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Arab Y, Harahsheh AS, Dahdah N, El-Kholy N, Abed MY, Abu Al-Saoud SY, Agha HM, Alahmadi F, Alamer SR, Awadhi ZA, Ali S, Ali MT, Alrabte H, Al-Saloos H, Al-Senaidi KS, Alzyoud R, Awidat N, Bouayed K, Bouaziz A, Boukari R, El Ganzoury MM, Elmarsafawy HM, Elrugige N, Fitouri Z, Kotby A, Ladj MS, Bekkar M, Mouawad P, Salih AF, Suleiman M, Choueiter NF. Kawarabi: Administrative Structuring of a Multicenter Research Collaborative to Study Kawasaki Disease in the Arab Countries. World J Pediatr Congenit Heart Surg 2024; 15:177-183. [PMID: 37981829 DOI: 10.1177/21501351231205570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Kawasaki disease (KD), the leading cause of acquired heart disease in children in developed countries, merits conducting detailed studies in Arab countries. We introduce Kawarabi, as a multicenter research collaborative effort dedicated to improving diagnosis, care, and outcome of children and adults with KD in the Arab world. During the COVID-19 pandemic, there emerged a new multisystem inflammatory syndrome in children; a disease similar to KD. This highlighted the challenges that Arab physicians face in diagnosing and managing children with KD and KD-like illnesses. Kawarabi brings together experts in North America and Arab nations to study this family of diseases in a not-for-profit, voluntary scientific collaborative setting. Bylaws addressing the vision, objectives, structure, and governance of Kawarabi were established, and vetted by the 45 organizing members in 2021. An initial scientific publication showed evidence of a decreased level of awareness of the disease in the general population, as well as the lack of access to resources available for physicians caring for children with KD in Arab countries. Kawarabi has since held several educational webinars and an inaugural yearly meeting. The groundwork for future initiatives targeted at increasing awareness and understanding of the management and the long-term outcomes of children with KD in the region was established. Data on KD in the Arab world are lacking. Kawarabi is a multicenter research collaborative organization that has the unique resources, diversified ethnic makeup, and energy, to accomplish significant advances in our understanding and management of KD and its variants.
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Affiliation(s)
- Yousra Arab
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ashraf S Harahsheh
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Montreal, Canada
- Professor of Pediatrics - Université de Montréal, Montreal, Canada
| | | | - Maysam Y Abed
- Al-Ramadi Maternity and Child Teaching Hospital, Al-Ramadi, Iraq
| | - Sima Y Abu Al-Saoud
- Department of Pediatrics, Faculty of Medicine, Makassed Hospital, Al-Quds University, East- Jerusalem, Palestine
| | - Hala M Agha
- Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Fahad Alahmadi
- King Faisal Specialist Hospital and Research Center, Taibah University, Madinah, Saudi Arabia
| | - Suad R Alamer
- Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Centre, Awali, Bahrain
| | - Zainab Al Awadhi
- Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Sulafa Ali
- Sudan Heart Center, University of Kharthoum, Kharthoum, Sudan
| | | | - Hanifa Alrabte
- Pediatric Cardiology Department, Tripoli Children Hospital, Tripoli, Libya
| | - Hesham Al-Saloos
- Division of Cardiology, Sidra Medicine, Doha, Qatar
- Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar
| | - Khalfan S Al-Senaidi
- Division of Pediatric Cardiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Raed Alzyoud
- Pediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children's Hospital, Amman, Jordan
| | | | - Kenza Bouayed
- Abderrahim Harouchi Mother-Child Hospital, CHU Ibn Rochd, Casablanca, Morocco
| | - Asma Bouaziz
- Children and Neonatal Department, Hôpital Régional, Ben Arous, Tunisia
| | - Rachida Boukari
- Department of Pediatrics, University Hospital Mustapha Bacha, Algiers University, Alger, Algeria
| | - Mona M El Ganzoury
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala M Elmarsafawy
- Division of Pediatric Cardiology, Children's Hospital, Mansoura University, Mansoura, Egypt
