by simple random sampling from the general population that gave rise to the cases . All patients were subjected to detailed history taking ( including past medical or pharmacy records), full clinical examination, and investigations including CBC, Iron profile: serum ferritin, total iron binding capacity and serum iron for all children. CRP and Chest X ray are done for cases only.
<strong>Results:</strong> The percentage of anemia was higher among case than control, with 81.4 % of hospitalized cases and 32.5%of healthy controls and the percent of iron deficiency anemia was higher in cases than controls 69.8% and 23.2% respectively with a significant P-value of 0.001.There were significant lower medians of serum iron, ferritin and transferrin saturation in cases than controls with highly and significant higher total iron binding capacity (TIBC) in cases than controls , also There’s significant lower serum iron and transferrin saturation in anemic cases than anemic controls with no significant difference as a regard TIBC and serum ferritinApproval of ethical committee in college, and written consent from patients′ parents were obtained.
<strong>Conclusion:</strong> we can conclude that anemia especially IDA is a risk factor for acute lower respiratory tract infections among Egyptian preschool children.
<strong> </strong>Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150101INCIDENCE OF URINARY TRACT INFECTION AMONG FEBRILE CHILDREN1303131910169710.21608/azjp.2015.101697ENMoftah M RabeeaNayera M El AkkadKhaled M ZayedBadawy W Abou BakrAbdullah M MahmoudJournal Article20200708Urinary tract infection (UTI) is the most common serious bacterial infection in young febrile children. The diagnosis and management of UTI in young children are clinically challenging. The aim of this study is to determine the incidence of UTI among febrile children of different ages presented with specific or non-specific symptoms suggestive of UTI. This cross sectional study was carried out on febrile children attending the outpatient clinic at Al-Hussein University Hospital from January to July 2014. A total of 200 febrile patients selected randomly aged 1-12 years were included in the study .They were 51 males and 149 females. Inclusion criteria were children from 1-12 years with explained or unexplained fever of 38ºc or higher, children with nonspecific symptoms of UTI such as lethargy, irritability, malaise, failure to thrive, vomiting, poor feeding and children with specific symptoms of UTI, such as increased frequency, dysuria, suprapubic pain, loin pain and tenderness. Exclusion criteria were patients on antibiotic treatment, patients with known history of recurrent UTI and patients with well-known urinary tract anomalies before or during the study.All patients enrolled in this study were subjected to Full history taking, clinical examination, complete urine analysis, culture and sensitivity, routine investigations as CBC, ESR, CRP and renal ultrasonography. The results clarified that dysuria was the predominant among urinary tract symptoms (6.5%) while sore throat was the predominant among symptoms other than UTI (60%). There was a statistically significant difference between febrile children and the level of Pyuria where febrile children having pus cells more than 10 / HPF considered significant for the infection, p-value is < 0.001. All patients with pyuria ( 16 patients) were positive for nitrite test and urine culture.
From this study, we can conclude that; unexplained fever is one of the common presenting symptoms of UTI and screening for UTI by strip nitrite test (simple, easy with immediate result) among febrile infants and children is an important mean for early detection of infection. We also recommend considering UTI in febrile patients with nonspecific symptoms or minimal symptoms of different systems. Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150101COMPARATIVE STUDY OF THE SUPER LIGHT-EMITTING DIODE VERSUS CONVENTIONAL PHOTOTHERAPY IN NEONATAL JAUNDICE IN NICU IN ZAGAZIG UNIVERSITY HOSPITAL1320133210170110.21608/azjp.2015.101701ENJournal Article20200708<strong>Background </strong>: In neonates, high levels of total serum bilirubin (TSB) can cause severe and irreversible brain damages. Thus, prompt diagnosis and treatment of indirect hyperbilirubinemia is of great importance in this age group. Phototherapy and exchange blood transfusion are two major therapeutic strategies to prevent bilirubin-induced brain damage in neonates. The choice of therapy depends on the severity of hyperbilirubinemia, but phototherapy is the most frequently used treatment .
<strong>Aim of the work:</strong> The aim of this study is to compare between the Super Light-Emitting Diode and Conventional Phototherapy in treatment of neonatal Jaundice.
