Steinhoff, M. C., C. F. Walker, A. W. Rimoin, and H. S. Hamza, "A clinical decision rule for management of streptococcal pharyngitis in low-resource settings.", Acta paediatrica (Oslo, Norway : 1992), vol. 94, issue 8, pp. 1038-42, 2005 Aug. Abstract

BACKGROUND: Most of the world's children live in regions where laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians' decisions on antibiotic therapy for streptococcal pharyngitis, and to reduce routine presumptive antibiotic therapy for all pharyngitis.

METHODS: Prospective cohort study to assess diagnostic signs and develop a prediction rule. Bivariate and multivariate analyses were used to develop clinical rules. Participants were 410 children in Cairo, Egypt, aged from 2 to 12 y, presenting with complaint of sore throat and whose parents provided consent. Main outcome measures included presence of signs and symptoms, and positive group A beta hemolytic streptococcal (GABHS) culture.

RESULTS: 101 (24.6%) children had positive GABHS culture. Pharyngeal exudate, tender or enlarged anterior cervical lymph nodes, season, absence of rash, or cough or rhinitis were associated with positive culture in bivariate and multivariate analyses. Three variables (enlarged nodes, no rash, no rhinitis), when used in a cumulative score, showed 92% sensitivity and 38% specificity in these children.

CONCLUSIONS: The proposed three-variable clinical prediction rule for GABHS may be useful when diagnostic laboratories are not available. In this setting, the rule identified more than 90% of true cases. Compared to universal treatment of all pharyngitis, the rule will reduce antibiotic use in GABHS-negative cases by about 40%.

Rimoin, A. W., C. F. L. Walker, R. A. Chitale, H. S. Hamza, A. Vince, D. Gardovska, A. L. da Cunha, S. Qazi, and M. C. Steinhoff, "Variation in clinical presentation of childhood group A streptococcal pharyngitis in four countries.", Journal of tropical pediatrics, vol. 54, issue 5, pp. 308-12, 2008 Oct. Abstract

We conducted a cross-sectional study from September 2001 to August 2003 during which children between 2 and 12 years of age presenting with complaint of sore throat were recruited from urban pediatric clinics in Brazil, Croatia, Egypt and Latvia. The objective of the study was to compare clinical signs and symptoms of children presenting to urban pediatric clinics with sore throat in and between countries and to identify common clinical criteria predicting group A beta hemolytic streptococcal (GAS) pharyngitis. Using a single standard protocol in all four sites, clinical data were recorded and throat swabs obtained for standard GAS culture in 2040 children. Signs and symptoms were tested for statistical association with GAS positive/negative pharyngitis, and were compared using chi(2) tests, ANOVA and Odds Ratios. Clinical signs of GAS pharyngitis in children presenting to clinics varied significantly between countries, and there were few signs or symptom that could statistically be associated with GAS pharyngitis in all four countries, though several were useful in two or three countries. Our results indicate that the clinical manifestations of pharyngitis in clinics may vary by region. It is therefore critical that clinical decision rules for management of pharyngitis should have local validation.

Rimoin, A. W., C. F. L. Walker, H. S. Hamza, N. Elminawi, H. A. Ghafar, A. Vince, A. L. A. da Cunha, S. Qazi, D. Gardovska, and M. C. Steinhoff, "The utility of rapid antigen detection testing for the diagnosis of streptococcal pharyngitis in low-resource settings.", International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, vol. 14, issue 12, pp. e1048-53, 2010 Dec. Abstract

OBJECTIVES: To evaluate the utility of rapid antigen detection testing (RADT) for the diagnosis of group A streptococcal (GAS) pharyngitis in pediatric outpatient clinics in four countries with varied socio-economic and geographic profiles.

METHODS: We prospectively evaluated the utility of a commercial RADT in children aged 2-12 years presenting with symptoms of pharyngitis to urban outpatient clinics in Brazil, Croatia, Egypt, and Latvia between August 2001 and December 2005. We compared the performance of the RADT to culture using diagnostic and agreement statistics, including sensitivity, specificity, and positive and negative predictive values. The Centor scores for GAS diagnosis were used to assess the potential effect of spectrum bias on RADT results.

RESULTS: Two thousand four hundred and seventy-two children were enrolled at four sites. The prevalence of GAS by throat culture varied by country (range 24.5-39.4%) and by RADT (range 23.9-41.8%). Compared to culture, RADT sensitivity ranged from 72.4% to 91.8% and specificity ranged from 85.7% to 96.4%. The positive predictive value ranged from 67.9% to 88.6% and negative predictive value ranged from 88.1% to 95.7%.

CONCLUSIONS: In limited-resource regions where microbiological diagnosis is not feasible or practical, RADTs should be considered an option that can be performed in a clinic and provide timely results.

