Adult vaccination against respiratory infections in Egypt: a review of expert opinions.

INTRODUCTION: Lower respiratory tract infection is one of the leading causes of morbidity and mortality all over the world, with a substantial impact on healthcare costs. In Egypt, local consensus on its burden, diagnosis, and vaccination is scarce. This expert opinion is the first to address the local recommendations for vaccinating adults against respiratory infection. It sheds light on the growing need to understand the barriers and underpublicized concept of adult vaccination in Egypt. AREAS COVERED: A collaborative multidisciplinary panel from Egypt developed an expert opinion-based suggestions/points, including epidemiology, microbiology, and highlights on vaccination in Egypt, as well as challenges and recommendations regarding adult vaccination. EXPERT OPINION: Adult vaccinations against respiratory infections are now recommended for high-risk people by all healthcare regulatory bodies. However, it was acknowledged that there may be hesitancy and concerns among patients; in addition, healthcare professionals' awareness about vaccination guidelines and benefits needs improvement. There are several strategies that could be implemented to enhance vaccine adherence in Egypt. These approaches encompass conducting community education programs, addressing the concerns of patients, and enhancing awareness among healthcare professionals through education, policy changes, and periodical reminders in each healthcare setting.

Expert consensus on oral corticosteroids stewardship for the treatment of severe asthma in the Middle East and Africa.

In the Middle East and Africa (MEA) region, overuse of oral corticosteroids (OCS) for asthma management, both as burst and maintenance therapy, poses a significant challenge. Gaps in knowledge regarding the need to taper OCS in patients with severe asthma and the use of OCS in comorbid conditions have been noted. OCS stewardship can help attain optimal and effective OCS tapering along with reducing OCS overuse and over-reliance. In this paper, we discuss current practices regarding the use of OCS in asthma, globally and in the MEA region. Expert recommendations for achieving OCS stewardship in the MEA region have also been presented. Regional experts recommend increasing awareness among patients about the consequences of OCS overuse, engaging community pharmacists, and educating primary healthcare professionals about the benefits of prompt appropriate referral. Innovative local referral tools like ReferID can be utilized to refer patients with asthma to specialist care. The experts also endorse a multidisciplinary team approach and accelerating access to newer medicines like biologics to implement OCS stewardship and optimize asthma care in the MEA region.

Recommended approaches for screening and early detection of lung cancer in the Middle East and Africa (MEA) region: a consensus statement.

Background: The prevalence of lung cancer in the Middle East and Africa (MEA) region has steadily increased in recent years and is generally associated with a poor prognosis due to the late detection of most of the cases. We explored the factors leading to delayed diagnoses, as well as the challenges and gaps in the early screening, detection, and referral framework for lung cancer in the MEA. Methods: A steering committee meeting was convened in October 2022, attended by a panel of ten key external experts in the field of oncology from the Kingdom of Saudi Arabia, United Arab Emirates, South Africa, Egypt, Lebanon, Jordan, and Turkey, who critically and extensively analyzed the current unmet needs and challenges in the screening and early diagnosis of lung cancer in the region. Results: As per the experts' opinion, lack of awareness about disease symptoms, misdiagnosis, limited screening initiatives, and late referral to specialists were the primary reasons for delayed diagnoses emphasizing the need for national-level lung cancer screening programs in the MEA region. Screening guidelines recommend low-dose computerized tomography (LDCT) for lung cancer screening in patients with a high risk of malignancy. However, high cost and lack of awareness among the public as well as healthcare providers prevented the judicious use of LDCT in the MEA region. Well-established screening and referral guidelines were available in only a few of the MEA countries and needed to be implemented in others to identify suspected cases early and provide timely intervention thus improving patient outcomes. Conclusions: There is a great need for large-scale screening programs, preferably integrated with tobacco-control programs and awareness programs for physicians and patients, which may facilitate higher adherence to lung cancer screening and improve survival outcomes.

