Pertussis seroimmunity in mother-neonate pairs and other pediatric age groups from Egypt

Background: Despite the widespread availability of 2 classes of effective vaccines, whole cell and acellular, pertussis has resurged as a serious public health problem. We sought to investigate the pertussis immune status of mother-neonate pairs and children in our country where pertussis vaccination is obligatory. Methods: This cross-sectional study included 75 healthy full-term neonates and their mothers, 100 infants (2-24 months), 170 children (2-12 years) and 80 adolescents (12-18 years). Serum pertussis IgG was measured in all enrolled subjects. A positive titre was defined as >24 U/ml. Results: Positive pertussis IgG levels were detected in 69 of the mothers (92%), in 63 of their newborns (84%). Seroimmunity to pertussis was positively noted in 55% of infants, 82.2% of preschool children, 77.5% of school-aged children and 75% in adolescents. Serum pertussis IgG titers among the neonates showed a significant positive correlation with the maternal titers (P=0.00001). Higher rates of pertussis seroimmunity was observed among residents in urban and suburban areas as compared to those living in rural areas (P<0.05) . Conclusion: This pilot study may suggest the presence of sufficient pertussis seroimmunity rates in the studied age groups. Still, there were some failures in immune acquisition probably due to inefficient vaccination in some localities or waning of immunity with age. Wider scale studies would allow better insight into the pertussis immune status in our country and hence the need for booster immunization

A study of health-related quality of life in pediatric atopic dermatitis

Background: Children of atopic dermatitis (AD) have difficulties in social adaptation and academic achievements. Health related quality of life (HRQOL) is a multidimensional measure not restricted to physical effects of disease or its treatment. Objective: We sought to assess, through validated questionnaire sets, the impact of AD on the HRQOL of children and their parents or caregivers. Methods: This analytical cross-sectional study was conducted on 85 children with physician diagnosed AD recruited from the Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University from May 2018 to December 2019. HRQOL of the patients was assessed using the Children’s Dermatology Life Quality Index (CDLQI) and that of parents/caregivers was assessed using the Family Dermatology Life Quality Index (FDLQI). Results: Analysing the CDLQI revealed that more than half of the studied sample (55.4%) had an extremely affected quality of life (QOL). The most affected physical aspects were itching and pain. There was statistically significant effect of face eczema on QOL of children. We also found that 65.9% of parents/caregivers had a significantly affected QOL score and the most frequently reported problems were emotional distress and treatment burden. The presence of other allergies in the affected child, other sib affection and adverse effects of treatment were the most significant distressing factors on the QOL of parents/caregivers. Poor QOL of children also impacted their parents’ mental and physical health .Conclusion: AD affects the QOL of both children and their guardians in many aspects. There is necessity to pay more attention to the psychological and social aspects in the children with AD and to respect their parents’ psychosocial impact and financial burden within the integrated management plans of AD

GPS Modeling for Designing Aerospace Vehicle Navigation Systems

The complexity of the design of a Global Positioning System (GPS) user segment, as well as the performance demanded of the components, depends on user requirements such as total navigation accuracy. Other factors, for instance the expected satellite/vehicle geometry or the accuracy of an accompanying inertial navigation system can also affect the user segment design. Models of GPS measurements are used to predict user segment performance at various levels. Design curves are developed which illustrate the relationship between user requirements, the user segment design, and component performance

Regulatory natural killer cell expression in atopic childhood asthma

Introduction: Different subsets of natural killer (NK) cells were found to play a role in pathogenesis of allergy. We sought to investigate the expression of regulatory NK cells (CD56+CD16+CD158+) in atopic children with bronchial asthma in order to outline the value of these cells as biomarkers of disease severity and/or control.Methods: A cross sectional controlled study was carried out in the Pediatric Allergy and Immunology Unit, Ain Shams University. The study included 45 atopic children [mean age(SD)= (2.9) years] with bronchial asthma (BA) and/or allergic rhinitis (AR)as well as 40 healthy matched controls. Enrolled subjects underwent complete blood counting and flow cytometric measurement of NK cell (CD16+ CD56+) and regulatory NK cells (CD16+CD56+CD158+).Results: Patients had significantly higher regulatory NK cell percentages [mean (SD)= 41 (52) %] than controls [mean (SD)=15 (7.1)]; p≤0.001. Regulatory NK cell counts and percentages did not vary with the concomitant presence of AR or the degree of asthma control. Regulatory NK cell counts tended to be higher in children with moderate/severe BA compared to those with mild asthma but the difference did not reach statistical significance (U= -1.8, p=0.06). NK cell counts [mean (SD)= 159 (164) cells/μl] and percentages [mean (SD)= 3.7 (3.2) %] were comparable among patients and controls and did not vary with the presence of AR (p= 0.51, 0.95) or with the degree of asthma control. NK cells absolute counts and percentages tended to be higher among patients with moderate/severe compared to mild asthma but the difference did not reach statistical significance.Conclusions: Regulatory NK cells seem to be increased in childhood asthma. We recommend wider scale prospective studies on steroid-naïve subjects involving measurement of cytokines that are secreted by different types of NK cells.Keywords: Natural killer, regulatory, asthma, children, allerg

