MERS Coronavirus in Dromedary Camel Herd, Saudi Arabia

A prospective study of a dromedary camel herd during the 2013–14 calving season showed Middle East respiratory syndrome coronavirus infection of calves and adults. Virus was isolated from the nose and feces but more frequently from the nose. Preexisting neutralizing antibody did not appear to protect against infection

Comorbidity of Kawasaki disease and group A streptococcal pleural effusion in a healthy child: a case report

Ahmed H Alhammadi, Mohamed A HendausGeneral Pediatrics Section, Department of Pediatrics, Hamad Medical Corporation, Doha, QatarBackground: Kawasaki disease is an acute self-limiting vasculitis that affects children. The most dreaded complication of Kawasaki disease reported in the literature over the years is coronary artery disease, which is considered as the main cause of acquired heart disease. However, pulmonary associations with Kawasaki disease have been overlooked. We present a rare, if not unique, case of Kawasaki disease associated with group A streptococcus pleural effusion in the English language literature. A search of the PubMed database was carried out, using a combination of the terms “Kawasaki disease”, “pneumonia”, and “group A streptococcus”. The majority of studies conducted in children with Kawasaki disease have concentrated on the coronary artery implications. Kawasaki disease is considered a self-limiting illness, but can have detrimental consequences if not diagnosed early. When there is a prolonged inflammatory reaction, with no infectious agent identified or remittent fever unresponsive to antibiotics, Kawasaki disease should be taken into consideration. Elevated Vβ2+ T cells compared with healthy controls suggest possible involvement of a superantigen in the etiology of Kawasaki disease, so it is wise that the health care provider concentrates not only on the cardiac consequences, but also on pulmonary associations.Keywords: Kawasaki disease, pneumonia, group A streptococcu

Virus-induced secondary bacterial infection: a concise review

Mohamed A Hendaus,1 Fatima A Jomha,2 Ahmed H Alhammadi3 1Department of Pediatrics, Academic General Pediatrics Division, Weill-Cornell Medical College, Hamad Medical Corporation, Doha, Qatar; 2School of Pharmacy, Lebanese International University, Khiara, Lebanon; 3Department of Pediatrics, Academic General Pediatrics Division, Weill-Cornell Medical College, Hamad Medical Corporation, Doha, Qatar Abstract: Respiratory diseases are a very common source of morbidity and mortality among children. Health care providers often face a dilemma when encountering a febrile infant or child with respiratory tract infection. The reason expressed by many clinicians is the trouble to confirm whether the fever is caused by a virus or a bacterium. The aim of this review is to update the current evidence on the virus-induced bacterial infection. We present several clinical as well in vitro studies that support the correlation between virus and secondary bacterial infections. In addition, we discuss the pathophysiology and prevention modes of the virus–bacterium coexistence. A search of the PubMed and MEDLINE databases was carried out for published articles covering bacterial infections associated with respiratory viruses. This review should provide clinicians with a comprehensive idea of the range of bacterial and viral coinfections or secondary infections that could present with viral respiratory illness. Keywords: bacteria, infection, risk, viru

Lung ultrasound for the diagnosis of childhood pneumonia: a safe and accurate imaging mode

Mohamed Ata Hendaus,1,2 Fatima Ahmed Jomha,3 Ahmed Hassan Alhammadi1,2 1Department of Pediatrics, Academic General Pediatrics Division, Hamad Medical Corporation, Doha, 2Weill Cornell Medical College-Qatar, Al Rayyan, Qatar; 3School of Pharmacy, Lebanese International University, Khiara, Lebanon Abstract: Pneumonia is the most common infectious cause of mortality in children worldwide. Chest x-ray (CXR) has been used as a supplementary mode in the diagnosis of pneumonia in children, but its frequent use might expose children to unnecessary ionizing radiation. In this review, we present up-to-date data of an alternative mode of imaging other than CXR in the diagnosis of pneumonia in children. We found that lung ultrasound is a safe and accurate mode of imaging that can be used by a health care provider in the cases of suspected pneumonia. It is more sensitive than CXR in the diagnosis of pneumonia and obviates the need for irradiation. Keywords: lung ultrasound, children, pneumoni