Proposed Strategies to Improve Adult Asthma Management in Egypt: Expert Review and Recommendations.

Background: Several challenges face asthma management in Egypt, including the high percentage of uncontrolled patients, inadequate compliance, and overuse of short-acting beta-agonists (SABAs) leading to increased asthma-related morbidity and mortality. In this regard, the recent Global Initiative for Asthma (GINA) recommendations included inhaled corticosteroids containing therapy for mild asthma. Local healthcare systems and healthcare professionals (HCPs) often experience practical challenges when implementing global guidelines. Objective: The present expert review aims to outline the development of local guidelines and health policies that integrate global advances in asthma management while addressing unmet needs and challenges in Egypt. Methods: A steering committee of health policymakers and respiratory experts from the principal healthcare sectors in Egypt came together in March 2021 to develop a consent and national guideline for local asthma management, codifying the current challenges and the required elements for adequate control. The recommendations were either evidence-based or consensus-based from the clinical expertise and perspectives of the committee. Results: The committee identified vital challenges facing all chronic airway diseases with initial focus on asthma management in Egypt in diagnosis, data collection, policymaking, patients' awareness, and physicians' attitudes. In general, the committee stated that globally adapted management protocols necessitate addressing from diverse perspectives through policymakers, HCPs, and patients. Accordingly, it is vital to provide relevant education for the patient and HCPs. The recommendations emphasize key elements concerning baseline assessment, diagnosis, treatment strategy with regular review of patient progress, and compliance toward the introduced reforms. Conclusions: Full integration of these recommendations into local practice allows physicians to sustain adequate management while reducing preventable exacerbations and unnecessary burdens. The proposed strategies outline efficient patient-centered management that approaches asthma as an inflammatory condition, encouraging health promotion and patients' compliance.

Over-prescription of short-acting ß2-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study.

BACKGROUND: The extent of short-acting ß2-agonist (SABA) overuse in Africa remains poorly documented. As part of the SABA use IN Asthma (SABINA) III study, we assessed SABA prescriptions/clinical outcomes in 3 African countries. METHODS: Data on disease characteristics/asthma treatments were collected from patients (≥12 years) using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma) and practice type (primary/specialist care). Multivariable regression models analyzed associations between SABA prescriptions and outcomes. RESULTS: Data from 1778 patients (mean age, 43.7 years) were analyzed. Most patients were female (62.4%) and had moderate-to-severe asthma (63.3%), with 57.1 and 42.9% of patients treated in specialist and primary care, respectively. Asthma was partly controlled/uncontrolled in 66.2% of patients, with 57.9% experiencing ≥1 severe exacerbation in the previous 12 months. Overall, 46.5% of patients were prescribed ≥3 SABA canisters in the preceding 12 months (over-prescription); 26.2% were prescribed ≥10 canisters. SABAs were purchased over-the-counter by 32.6% of patients, of whom 79.3% had received SABA prescriptions; 71.9% and 40.1% for ≥3 and ≥10 canisters, respectively. Higher SABA prescriptions (vs. 1-2 canisters) were associated with increased incidence rate of severe exacerbations and lower odds of having at least partly controlled asthma (except 3-5 canisters). CONCLUSIONS: Findings from this African cohort of the SABINA III study indicate that SABA over-prescription and SABA over-the-counter purchase are common and associated with poor asthma-related outcomes. This highlights the need for healthcare providers/policymakers to align clinical practices with the latest treatment recommendations.

Bronchoscopic management as an alternative treatment in non-operable benign tracheal stenosis.

