Factors affecting remission for asthma exacerbation in children attending Alexandria university children's hospital

Background: the admission rate for bronchial asthma has increased dramatically all over the world. Part of this increase in hospital admissions is due to patient readmission, which has an impact on children's quality of life, lost productivity and reduced participation in family life in addition To health care cost

Objective: to identify the risk factors for readmission because of acute asthmatic attacks. If these risk factors could be eliminated, there would be potential savings for health services, familial expenses and improvement in the quality of life of the whole family

Subjects: children attending Emergency Room [ER], Pediatric Intensive Care Unit [PICU] and inpatient wards of Alexandria University Children's Hospital, Alexandria, Egypt in the period from Sept. 2013 to Jul. 2015 aged 14 years or less of both sex

Methods: case control study in children who were admitted because of acute asthma attacks. The study was divided into two groups, group readmitted within one year from first admission [group A] and group firstly admitted [group B] and the factors that might have affected readmission were evaluated

Results: age in-group A ranged 4.5-13 with mean value 9.09+/- 3.98. Age in-group B ranged 4-14 years with mean value 8.65+/- 4.01. Males are more than females in both groups, and no sex differentiation effects on readmission. The duration of the disease in readmitted group in our study ranged from 1-8 years, it is a risk factor for acute asthma exacerbation readmission. Viral infection, common cold and dust as asthma triggers are risk factors for acute asthma exacerbation readmission. Regarding disease severity it was found that there was a higher percentage of hospitalization among cases with severe and moderate bronchial asthma compared to mild cases and it was found that readmission cases had more number of acute asthmatic attacks per month and have more sleep disturbance and lack of school attendance. Regarding taking controller medication in between attacks, it was found that readmission group take more controller medication

Conclusion: the prevalence of readmission rate increased dramatically, the duration of the disease, viral infections, common cold, dust and exercise as an asthma triggers are the risk factors for acute asthma exacerbation readmission, severity of the disease and controller medications affect acute asthma exacerbation readmission

Acute Guillain Barre Syndrome in childhood: clinical, electrophysiological and immunological study

Acute Guillain Barre Syndrome [acute GBS] is one of the leading causes of acute flaccid paralysis [AFP] in children. The syndrome has been recognized as a heterogeneous disorder with different subtypes, by clinical, electrophysiological and pathologic criteria. The disease may present with a wide variety of clinical presentations as well as prognostic outcome. The study was conducted on all children with acute GBS attending Alexandria University Children's Hospital during the period from September 2000 to September 2001 for the purpose of characterization of acute GBS in Egyptian Children and its relation to presumed infection with Cytomegalovirus [CMV] or Epstien-Barr virus [EBV]. All clinical, laboratory and electrophysiological data of the children with acute GBS who are admitted to the hospital during the period of the study were evaluated. Serum IgM titer against CMV and EPV were assessed and correlated with other patients'data. Thirty five children were admitted to the hospital during that period. Sixty age and sex matched healthy children were included as controls for studying IgM titre of EBV and CMV. Affected children were 22 boys and 13 girls. Their ages ranged between one and 10 years. Eight cases did not have preceding illness before the disease. The initial symptom was motor in 11 cases, sensory in 2 cases and mixed in 22 cases. Ascending paralysis was dominant in all cases except three who had descending paralysis. Only five cases did not exhibit severe pediatric GBS [grade 4 or 5] according to the functional grading system. Twenty nine cases exhibited the major electrophysiological type of acute inflammatory demyelinating polyneuropathy [AIDP]. Albuminocytologic dissociation was encountered in 25 cases. Two cases died in the acute phase, one was left with residual neurological deficit while the rest recovered completely. There was a statistically significant difference between cases and controls as regards the IgM titre against CMV virus [P < 0.05] while IgM titres against EBV were not statistically different from the control group. In addition children with presumed Prior CMV infection tended to be younger in their age significantly more than those with presumed EBV infection [r = 0.382, P = 0.003]. The only significant association was the relation between the type of initial symptoms versus the IgM titre against CMV and EBV where sensory symptoms were prominent more significantly among cases with presumed CMV infection than those with presumed EBV infection [P<0.005]. Acute GBS demonstrates diverse clinical, electrophsyiolgical and laboratory dilemma. Clinical and electrophysiological criteria remain the most important prognostic factors. Despite its initial grave presentation, early institution of therapy using intra-venous immunoglobulin [IVIG] or plasma exchange ensures dramatic recovery in most of cases. The underlying etio-pathologic mechanisms are still not properly understood. Their clarification might have its impact on better delineation of clinical presentations, outcome and prevention

Serum level of soluble interleukin-2 receptors during acute asthma exacerbation, and its relation to severity and response to bronchodilator therapy

Lymphocytes are prominent among the inflammatory cells infiltrating the asthmatic airways and T-cell activation appears to be a characteristic feature of acute asthma. In patients with acute asthma who respond well to bronchodilator therapy, the main mechanism of airflow obstruction is smooth muscle contraction, while in patients with poor response the main mechanism is airway inflammation. This study was conducted on 60 children with acute exacerbation of bronchial asthma. They were divided into three groups [mild, moderate and severe] according to the severity of the acute attack, utilizing a clinical scoring system and through measuring Peak Expiratory Flow Rate [PEFR], and oxygen saturation. Serum level of sIL-2R was measured using enzyme-linked immunosorbent assay both in the studied cases and in 20 healthy controls. The mean serum level of sIL-2R in the studied cases [5207.5 +/- 2084.9 pg/ml] was significantly higher than its mean level in controls [1742.5 +/- 801.9 pg/ml] [t=9.37, P=0.000]. Its mean level in severe exacerbation [8090.8 +/- 1222.6 pg/ml] was significantly higher than its mean level in moderate exacerbation [5255.0 +/- 1112.8 pg/ml], that was significantly higher than its mean level in mild exacerbation [3164.6 +/- 990.8 pg/ml] [F= 77.36, P=0.000]. There was a significant negative correlation between the levels of sIL-2R and both the baseline PEFR [r = -0.710, P=0.000] and oxygen saturation [r = -0.521, P=0.000]. After receiving bronchodilator therapy, the mean level of sIL-2R in cases with no or partial response [6486.8 +/- 1900.4 pg/ml] was significantly higher than its mean level in cases with complete response [4088.1 +/- 1534.9 pg/ml] [t=5.406, P=0.000]. A higher level of sIL-2R at acute asthma exacerbation was associated not only with more severe exacerbation but also with a lower degree of bronchodilator responsiveness