Characteristics of pregnant women admitted with 2009 H1N1 Influenza in a referral maternity hospital at Al Madinah, Saudi Arabia

To date there has been no study done in Saudi Arabia to identify the risk factors for poor outcome of H1N1 infection in pregnancy. We aimed to evaluate the epidemiological data, clinical course, treatment modalities, and maternal and fetal outcomes of 33 pregnant women diagnosed with H1N1 Influenza A in a referral maternity and children hospital at Al- Madinah Saudi Arabia on the period from June 2009 till February 2010. This retrospective cohort study reported 33 pregnant women [9.1% primigravida] aged 27.7 +/- 5.6 years who were laboratory-confirmed cases diagnosed with H1N1 Influenza A in a referral maternity and children hospital at Al- Madinah Saudi Arabia on the period from June 2009 till February 2010. Their mean gestation age was 23.5 +/- 10.9 weeks with history of bronchial asthma in 45.5%. The mean duration between symptoms' onset and hospital presentation was 5.0 +/- 2.2 days with late presentation in 10 cases [30,3%]. Large number of cases presented with fever more than 39 [24 [72.7%], sore-throat [24 [72.7%] and cough [29 [87.9%] while 19 patients presented with dyspnea [57.6%]. Pregnant patients with H1N1 received Tamiflu [oseltamivir]] from 2 to 7 days with a mean of 4.7 +/- 1.3 days. They stayed at hospital for variable periods from 2 to 28 days with a mean of 7.9 +/- 6.6 days [Table 4]. Most patients [31[93.9%]] received antibiotics. Maternal poor outcome included hypoxia in 6 patients [18.2%], ICU admission for 2-3 days with mechanical ventilation in 4[12.1%]]. The main fetal poor outcome was intrauterine fetal death in 2 [6.1%] babies. The main presentation of H1N1 among pregnant women was typical influenza-like illness. Considerable percentage of patients presented late [30.3%]. The duration of hospital admission is variable up to 28 days. Bronchial asthma was prevalent [45.5%] among pregnant women with H1N1 infection. The main poor outcomes were maternal respiratory failure [18.2%] and intrauterine fetal death [6.1%]. There is increased risk of intrauterine fetal mortality [6.1%] rather than materanl mortality [0%]

Study of some factors associated with high-risk asthma in children

Background: Bronchial asthma is characterized by lower respiratory tract inflammation associated with bronchial hyper responsiveness with variable and reversible airflow obstruction. The majority of asthmatics are sensitized to at least one common allergen

Aim of the study: The aim of this study is to determine the association of high-risk asthma with allergy-related parameters [total serum IgE levels, serum levels of allergen- specific IgE, eosinophil count, eosinophil percentage ] and pulmonary functions in children

Subjects and methods: 50 Children aged 8-15 years diagnosed with atopic asthma were enrolled in the study. Pulmonary function tests, total leukocyte count [TLC], eosinophil count, and eosinophil percentage were estimated. Total serum immunoglobulin E [IgE] levels and serum IgE levels specific to antigens from 1 to 9 allergens with class 1 or higher, namely, Dermatophagoides pteronyssinus [D. pteronyssinus] , Dermatophagoides farina [D. farina ], cat dander , dog dander, cockroach, egg white, milk, Aspergillus fumigatus, and fish, were measured using UniCAP fluoroenzyme immunoassay [FEIA]

Results: This study includes 50 participants, 20 [40%] belonged to the high-risk and 30 [60%] to the low-risk groups. This study revealed no significant association in peak expiratory flow rate [PEFR, %] values between high-risk and low-risk asthma groups [p ? 0.05]. There was no significant association in forced expiratory volume in first second [ FEV1 [L]] values between high-risk and low-risk asthma groups [ p ? 0.05], whereas there was significant association in FEF 25-75% [forced expiratory flow 25-75%] values between high-risk and low-risk asthma groups [ p ? 0.05]. There was a significant association between total serum IgE level and high-risk asthma, but TLC, eosinophil count, and eosinophil percentage showed non significant association with high-risk asthma. Serum levels of IgE specific to D. pteronyssinus, D. farina, cat dander, and dog dander were significantly associated with high-risk asthma. The high-risk group had higher serum levels of IgE specific to D. pteronyssinus [ p < 0.0001], D. farina [ p < 0.0001], cat dander [ p < 0.0001], and dog dander antigens [ p < 0.0001] compared with those in the low-risk group. There was no significant association between high-risk asthma and the serum levels of IgE specific to antigens from other allergens [including cockroach, egg white, and milk]. Serum levels of IgE specific to Aspergillus fumigatus and fish were both negative [class level < 1] in both the high-risk group and the low-risk group

Conclusion: Children with higher serum levels of IgE specific to D.pteronyssinus, D. farina, cat dander and dog dander antigens, and total serum IgE levels, and lower FEF25-75% values belong to the high-risk asthma group. The characterization of risk factors has enabled us to identify high-risk asthma in children , leading to better treatment options