RESUMEN
For more than five decades since benzathine penicillin G has been the gold standard for secondary prophylaxix of rheumatic fever. It remains the unique and has withstood the test of time. This study was designed to verify the use of benzathine penicillin G [Long acting penicillin] for cases of rheumatic fever among schoolchildren at El-Mahalla El-Kobra Province, Gharbia Governorate. It was conducted at two communities [one urban and one rural] during a period of five months from December 2004 up to the end of April 2005. A multistage random sampling was used to select both areas and schools [primary and preparatory] being studied. All children used long acting penicillin [LAP] at the studied schools were included at the study. The required data was collected through filling a pre-designed questionnaire sheet by direct interview, clinical examination together with measurement of antistreptolycin O titer [ASO] and erythrocyte sedimentation rate [ESR] to verify the importance of these test in diagnoses of acute rheumatic fever and continuation of long acting penicillin prophylaxis. Out of 4904 schoolchildren, a total of 220 children representing 44.9/1000 reported long acting penicillin intake. Their mean age was 12.3 +/- 1.9 years. The results reflected the overuse of LAP where; Females constituted 76.4% and atypical presentations reported by 65.9%, mostly knee/or leg pain [66.9%]. Residence has no significant effect on sex [p=0.216], first presentations [p=0.076] and level of ASO titer [p= 0.574], ESR; 1[st] hour [p=0.073] and 2[nd] hour [p=0.288]. On the other hand, first presentations were significantly affected by age [p=0.04] and sex [p=0.015]. Residence and type of first presentations had no significant effect on continuation of LAP intake continuation; Also, the results revealed mal use of LAP where; 26.7% of children with typical presentations discontinued their prophylaxis and 60.7% of those had atypical presentation continue LAP intake. Children with typical presentations had significantly higher levels of ASO [p=0.018] and ESR; 1[st] hour [p=0.026] and 2[nd] hour [p=0.048] at the initial presentations. This difference between typical and atypical presentations disappeared by time. Thus, ASO titer and ESR tests can help in diagnosis of the initial attack of rheumatic fever but, they are not suitable indicators for continuation of rheumatic fever prophylaxis
RESUMEN
It is known that streptococcal infections of the pharynx are the precipitating cause of rheumatic fever. The aim of the present study was to determine some preventable challenges in dealing with acute pharyngitis at a rural community in Gharbia Governorate. This study was conducted at Kafr Hegazy Village, during a period of four months from October 2004 up to the end of January 2005. All primary and preparatory schools of Kafr Hegazy Village were surveyed for children taking long acting penicillin as a preventive measure for rheumatic fever. Sociodemographic characteristics, history of attacks of acute pharyngitis, investigations performed for diagnosis, source of medical care, and type and duration of medications used for treatment were obtained from parents by direct interview using structured questionnaire sheet. All related investigations were reviewed. The results revealed that: In all primary and preparatory schools of Kafr Hegazy Village, 173 children were taking long acting penicillin as a prophylactic measure for rheumatic fever. Of them, 95.4% had past history of acute pharyngitis and 61.9% of them had their first attacks below 6 years and suffered from more than 6 attacks per year. There was no statistically significant difference between mother's education [chi[2] =7.194] and source of medical care [chi[2] =5.838] on one hand and frequency of attacks of acute pharyngitis on the other. Governmental health services [53.3%], mainly school health insurance and primary health care unit were the main sources of medical care. The study showed that 58.2% of studied children were not asked for any investigations and only 1.2% of them were asked for throat culture. Also, the study revealed that the majority [84.2%] of rural mothers were seeking medical care for treating acute pharyngitis which was not significantly affected by their education [chi[2] =1.309]. According to the findings of the study, oral antibiotic therapy was the commonly prescribed, [42.4%], but it was used for 3.9+/-1.6 days. On the other hand, injection therapy [30.3%] was used commonly for 2.4+/-0.7 days. There was no statistically significant effect of mother's education or source of medical care on duration of treatment. The following was recommended: Special health education program for mothers to minimize throat infections and rheumatic fever and stress on the necessity of 10-day course of oral treatment, orientation and on job training courses for physicians especially those of the school health insurance, primary health care units, and private ones. Strategies for diagnosis and treatment of acute pharyngitis should be directed at identifying those patients who have group A Beta hemolytic streptococcal infections by using throat culture [especially for children under 6 years] and implementation of a single injection of benzathine penicillin G as recommended regimen for both treatment of acute pharyngitis and primary prevention of rheumatic fever
RESUMEN
The incidence of lung abscess declined since the introduction of antibiotic treatment and the prognosis has improved. However, this improvement is not sufficient in spite of medical drug's efficacy. The aim of this work was to study the epidemiological, clinical aspects and outcome of lung abscess cases admitted to El Mahalla El Koubra Chest Hospital during five years period [1999-2003]. The medical records of diagnosed cases of lung abscess admitted to the hospital during the period from January 1999 to December 2001 were reviewed and studied retrospectively. On the other hand cases admitted in the years 2002 and 2003 were studied prospectively. The results of this work revealed that there were 116 diagnosed cases of lung abscess admitted to the hospital during the period from January 1999 to December 2003. Of the 1 16 cases 75.1% were aged between 20 and 60 years, 66.44 % were males. 67.2% were of rural residence. Housewives farmers and unskilled manual workers constituted 29.3%, 25% and 20.6% of cases respectively. One or more predisposing factors were identified in 46.6% of patients. Diabetes and pneumonia were the most common [21.6% and 18.1 % respectively]. Cough [88.8%] and purulent sputum [87.1 %] were the most common presenting symptoms followed by fever [69.13%] and chest pain [44%], the abscesses were located mainly in right lower lobe, left lower lobe and right upper lobe. Sputum was positive for TB in two cases and there was need for surgery in five cases [4.3%]. The results of culture and sensitivity test revealed that aminoglycosides group, was ranked on top of the first choice of drug. Metronidazole ranked the first on the 3rd choice drugs. Only 54.3% of cases had favorable outcome, with significant difference in mean age between favorable [38 +/- 15.9 years] and unfavorable ones [47.5 +/- 17.1 years]. The mean duration of hospitalization for the favorable cases was 45.7 +/- 29.2 days. Private clinics were the source of reference in 14.7% of cases and only 29.4% of them were had favorable outcome the case fatality rate was 2.6% this study recommends health education for the vulnerable groups and private physicians for early detection and admission of lung abscess cases to the hospital and to be patient for the needed period of treatment