| | - Najat Elrugige
- Pediatric Cardiology Department, Benghazi Children Hospital, Benghazi University, Benghazi, Libya
| | - Zohra Fitouri
- Division of Rheumatology, Pediatric Hospital of Béchir Hamza of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Alyaa Kotby
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed S Ladj
- Department of Pediatrics, Djillali Belkhenchir University Hospital, Algiers, Algeria
- Faculty of Medicine, Algiers University, Alger, Algeria
| | - Mokhtar Bekkar
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Oran, Oran, Algeria
| | - Pierre Mouawad
- Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Aso F Salih
- Pediatric Cardiology Department, Children's Heart Hospital-Sulaimani College of Medicine, Sulaimani University, Al-Sulaimaniyah, Iraq
| | | | - Nadine F Choueiter
- Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine, Mount Sinai Kravis Children's Hospital, New York, NY, USA
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Alzyoud R, El-Kholy N, Arab Y, Choueiter N, Harahsheh AS, Aselan AS, Kotby A, Bouaziz A, Salih AF, Abushhaiwia A, Alahmadi F, Agha HM, Elmarsafawy HM, Alrabte H, Al-Saloos H, Boudiaf H, Hijazi I, Bouayed K, Al Senaidi KS, Boughammoura L, Jalal M, Ladj MS, Abu-Shukair ME, ElGanzoury MM, Hammadouche N, Elsamman N, Mouawad P, Boukari R, Benalikhoudja N, Jdour S, Abu Al-Saoud SY, Touri SN, Kammoun T, Fitouri Z, Dahdah N. Access to Care and Therapy for Kawasaki Disease in the Arab Countries: A Kawasaki Disease Arab Initiative (Kawarabi) Multicenter Survey. Pediatr Cardiol 2023:10.1007/s00246-023-03166-1. [PMID: 37126143 DOI: 10.1007/s00246-023-03166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
Kawasaki Disease (KD) is still the most common acquired heart disease in children below the age of five years; it has been well described in the developed world; however, data from the Arab world are limited to case reports or single-center case series. In an effort of optimizing KD research in the Arab world, a group of physicians and researchers established the KD Arab Initiative (Kawarabi) in 2021, and published the first survey, which showed disparities in the availability of intravenous immunoglobulin (IVIG); this had prompted Kawarabi to assess the access to care and therapy of KD patients in Arab countries. A 32 structured questions survey was conducted in thirteen Arab countries and addressed KD patients' access to healthcare in urban and rural settings. The survey results showed that access to care was uniform across large, mid-size cities and rural areas in 7/13 (54%) countries, while in 6/13 (46%) countries, it was in favor of large and mid-size cities over rural areas. The quality of medical services received by children with KD in large cities was rated as excellent in 6/13 or good in 7/13 countries compared to fair in 4/13 or poor in 4/13 countries in rural areas. Availability of IVIG was limited (23%) in mid-size cities and almost impossible (23%) in rural areas. The KD patients in mid-size cities and rural areas have limited access to standard healthcare in the Arab world. This survey laid the foundation for future Kawarabi endeavors to improve the care of children with KD.
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Affiliation(s)
- Raed Alzyoud
- Chief of Pediatric Allergy, Immunology and Rheumatology Divsion, Queen Rania Children's Hospital, Amman, Jordan
| | | | - Yousra Arab
- Université de Sherbrooke, Sherbrooke, Canada
| | | | - Ashraf S Harahsheh
- Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine & HealthSciences Cardiology, Washington, DC, USA
| | - Adnan Salem Aselan
- Pediatric Cardiologist, Madinah Maternity and Children Hospital, King Salman Medical City, Al Madinah Al Munawwarah, Saudi Arabia
| | - Alyaa Kotby
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Asma Bouaziz
- Headmaster of Children and Neonatal Department, Hôpital Régional, Tunis, Tunisia
| | - Aso F Salih
- HD Cardiology, Pediatric Cardiology Department, Children's Heart Hospital, Sulaimani College of Medicine, Sulaimani University, Sulaimani, Iraq
| | - Awatif Abushhaiwia
- Pediatric Rheumatology Department, Tripoli Children's Hospital, Tripoli, Libya
