Epidemiological study of risk factors in pediatric asthma

Background: Childhood asthma is a major public health problem in Egypt and worldwide. Epidemiologic, physiologic, and social factors appear to be associated with an increased risk of asthma. Objective: The aim of the study was to determine the most frequent risk factors of childhood asthma exacerbation and severity in our community. Methods: This cross sectional study involved 206 asthmatic children, 5 to 15 years old. They were enrolled from the School Students Health Insurance facility of El-Matareya Teaching Hospital and from the Pediatric Outpatient Clinic of Saint Mark Charity Hospital representing several social and residential classes. They were assessed clinically and by peak expiratory flow rate (PEFR). Parents of children were interviewed for symptoms and some demographic, social, environmental, housing and familial data as well as asthma triggers through a comprehensive detailed questionnaire. Results: Residential distribution and social status were significantly associated with asthma severity as most moderate persistent asthmatics lived in semi-urban areas (70.8%) and belonged to the low-level segment of social classification (47.9%). In the majority of the study population (69.9%), a family member or more had a positive history of bronchial asthma, and this was especially evident in moderate persistent cases (70.8%). Passive smoking and dust triggered exacerbations in 48.6% and 65% of the studied sample respectively and in most moderate persistent asthmatics (83.4% and 93.7%). Most houses of moderate asthmatics were infested with cockroaches (91.7%) and domestic animals were present in 56.2%. Recurrent chest infections and cold/flu attacks were strongly associated with asthma exacerbation and severity (93.8% and 93.7% of moderate persistent cases respectively). Most moderate persistent asthmatics (91.7%) reported exercise-induced asthma while 64.6% stated that emotional stress triggered their symptoms. Indoor pollutants such as insecticides, household chemicals and odors were strongly associated with asthma severity and exacerbation especially in moderate persistent cases (triggered symptoms in 66.7%, 52.1% and 58.3% of cases respectively). Conclusion: Smoking, emotional stress and dust were the most significant triggers of asthma exacerbation and severity in our series. Identification and avoidance of risk factors for persistent asthma, combined with early institution of pharmacologic and other intervention strategies, may lead to a better outcome.Keywords: asthma severity; asthma triggers; children; residence; risk factors; smoking; social statusEgypt J Pediatr Allergy Immunol 2007; 5(1): 11-1

Epidemiological study of school performance and asthma medications among asthmatic Egyptian school children

Background: Childhood asthma is a major health problem in Egypt and worldwide. Barriers to reducing the burden of asthma include symptom-based rather than disease-based approaches, tendency of care to be ‘‘acute’’ rather than “regular” and cultural attitudes towards drugs and drug delivery systems. Objective: To measure the disease effect on school performance and to map asthma medications with respect to types, routes and course of use. Methods: This cross sectional study involved 206 Cairene asthmatic school children, enrolled from the school students’ health insurance facility of El-Matareya Teaching Hospital and the pediatric outpatient clinic of Saint Mark Charity Hospital representing different social classes and residential locations. Their ages ranged between 5 and 15 years and they comprised 100 males and 106 females. They were assessed clinically and by peak expiratory flowmetry. Parents or caregivers were interviewed about disease symptoms, school achievement and attendance and medications used including relievers and controllers, route and course of use, whether continuously, intermittently and/or during attacks. Results: Asthma had a strong impact on school achievement and school absence; 77.3% of study population reported school absence due to asthma and 41.3% reported weak to average school achievement. School performance was associated with asthma severity; the majority of moderate asthmatics (64.6%) had average and weak school performance. Number of days of school absence demonstrated highly significant relation with asthma severity; 43.6% of moderate asthmatics had 5-6 absent days/month and 33.4% had 3-4 absent days/month. Combined β2-agonists and xanthines was the most commonly used (54.8%) reliever therapy followed by β2-agonists alone (44.2%) while corticosteroids were the most common controllers used (97.6%). Therapy was taken mainly by oral than inhalation route. Other medications like cromolyns, anti-histamines, anti-leukotrienes and anti-cholinergics were rarely used. Both rectal and injection routes were rarely used also. Conclusion: Asthma has a social burden on asthmatic children as it affects both school achievement and school attendance. Medical management of asthma in Egyptian children still lags behind available medical knowledge. Patients’ and health care givers’ education is a cornerstone in improving the current status of asthma management in Egypt.Keywords: asthma medications; asthma severity; children; school performanceEgypt J Pediatr Allergy Immunol 2009;7(1):23-3

