Hanaa M. Emam

Epidemiologic study of dermatologic disorders among children in South Sinai, Egypt

Background  Few epidemiologic surveys have been carried out to determine the prevalence of skin diseases in the population of Egypt, particularly in the Sinai Peninsula. Thus, the necessity of such research in South Sinai is pressing. This study aimed to determine the prevalence of various skin diseases among children in South Sinai.

Serum levels of interleukin-8, tumor necrosis factor-α and γ-interferon in Egyptian psoriatic patients and correlation with disease severity

Psoriatic plaques have been shown to contain increased levels of pro‐inflammatory cytokines. Also, serum levels of several cytokines have been reported elevated in psoriatic patients. It is postulated that changes in cytokine production both locally and systemically could be useful in monitoring disease activity. The aim of this study was to evaluate serum cytokine profile of interleukin (IL)‐8, γ‐interferon (IFN‐γ) and tumor necrosis factor‐α (TNF‐α) in Egyptian psoriatic patients by enzyme‐linked immunosorbent assay (ELISA) technique and to correlate these levels with disease severity. We analyzed serum samples from 60 Egyptian patients (31 females and 29 males) with a mean age of 40.2 ± 17.4 years with active psoriasis, and 21 healthy volunteers for major T‐helper type 1 cytokines using the ELISA technique. The disease severity, including erythema, induration and scales, was assessed by Psoriasis Area and Severity Index (PASI) score. TNF‐α and IFN‐γ were markedly elevated in all sera from psoriatic patients. TNF‐α was found a more efficient predictor for disease severity than IL‐8 and IFN‐γ using three receiver–operator curves with accuracy. IL‐8 was also moderately elevated and correlated with the age of patients (r = 0.28). We have obtained evidence that TNF‐α in our study was found to be more useful than the other two tested cytokines, IL‐8 and IFN‐γ as a follow‐up marker for monitoring disease severity in Egyptian psoriatic patients. A positive correlation between lL‐8 and the age of the patients was also noted.

Effectiveness of hepatitis B virus vaccination program in Egypt: Multicenter national project.

AIM To assess the effectiveness of hepatitis B virus (HBV) vaccination program among fully vaccinated children. METHODS A national community based cross-sectional study was carried out in 6 governorates representing Egypt. A total of 3600 children aged from 9 mo to 16 years who were fully vaccinated with HBV vaccine during infancy were recruited. Face to face interviews were carried out and sera were evaluated for hepatitis B surface antigen (HBsAg), anti-HBV core antibodies (total) and quantitative detection of hepatitis B surface antibody using enzyme linked immunoassays techniques. Samples positive to HBsAg/anti-HBV core antibodies were subjected to quantitative HBV-DNA detection by real time polymerase chain reaction with 3.8 IU/L detection limit. RESULTS Sero-protection was detected among 2059 children (57.2%) with geometric mean titers 75.4 ± 3.6 IU/L compared to 3.1 ± 2.1 IU/L among non-seroprotected children. Multivariate logistic analysis revealed that older age and female gender were the significant predicting variables for having non sero-protective level, with adjusted odds ratio 3.3, 9.1 and 14.2 among children aged 5 to < 10, 10 to < 15 and ≥ 15 years respectively compared to those < 5 years and 1.1 among girls compared to boys with P < 0.01. HBsAg was positive in 0.11% and breakthrough infection was 0.36% and 0.39% depending on positivity of anti-HBc and DNA detection respectively. The prevalence of HBV infection was significantly higher among children aged ≥ 7 years (0.59%) compared to 0.07% among younger children with odds ratio equal to 8.4 (95%CI: 1.1-64.2) and P < 0.01.The prevalence was higher among girls (0.48%) than boys (0.29%) with P > 0.05. CONCLUSION The Egyptian compulsory HBV vaccination program provides adequate protection. Occult HBV infection exists among apparently healthy vaccinated children. Adherence to infection control measures is mandatory.

The effectiveness of narrow-band phototherapy, corticosteroid, and methotrexate on clinical picture and serum level of soluble interleukin-2 receptors among vitiligo patients

ObjectiveVitiligo is a specific type of leukoderma characterized by depigmentation of the epidermis. This study aimed to compare the effectiveness of methotrexate, narrow-band phototherapy, and corticosteroid as three different treatment modalities for vitiligo. Patients and methodsThe study included 52 patients suffering from nonsegmental vitiligo and 20 healthy participants that served as the control group. They were recruited from the Dermatology Outpatient Clinic, National Research Center (Cairo, Egypt). The patients were randomly divided into three groups according to the treatment modalities (narrow-band ultraviolet radiation, methrotrexate, and corticosteroids). Clinical evaluation and serum level of soluble interleukin-2 receptor (sIL-2R) estimation were performed before and after treatment with follow-up duration of 6 months. ResultsThe serum level of sIL-2R was significantly higher among patients compared with controls. The study also showed a highly statistically significant lowering of serum level of sIL-2R among both narrow-band-treated and corticosteroid-treated patients, whereas the decrease was not statistically significant among those treated with methotrexate. No statistically significant difference was detected between the three groups of patients regarding clinical response to treatment or severity of the disease. However, regarding patient satisfaction it was significantly higher among both narrow-band-treated and corticosteroid-treated patients compared with those belonging to the methotrexate group. A statistically significant negative correlation between patient satisfaction and serum level of sIL-2R after treatment was detected. ConclusionNo statistically significant difference was detected between the three modalities of treatment (narrow-band ultraviolet radiation, methrotrexate, and corticosteroids) regarding clinical response or severity of the disease. However, only narrow band and corticosteroid significantly decreased the serum level of sIL-2R. Patients receiving methotrexate reported the least satisfaction compared with the other two groups.