| | - Fahad Alahmadi
- King Faisal Specialist Hospital and Research Center, Pediatric Cardiology, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| | - Hala M Agha
- Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Hala M Elmarsafawy
- Pediatric Cardiology Division, Children Hospital, Mansoura University, Mansoura, Egypt
| | - Hanifa Alrabte
- Pediatric Cardiology Department, Tripoli Children's Hospital, Tripoli, Libya
| | - Hesham Al-Saloos
- Division of Cardiology, Clinical Pediatrics, Sidra Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Houda Boudiaf
- Onco-Pediatric Department, University Hospital Mustapha Bacha, Algiers University, Algiers, Algeria
| | - Issa Hijazi
- Cardiology Center, King Hussein Medical Center, Amman, Jordan
| | - Kenza Bouayed
- Harouchi, Mother and Child Hospital, CHU Ibn Rochd, Casablanca, Morocco
| | | | - Lamia Boughammoura
- Pediatric Department of Farhat Hached Hospital, Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Maryam Jalal
- Harouchi, Mother and Child Hospital, CHU Ibn Rochd, Casablanca, Morocco
| | - Mohamed S Ladj
- Pediatric Department, Faculty of Medicine, Djillali Belkhenchir University Hospital, Algiers University, Algiers, Algeria
| | | | - Mona M ElGanzoury
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nacera Hammadouche
- Pediatric Department, Faculty of Medicine, Djillali Belkhenchir University Hospital, Algiers University, Algiers, Algeria
| | - Nora Elsamman
- Pediatric Cardiology, Pediatrics Department, Ain Shams University, Cairo, Egypt
| | - Pierre Mouawad
- Pediatric Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rachida Boukari
- Pediatric Department University Hospital, Mustapha Bacha, Algiers, Algeria
| | | | - Salima Jdour
- Pediatric Cardiology Department, Tripoli Children's Hospital, Tripoli, Libya
| | - Sima Y Abu Al-Saoud
- Department of Pediatrics, Faculty of Medicine, Makassed Hospital, Al- Quds University, Jerusalem, Palestine
| | | | - Thouraya Kammoun
- Pediatric Department of Hedi Chakar Hospital, Faculté de Médecine de Sfax, Sfax, Tunisia
| | - Zohra Fitouri
- Unit of Rheumatology, Emergency and Outpatient Department, Pediatric Hospital of Béchir Hamza of Tunis. University Tunis El Manar, Tunis, Tunisia
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Université de Montréal, Montréal, Canada.
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Baris S, Abolhassani H, Massaad MJ, Al-Nesf M, Chavoshzadeh Z, Keles S, Reisli I, Tahiat A, Shendi HM, Elaziz DA, Belaid B, Al Dhaheri F, Haskologlu S, Dogu F, Ben-Mustapha I, Sobh A, Galal N, Meshaal S, Elhawary R, El-Marsafy A, Alroqi FJ, Al-Saud B, Al-Ahmad M, Al Farsi T, Al Sukaiti N, Al-Tamemi S, Mehawej C, Dbaibo G, ElGhazali G, Kilic SS, Genel F, Kiykim A, Musabak U, Artac H, Guner SN, Boukari R, Djidjik R, Kechout N, Cagdas D, El-Sayed ZA, Karakoc-Aydiner E, Alzyoud R, Barbouche MR, Adeli M, Wakim RH, Reda SM, Ikinciogullari A, Ozen A, Bousfiha A, Al-Mousa H, Rezaei N, Al-Herz W, Geha RS. The Middle East and North Africa Diagnosis and Management Guidelines for Inborn Errors of Immunity. J Allergy Clin Immunol Pract 2023; 11:158-180.e11. [PMID: 36265766 DOI: 10.1016/j.jaip.2022.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/07/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
Human inborn errors of immunity (IEI) are a group of 485 distinct genetic disorders affecting children and adults. Signs and symptoms of IEI are heterogeneous, and accurate diagnosis can be challenging and depends on the available human expertise and laboratory resources. The Middle East and North Africa (MENA) region has an increased prevalence of IEI because of the high rate of consanguinity with a predominance of autosomal recessive disorders. This area also exhibits more severe disease phenotypes compared with other regions, probably due to the delay in diagnosis. The MENA-IEI registry network has designed protocols and guidelines for the diagnosis and treatment of IEI, taking into consideration the variable regional expertise and resources. These guidelines are primarily meant to improve the care of patients within the region, but can also be followed in other regions with similar patient populations.