BACKGROUND: Endoluminal therapy either by dilatation, scar tissue resection or stent insertion is an established treatment for non-malignant airway stenosis although the surgical approach is still considered the "gold standard." No clear consensus exists on the structured role of each modality. AIMS: We aimed to investigate the role of bronchoscopic management in non-operable tracheal stenosis cases, evaluating the effectiveness and safety of each procedure based on a structured algorithmic approach. PATIENTS AND METHODS: This prospective study was carried out on (40) consecutive patients diagnosed between March 2017 and March 2020 with tracheal stenosis not amenable to surgery. All strictures were first evaluated by flexible bronchoscopy and classified as simple or complex. Patients were treated following a standardised therapeutic algorithm approach based on published evidence and our own expertise. RESULTS: The mean age of the study population was 45.25 ± 18.79; lesions were classified as simple (14) and complex (24), while two patients had mixed type stenosis. Long term success rate was 100% in simple stenosis and 87.5% in the complex ones. Stents were deployed in 24 cases, most of which were of the complex type and only two of the simple type. Post-procedural mild to moderate complications were detected overall in 70% of the patients. All complications were non-life threatening, mostly stent-related and were effectively managed. CONCLUSION: We conclude that after accurate classification and a structured algorithmic approach, interventional bronchoscopic management may play a crucial role in the effective treatment of benign tracheal stenosis.

Bronchoscopic foreign body extraction in a pulmonary medicine department: a retrospective review of egyptian experience.

Foreign body (FB) removal in our hospital was almost exclusively performed by surgeons through a rigid bronchoscope until the pulmonologists started getting involved in FB extraction. This study aimed to retrospectively review the results of 2 years of experience with 120 patients who presented or were referred to the Pulmonary Medicine Department, Ain Shams University Hospital in Cairo, Egypt, with clinical suspicion of FB aspiration during the period between December 2006 and December 2008. FBs were removed by either rigid and/or flexible bronchoscopy using either general or topical anesthesia. There were 54 male and 66 female patients with an age range between 3 months and 70 years and 68.5% of the patients were under the age of 10 years. Ninety patients (75%) presented with a definite history of FB aspiration, with a time interval between aspiration and presentation ranging between less than 6 hours and 12 months. The FB was visible on the chest x-ray in 42 cases. Aspirations were primarily into the right lung (53.2%). Seeds and scarf pins were the most common FB found, and were retrieved in 36 cases. Pulmonologists were successful in extracting 110 out of 111 (99.1%) bronchoscopically visualized FBs, and open thoracotomy was required in only 1 case for FB removal. In another 6 cases, only mucous plug was found to be the endogenous FB, whereas no FB could be found in 3 cases. No mortality or serious complications took place during or after the bronchoscopy. In conclusion, pulmonologists can extract FBs easily and safely either by using rigid and/or flexible bronchoscopes if they have the appropriate experience.

Endobronchial Ultrasound-directed Transbronchial Needle Aspiration in Diagnosis of Mediastinal Lesions: Initial Egyptian Experience.

Mediastinal lesions represent a diagnostic challenge and often require invasive approaches. We evaluated the role of radial probe endobronchial ultrasound-directed transbronchial needle aspiration (EBUS-TBNA) in the evaluation of mediastinal lesions. Between March 2005 to February 2006, 30 consecutive patients with enlarged mediastinal lymph nodes from unknown etiologies or suspicious for metastatic bronchogenic carcinoma and mediastinal masses underwent EBUS-TBNA and were clinically followed up. EBUS-TBNA was applied under topical anesthesia, midazolam sedation with a mean dose of 4.6+1.7 mg and prolonged the examination by 14.7 minutes on average. EBUS-directed TBNA was performed in 17 lymph nodes and 13 mediastinal masses, achieving specific diagnosis in 82.3% (14/17) and 84.6% (11/13) of examined lesions, respectively, with an overall yield of 83%. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing benign from malignant mediastinal lesions were 89.4%, 100%, and 93.3%, respectively. EBUS was well tolerated by most of the patients with no TBNA-related complications. In conclusion, EBUS-TBNA of mediastinal lesions is a minimally invasive safe diagnostic technique with high yield, even in the hands of those with initial experience. This initial study is convincing and stimulating for widespread application of EBUS-TBNA in Egyptian bronchoscopy practice.