Alteration of liver function due to H1N1 infection: a case report

Ahmed H Alhammadi, Mohamed A Hendaus, Anas A Kayoum Department of Pediatrics, Section of General Pediatrics, Hamad Medical Corporation, Doha, Qatar Abstract: H1N1 virus is known to affect the respiratory tract. The majority of healthcare providers focus on the respiratory complications attributed to H1N1 infection, overlooking possible multi-organ involvement. We present a rare case of abnormal liver function in a child who was admitted for respiratory illness due to the H1N1 virus. There was a marked elevation in liver function tests concurrent with the respiratory disease. Our patient was treated with oseltamavir for the H1N1 infection, and the liver function levels decreased dramatically in 72 hours. Keywords: H1N1 subtype influenza A virus, hepatic function impairmen

The importance of educating postgraduate pediatric physicians about food allergy

Mehdi Adeli,1–3 Mohamed A Hendaus,1,2 Lukman I Abdurrahim,1 Ahmed H Alhammadi,1,2 1Department of Pediatrics, Hamad Medical Corporation, 2Department of Clinical Pediatrics, Weill-Cornell Medical College, 3Department of Pediatrics, Sidra Medical and Research Center, Doha, Qatar Background: Food allergy is an increasing public health burden, and is considered among the most common chronic noncommunicable diseases in children. Proper diagnosis and management of food allergy by a health care provider is crucial in keeping affected children safe while simultaneously averting unnecessary avoidance. Objective: The rationale of the study was to estimate the knowledge of pediatric residents and academic general pediatric fellows with regard to food allergies in children. Methods: A cross-sectional and prospective study was carried out at Hamad Medical Corporation, the only tertiary care, academic and teaching hospital in the State of Qatar. The study took place between January 1, 2015 and September 30, 2015. Results: Out of the 68 questionnaires distributed, 68 (100%) were returned by the end of the study. Among the participants, 15 (22%) were in post-graduate year-1 (PGY-1), 16 (23.5%) in PGY-2, 17 (25%) in PGY-3, 12 (16%) in PGY-4, and 8 (12%) were academic general pediatric fellows. Our trainees answered 60.14% of knowledge based questions correctly. In the section of treatment and management of food allergy in childhood, 23 (34%) of respondents’ main concern when taking care of a patient with food allergies was making sure the patient is not exposed to food allergen, while 22 (33%) reported no concerns. In the section of treatment and management of food allergy in childhood, 22 (33%) of participants reported no concerns in taking care of a child with food allergy, while 23 (34%) of respondents’ main concern was making sure the patient is not exposed to food allergen. In the teaching and training section, 56% of participants stated that they have not received formal education on how to recognize and treat food allergies, while 59% claimed not being trained on how to administer injectable epinephrine. Furthermore, approximately 60% of all participants expressed the need of additional information about recognizing and treating food allergies and recommended certification and regulation of food allergy training for all residents. Conclusion: There is an appreciable lack of knowledge in identifying food allergy and managing anaphylaxis reaction in children, among pediatric residents. Robust efforts should be implemented by attending immunologists to improve the lack of knowledge and improve the trainee’s confidence when facing such cases. Keywords: allergy, attitude, food, knowledge, training, management, residents, survey, diagnosis, Qata

