Influenza virus vaccination for adults and children as a part of protection of Hajj and Umrah persons from respiratory tract infections

Spread of respiratory tract infection starting by influenza attacks among Hajjs represents a real threat to this overcrowded, population in the context of SARS, Avian influenza and Multi Drug Resistant TB. The aim of this work was to: [1] test the protective effect of influenza virus vaccination and wearing of face mask as two components of the project to control respiratory tract infections during Hajj and Umrah seasons, [2] compare between the subunit and split virus influenza vaccines as regards the safety and protection, [3] test the effect and safety of subunit virus influenza vaccine in COPD and asthmatic patients. Five groups were enrolled in this prospective study: Three groups of high risk persons for recurrent chest infection; group I was vaccinated with subunit vaccine, group II was masked without vaccination, group Ill was neither vaccinated nor masked. The other two groups [groups lV and V] were care givers: group IV was vaccinated by split virus vaccine and was wearing masks [medical staff] while group V was vaccinated with split virus vaccine without face mask [paramedical]. All groups were followed up for one year. The selected internal Halls and Umrah persons [groups I, II, and Ill] were at high risk for recurrent respiratory tract infection. They included COPD, asthmatics that were not sensitive to egg protein, persons in irritant occupations, cases of recurrent pneumonia, bronchiectasis, D.M. or rheumatic heart diseases and elderly. The studied medical and paramedical staffs were vaccinated with split virus vaccine [516 females and 434 males sharing in internal Hajj and Umrah activities in El-Noor specialized Hospital [where most of Hajj and Umrah patient were referred]. The percent of protected persons in the studied groups was 98.5%, 59.0%, 21.0%, 984%and 40.9% in groups I, II, Ill, IV and V respectively. There was a significant difference between all groups regarding protection rate except between groups IV and I. Number of audible coughs/mm. in Mecca Haram was 90/mm during Dhu Alhejja compared to 1/mm. in Ragab, and 10 1mm. in Shaaban. Number of audible coughs/mm. in Madina Haram was 120/mm during Dhu Alhejja compared to one/mm. in Ragab. Most of respiratory tract infection attacks in Ragab Omrah started after Madina visits. The percentage of masked halls was 5% as counted between hajjs coming out from a Haram door. None of the vaccinated group with subunit virus vaccine was presented by lower respiratory tract infections. Only 1.5% of the vaccinated group with the sub-units vaccine were presented by uncomplicated flu, while 60% of the group who received split virus vaccine and unmasked was followed by bacterial phaiyngitis caused by haemophilus influenza in 42.8%, pneumococci in 34.2%, sterpt haemolyticus in 20% either A, C, D., and Klebsiella in 3%. One percent of cases were complicated by pneumonia Conclusions:-1] Influenza vaccination is effective to protect Halls and Umrah persons. 2] Subunit TIV is more effective and safer than split TIV. 3] Asthmatics, non-allergic to egg protein can be vaccinated by subunit TIV safely and can be benefited, 4] COPD patients are benefited from TIV 5] Face mask is partially protective for Hajjs and Umrah persons and may help in combination with TIV to control spread of respiratory tract infections among adults and children during Ha]] and Umrah season. Recommendations: 1-Broadening of TIV up to generalization to control influenza epidemic during Ha]]s and Umrah seasons 2-Co-vaccination with TIV and polyvalent pneumococcal to the risky group of Hajjs and Umrah patients vaccine should be furtherly investigated. 3-Combination of facemask wearing to vaccination with TIV can be recommended to promote control the spread of respiratory tract infections among all Hajjs and Umrah persons. 4-Holding a pan Islamic conference in Mecca and Madina for respiratory experts and Ministers of Health is recommended to discuss the control of respiratory infections during Hajj and Umrah seasons

Natural history of hepatitis C virus among apparently normal schoolchildren: follow up after 7 years

In November 1994, we started a community-based study upon 294 rural, randomly selected school children, aged 6-75 years. Anti-Hepatitis C virus antibodies [HCV-Ab] were tested for all children with Enzyme Linked immunosorbent Assay [version III] and positive cases were confirmed by Polymerase Chain Reaction [PCR]. Liver function tests, Hepatitis B surface antigen [HBsAg], Hepatitis B core antibodies [HbcAb], urine, stool analysis for parasite ova as well as abdominal ultrasonography were done. The overall prevalence of anti-HCV Ab, HBsAg, HBcAb, Schistosoma [S] mansoni infection and periportal thickening detected by ultrasonography was 5.8%, 1%, 3.7%, 45% and 58% respectively. Active S. mansoni infection and its intensity were the risk factors significantly correlated to anti-HCV seropositivity [P<0.04, Odd's ratio [OR] 3, 95% confidence interval [CI] 0.95-10.1. The PCR confirmed viremia in 41% of anti-HCV seropositive cases which was significantly correlated with elder children, [P=0.03, 95% CI 0.3-5.8], past history of schistosomiasis [SCH] P<0.05, OR 12, S. mansoni infection [P0.03] and raised aspartate aminotransferase level [AST] [P< 0.001]. No significant past history of the mode of acquisition of HCV infection was detected among our cases. We followed up our apparently normal schoolchildren for 7 years, positive [15 cases] and negative [8 cases] for anti-HCV antibody. The above laboratory investigations were repeated in November 2001 [the seventh year of follow up]. All of them still had no risk factor for HCV infection nor abnormal findings by clinical examination and abdominal sonar. Cases and controls were negative for HbsAg. One case out of six became PCR negative comprising 17% spontaneous clearance of viremia. Six cases out of nine [67%] of PCR negative, anti-HCV positive cases lost their antibody positivity after 7 years

