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Biomedical subjects

Z Hijazi

Publications and source records attributed to Z Hijazi.

At least 19 recordsLinked to original sources
PubMed2005

Pulmonary function studies in Kuwaiti children with sickle cell disease and elevated Hb F.

Conflicting ventilatory defects have been reported in children with sickle cell disease (SCD). In Kuwait, the disease is relatively mild with a low incidence of acute chest syndrome and other complications, presumably due to the Arab-Indian haplotype chromosomal background and elevated Hb F levels. There have been no previous studies of pulmonary function in patients with this haplotype. Pulmonary function test (PFT) was carried out on 28 steady state children with SCD (21 homozygous sickle cell (SS), seven S beta(o) thal) and two group of controls: 17 age- and sex-matched healthy children and 10 children with HbH disease. The charts of the SCD patients were reviewed for frequency of acute chest syndrome and vaso-occlusive crisis. The mean values of forced vital capacity (FVC) (83.2 +/- 11.9 vs. 91.2 +/- 11.7) and vital capacity (VC) (81.5 +/- 11.8 vs. 90.5 +/- 10.9) were significantly lower in the SS patients compared with healthy controls (p < 0.05). Similarly, these values were significantly lower than in those of the HbH group (p < 0.001 for VC and p < 0.01 for FVC). The mean forced expiratory volume in 1 s (FEV1) was lower in SS patients (86.4 +/- 11.5) compared with healthy controls (94.2 +/- 14.2), but the difference was not significant (p = 0.07). Also, the FEV1 was significantly lower in SS patients than in the HbH group (p < 0.001). There was no significant difference in the PFT parameters between SS patients with acute chest syndrome and those without. Although patients with frequent vaso-occlusive crisis had lower PFT parameters, the differences were not significant in comparison to those with infrequent crisis. This study revealed an early restrictive and obstructive pulmonary function pattern in steady state children with SCD. The finding also indicates that the changes of PFT parameters in SS patients could not be attributed to anaemia per se as patients with HbH who also have chronic anaemia did not show similar changes. This observation underscores the early occurrence of pulmonary involvement, even in patients with an otherwise relatively mild SCD.

Adolescent↗
PubMed2004

Intestinal permeability is increased in bronchial asthma.

BACKGROUND: Increased intestinal permeability has been reported in one study of adult asthmatics. AIM: To determine whether children with asthma have altered intestinal permeability. METHODS: Thirty two asthmatic children, and 32 sex and age matched controls were recruited. The dual sugar (lactulose and mannitol) test was used to evaluate intestinal permeability, and the percentage of ingested lactulose (L) and mannitol (M) in the urine, and the L:M ratio were determined. All patients were skin prick tested for common aeroallergens, and specific IgE to some food items was determined. RESULTS: The median value of L in asthmatic children (2.29, IQR 0.91-4.07) was significantly higher than that in controls (0.69, IQR 0.45-1.08), and that of M was almost similar. The ratio L:M was significantly higher in asthmatic children (0.20, IQR 0.11-0.40) than in controls (0.06, IQR 0.04-0.09). Intestinal permeability did not correlate with eczema, inhaled steroids, positive skin prick test to aeroallergens, or severity of asthma. CONCLUSIONS: Intestinal permeability is increased in children with asthma, suggesting that the whole mucosal system may be affected.

Allergens↗
PubMed2002

Characteristics of asthmatic children in Kuwait.

This article summarizes clinical characteristics and identifies sensitizing allergens in 135 asthmatic children under 13 years of age in Kuwait, a desert environment with scant vegetation and weather conditions least associated with asthma. There were 84 males (M:F 1.65:1). Almost 70% were breast-fed (1-24 months), 59% had eczema, 52% allergic rhinitis, 78% of first-degree relatives had atopy, and 52% of parents were consanguinous. Cough was the presenting symptom in 92% and together with wheezing occurred in 76%. Most (91%) were < or = 5 years of age at diagnosis and 42% < 2 years. Mean duration of symptoms prior to diagnosis was 9.3+/-2 months (1 week-1 year). Viral upper respiratory tract infections, cigarette smoke, and exercise were the commonest triggers of symptoms (79%, 68%, 62%). Fumes of traditional Bokhour (incense) constituted a major indoor hazard. The most common sensitizing allergens were pollens of imported plants, molds, house dust mites, cockroaches, and peanuts. Management showed considerable under-treatment and included alternative medicines. In conclusion, childhood asthma in this desert environment starts at an early age, and is associated with high rate of atopy and high frequency of sensitization to aero- and food allergens. Asthmatic children are disadvantaged by delay in diagnosis, undertreatment, exposure to indoor cigarette smoke, and local traditions.