Breastfeeding rates and barriers: a report from the State of Qatar

Mohamed A Hendaus,1–3 Ahmed H Alhammadi,1–3 Shabina Khan,1 Samar Osman,1 Adiba Hamad1,2 1Department of Pediatrics, Section of Academic General Pediatrics, Hamad General Corporation, Doha, Qatar; 2Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar; 3Department of Clinical Pediatrics, Weill-Cornell Medicine, Doha, Qatar Objective: The aim of the study was to outline breastfeeding barriers faced by women residing in the State of Qatar.Methods: A cross-sectional study through a telephone interview was conducted at Hamad Medical Corporation, the only tertiary care and accredited academic institution in the State of Qatar. Mothers of children born between the period of January 1, 2012 and December 31, 2012 in the State of Qatar were contacted.Results: Of the total 840 mothers who were contacted for the telephone survey, 453 mothers agreed to be interviewed (response rate 53.9%), while 364 (43.3%) did not answer the phone, and 21 (2.5%) answered the phone but refused to participate in the study. The overall breastfeeding initiation rate among the mothers was 96.2%, with 3.8% mothers reporting that they had never breastfed their baby. The percentage of mothers who exclusively breastfed their children in the first 6 months was 24.3%. The most common barriers to breastfeeding as perceived by our participants were the following: perception of lack of sufficient breast milk after delivery (44%), formula is easy to use and more available soon after birth (17.8%), mom had to return to work (16.3%), lack of adequate knowledge about breastfeeding (6.5%), and the concept that the infant did not tolerate breast milk (4.9%).Conclusion: Exclusive breastfeeding barriers as perceived by women residing in the State of Qatar, a wealthy rapidly developing country, do not differ much from those in other nations. What varies are the tremendous medical resources and the easy and comfortable access to health care in our community. We plan to implement a nationwide campaign to establish a prenatal breastfeeding counseling visit for all expecting mothers. Keywords: barrier, delineate, breastfeeding, Qata

Identifying agents triggering bronchiolitis in the State of Qatar

Mohamed A Hendaus,1–3 Ahmed H Alhammadi,1–3 Prem Chandra,4 Eshan Muneer,1 Mohamed S Khalifa1 1Department of Pediatrics, Section of Academic General Pediatrics, Hamad General Corporation, Doha, Qatar; 2Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar; 3Department of Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar; 4Department of Statistics, Medical Research Center, Hamad General Corporation, Doha, Qatar Background: Bronchiolitis is considered as the most frequent lower respiratory tract infection in infants and young children. This disorder is marked by acute inflammation, edema, damage of epithelial cells lining small airways, and augmentation of mucus production. Objective: The goal of the study was to identify agents triggering bronchiolitis in the State of Qatar. Materials and methods: A cross-sectional retrospective study was performed at Hamad Medical Corporation, the only tertiary and academic medical center in the State of Qatar. The study included infants and young children aged 0–24 months who were admitted to our pediatric ward with diagnosis of acute bronchiolitis (2010–2012) Results: Eight hundred thirty-five infants and young children met the study inclusion criteria with mean age at diagnosis of 3.61±3.56 months. Respiratory virus real-time polymerase chain reaction was performed on 769 (92.0%) of the participants. Respiratory syncytial virus (RSV) was positive in 352 (45.7%) children admitted with clinical bronchiolitis. In addition, no viruses were identified in 142 (18.4%) of those admitted, and respiratory viruses other RSV were found in 275 (35.7%) of the children. Our investigations and observations show that there has been a steady and periodic seasonal variation in the RSV rate over the study period. A seasonal trend for the RSV (detected by respiratory virus real-time polymerase chain reaction) rate was evident, showing annual peaks in the months of October, November, December, and January, with a significant test for seasonality (test statistics [T]=3.15, P=0.009). Conclusion: In countries with desert hot weather, bronchiolitis might affect children throughout the year. Our results suggest that the combination of date regarding uninterrupted RSV seasonality can provide guidance for health care planning and application of RSV prevention scheme, such as extending the palivizumab immunoglobulin series. Keywords: bronchiolitis, desert, syncytial, virus, Qata

Parental preference and perspectives on continuous pulse oximetry in infants and children with bronchiolitis