Conclusion: intestinal SCH may be a risk factor for the development of viremia and to the rise of AST level in HCV infection. The persistently high prevalence of SCH infection in our community was confirmed. It could be suggested that the natural history of community acquired hepatitis C virus in asymptomatic children may be more benign than previously thought

Plasma endothesin-1 and renin as predictor factors in schistosomal liver disease of children

Endotheh-1 [ET-1] is a mitogenic and a potent vasoconstrictor peptide. It affects the hemodynamics of the liver and plays a role in fibro genesis through activation of stellate cells. Also renin-angiotensin system, which is activated in liver cirrhosis, may play a role in the pathogenesis of portal hypertension associated with schistosomal liver disease. The role of plasma ET-1 and renin in schistosomal liver disease and their clinical significance remain largely under investigated particularly in children. This study included 20 patients attending Pediatric Department of National Liver Institute, Menoufyia University, or Pediatric Department of Tanta University Hospital. Their mean age was 10.2 +/- 2.1 years. A control group of 20 healthy children of matched age and sex was included in the study. For all study children, history, physical examination, urine and stool analysis, CBC, kidney function tests and liver function tests were undertaken. Rectal snip biopsy, abdominal ultrasound examination and liver biopsy were utilized to diagnose our patients. Plasma ET-4 and renin were measured by radioimmunoassay. The mean level of ET-1 in the control group was 0.83 +/- 0.20 pg/ml with a range of 0.49 to 0.99 pg/ml, In contrast, the mean ET-1 level in the patients group was 1,37 +/- 0.6 pg/ml with a range of 0.49 to 2.24 pg/ml. The difference was statistically significant [p=0.001]. ET-1 was found to be elevated [2 SD above the mean control value] in 9 of 20 patients [45 %] with mean of 7.8 +/- 0.37 pg/ml and a range of 1.49 to 2.24 pg/ml. ET-1 was elevated in 2/11 [19%] of patients with hepatomegaly, in 2/3 [67%] of patients with hepatosplenomegaly, in the only case with shrunken liver 1/1 [100%] and in 4/5[80%] of patients with ascites. The relation of ET-1 elevation to the stage of disease was statistically significant [p=0.026]. Elevated ET-1 was found in 6/1 [86%] of patients with elevated ALT, compared with 3/13 [23%] of patients with normal ALT. This relation was statistically significant [p=0.017]. Plasma ET-1 levels appeared to correlate with duration and severity of the disease. Unlike in cirrhotic patients previously reported, renin was normal in all studied cases with no significant difference between patients of all disease stages versus controls. in the control group the mean plasma renin level was 2.52 +/- 1.23 ng/L and ranged from 1.23 to 3.81 ng/L while in the patients group it was 2.09 +/- 1.06 ng/L and ranged from 0.72 to 3.45 ng/L. This might be attributed to the stable hemodynamics and normal renal function of our study cases

Conclusions: the present study suggests that ET-7 level might be elevated in cases of schistosomal liver disease of Egyptian children particularly advanced cases. Elevated ET-1 might be involved in the aggravation of the disease or development of complications like portal hypertension 3rd ascites. So, monitoring ET-1 level along the course of the disease may be useful as a predictor for the development of these complications and may be helpful in the prevention planning. Plasma renin measurement probably has no important role in following up schistosomal liver disease during childhood

Steroid sparing using safer drugs in the management of children and adolescents with chronic asthma

This study included forty five [19 males and 26 females] children and adolescent patients [mean age 11.2 +/- 3.4 years] suffering from chronic bronchial asthma, in whom oral and/or inhaled steroids were necessaary to control their symptoms. They were selected from patients attending outpatient clinics of Pediatrics and Chest Departments of Tanta University Hospital. They were assigned randomly into 3 treatment groups [15 cases each]; Lidocaine group receiving nebulized lidocaine 1 mg/kg/dose twice daily, Montelukast group receiving oral montelukast 5 mg once daily, and control group who continued on their traditional drugs [bronchodilators and steroids]. History and clinical examination were performed and the following investigations were done to all study cases as a base line and after 2 weeks of treatment: PEFR, FEV1, FEF[25.75%], Induced sputum was collected and utilized to do sputum eosinophil count, sputum eosinophilic cationic protein [ECP] and sputum nitric oxide [NO] metabolites [nitrites and nitrates]. PEFR increased significantly 20 minutes after lidocaine inhatation, indicating bronchodilating effect of lidocaine. Studied pulmonary function parameters [PEFR, FEV1 and FEF[25-75%], significantly increased, while induced sputum analysis data [sputum eosinophil count % and sputum ECP] significantly decreased after treatment in Iidocaine and montelukast groups as compared to base line values and control group. However, the difference between the two groups after treatment was not significant. Sputum total nitriteslnitrafes did not change significantly after treatment in both groups and in controls due to pretreatment of ail study cases with steroids. Successful steroid withdrawal was obtained in 86% of lidocaine group and 73% of montelukast group along of 2 weeks. The difference between success rates in the two groups was statistically insignificant [p0.05]