Age of Onset↗
PubMed2002

Performance of students in the final examination in paediatrics: importance of the "short cases".

AIMS: To determine which component of the final examination in paediatrics at Kuwait University best predicted the final outcome. METHODS: The performance of 356 medical students in the short cases, the long case, multiple choice questions (MCQs), and the essay components of the final examination in paediatrics at Kuwait University was correlated with the final grade, and the mean difference between each component and the final score calculated. RESULTS: The correlation was highest for the short cases, followed by MCQs, the long case, and essays. The mean difference between the final score and that of short cases was not significant, but was highly significant for the other components. CONCLUSION: Results show that performance in the short cases component of the final examination in paediatrics is a better discriminator of competence than that in the long case.

Achievement↗
PubMed2001

Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography.

Transesophageal echocardiography (TEE) has been employed successfully for guiding transcatheter device closure of secundum atrial septal defect (ASD) and patent foramen ovale (PFO). However, the use of TEE for device closure requires general anesthesia. Intracardiac echocardiography (ICE) can provide similar anatomical views that might replace the use of TEE for device closure. Eleven patients (eight female/three male) with secundum ASD and PFO associated with strokes underwent attempts at transcatheter closure of their defects under sequential TEE and ICE guidance (six patients) and under ICE alone (five patients). The ages of the patients ranged from 6.6 to 74.7 yr, and their weights ranged from 23 to 124.5 kg. The sizes of the defects, as measured by TEE (six patients), ranged from 3 to 27 mm and, as measured by ICE (11 patients), from 3 to 27 mm. The balloon-stretched diameter of the ASD, as measured by TEE (six patients), ranged from 16 to 38 mm and, as measured by ICE (11 patients), from 16 to 35 mm. Both techniques correlated well for the measured two-dimensional diameter and for the balloon-stretched diameter (r = 0.97 and 0.98, respectively). Both TEE and ICE provided similar views of the defects and the various stages of device deployment. Owing to the proximity of the left atrium to the esophagus, however, the images obtained by ICE were more helpful and informative than those obtained by TEE. All patients experienced successful device placement (six patients under both TEE and ICE; five patients under ICE guidance alone); complete closure of the defects was effected in nine patients, whereas two patients had small residual shunts. There were no complications. We conclude that ICE provides unique images of the atrial communications and measurements similar to those obtained by TEE. ICE potentially could replace TEE as a guiding imaging tool for ASD and PFO device closure, thus eliminating the need for general anesthesia.

Adolescent↗
PubMed2001

Influence of consanguinity and IgE receptor genotypes on clinical manifestations of asthma in Kuwaiti children.

An association between IgE receptor FcepsilonRIbeta polymorphism and atopy has been reported and proposed to be maternally transmitted. In a previous communication we reported high prevalence of the IgE receptor FcepsilonRIbeta variant (Leu 181/Leu 183) in Kuwaiti Arabs with asthma. This study investigates the association of this variant with parental consanguinity, maternal vs paternal inheritance, gender, and severity of asthma in 52 Kuwaiti families in whom at least one person had asthma. Using an allele refractory mutation screening (ARMS) test, blood (from 212 subjects, including asthmatic children, their parents and siblings) was tested for the presence of the normal and variant sequence of the IgE receptor FcepsilonRIbeta [homozygous normal sequence (Ile 181/Val 183, NN), the variant sequence (Leu 181/Leu 183, LL) and the heterozygous state NL]. In the 52 families 99 subjects were asthmatic. The consanguinity rate was 42 per cent which is similar to the 54 per cent reported for the Kuwaiti population as a whole. There were slightly more asthmatic fathers (27 per cent) than mothers (21 per cent) but this difference is not significant. The male to female ratio amongst the asthmatics was 1.5:1 and there was no gender effect on the frequency of the homozygous variant. Fifty-eight subjects (59 per cent) had severe and 41 (41 per cent) moderate asthma. Significantly more patients with severe asthma (58 per cent) were homozygous for the variant (Leu 181/Leu 183) than those with moderate disease (33 per cent) (p < 0.018). Our data suggest an equal maternal and paternal contribution to the inheritance of asthma and an association of the homozygous variant (Leu 181/Leu 183) of the IgE receptor FcepsilonRIbeta with disease severity.

