Measles surveillance in Qatar, 2008: quality of surveillance data and timeliness of notification

Disease surveillance systems require that data are complete and submitted on time so that effective prevention and be initiated promptly. Qatar is in the elimination phase of measles control. A retrospective review of records was conducted in Qatar to evaluate the timeliness of notification and completeness of measles and investigation forms for the year 2008 were analysed. About 85% of the at least 2 of the WHO recommended minimum data elements, and only 27.8% of the suspected measles cases were reported within 2 days. Lack of vaccination status information and blood specimen collection were the most prominent defects in the notification forms. The major deficiency in the investigation forms were information on the source of infection, measles serology results and date of blood specimen collection. Ways to improve the quality of the notification system need to be investigated

Measles surveillance in Qatar, 2008: physicians' knowledge and practices and support received

Qatar is in the elimination phase of measles control which requires every suspected measles case to be notified and investigated immediately. This cross-sectional study aimed to assess physicians' self-reported knowledge and practices concerning measles surveillance and the support they received. Of 290 physicians participating in the study, only 22.4% met the criterion for best practice in measles surveillance [i.e. knowing and applying the case definition and immediately ordering the correct blood test and immediately reporting suspected cases]. Only 14.1% reported getting training and feedback on surveillance. Physicians supervised on their surveillance activities had significantly better surveillance practices than non-supervised physicians, whereas physicians who received training and feedback on their surveillance activities did not perform any better than those who did not. We recommend training activities for physicians and health care workers involved in the measles control as well a system of feedback to health care workers

Knowledge, Attitudes and practices of patients attending west bay health center towards upper respiratory tract infections

Upper respiratory tract infections [URI] are very common in general practice. Although viruses cause the majority of URI, many patients expect antibiotic treatment. At one Primary Health Care Center in Qatar, during October-November 2004, eleven hundred and eleven adult patients completed a short questionnaire on demographics, knowledge, attitudes, practices towards URI, and patient satisfaction. Four hundred and forty eight [40.3 percent] recognized viruses as the most common cause of URI; seven hundred and eighty-eight [70.9 percent] chose consulting a physician as the first line of action when contracting URI; 721 [64.9 percent] stated that management should be based on physician's diagnosis while 28 percent expected antibiotics. A majority of participants acknowledged the importance of counseling in their satisfaction but 49.6 percent reported dissatisfaction if antibiotics were not prescribed and 31.6 percent reported seeking antibiotics when not prescribed. Participants expecting antibiotics differed significantly regarding knowledge of causes of URI [p = 0.004]. There was no significant difference regarding factors affecting satisfaction based on antibiotic expectation. Results highlight the need for public education and counseling on etiology, course, and management of URI by physicians

Apoptosis and markers of oxidative stress during phototherapy of neonatal hyperbilirubinemia

The aim of this work is to look for apoptosis and markers of oxidative stress during phototherapy of neonates complaining of hyperbilirubinemia in order to know the optimum type, dose and duration of phototherapy application, so as to avoid unnecessary prolonged exposure of the neonate to the laser light and its hazards. The plan was to assess apoptosis in circulating lymphocytes, malondialdehyde serum level [MDA] as a significant marker of oxidative stress, antioxidant enzymes e.g. superoxide dismutase [SOD], catalase [CAT] and glutathion peroxidase [GPx] in various phototherapy light wavelengths. The results revealed that the serum antioxidant enzymes were higher in the control group than in the neonates with hyperbilirubinemia. Apoptosis and serum MDA were higher in neonates after exposure to phototherapy. Blue light has the greatest ability to reduce serum bilirubin, lipid peroxidation and apoptosis, followed by the combined and then the white light. Combined light is better regarding reduction of bilirubin than the white light. Phototherapy has no or little and variable effects on antioxidant enzymes

Conclusion: The use of phototherapy in neonates with hyperbilirubinemia needs an intelligent judgment, giving more care to the type of light used and period of exposure. The various types of phototherapy light have different effects. 30 we recommend more expansion of the use of combined blue and white light, more than the blue light or the white light alone, as it has less side effects and satisfactory serum bilirubin reduction. More researches should be done for more elucidation of the effects of phototherapy on neonates, whether these effects are permanent or not and whether they have any clinical harmful effects