Physical and functional profile of ICU patients and correlation between functional scales (Physical function in ICU test – scored PFIT)

Background Each component of the original physical function ICU test (PFIT) had little clinical utility. Given the growing body of research on ICU strength and mobility, objective functional evaluations with great clinical usefulness are needed. Scoring the original PFIT improves clinical utility and research to compare ICU patient function and intervention responsiveness. Aim To evaluate the muscle strength and functional condition of ICU patients and link these procedures to the length of stay at Ain Shams University Hospital and outcome. Patients and methods The research included 40 patients who were admitted to the respiratory ICU either mechanically ventilated or not. Results There was high significant decrease in TLC; there was high significant increase in Hb, albumin, K, and Mg according to two assessment points. Most patients had a score of 3 of shoulder strength and knee strength but score 2 regarding Sit to stand assistance. There was high significant increase in PFIT-s in the second assessment. There was substantial enhancement in the second assessment compared with first assessment regarding different score results. Conclusion Based on the finding we conclude that, prolonged immobility during hospitalization results in loss of muscle strength and functional capacity. There was positive correlation between muscular strength and functional status, considering PFIT scales. The longer length of stay in ICU, the greater the loss of functional capacity in critical patients

Proportion and prognosis of ICU-admitted coronavirus disease 2019-infected patients in relation to all hospitalized cases in Abbasia Chest Hospital, Cairo

Background Because of the outbreak of coronavirus disease 2019 (COVID-19), there has been an increase in the demand for intensive care services all over the world. Severe cases fulfill one of the following criteria: respiratory rate more than 30/min, oxygen saturation less than or equal to 93%, and PaO2/FiO2 less than or equal to 300 mmHg. ICU admission is required for seriously ill patients who require high-flow nasal cannula, intubation, or more oxygen to treat hypoxemia or multiple organ dysfunctions. However, it is unclear whether patients with COVID-19 who are admitted to the ICU will survive. Aim To estimate the proportion and prognosis of ICU-admitted COVID cases in relation to whole COVID cases admitted at Abbassia Chest Hospital and estimation of risk factors responsible for mortality. Patients and methods This retrospective observational study was conducted on all cases of COVID-19-infected patients admitted at respiratory ICU of Abbassia Chest Hospital in relation to all hospitalized cases during the period between January 2021 and June 2021. All of the cases were subjected to full history taking, laboratory investigations, and radiological assessment with chest radiograph and computed tomography. The reported outcomes included weaning from mechanical ventilation, discharge, mortality, and cause of death. Results The study included 76 patients with COVID-19. Overall, 43 (56.6%) were males and 33 (43.4%) were females, with a mean age of 57.17 ± 12.54 years. The incidence of mortality was 32.9%. The acute respiratory distress syndrome (ARDS) was the most common cause for ICU admission and encountered in 57.4% of the cases. All of the dead cases had severe ARDS. The use of invasive mechanical ventilation was reported in 76.5% of the included died cases, and this was statistically significantly higher as compared with the survived group. On the contrary, the length of ICU stay was statistically significantly higher in the survived group. Conclusion COVID-19 infection is associated with a high percentage of ICU admission with a high mortality rate. Many factors are associated with the high risk of mortality among the ICU admitted COVID-19-infected patients including severe ARDS, deterioration of the systemic organ functions, and the utilization of invasive mechanical ventilation