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Affiliation(s)
- Safa Baris
- Faculty of Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey; The Isil Berat Barlan Center for Translational Medicine, Istanbul Jeffrey Modell Foundation Diagnostic Center for Primary Immune Deficiencies, Istanbul, Turkey.
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Division of Clinical Immunology, Department of Biosciences and Nutrition, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Michel J Massaad
- Department of Experimental Pathology, Immunology, and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon
| | - Maryam Al-Nesf
- Allergy and Immunology Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Zahra Chavoshzadeh
- Allergy and Clinical Immunology Department, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sevgi Keles
- Division of Pediatric Allergy and Immunology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ismail Reisli
- Division of Pediatric Allergy and Immunology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Azzeddine Tahiat
- Laboratory of Immunology, Department of Medical Biology, University of Algiers, Rouiba Hospital, Algiers, Algeria
| | - Hiba Mohammad Shendi
- Division of Pediatric Allergy and Immunology, Tawam Hospital, Abu Dhabi, United Arab Emirates
| | - Dalia Abd Elaziz
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Brahim Belaid
- Department of Medical Immunology, Beni Messous University Hospital Center, Faculty of Pharmacy, University of Algiers, Algiers, Algeria
| | - Fatima Al Dhaheri
- Department of Pediatrics, Pediatric Infectious Diseases, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sule Haskologlu
- Department of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Figen Dogu
- Department of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Imen Ben-Mustapha
- Department of Immunology, Institut Pasteur de Tunis and University Tunis El Manar, Tunis, Tunisia
| | - Ali Sobh
- Department of Pediatrics, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nermeen Galal
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Safa Meshaal
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rabab Elhawary
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aisha El-Marsafy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Fayhan J Alroqi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Bandar Al-Saud
- Department of Pediatrics, Division of Allergy and Immunology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mona Al-Ahmad
- Department of Microbiology, College of Medicine, Kuwait University, Kuwait
| | - Tariq Al Farsi
- Department of Pediatric Allergy and Clinical Immunology, The Royal Hospital, Muscat, Oman
| | - Nashat Al Sukaiti
- Department of Pediatric Allergy and Clinical Immunology, The Royal Hospital, Muscat, Oman
| | - Salem Al-Tamemi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Cybel Mehawej
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Ghassan Dbaibo
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon
| | - Gehad ElGhazali
- Department of Immunology, Sheikh Khalifa Medical City-Union 71-Purehealth, Abu Dhabi, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sara Sebnem Kilic
- Department of Pediatric Immunology and Rheumatology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Ferah Genel
- Department of Pediatric Immunology and Allergy, University of Health Sciences Dr. Behcet Uz Children's Hospital, İzmir, Turkey
| | - Ayca Kiykim
- Division of Pediatric Allergy and Immunology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ugur Musabak
- Department of Internal Medicine, Division of Immunology and Allergy, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Hasibe Artac
- Division of Immunology and Allergy, Department of Pediatrics, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Sukru Nail Guner
- Division of Pediatric Allergy and Immunology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Rachida Boukari
- Department of Pediatrics, Mustapha Pacha Faculty of Medicine, Algiers University, Algeria
| | - Reda Djidjik
- Department of Medical Immunology, Beni Messous University Hospital Center, Faculty of Pharmacy, University of Algiers, Algiers, Algeria
| | - Nadia Kechout
- Department of Immunology, Pasteur Institute of Algeria, Faculty of Medicine, Algiers, Algeria
| | - Deniz Cagdas
- Department of Pediatrics, Section of Pediatric Immunology, Ihsan Dogramaci Children's Hospital, Institute of Child Health, Hacettepe University Medical School, Ankara, Turkey
| | - Zeinab Awad El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Elif Karakoc-Aydiner
- Faculty of Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey; The Isil Berat Barlan Center for Translational Medicine, Istanbul Jeffrey Modell Foundation Diagnostic Center for Primary Immune Deficiencies, Istanbul, Turkey
| | - Raed Alzyoud
- Section of Immunology, Allergy and Rheumatology, Queen Rania Children Hospital, Amman, Jordan
