Introduction: Group A streptococcus (GAS) remains a global burden, particularly in developing countries, with long-term morbidity and mortality complications. Different strains and immune responses to GAS can lead to various disease patterns, from predominantly throat and skin manifestations to renal and cardiac involvement. Myocarditis associated with glomerulonephritis can progress to carditis, which may present with signs and symptoms similar to rheumatic heart disease. Although uncommon, this condition can deteriorate into dilated cardiomyopathy, potentially leading to cardiogenic shock and death, necessitating early recognition, intervention, and preventive measures. Case Presentation: We report three pediatric cases of post-streptococcal infection with cardiac manifestations. The first case involves an 8-year-old female with palpitations and a recurring cough, diagnosed with acute rheumatic carditis. The second case is a 10-year-old female presenting with hemoptysis and edema in the lungs and extremities due to acute rheumatic carditis and prior suspected vegetation. The third case is a 9-year-old male initially diagnosed with post-streptococcal glomerulonephritis (PSGN), who deteriorated into dilated cardiomyopathy with an ejection fraction of 32% and multiple organ dysfunction syndrome. All three patients recovered well, received prophylactic management, and were referred for further investigation. Conclusions: Identifying specific features on echocardiography can help differentiate between rheumatic heart disease (RHD) and PSGN-associated cardiac involvement. Additionally, echocardiography is a more readily available and cost-effective screening method, especially in endemic populations. Early recognition and management of post-streptococcal cardiac complications may prevent long-term morbidity and mortality.

Pancreatic injury in paediatrics is a rare condition and can be difficult to diagnose. The diagnostic challenge is due to its symptom of vague abdominal pain which usually results in late presentation. Elevated biochemical markers such as amylase and lipase can aid in the evaluation of pancreatic injury, however, it is not specific and is only evident after several hours of trauma. Ultrasound is commonly used as a primary modality to evaluate abdominal organ injuries, but its role in detecting pancreatic injury is limited due to low sensitivity. High index of suspicion is needed to avoid undiagnosed pancreatic injury which could be lethal to children. We herein report a case of delayed presentation of isolated pancreatic tail injury in a child who was sufficiently diagnosed with ultrasound and treated conservatively. Proper initial assessment and diagnosis will allow appropriate management of pancreatic injury. Conservative management should include serial imaging to look at the evolution of pancreatic injury and detect complications such as pseudocyst or abscess formation.

Introduction: Cardiovascular disease prevention in pediatrics is important. The aim of this research was to investigate the relationships and response of incremental exercise on inflammatory, immune and hormonal markers in pediatricsMaterials & methods: Thirty healthy non-active pediatrics boys with the age range of 9-11 years old participated voluntarily in this study, and were randomly divided into control (C; n=11) and exercise group (E; n=11). Blood and salivary samples were collected in the two stages: prior to GXT (Graded exercise test) exercise test and immediately after graded exercise test. ELISA method was used for measurement of salivary immunoglobulin A, C-reaction protein, cortisol and fibrinogen serum levels. The research data were analyzed using the Pearson correlation coefficient, Multiple Linear Regression, independent and paired t testFindings: CRP (p=0.043), fibrinogen (p=0.039) cortisol serum (p=0.001) and S-IgA (p=0.021), concentrations were significant increased immediately after the exercise in the exercise group. A significant relationship was observed between CRP and fibrinogen (r=0. 525, p=0.048), CRP and S-IgA (r=0. 621, p=0.022), CRP and cortisol serum (r=0.712, p=0.012), fibrinogen and S-IgA (r=0.638, p=0. 028), cortisol and fibrinogen serum (r=0.562, p=0.038), also cortisol and S-IgA (r=0.734, p=0.003) in the exercise group.Discussion & Conclusions: Incremental exercise not only significantly increases inflammatory immune-saliva and stress hormonal markers in non-active pediatrics, but also cardiovascular risk factors in this paediatrics. Rather reveals the close relationships between these indicators that can be effective in predicting cardiovascular risk factors in paediatrics.