Spectrum of childhood interstitial and diffuse lung diseases at a tertiary hospital in Egypt.

BACKGROUND: Childhood interstitial and diffuse lung diseases (chILD) encompass a broad spectrum of rare pulmonary disorders. In most developing Middle Eastern countries, chILD is still underdiagnosed. Our objective was to describe and investigate patients diagnosed with chILD in a tertiary university hospital in Egypt. METHODS: We analysed data of consecutive subjects (aged <18 years) referred for further evaluation at the Children's Hospital, Ain Shams University (Cairo, Egypt). Diagnosis of chILD was made in accordance with the ChILD-EU criteria. The following information was obtained: demographic data, clinical characteristics, chest computed tomography findings, laboratory studies, spirometry, bronchoalveolar lavage and histopathology findings. RESULTS: 22 subjects were enrolled over 24 months. Median age at diagnosis was 7 years (range 3.5-14 years). The most common manifestations were dyspnoea (100%), cough (90.9%), clubbing (95.5%) and tachypnoea (90.9%). Systematic evaluation led to the following diagnoses: hypersensitivity pneumonitis (n=3), idiopathic interstitial pneumonias (n=4), chILD related to chronic granulomatous disease (n=3), chILD related to small airways disease (n=3), post-infectious chILD (n=2), Langerhans cell histiocytosis (n=2), idiopathic pulmonary haemosiderosis (n=2), granulomatous lymphocytic interstitial lung disease (n=1), systemic sclerosis (n=1) and familial interstitial lung disease (n=1). Among the subjects who completed the diagnostic evaluation (n=19), treatment was changed in 13 (68.4%) subjects. CONCLUSION: Systematic evaluation and multidisciplinary peer review of chILD patients at our tertiary hospital led to changes in management in 68% of the patients. This study highlights the need for an Egyptian chILD network with genetic testing, as well as the value of collaborating with international groups in improving healthcare for children with chILD.

Nocturnal attacks, emergency room visits and ICU admission of pediatric asthma: frequency and associated factors.

UNLABELLED: Asthma is the most frequent cause of chronic illness in childhood and emergency department visits. This study aims to determine the frequency of emergency room (ER) visits, intensive care unit (ICU) admission, and nocturnal attacks among asthmatic children and to identify associated factors. Records of asthmatic children in the pediatric chest clinic, Ain Shams University during 1995-2004 were reviewed. Asthmatic children with documents of ER visits, ICU admission, or nocturnal attacks were compared with asthmatic children without previously mentioned events. Out of 691 asthmatic patients, 302 (43.7%) had nocturnal attacks, 258 (37.3%) had emergency room visits, 39 (5.6%) were admitted to ICU, and 249 (36%) had no reports of previous events. ER visits and nocturnal attacks were more in children above 4 years. ER visits and ICU admission were higher among those with positive family history of asthma (p< 0.01), those exposed to environmental tobacco smoke (ETS) (p< 0.01), and those who had previous respiratory infections (p< 0.05). Attacks of nocturnal asthma were associated with the previous factors in addition to animal contact (p<0. 01) and living in bad housing conditions (p<0.05). Logistic regression showed that family history (OR= 2.87, CI= 1.9-4.1) and bad housing conditions (OR= 2.65, CI= 1.3-5.3) were the significant factors for ER visits, while respiratory infections (OR= 5.24, CI= 2.1-12.0) and family history (OR= 3.48 CI, 1.3-9.2) were the significant factors for ICU admission. For nocturnal attacks, all factors were significant. CONCLUSION: Control of respiratory infections, limitation of ETS exposure and good housing conditions are needed to limit severe asthmatic attacks.

Burden of pediatric influenza A virus infection post swine-flu H1N1 pandemic in Egypt.

OBJECTIVE: To screen children with influenza like illness or with symptoms of acute respiratory tract infections for influenza A virus infection - post swine flu pandemic era - using rapid influenza diagnostic tests. METHODS: During two years (2010 & 2011), 1 200 children with influenza like illness or acute respiratory tract infections (according to World Health Organization criteria) were recruited. Their ages ranged from 2-60 months. Nasopharyngeal aspirates specimens were collected from all children for rapid influenza A diagnostic test. RESULTS: Influenza A virus rapid test was positive in 47.5% of the children; the majority (89.6%) were presented with lower respiratory tract infections. Respiratory rate and temperature were significantly higher among positive rapid influenza test patients. CONCLUSIONS: Influenza A virus infection is still a major cause of respiratory tract infections in Egyptian children. It should be considered in all cases with cough and febrile episodes and influenza like symptoms even post swine flu pandemic.

Sputum dipalmitoylphosphatidylcholine level as a novel airway inflammatory marker in asthmatic children.

INTRODUCTION: Pulmonary surfactant is a unique mixture of lipids and surfactant-specific proteins. Phosphatidylcholine comprises almost 80% of the total surfactant lipids, about half of which is dipalmitoylphosphatidylcholine (DPPC). Alteration of surfactant composition and function is documented with various airway or lung parenchyma disorders. OBJECTIVE: To assess sputum concentration of DPPC as a major component of airways surfactant in asthmatic children compared to conventional airway inflammatory markers. METHODS: This case control study included 68 well-known asthmatic children of different grades of severity and 20 age- and sex-matched normal children as controls. All children were subjected to thorough clinical examination, pulmonary function tests, sputum induction and processing for cytology, DPPC level and eosinophil cationic protein (ECP) level assessment. RESULTS: Elevated DPPC levels were evident in all sputum samples of asthmatic children (mean value 626.6 +/- 189.7 mcg/mL) compared to controls (mean value 49.3 +/- 20.1 mcg/mL). Significant negative correlations (r = -0.83, -0.752 and -0.384) were found between asthmatics sputum DPPC levels and pulmonary function test parameters [% of forced expiratory volume in first second, % of forced vital capacity (FVC) and forced expiratory flow rate over 25%-75% part of FVC], respectively. Meanwhile, significant positive correlations were evident between asthmatics sputum DPPC levels and the sputum inflammatory cells and their sputum ECP levels. CONCLUSION: Elevated DPPC levels are evident in induced sputum of all asthmatic children and they are significantly related to sputum ECP levels and pulmonary function test parameters. Nevertheless, the value of DPPC estimation in the clinical management of children with asthma remains to be determined.