Diagnosis and genetic susceptibility of pulmonary tuberculosis in children

This study consisted of 3 closely related parts; the first part included 70 children with pulmonary tuberculosis [TB], aged 2 - 10 years and 20 healthy children as controls. All were subjected to thorough history taking, clinical examination, chest x-ray and tuberculin test. Blood samples were taken to perform glutaraldehyde test and for detection of IgG antibodies against mycobacterium TB by ELISA technique using antigen A60. The sensitivity of glutaraldehyde test was 87.1% and its specificity was 90% with high significance, while the sensitivity of ELISA test was 48.6% and its specificity was 90%. In the second part of the study, sputum samples from 57 children recently diagnosed as having pulmonary tuberculosis, were processed for microscopic examination of smears after staining for acid fast bacilli, culture on Lowenstein-Jensen medium and nested polymerase chain reaction [PCR]. Patients included in this part were divided into 3 groups. In a group of 20 children not-receiving antituberculous therapy yet, the results of smear examination and PCR were identical in 75% of cases. In 10% of cases culture was most sensitive, but in 25% of patients nested PCR was positive even when smear and culture were negative. In a group of 20 children receiving antituberculous therapy for less than six months, PCR positive results were obtained even when both smear and culture were negative. In a group of 17 children receiving antituberculous therapy for more than six months, positive PCR results were detected up to the 7[th] month of therapy. The third part of the study included the HLA [A, B, C loci] phenotyping in 25 cases out of 70 studied in the first-part, and 92 controls. The results showed higher frequency of the following HLA antigens among cases of pulmonary TB than the controls: A25[10], A26[10], AW66, B35, BW55, CW3, CW4 and CW5, and associated with increased relative risk [RR] above one and the etiologic factor for CW4 antigen was 0.408. On the other hand HLA- B5+ B18+ B35, B12, B27 were significantly higher among the controls than the cases. We concluded that glutaraldehyde test can be used as simple, rapid, inexpensive, not tedious test and was positive in cases of TB with malnutrition. Concerning ELISA test, it can be used as rapid serodiagnostic test which is reliable and relatively inexpensive technique for diagnosis of active pulmonary TB in children. Application of nested PCR assay could be used as a follow-up tool in monitoring of pulmonary tuberculosis in children. Regarding HLA antigens the results showed high frequency of the previously mentioned HLA antigens with pulmonary TB, which may indicate, increased susceptibility to pulmonary TB infection. On the other hand, high frequency of other mentioned HLA antigens among controls may indicate a protective effect of these antigens. Anyhow further studies are still needed to be done and on a wide scale to prove the association of HLA antigens and tuberculosis

Studies on chronic hyperplastic laminitis in the horse

Chronic hyperplastic laminitis is usually a sequal to acute attack, associated with mechanical failure of the foot. The nature of the thickening or hyperplastic chronic laminitis were studied histopathologically. Evaluation displayed formation of a new intermediate degenerative layer interposing between stratum lamellatum and stratum medium, leading to weakening and disruption in the attachment between hoof wall and pedal bone. This layer consisting of areas of incomplete keratinization and multiple areas of necrosis, heamorrhage and pseudotubular like structures in different stages of degeneration and hyalinization. The nature of these changes is irreversible

Splenectomy in donkeys with reference to the postoperative immune response and Phagocytic activity of neutrophils

The resent study clarify characteristic changes in serum protein fractions, immunoglobulin levels, and neutrophil phagocytic activity in splenectomized donkeys. The post-operative blood picture revealed a fluctuating tendency toward lymphocytosis and monocytosis. The electrophoretic pattern after splenectomy showed an elevation in albumin, Beta[1] and Beta[2] globulins and a fairly constant level in gamma globulins. Serum immunoglobulins, IgG, was significantly decreased 1-2 weeks after operation followed by a significant rise [3-4 weeks]. IgG [T], IgG and IgA levels were also significant lowered at different intervals after splenectomy. Preoperative antibiotic prophylaxis therapy was recommended for the control of overwhelming infection after splenectomy and for the decrease in the humoral immunity and defective phagocytic activity