Rimoin, A. W., N. A. Hoff, C. L. Fischer Walker, H. S. Hamza, A. Vince, N. A. Rahman, S. Andrasevic, S. Emam, D. Vukelic, N. Elminawi, et al., "Treatment of streptococcal pharyngitis with once-daily amoxicillin versus intramuscular benzathine penicillin G in low-resource settings: a randomized controlled trial.", Clinical pediatrics, vol. 50, issue 6, pp. 535-42, 2011 Jun. Abstract

BACKGROUND: Primary prevention of acute rheumatic fever is achieved by proper antibiotic treatment of group A β -hemolytic streptococcal (GAS) pharyngitis.

METHODS: To assess noninferiority of oral amoxicillin to intramuscular benzathine penicillin G (IM BPG). Children (2 to 12 years) meeting enrollment criteria were randomized 1:1 to receive antibiotic treatment in 2 urban outpatient clinics in Egypt and Croatia.

RESULTS: A total of 558 children (Croatia = 166, Egypt = 392) were randomized, with 368 evaluable in an intention-to-treat (ITT) analysis, and 272 evaluable in the per protocol (PP) analysis. In Croatia, ITT and PP treatment success rates were comparable for IM BPG and amoxicillin (2.5% difference vs 1.1% difference, respectively). In Egypt, amoxicillin was not comparable with IM BPG in ITT analysis (15.1% difference), but was comparable in PP analysis (-9.3% difference).

CONCLUSION: If compliance is a major issue, a single dose of IM BPG may be preferable for treatment of GAS pharyngitis.

Gaafar, T. M., H. A. Abdel Rahman, W. Attia, H. S. Hamza, K. Brockmeier, and R. E. El Hawary, "Comparative characteristics of endothelial-like cells derived from human adipose mesenchymal stem cells and umbilical cord blood-derived endothelial cells.", Clinical and experimental medicine, vol. 14, issue 2, pp. 177-84, 2014 May. Abstract

Adult peripheral blood contains a limited number of endothelial progenitor cells that can be isolated for treatment of ischemic diseases. The adipose tissue became an interesting source of stem cells for regenerative medicine. This study aimed to investigate the phenotype of cells obtained by culturing adipose-derived mesenchymal stem cells (ad-MSCs) in the presence of endothelial growth supplements compared to endothelial cells obtained from umbilical cord blood (UCB). Passage 3 ad-MSCs and mononuclear layer from UCB were cultured in presence of endothelial growth media for 3 weeks followed by their characterization by flow cytometry and polymerase chain reaction. After culture in endothelial inductive media, ad-MSCs expressed endothelial genes and some endothelial marker proteins as CD31 and CD34, respectively. Adipose tissue could be a reliable source for easy obtaining, expanding and differentiating MSCs into endothelial-like cells for autologous cell-based therapy.

Ibrahim, L. A., A. M. Fattouh, H. S. Hamza, and W. A. Attia, "Pattern of Rheumatic Fever in Egyptian Children Younger Than 5 Years", British Journal of Medicine and Medical Research, vol. 3, issue 4, 2013. Abstract

Aims: Acute rheumatic fever (ARF) is common between 5-15 years, uncommon with different presentation 25 in children below 5 years. The aim of this study is to assess the frequency and characterize the pattern of 26 presentation of rheumatic fever (RF) in Egyptian children younger than 5 years. Study Design: Retrospective study. Place and Duration of the Study: Pediatric department, cardiology division, Cairo University Children’s Hospital, 5 years follow up. Methodology: We retrospectively reviewed the pre-completed data of 766 patients following up in the rheumatic fever clinic. Those with incomplete medical records were excluded. We compared between children younger than 5 years and those who are 5 years or older as regards their demographic data, clinical presentations, laboratory findings and echocardiographic findings. Results: We enrolled 667 patients; 17 of them (2.5%) were younger than 5 years (mean age 3.82± SD 0.393 years). The group of patients younger than 5 years old; included 10 females (58.8%) and 7 males (41.2%). Positive family history was encountered in 6 patients (37.7%). The most common presentations of the younger age group of patients were arthritis in 12 patients (70.5%), followed by carditis in 5 patients (29.4%), chorea in 3 patients (17.6%), and skin manifestations in 2 patients in the form of erythema marginatum (11.7%). Subclinical carditis was more common in younger children than the older group, with more severe valve affection. None of the patients in the younger age group had recurrence of the RF during a period of 5 years follow up while recurrences were encountered in 16 patients (2.5%) of the older age group. Conclusion: ARF can occur in children younger than 5 years. The possibility of rheumatic fever should be adequately investigated in those young children presenting with arthritis, chorea, or skin rash especially in developing countries like Egypt. Echocardiography is an essential tool to diagnose cases with5 subclinical carditis. - See more at: http://www.sciencedomain.org/abstract.php?iid=205&id=12&aid=1516#.UyASuvmSyYw

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