Adolescent↗
PubMed2000

Nonsurgical closure of a patent foramen ovale in a patient with carcinoid heart disease and severe hypoxia from interatrial shunting.

We report the percutaneous transcatheter closure of a patent foramen ovale using an Amplatzer septal occluder in a rare patient with carcinoid heart disease involving both the right and left heart who presented with severe hypoxemia secondary to intra-atrial shunting. We believe this is the first report of this technique being utilized in a patient with carcinoid heart disease and it may represent an alternative to surgical closure in these patients at high risk for surgical complications.

Carcinoid Heart Disease↗
PubMed2000

Sensitization to aeroallergens among patients with allergic rhinitis in a desert environment.

BACKGROUND: The causative allergens of allergic rhinitis in desert environments are uncertain. OBJECTIVE: To determine the sensitizing aeroallergens in patients with allergic rhinitis in Kuwait, a desert country. METHODS: A total of 706 patients aged 6 to 64 years (mean 34.3 years) with allergic rhinitis were studied. Sera from the patients were screened for specific IgE to 14 inhalant allergens by the CAP-RAST method. RESULTS: Specific IgE to any allergen was detected in 86.3% of patients. The prevalence rates for allergen groups were: pollens (77.3%), house dust (62.3%), and molds (14.7%). The individual allergens with the highest positive rates were pollens of the weed Chenopodium (64.3%); Bermuda grass (55.0%), and Prosopis tree (50.3%). These plants were all imported and cultivated for the purpose of "greening" the desert. German cockroach (48.2%) and house dust mites (32.4% to 39.2%) were the most prevalent indoor sensitizers. With the exception of the molds, sensitization rates were higher for males than females. The youngest age group (6 to 17 years) had significantly higher sensitization rates than the older ones, particularly with respect to the molds (P < .01 to .001). Severe sensitization was more common with Alternaria than the other allergens and in general mold sensitization was more frequently associated with severe symptoms. Polysensitization was very common, with 81.8% of all sensitized patients positive to more than one allergen. CONCLUSIONS: Pollens of the local horticultural plants are the main sensitizing allergens among patients with allergic rhinitis in this desert environment. The practices that "green" the desert seem to also encourage allergen sensitization.

Adolescent↗
PubMed2000

Asthma in the desert: spectrum of the sensitizing aeroallergens.

BACKGROUND: Bronchial asthma is common in Kuwait, a desert country, but the sensitizing allergens are uncertain. This study investigated the sensitizing allergens in Kuwaiti patients with extrinsic asthma. METHODS: A total of 553 asthmatics (male:female ratio: 1.4; mean age: 31.7 years [range 3-76 years]) and 112 matched controls were studied. Sera from all patients/subjects were tested by the CAP-RAST method for specific IgE to 14 locally relevant inhalant allergens. RESULTS: Specific IgE to at least one allergen was detected in 87.2% of the patients compared with 24.1% of controls. Among the confirmed extrinsic asthmatics, the sensitization rates for the allergen groups were as follows: pollens (87.1%), house dust (76.1%), and molds (30.3%). The three most prevalent sensitizing pollens were from Chenopodium (70.7%), Bermuda grass (62.9%), and Prosopis (62.7%), all of which are horticultural plants imported for the purpose of "greening" the desert. For all allergens, except the molds, the prevalence rate was higher in males than females, but age had only a weak effect. Severe asthma occurred significantly more frequently among mold-sensitized patients. CONCLUSIONS: These results show that even in a desert environment, pollens and house-dust allergens may be important sensitizing allergens. They also illustrate how practices that "green" the desert can affect public health.

Adolescent↗
PubMed2000

IgE-mediated sensitization to mould allergens among patients with allergic respiratory diseases in a desert environment.