<strong>Subject and method:</strong> Randomized controlled study were carried out at Zagazig university children’s hospital on 28 neonate who were classified onto 2 groups .Both groups included preterm and full term neonates 14 subjected to conventional phototherapy and the other 14 subjected to super LED phototherapy .
<strong>Results </strong>:super LED is more effective than conventional phototherapy as mean TSB at admission on super LED was 18.5 mg/dl , after 6 hours from super LED phototherapy mean TSB became 15.5 mg/dl 35% from initial value and after 24 hours from phototherapy mean TSB became 10.93 mg/dl 50% of initial value After24 h of treatment and normalization of serum bilirubin occurs after30 hours.butmean TSB at admission on conventional phototherapy was 17 mg/dl , after 6 hours from conventional phototherapy mean TSB became 15,9 mg/dl ,and after 24 hours from phototherapy mean TSB became 13.,8 mg/dl and normalization of serum bilirubin occurs after 47,5 hours.
<strong>Conclusion:</strong> Super LED phototherapy is more effective than conventional phototherapy devices as they can provide rapid reduction on high levels of hyperbillirubinemia .more time saving and less side effects.Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150101SEROPREVALENCE OF AUTO-IMMUNE THYROIDITIS IN TYPE 1 DIABETIC CHILDREN IN DAMIETTA GOVERNORATE1333134710170310.21608/azjp.2015.101703ENJournal Article20200708<strong><em>Background</em></strong><em>: Type 1 diabetes mellitus (T1DM) is a common Pediatric autoimmune disorder. Children with type 1 diabetes mellitus are more prone to develop other organ-specific autoimmune diseases, among which autoimmune thyroiditis (AIT) is more frequently encountered. </em><strong><em>Objective:</em></strong><em> the present study designed to determine the seroprevalence and biochemical characteristics of autoimmune thyroiditis among children with insulin-dependent diabetes mellitus in Damietta Governorate in the period from October2011 to October2012.<strong> Patients and Methods</strong>: </em><em>This cross sectional analytic study included 90 diabetic children receiving insulin therapy. They were selected from diabetic outpatients' clinic of Health Insurance Hospital in Damietta governorate; 54 of them were females and 36 of them were males. All patients were subjected to history taking, examination to detect major complications of diabetes & signs of other autoimmune disorders especially thyroiditis and laboratory investigations in the form of Hemoglobin A1C, Thyroid stimulating hormone (TSH), Anti-thyroid peroxidase antibody (TPO), Anti-thyroglobulin antibody (Tg) and Free tri-iodothyronine (T3)& Free thyroxin (T4) for patients with abnormal TSH. Thyroid ultrasound for all subjects with seropositive anti- thyroid autoantibody was also performed.</em><strong><em>Results:</em></strong><em> Mean age of studied cases was 11.2±3.3 years. Most of our cases were more than 6 years (87.8%), with duration of diabetes less than 3 years (62.2%), had positive family history of diabetes (70%), and negative family history of autoimmune diseases (66.7%). Prevalence of seropositive thyroiditis was 10 cases (11.1%) out of 90 patients, 8 (8.9%) of them shows picture of thyroiditis with neck ultrasound. Among patients with seropositive thyroiditis, there was no significant risk as regard sex of the patients (8 females and 2 males; P: 0.17), age (all patients more than 6 years; P: 0.2), and duration of diabetes (P: 0.59). There was significant difference as regard positive family history of autoimmune diseases (7 cases; P: 0.009). Regarding thyroid function status, 2.2% were suffering from hypothyroidism and were complaining only from goiter; TSH level was only increased in the two cases with low free T4 and low free T3. There was statistically significant difference as regard TPO Abs mean in negative cases and positive thyroiditis cases (2.74±8.03 and 263.69±231.77) respectively, and TG Abs mean in negative cases and positive thyroiditis (7.48±7.31 and 205.69±211.51).<strong> Conclusion</strong>: The presence of thyroid antibody positivity and the subsequent development of subclinical autoimmune thyroiditis were prevalent among the children with T1DM of our study.</em><em> Positive family history of thyroid disease and abnormality in neck ultrasound were significant risk factors.</em><strong><em> Recommendations</em></strong>:<em>All patients with T1DM should be screened for autoimmune thyroiditis upon diagnosis, and in case of thyroid antibody positivity they should be regularly followed up in terms of their thyroid function and growth status.