Prolonged detection of indigenous wild polioviruses in sewage from communities in Egypt

Environmental surveillance for polioviruses has been implemented in Egypt. This paper reports on a study in which 130 sewage samples were collected between January 2001 and December 2001 from eight provinces of Egypt. Samples were analyzed by virus isolation in L20B and RD cell cultures, and wild polioviruses were characterized by sequencing of the VP1 protein coding region. Wild type 1 polioviruses were detected in 57% of the sewage samples and 91% of the study sites, only two of which reported paralytic poliomyelitis cases in 2001. Three genetic lineages of a single indigenous type 1 poliovirus genotype were detectable in sewage, and only one lineage was also detected through surveillance for acute flaccid paralysis. Wild polioviruses persisted in the environment despite implementation of oral poliovirus vaccine immunization campaigns. Continued analysis of sewage samples, critical evaluation of immunization coverage, and performance of surveillance for acute flaccid paralysis are proposed as follow-up activities.     

A comparison of two transfusion regimens in the perioperative management of children with sickle cell disease undergoing adenotonsillectomy

Adenotonsillar hypertrophy and chronic tonsillitis are common findings in patients with sickle cell disease (SCD). Various preoperative transfusion regimens have been suggested to reduce the population of sickle erythrocytes and correct the anemia, ranging from conservative (correcting the anemia) to aggressive (lowering the level of HbS to less than 30%). A total of 39 patients with SCD were included in the study. They were divided into 2 groups. Fourteen patients in group 1 were assigned aggressive exchange transfusion and 25 patients in group 2 were assigned a conservative (simple) transfusion. The 2 groups were compared for possible operative and postoperative complications. Thirty percent of patients in both groups had postoperative complications. They ranged from mild local infection to acute chest syndrome. Simple transfusion was not associated with higher incidence of complications and resulted in only one-third as many transfusion requirements.     

Sotos syndrome (cerebral gigantism): a clinical and radiological study of 14 cases from Saudi Arabia

Fourteen children (of Arab ethnic origin) with Sotos syndrome are described. They were referred to King Khalid University Hospital, Riyadh between July 1992 and June 1997. Their phenotypic characteristics were compared with established diagnostic criteria. There was a male:female ratio of 1.3:1 and a high rate of consanguinity (36%) among parents. At birth, 54% were large and about one-third showed increased height and occipitofrontal head circumference (OFHC). The neonatal histories revealed respiratory and feeding problems in 21%, followed later by delayed motor milestones and speech development in 57%. During childhood, weight, height and OFHC increased further to > 97th centile in 71%, 71% and 93%, respectively. A seizure disorder affected 43%, and 75% had mental retardation (IQ < 70). A non-specific EEG abnormality was found in half of those with seizures. Cranial CT/MRI showed ventricular dilatation in 15% and one patient had corpus callosum dysgenesis. Abdominal ultrasound revealed hydronephrosis in two patients. Radiological cephalometric measurements showed relative prognathism in cases of Sotos syndrome compared with controls (p = 0.003). The study highlights the importance of considering Sotos syndrome in children who present with psychomotor delay.     

Ambulatory tympanomastoid surgery in children: factors affecting hospital admission

OBJECTIVE: To identify clinical factors associated with postoperative nausea and vomiting (PONV) and failure to discharge from the hospital on the day of surgery in children undergoing tympanomastoid surgery. DESIGN: Records of 144 children undergoing 152 tympanomastoid surgical procedures from July 1, 2001, through June 30, 2002, were retrospectively reviewed and the data analyzed. SETTING: A tertiary care university-affiliated hospital. RESULTS: The mean +/- SD age of the cases was 11 +/- 3.7 years. Sixty-eight cases (45%) were middle ear procedures, while 84 cases (55%) were mastoid procedures. Forty-three cases (28%) were discharged home from the postanesthesia care unit (PACU), 55 cases (36%) were discharged on the day of surgery, and 142 cases (92%) were discharged home from the day surgery unit (DSU) within 23 hours after surgery. Patients who underwent mastoid procedures were more likely to require intravenous (IV) morphine sulfate in the PACU (75% vs 56%; P = .02) and were less likely to be discharged from PACU (15% vs 44%; P<.001) compared with patients who had middle ear procedures. In patients who underwent mastoid procedures, the presence of cholesteatoma (odds ratio, 1.9; 95% confidence interval, 1.0-3.7; P = .04) was associated with a higher likelihood of PONV. In both groups, the need for IV morphine sulfate to control pain on admission to DSU was associated with a higher occurrence of PONV. Factors that were significantly associated with failure to discharge from the hospital on the day of surgery were a pain score of 5 or greater, the presence of PONV, and the requirement of IV morphine sulfate on admission to DSU. CONCLUSIONS: Factors associated with higher risks of PONV and failure to discharge from the hospital on the day of surgery include the presence of cholesteatoma, a pain score of 5 or greater, and the requirement of IV morphine sulfate at the time admission to the DSU.     

Rural urban differences in weight,body image,and dieting behavior among adolescent Egyptian schoolgirls

Overweight and obesity prevalence among adolescents is increasing worldwide and may be associated with increased risk for the development of obesity and chronic diseases in adulthood. Dissatisfaction with weight and body shapes is a contributor to the growing incidence of adolescent eating disorders. Our purpose was to compare the relationship between body weight and body image in a convenience sample of rural and urban girls. We also wanted to examine the influence of the mothers on their daughters by asking the girls how their mothers would classify their body shapes. Three hundred and forty adolescent Egyptian schoolgirls representing Cairo and surrounding rural areas were studied. The girls were from private and public schools. Weight, height, waist and hip circumferences were measured. Body image was determined by asking participants to indicate which of five silhouettes of a female body most closely resembled her own current body size. We also asked them to select the silhouette that closely resembled their mothers' current body size. Using the Centers for Disease Control and Prevention reference standards, 35% of the girls were > or = 85th percentile, while 13% were > or = 95th percentile. Overweight was more prevalent in urban than rural girls and in those with higher socio-economic status than in lower socio-economic status girls. Girls' perceptions of how their mothers viewed their bodies differed from how the girls viewed their own bodies. From a policy point of view, these data underscore the need to consider not only the health risks associated with overweight and its distribution on the body, but also the weight and body image of the target audience in the design of clinical and public health intervention programs worldwide.