BACKGROUND: The importance of fungal allergens in the development of allergic diseases in a desert environment is uncertain. This study evaluated the prevalence of IgE sensitization to moulds among patients with allergic respiratory diseases in Kuwait - a desert country. METHODS: A total of 810 patients (male:female ratio 1.4) with a mean age of 32.3 years (range 2-76 years) with extrinsic asthma or allergic rhinitis were studied. Sera from the patients were tested by the CAP-RAST method for specific IgE to 6 fungi (Penicillium, Cladosporium, Aspergillus, Candida, Alternaria and Helminthosporium). For comparison house dust mite and Bermuda grass were also assessed. RESULTS: The overall positivity to at least one mould was 20.9%. Among 120 matched control subjects, the value was 5. 8%. The value was much higher among patients with asthma alone (45. 8%) or both asthma and rhinitis (28.3%) than those with rhinitis alone (11.8%; p < 0.001). Asthmatic children had the highest sensitization rate (66.0% in the 7- to 12-year age group), which declined sharply with age. Among asthmatics, Candida and Aspergillus had the highest sensitization rates (23.1 and 21.3%, respectively), followed by Helminthosporium (18.8%), Cladosporium (15.9%), Alternaria (14.6%) and Penicillium (13.9%). The values for mite and Bermuda grass were 41.2 and 54.6%, respectively. Among asthmatic children, severe asthma was significantly more frequent among mould-positive (51.6%) than mould-negative patients (17.5%; p < 0. 0001). CONCLUSIONS: Even in this desert environment, sensitization to moulds is quite common among patients with allergic respiratory diseases, with a striking preponderance among children with asthma. Mould allergy could also be an important factor determining asthma severity in this environment.

Adolescent↗
PubMed2000

Interleukin-4 gene promoter polymorphism [C590T] and asthma in Kuwaiti Arabs.

BACKGROUND: Recent studies have demonstrated an association of the T allele of a promoter polymorphism [C590T] of interleukin-4 (IL-4) gene with asthma/atopy in the US and Japanese populations, but data from the UK and Australian families failed to find an association. We have investigated the association of this [C590T] promoter polymorphism in Kuwaiti Arabs with asthma. METHODS: This study included 184 subjects (84 asthmatics and 100 non-asthmatics, 47 of whom were totally unrelated normal healthy controls with no history of asthma/atopy in three generations of near relatives). The [C590T] promoter polymorphism of the IL-4 gene was analyzed by a polymerase chain reaction-restriction fragment length polymorphism method using the restriction enzyme AvaII. RESULTS: The frequency of the T allele was found to be 0.79 in asthmatics, 0.75 in non-asthmatic first-degree relatives and 0.76 in unrealted controls in Kuwaiti Arabs. No significant difference was detected in the distribution of the three genotypes (TT, CT and CC) between the asthmatic, non-asthmatic relatives and the unrelated controls. The incidence of co-existing phenotypes e.g. hay fever, eczema and a positive skin prick test was significantly higher in asthmatics than in the non-asthmatics irrespective of the [C590T] genotype. However, within the asthmatic group, a higher incidence of eczema was detected in asthmatics with a heterozygous CT genotype compared to the asthmatics with a TT genotype. CONCLUSIONS: Our results do not show an association between [C590T] promoter polymorphism of the IL-4 gene and asthma in Kuwaiti Arabs. Our results are in keeping with the reports from the UK and Australian families (no association) but in contrast to the findings from US and Japanese populations (an association reported).

Alleles↗
PubMed1999

Reference values of total serum IgE and their significance in the diagnosis of allergy among the young adult Kuwaiti population.

BACKGROUND: The reference total serum immunoglobulin (IgE) values and the usefulness of total IgE values in the diagnosis of allergy have not been established for the Kuwaiti population. The literature reference values may not be applicable since such values often vary among ethnic nationalities. OBJECTIVE: The aim of this study was to establish the reference IgE values for the young adult Kuwaiti population and to determine the usefulness of such values in the diagnosis of allergic diseases in the community. METHODS: A total of 1057 randomly selected young adults were screened for atopy using the Pharmacia CAP-PhadiatopR method. Atopy was detected in 423 individuals (40.0%). Total serum IgE was then measured in 542 randomly selected Phadiatop-negative (non-atopic) cases in the age range 18-50 years (mean 28.9 years) and male:female ratio of 1.3. RESULTS: Serum total IgE values in non-atopics covered a very wide range (< 2-1993 kU/L) with a geometric mean (GM) value of 43.7 kU/L. The reference range, calculated as the 95% confidence interval of the log IgE (95% CI) was 3.2-602.5 kU/L. The 90% CI was 11.7-162 kU/L. The GM was significantly higher for males than females, (53.7 vs. 35.5 kU/L, P < 0.001) and for smokers than non-smokers, (64.6 vs. 40.7 kU/L, P < 0.01), but was independent of age. Although the GM for the non-atopics (43.7 kU/L) was significantly lower than those of the asymptomatic atopics (213.8 kU/L) and allergic asthmatics (626.6 kU/L), the 95% CI for the three groups showed considerable overlap. CONCLUSIONS: These results show that the normal total IgE values in the young adult Kuwaiti population are generally high and that the distribution of the values is so wide that the diagnostic value of total serum IgE in this community is likely to be very limited.