Conclusion: the present study suggests that both nebulized lidocaine and oral montelukast could be reasonable steroid sparing agents allowing maintained asthma control with no or reduced dose of steroids. Lidocaine is cheap while montelukast is easily administered in children. Both agents exhibited comparable steroid sparing actions without significant side effects. However, lidocaine inhalation works as asthma reliever as well, due to its bronchodilating action

prospective and year study of risk factors for adverse events associated with pediatric cardiac catheterization in Tanta university hospital

The role of the pediatric cardiac catheterization laboratory has evolved in the last decade as a therapeutic modality, although remaining an important tool for anatomic and hemodynamic diagnosis. The aim of this study was to determine the relative risks of pediatric diagnostic and interventional cardiac catheterizations in a prospective study of suitable duration [5 years]. A study of 760 consecutive pediatric cardiac catheterization procedures was undertaken according to standard techniques. All necessary laboratory investigations, imaging or life support measures required for diagnosis, treatment or follow up of patients were done according to the situation. The results demonstrated that patients' age, ranged from 20 days to 15 years [mean 2.5 years]. One or more complications occurred in 68 studies, [8.9%] and were classified as major in 14 [1.8% of procedures] and minor in 54 [7.1% of procedures], with 1 interventional procedure associated complications [n=21; 2.7% of procedures] the most common adverse I, event. Arrhythmic complications [n=17; 2.3% of procedures] were the second most common I complication. Vascular related complications occurred in 73 cases [7.7%] bleeding in 12 cases [1.6%] while catheter manipulation caused complications in 5 cases [0.66%]. Death occurred in one case aged 20 days [0.13%] due to uncontrollable arrhythmia. Patient weight <5 kg, age<2 years and interventional studies were the independent risk factors for morbidity

Conclusions and Recommendations: complications continue to be associated with pediatric cardiac catheterization. Their incidence in Tanta University Cardiac Catheter Laboratory parallels that achieved elsewhere in the world nowadays. The most frequent and serious categories of complications we have encountered are those related to interventional procedure followed by arrhythmias, Independent risk factors for complications included a young patient age, with a lower body weight and undergoing an interventional procedure. Efforts should be directed to improving equipment for flexibility and size, raising operator experience. Patient selection and preparation as well as the per catheterization intensive medical care should be improved

Leptin, insulin-like growth factor I and its binding proteins I and 3 as indicators of pre-natal and post-natal growth potentials

The study was conducted on 50 newborn infants [20 females and 30 males] who were born in Menoufiya University Hospital or Tanta University Hospital. Among these infants 25 cases were full term appropriate for gestational age [group I or controls] while the other 25 cases were low birth weight small for gestational age [LB W-SGA] patients [group II]. Cases with maternal pre-eclampsia and infants of diabetic mothers were excluded. The study also included the mothers of these two groups [50 mothers]. The aims were to evaluate cord serum IGF-I, IGFBP-3, IGFBP-1 and leptin as indicators of prenatal and postnatal growth potentials and to correlate between maternal and fetal concentrations of these parameters. History and clinical examination including anthropometric measurements [birth weight, length, head circumference and chest circumference] were done and cord serum leptin, IGF-l, IGFBP-I and IGFBP-3 were measured. For mothers of studied groups, full history and through clinical examination were done including general nutritional status, blood pressure, weight, height, parity and any complication. Also their serum leptin, IGF-l, IGFBP-I and IGFBP-3 were measured. We followed up our cases with intrauterine growth retardation, [IUGR] at birth [group II] who were observed after 6 months whether catch up of weight and length has occurred [catch up subgroup] or not [non-catch up subgroup]. Cord serum leptin, IGF-I and IGFBP-3 were significantly lower while IGFBP-I higher in LBW SGA infants [group II] than that in normal controls [group I]. These parameters correlated well with birth anthropometric measurements in the studied cases. On the other hand, maternal serum levels of leptin, IGF-I, IGFBP-I and IGFBP-3 did not correlate significantly with their levels in cord serum of the studied infants nor with birth anthropometric measurements. On follow up after 6 months, infants with successful catch up of growth showed higher birth weights and cord serum levels of IGF-I than those without growth catch up. Cord serum leptin, IGF-I, IGFBP-1 and IGFBP-3 could be useful in evaluating preterm small gestational age [SGA] infants and correlate with their anthropometric parameters at birth. Cord serum IGF-l and birth weight can be predictive of the future catch up potential of growth in IUGR infants. Maternal anthropometric parameters and maternal serum leptin, IGF-I, IGFBP-1 and IGFBP-3 did not correlate to the infant's parameters at birth [anthropometric or cord serum levels] nor to the potential for successful catch up of growth during the following six months