Health-related quality of life assessment using EQ-5D-Y questionnaire in a group of Egyptian asthmatic children

Background: Asthma, as a common chronic illness, negatively influences children's quality of life. We sought to investigate the health-related quality of life (HRQoL) in a sample of Egyptian asthmatic children. Methods: A cross-sectional study was conducted in the Pediatric Allergy and Immunology Unit of Ain Shams University, including three groups of age and gender-matched children, aged 6-12 years; an asthma group (n=100), non-asthmatic group with respiratory tract infections (n=114), and a healthy control group (n=100). The EQ-5D-Y questionnaire was used to evaluate the HRQoL in each study group. This questionnaire also comprises a visual analogue scale (VAS) which is scored from zero (worst) to 100 (best) as judged by the patient. Results: HRQoL assessment revealed that 86% of the asthmatic children faced problems with their daily activities, 43 % had worries, sadness and unhappiness and 22% had mobility problems (walking around). Thirteen percent of the cases expressed some pain or discomfort due to their disease, while self-care was the least affected (6%). Parameters of mobility, doing usual activities, feeling worried or sad were more frequently affected among the asthmatics in comparison to the other two groups (X2 = 37.02, 46.38, 22.90, respectively with p <0.001). Enrolled asthmatic children showed the lowest values of visual analogue scale (VAS) scores (mean ± SD: 72.2 ± 24.6) in comparison to the infection and healthy control groups (mean ± SD: 84.6 ± 12, 92.8 ± 9.6, respectively; f = 39.03; p value = 0.001). Conclusion:Asthma has a significant adverse impact on HRQoL of children and the EQ-5D-Y questionnaire could be an applicable instrument to measure their quality of life

Refined Continuous Control of DDPG Actors via Parametrised Activation

Continuous action spaces impose a serious challenge for reinforcement learning agents. While several off-policy reinforcement learning algorithms provide a universal solution to continuous control problems, the real challenge lies in the fact that different actuators feature different response functions due to wear and tear (in mechanical systems) and fatigue (in biomechanical systems). In this paper, we propose enhancing the actor-critic reinforcement learning agents by parameterising the final layer in the actor network. This layer produces the actions to accommodate the behaviour discrepancy of different actuators under different load conditions during interaction with the environment. To achieve this, the actor is trained to learn the tuning parameter controlling the activation layer (e.g., Tanh and Sigmoid). The learned parameters are then used to create tailored activation functions for each actuator. We ran experiments on three OpenAI Gym environments, i.e., Pendulum-v0, LunarLanderContinuous-v2, and BipedalWalker-v2. Results showed an average of 23.15% and 33.80% increase in total episode reward of the LunarLanderContinuous-v2 and BipedalWalker-v2 environments, respectively. There was no apparent improvement in Pendulum-v0 environment but the proposed method produces a more stable actuation signal compared to the state-of-the-art method. The proposed method allows the reinforcement learning actor to produce more robust actions that accommodate the discrepancy in the actuators’ response functions. This is particularly useful for real life scenarios where actuators exhibit different response functions depending on the load and the interaction with the environment. This also simplifies the transfer learning problem by fine-tuning the parameterised activation layers instead of retraining the entire policy every time an actuator is replaced. Finally, the proposed method would allow better accommodation to biological actuators (e.g., muscles) in biomechanical systems