Mohamed A Hendaus,1,2 Suzan Nassar,3 Bassil A Leghrouz,3 Ahmed H Alhammadi,1,2 Mohammed Alamri4 1Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar; 2Department of Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar; 3Department of Pediatrics, Hamad General Corporation, Doha, Qatar; 4Pediatric Emergency Center, Hamad General Corporation, Doha, Qatar Objective: The purpose of the study was to investigate parental preference of continuous pulse oximetry in infants and children with bronchiolitis. Materials and methods: A cross-sectional prospective study was conducted at Hamad Medical Corporation in Qatar. Parents of infants and children <24 months old and hospitalized with bronchiolitis were offered an interview survey. Results: A total of 132 questionnaires were completed (response rate 100%). Approximately 90% of participants were 20–40 years of age, and 85% were females. The mean age of children was 7.2±5.8 months. Approximately eight in ten parents supported the idea of continuous pulse oximetry in children with bronchiolitis. Almost 43% of parents believed that continuous pulse-oximetry monitoring would delay their children’s hospital discharge. Interestingly, approximately 85% of caregivers agreed that continuous pulse oximetry had a good impact on their children’s health. In addition, around one in two of the participants stated that good bedside examinations can obviate the need for continuous pulse oximetry. Furthermore, 80% of parents believed that continuous pulse-oximetry monitoring would give the health-care provider a good sense of security regarding the child’s health. Finally, being a male parent was associated with significantly increased risk of reporting unnecessary fatigue, attributed to the sound of continuous pulse oximetry (P=0.031). Conclusion: Continuous pulse-oximetry monitoring in children with bronchiolitis was perceived as reassuring for parents. Involving parents in decision-making is considered essential in the better management of children with bronchiolitis or any other disease. The first step to decrease continuous pulse oximetry will require provider education and change as well. Furthermore, we recommend proper counseling for parents, emphasizing that medical technology is not always essential, but is a complementary mode of managing a disease. Keywords: bronchiolitis, parents, medical, technolog

Parental preference for fluoride varnish: a new concept in a rapidly developing nation

Mohamed A Hendaus,1,2 Hibaq A Jama,1 Faisal J Siddiqui,1,3 Sohair A Elsiddig,1 Ahmed H Alhammadi1,2 1Department of Pediatrics, General Academic Pediatrics Section, Hamad Medical Corporation, Doha, 2Department of Clinical Pediatrics, Weill Cornell Medical College, 3Pediatric Residency Program, Hamad Medical Corporation, Doha, Qatar Objective: The objective of this study was to investigate parental preference for fluoride varnish in a country where the average percentage of dental caries in young children is up to ~73%. Consequently, the aim of this study, despite being a pilot, was to create a nationwide project in the State of Qatar to promote oral health in children. Methods: A cross-sectional perspective study was conducted at Hamad Medical Corporation in Qatar. Parents of children aged ≤5 years were offered an interview survey. A total of 200 questionnaires were completed (response rate =100%). The study was conducted between December 1, 2014 and March 30, 2015, and included all children aged >1 year and <5 years who came to the outpatient clinics for well-child and sick visits. We also included children who were admitted to the inpatient wards. Results: The mean age of participant children was 2.8±1.1 years. When inquiring regarding parents’ knowledge and awareness of dental health, we found that >90% of families were aware that dental health affects the health of the whole body. The study showed that ~70% of parents were not aware of the existence of fluoride varnish, but would allow a health provider to apply fluoride varnish. Furthermore, ~80% of parents would not stop brushing their child’s teeth and would not skip dentist appointments if varnish was to be applied. Approximately 40% of parents conveyed some concerns regarding the safety of fluoride varnish, despite being considered as a new concept. The main concern was that the child might swallow some of the fluoride. Another important concern expressed by parents was the availability of the fluoride varnish in all clinics. Conclusion: The robust positive attitude of parents in this sample suggests that introducing fluoride varnish is feasible and acceptable in our community. Actions to augment fluoride varnish acceptability in the developing world, such as focusing on safety, could be important in the disseminated implementation of fluoride varnish. Keywords: fluoride, parents, varnish, Qata