Adolescent↗
PubMed1998

High frequency of IgE receptor Fc epsilonRIbeta variant (Leu181/Leu183) in Kuwaiti Arabs and its association with asthma.

The presence of IgE receptor Fc epsilonRIbeta polymorphism (181/183) was investigated in Kuwaiti asthmatic patients and controls using an allele refractory mutation screening (ARMS) test. The variant sequence (Leu181/Leu183) was detected in 72% (320/442) chromosomes analysed. Homozygous LL genotype was detected in 48% (46/96) asthmatic subjects compared to 31% (39/125) in non-asthmatics. In 11/52 families mothers of the asthmatic children were themselves asthmatic and 3/11 asthmatic mothers had homozygous LL genotype. 80% of the homozygous LL asthmatics showed a positive skin prick test (SPT) compared with 28% of non-asthmatics with the same genotype. In heterozygous NL asthmatics a positive SPT was found in 60% cases compared to 17% in non asthmatics with the same genotype. The incidence of hay fever (HF) and eczema (E) was also found to be higher in homozygous LL asthmatics compared with the non-asthmatics with the same genotype. This study reports a high prevalence of IgE receptor Fc epsilonRIbeta variants in Kuwaiti Arabs compared with British, Australian and Austrian populations studied before. The association of Leu181/Leu183 variant with asthma in Kuwaitis underlines its significance as a risk factor in manifesting the clinical phenotype in this population.

Arabs↗
PubMed1997

Acute lower respiratory tract infections in children in Kuwait.

The features of community-acquired acute lower respiratory tract infections in 390 children are described. Half (50%) presented with bronchiolitis, 37% with pneumonia and 13% with croup. Respiratory syncytial virus was the commonest agent identified (52% of bronchiolitis, 29% of pneumonia, 51% of croup). Positive bacterial blood cultures were obtained in 10% of the patients, all except one with pneumonia. Fever (> 39 degrees C), a toxic ill look, bronchial breathing, WCC > 20 x 10(9)/l, neutrophils > 5 x 10(9)/l, platelet count > 500 x 10(9)/l, ESR > 45 mm/hr, lobar consolidation and pleural effusion were more likely to be associated with bacterial than with viral pneumonia (relative risk > 1.81; p < 0.05). In areas with limited resources, a high fever, a toxic ill look, bronchial breathing and simple laboratory tests may help to identify patients with bacterial pneumonia.

Acute Disease↗
PubMed1996

Laboratory diagnosis of acute lower respiratory tract viral infections in children.

This report summarizes and compares the results of complement fixation test (CFT), virus isolation (VI), and direct immunofluorescence test (DIF) for the antigen detection of respiratory syncytial virus (RSV), influenza A virus (Flu A), and adenovirus in 62 children with acute lower respiratory tract infections (ALRI) in Kuwait. It includes, as well, CFT results for parainfluenza virus and Mycoplasma pneumoniae. Combining the three methods, a potential causative agent was identified in 56 (90 per cent) children, of whom 14 (22 per cent) had evidence of infection with more than one pathogen. RSV was most frequently identified followed by Flu A, parainfluenza, Mycoplasma pneumoniae and adenovirus. Virus isolation proved the best method for identification of RSV, Flu A, and adenovirus [identified 52 (84 per cent) cases]. DIF was sensitive for RSV detection (sensitivity 84 per cent, specificity 94 per cent), and less sensitive for Flu A (sensitivity 62 per cent, specificity 98 per cent). However, DIF was completely insensitive to adenovirus (no positives). CFT was positive for the five pathogens in 44 (71 per cent) of the population studied; therefore, almost 20 per cent of positive identifications would have been missed if VI and DIF were not done. The sensitivity and specificity of CFT for RSV, adenovirus and Flu A were 71, 75, and 31 per cent, and 94, 96, and 94 per cent, respectively. Based on the results of this pilot study, it appears that a combination of the three tests yields the best rate of virus detection. Cell culture cannot be discarded for the identification of some respiratory viruses, especially adenovirus, until better techniques, or more sensitive reagents are applied. However, since RSV is the virus most commonly involved in children with ALRI, we recommend using DIF on routine basis for diagnosis. Its results compare well with virus isolation; it is simple, rapid, and inexpensive.

Acute Disease↗