ARIA 2016 Executive Summary Integrated care pathways for predictive medicine across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization (WHO) workshop in 1999. The initial goals were (i) to propose a new allergic rhinitis classification, (ii) to promote the concept of multi-morbidity in asthma and rhinitis and (iii) to develop guidelines with all stakeholders for global use in all countries and populations. ARIA - disseminated and implemented in over 70 countries globally - is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK (MACVIA (Contre les MAladies Chroniques pour un VIeillissement Actif)-ARIA Sentinel NetworK) uses mobile technology to develop care pathways in order to enable the management of rhinitis and asthma by a multi-disciplinary group or by patients themselves. An App (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom  control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.Keywords: ARIA, rhinitis, ICT, EIP on AHA, mobile technology, AIRWAYS ICP

The Pediatric Allergy and Immunology Unit of Ain Shams University in times of SARS-CoV-2 pandemic: approach and challenges

The Pediatric Allergy and Immunology (PAI) Unit of Ain Shams University, founded in 1988 by Professor Yehia El-Gamal and currently headed by Professor Shereen Reda, is a tertiary referral center for pediatric allergy, primary immunodeficiency, and rheumatology patients in Egypt. It serves more than 1300 patients with different immunological disorders, with an outpatient and inpatient sections and investigational laboratory. With the widespread of the SARS-CoV-2 and its declaration as a "pandemic", and owing to the heterogeneity of the different disorders managed and followed up in the unit, several measures have been taken in order to provide the necessary services for the patients. This service should maintain a rational balance between the need to mitigate the virus spread and to provide the optimum care for those who get infected, when in the meantime keep their original disease morbidity and mortality to the minimum. These measures were taken by the members of the PAI unit with the help of the head management team of Children’s Hospital, Ain Shams University and were subjected to continuous modification based on the evolving situation, emerging information, problems faced and the availability of human and medical resources

Allergy education and training for physicians.

The increasing prevalence of allergic diseases has placed a significant burden on global healthcare and society as whole. This has necessitated a rapid development of "allergy" as a specialist area. However, as allergy is so common and, for most, relatively easy to diagnose and control, all clinicians need to have basic knowledge and competence  to manage  mild disease and recognize when referral is required. The allergology specialty has not yet been recognized in many countries and even where allergy is fully recognized as a specialty, the approach to training in allergy differs significantly. In the light of recent developments in allergy diagnosis and management, there is an urgent need to harmonize core competences for physicians, as well as the standardization of core principles for medical education and post-graduate training in allergy. All physicians and allied health professionals must appreciate the multidisciplinary team (MDT) approach to allergy, which is key to achieving the highest standards in holistic care. Due to worldwide variation in resources and personnel, some MDT roles will need to be absorbed by the treating physician or other healthcare professionals. We draw particular attention to the role of psychological input for all allergy patients, dietetic input in the case of food allergy and patient education to support all patients in the supported self-management of their condition on a daily basis. A strong appreciation of these multidisciplinary aspects will help physicians provide quality patient-centered care. We consider that harmonization of allergy components within undergraduate curricula is crucial to ensure all physicians develop the appropriate allergy-related knowledge and skills, particularly in light of inconsistencies seen in the primary care management of allergy. This review from the World Allergy Organization (WAO) Education and Training Committee also outlines allergy-related competences required of physicians working with allergic patients and provides recommendations to promote harmonization of allergy training and practice worldwide

The effect of fluoride on enamel and dentin formation in the uremic rat incisor

Renal impairment in children is associated with tooth defects that include enamel pitting and hypoplasia. However, the specific effects of uremia on tooth formation are not known. In this study, we used rat mandibular incisors, which continuously erupt and contain all stages of tooth formation, to characterize the effects of uremia on tooth formation. We also tested the hypothesis that uremia aggravates the fluoride (F)-induced changes in developing teeth. Rats were subjected to a two-stage 5/6 nephrectomy or sham operation and then exposed to 0 (control) or 50 ppm NaF in drinking water for 14 days. The effects of these treatments on food intake, body growth rate, and biochemical serum parameters for renal function and calcium metabolism were monitored. Nephrectomy reduced food intake and weight gain. Intake of F by nephrectomized rats increased plasma F levels twofold and further decreased food intake and body weight gain. Uremia affected formation of dentin and enamel and was more extensive than the effect of F alone. Uremia also significantly increased predentin width and induced deposition of large amounts of osteodentin-like matrix-containing cells in the pulp chamber. In enamel formation, the cells most sensitive to uremia were the transitional-stage ameloblasts. These data demonstrate that intake of F by rats with reduced renal function impairs F clearance from the plasma and aggravates the already negative effects of uremia on incisor tooth development