</em>Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150101ASSESSMENT OF THE ROLE OF SERUM ISCHEMIA MODIFIED ALBUMIN IN THE EARLY DIAGNOSIS OF NEONATAL SEPSIS1348135910170710.21608/azjp.2015.101707ENSawsan H.A. AzzabNasser I.A AbdelrahmanAbdelrahman A. AbdelnaimJournal Article20200708<strong><span>Background: </span></strong><span>Neonatal sepsis is one of the most challenging problems despite the ongoing progress in diagnosis and treatment. Neonatal sepsis is the single most important cause of neonatal deaths in the community, accounting or over half of them. Ischemia modified albumin (IMA), a Food and Drug Administration-approved serum biomarker of cardiac ischemia and a risk stratification tool for suspected acute coronary syndrome is produced during an ischemic condition or attack and is present in the blood in early and easily detectable levels. Growing evidence suggests that IMA is also increased in diseases associated with oxidative stress such as diabetes mellitus, obesity and hypercholesterolemia. Also, it has been reported that circulating IMA was associated with inflammation markers, because inflammation reduces the capacity of albumin to bind to cobalt. Serum IMA has recently gained interest as marker for neonatal sepsis.</span>
<strong><span>Objectives: </span></strong><span>The aim of this study is to evaluate the role of serum ischemia modified albumin as a marker for early diagnosis of neonatal sepsis. </span>
<strong><span>Patients and Methods: </span></strong><span>The</span><span> present comprised 30 neonates with sepsis, age 35.4 <span style="text-decoration: underline;">+</span> 2.62 weeks and 30 healthy control neonates age 36.50 <span style="text-decoration: underline;">+</span> 1.85 weeks. It was carried out as a case control study. An informed written consent was obtained from parents of all neonates. Patients and controls were subjected detailed history taking, thorough physical examination, routine laboratory investigations (CBC, CRP and blood cultures) and assessment of serum IMA.</span>
<strong><span>Results: </span></strong><span>Analysis of our results showed statistically significant difference between sepsis group and control group in serum IMA levels. We found that no statistically significant difference was found between full term and preterm neonates with sepsis as regards serum IMA levels. </span>
<strong><span>Conclusion: </span></strong><span>Serum IMA levels is a useful marker in early diagnosis of neonatal sepsis and further studies are needed to confirm our results in larger groups of patients<strong>.</strong></span>Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150101ANTI-TRANSGLUTAMINASE 6 ANTIBODIES AS A SEROLOGICAL MARKER FOR GLUTEN RELATED NEUROLOGIC DYSFUNCTION IN CHILDREN WITH CEREBRAL PALSY1360137310173410.21608/azjp.2015.101734ENEhab Ibrahim I. SorourMohamed Abdel Moneim AttiaJournal Article20200708Gluten sensitivity typically presents as celiac disease, a chronic, autoimmune mediated, small-intestinal disorder. Neurological disorders occur with a frequency of up to 10% in these patients. However, neurological disorders can also be the sole presenting feature of gluten sensitivity. Development of autoimmunity directed toward different members of the Transglutaminase gene family could offer an explanation for the diversity in manifestations of gluten sensitivity. Antibodies against Transglutaminase 6 (anti-TG6) represent a new marker associated with gluten-related neurological dysfunction. <em>The aim of this study</em> was to investigate the prevalence of anti-TG6 antibodies in this group of individuals with an early neurological injury resulting in CP. <em>Materials and Methods</em>: 60 children with different forms of cerebral palsy and 40 healthy control children were included and investigated for IgA/IgG class anti-TG6 by ELISA. <em>Results:</em> Anti-TG6 antibodies were found in 9/60 (15%) of patients with CP compared to 3/40 (7.5%) in controls. The quadriplegic subgroup of CP had a significantly higher prevalence of anti-TG6 antibodies 7/15 (46.7%) compared to the other subgroups and controls.<em> Conclusions:</em> An early brain insult and associated inflammation may predispose to future development of TG6 autoimmunity.Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150101ISCHEMIC PEDIATRIC STROKE: CLINICAL AND RADIOLOGICAL FINDINGS1374138410173510.21608/azjp.2015.101735ENHassan Ali HassanJournal Article20200708<strong>Background:</strong> Children presenting with acute hemiplegia/ hemiparesis can be diagnostically challenging. Causes of acute cerebrovascular stroke in children are diverse and more complex than those in adults. Stroke is more common than brain tumors in children. <strong>Objectives:</strong> To identify clinical presentation and role of diagnostic radiology in early detection of cases with ischemic stroke.<strong> Patients and Method</strong><strong>:</strong> Forty patients were enrolled in this descriptive study(1months to 12 years of age) who presented with acute onset of sudden neurological deficit. All patients were admitted in Al-Hussein and Sayed-Galal University Hospitals over aperiod of 8 months from February 2016 to September 2016.All patients were submitted for full history taking and complete neurological examination. Also, patients were investigated by C.T. scan and MRI.<strong> Results:</strong> We studied 40 cases, 28 males and 12 females. Their ages at presentation ranged from 1 month to 12 years. Hemiplegia/paresis was the most common clinical picture present in all patients; right sided were 25 cases (62.5%) and left sided were 15 cases (37.5%). Upper motor neuron facial palsy, seizures and disturbed level of consciousness all were observed in 13cases (32.5%). Aphasia was founded in 10 cases (25%), and headache was observed in 6 cases (15%).The present study revealed that cardiac diseases congenital acquired were the most frequent risk factors identified in this study (17/40- 42.5%) followed by hematological ones (13/40- 32.5%). <strong>Conclusion:</strong> Hemiplegia was the most presenting symptom. Cardiac disorders were the most prevalent risk factor. Magnetic resonance imaging with diffusion weighted is the best imaging modality for early diagnosis of ischemic cerebrovascular accident.Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777418120150101PREVALENCE OF CARDIOMYOPATHY IN CONGENITAL HEART DISEASES IN INFANTS AND CHILDREN1385140410173610.21608/azjp.2015.101736ENYasser A. AahmedTaghreed Abd Alrahman AhmedJournal Article20200708<strong>Background: </strong>Pediatric cardiomyopathy (CM) is a rare but serious and often life-threatening condition. In children, cardiomyopathy is often a part of multisystem disorder, which requires the attention of multiple subspecialists.
<strong>Aim</strong>: The aim of this study was to estimate the prevalence of cardiomyopathy among infants and children with congenital heart disease (CHD) and to determine the relationship of cardiomyopathy to type of CHD. <strong>Methods</strong>: This retrospective descriptive study was carried out in the Pediatric Cardiology outpatient clinic, Al Zahra Hospital , AssiutHospitalAl-AzharUniversity, during the period from January 2012 to September 2014, to review the files of patients diagnosed with cardiomyopathy. The study included 60 cases included 29 (48.3 %) cases with DCM, 28 (46.7%) cases with HCM and 3 (5%) cases with RCM The age of studied cases ranged from 10 days to 8 years with mean age 20.61± 25.62 month .The files of all of these patients were reviewed for the following data: file number, name, age, sex, address, date of diagnosis, frequency of follow up, date of last follow up, presenting symptoms, clinical manifestation, consanguinity, other affected sibling, previous viral infection, history of drug intake and investigation done including electrocardiogram, chest X-ray and echocardiographic data.
<strong>Results:</strong> The most common clinical presentation was dyspnea (86.6%) followed by respiratory infection (48.3%), followed by palpitation (15%). According to different types of congenital heart diseases, our study showed that patent foramen oval (PFO), patent ductus arteriosus (PDA) and atrial septal defect (ASD) were the main congenital heart defects in the isolated shunt lesion where they represented 50%, 25% and 22.7% respectively. Consanguinity was positive in 50% of patients, while a family history of another affected sibling was positive in (10%).
<strong>Conclusion: </strong>The most prevalent form of CHD among cardiomyopathic patient was the isolated shunt lesion followed by combined obstructive and shunt lesion then isolated obstructive lesions and lastly the cyanotic lesion. Our results reveals highly significant difference between types of cardiomyopathy and left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) .