Early and long term anamnestic response to HBV booster dose among fully vaccinated Egyptian children during infancy

OBJECTIVE To evaluate early and long term anamnestic response to a booster dose of HBV vaccine among non-seroprotected children. SUBJECTS AND METHOD A national community based project was carried out on 3600 children aged 9 months to 16 years, fully vaccinated during infancy. They were recruited from 6 governorates representing Egypt. It revealed that 1535 children (42.8%) had non sero-protective anti-HBs (<10 IU/L) and were HBsAg or anti-HBc negative. A challenging dose of 10 μg of mono-valent Euvax HBV vaccine was given to 1121/1535 children. Quantitative assessment of anti-HBs was performed to detect early (2-4 weeks) and long term (one year) anamnestic responses. RESULTS Early anamnestic response developed among 967/1070 children (90.3%).Children having detectable anti-HBs (1-9 IU/L) significantly developed early anamnestic response (90%) compared to 85% with undetectable anti-HBs (<1 IU/L), P < 0.001. Multiple logistic analysis revealed that undetectable anti-HBs, living in rural residence and children aged 15-16 years were the most significant predicting risk factors for the absence of early anamnestic response (<10 IU/L), with AOR 2.7, 2.7 & 4.7 respectively. After one year, long term anamnestic response was absent among 15% of children who previously showed early response. Poor early anamnestic response and undetectable pre-booster anti-HBs were the significant predicting risk factors for absent long term anamnestic response, with AOR 18.7 & 2.7 respectively. CONCLUSION Immunological memory for HBV vaccine outlasts the presence of anti- HBs and HBV vaccination program provides effective long term protection even in children showing waning or undetectable concentrations of anti-HBs. This signifies no need for a booster dose especially to healthy children.

Evaluation of Acitretin in the Treatment of Multiple Recalcitrant Common Warts: a Pilot Study

Background: Oral acitretin, a synthetic compound of retinoids, seems to be a promising modality in treating warts. To the best of our knowledge, no studies regarding its use have been performed on Egyptian patients. Objectives: Evaluating the role of acitretin in the treatment of multiple recalcitrant common warts. Patients and Methods: Forty adult patients with multiple recalcitrant warts were treated with oral acitretin [20 with 1 mg/kg/day for 3 month (group A), 20 with 0.5 mg/kg/day for 3 months (group B), and 20 served as controls and were given placebo (group C)]. Results: Oral acitretin was found to be a statistically significant therapy compared to placebo in treating warts. Total clearance of lesions was noted in 70% of group A compared to 80% in group B and none in group C. A non significant difference between group A and B was noted. However, there was a significant relation between the clinical response and the duration of disease, as the longer the duration of the disease, the higher was the percentage of patients showing complete response to therapy. Conclusions: Acitretin can be used as an effective non-invasive alternative form of therapy for multiple recalcitrant common warts.

Serum selenium levels in alopecia areata

BackgroundAlopecia areata (AA), an immune mediated form of hair loss, occurs in all ethnic groups, ages, and in both sexes. Oxidative stress is one of the possible mechanisms involved in the pathogenesis of AA. Selenium (Se) as an antioxidant plays an important role in maintaining immunological competence, an important point in the pathogenesis of AA. ObjectiveThe study aimed at measuring serum Se levels in a group of Egyptian AA patients and comparing them with those in healthy volunteers in an attempt to highlight the role of Se in the pathogenesis of the disease. Patients and methodsThe study included 100 participants; 50 AA patients and 50 healthy volunteers as controls. All patients were subjected to detailed history taking and examination to detect the type and extent of AA (Severity of Alopecia Tool score). Blood samples were taken from all participants to assess serum Se levels using an atomic absorption spectrometer. ResultsThe results revealed a significant decrease in serum Se levels (&mgr;g/l) in AA patients (mean±SD, 60.2±8.8) in comparison with controls (mean±SD, 77.4±9.6; P=0.0001). This decrease was more in extensive forms of the disease than in mild forms. ConclusionThe study revealed that AA is associated with decreased serum Se levels. This might be caused by increased demand for antioxidants to combat the oxidative stress and inflammation in AA.