| | - Mohamed Ridha Barbouche
- Department of Immunology, Institut Pasteur de Tunis and University Tunis El Manar, Tunis, Tunisia
| | - Mehdi Adeli
- Department of Immunology, Sidra Medicine, Ar-Rayyan, Qatar
| | - Rima Hanna Wakim
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon
| | - Shereen M Reda
- Pediatric Allergy, Immunology and Rheumatology Unit, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Aydan Ikinciogullari
- Department of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Ahmet Ozen
- Faculty of Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey; The Isil Berat Barlan Center for Translational Medicine, Istanbul Jeffrey Modell Foundation Diagnostic Center for Primary Immune Deficiencies, Istanbul, Turkey
| | - Aziz Bousfiha
- Laboratory of Clinical Immunology, Inflammation and Allergy, Faculty of Medicine and Pharmacy of Casablanca, Department of pediatric infectious and immunological diseases, Ibn Rushd Children Hospital, King Hassan II University, Casablanca, Morocco
| | - Hamoud Al-Mousa
- Department of Pediatrics, Division of Allergy and Immunology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait City, Kuwait; Allergy and Clinical Immunology Unit, Pediatric Department, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Raif S Geha
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
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Arab Y, Choueiter N, Dahdah N, El-Kholy N, Abu Al-Saoud SY, Abu-Shukair ME, Agha HM, Al-Saloos H, Al Senaidi KS, Alzyoud R, Bouaziz A, Boukari R, El Ganzoury MM, Elmarsafawy HM, ELrugige N, Fitouri Z, Ladj MS, Mouawad P, Salih AF, Rojas RG, Harahsheh AS. Kawasaki Disease Arab Initiative [Kawarabi]: Establishment and Results of a Multicenter Survey. Pediatr Cardiol 2022; 43:1239-1246. [PMID: 35624313 PMCID: PMC9140321 DOI: 10.1007/s00246-022-02844-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
Studies on Kawasaki disease (KD) in Arab countries are scarce, often providing incomplete data. This along with the benefits of multicenter research collaboratives led to the creation of the KD Arab Initiative [Kawarabi] consortium. An anonymous survey was completed among potential collaborative Arab medical institutions to assess burden of KD in those countries and resources available to physicians. An online 32-item survey was distributed to participating institutions after conducting face validity. One survey per institution was collected. Nineteen physicians from 12 countries completed the survey representing 19 out of 20 institutions (response rate of 95%). Fifteen (79%) institutions referred to the 2017 American Heart Association guidelines when managing a patient with KD. Intravenous immunoglobulin (IVIG) is not readily available at 2 institutions (11%) yet available in the country. In one center (5%), IVIG is imported on-demand. The knowledge and awareness among countries' general population was graded (0 to 10) at median/interquartiles (IQR) 3 (2-5) and at median/IQR 7 (6-8) in the medical community outside their institution. Practice variations in KD management and treatment across Arab countries require solid proactive collaboration. The low awareness and knowledge estimates about KD among the general population contrasted with a high level among the medical community. The Kawarabi collaborative will offer a platform to assess disease burden of KD, among Arab population, decrease practice variation and foster population-based knowledge.
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Affiliation(s)
- Yousra Arab
- University of Sherbrooke, Sherbrooke, QC Canada
| | - Nadine Choueiter
- Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montreal, QC H3T 1C5 Canada
| | - Nermeen El-Kholy
- Pediatric Cardiology Department, AlJalila Children’s Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Sima Y. Abu Al-Saoud
- Department of Pediatrics, Makassed Hospital, Faculty of Medicine, Al- Quds University, East-Jerusalem, Palestine
| | | | - Hala M. Agha
- Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Hesham Al-Saloos
- Division of Cardiology, Sidra Medicine, Doha, Qatar
- Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar
| | | | - Raed Alzyoud
- Pediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, Amman, Jordan
| | - Asma Bouaziz
- Headmaster of Children and Neonatal Department, Hôpital Régional, Ben Arous, Tunisia
| | - Rachida Boukari
- Pediatric Department, University Hospital Mustapha Bacha, Algiers University, Algiers, Algeria
| | - Mona M. El Ganzoury
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala M. Elmarsafawy
- Pediatric Cardiology Division, Children Hospital, Mansoura University, Mansoura, Egypt
| | - Najat ELrugige
- Pediatric Cardiology Department, Benghazi Children Hospital, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Zohra Fitouri
- Unit of Rheumatology, Emergency and Outpatient Department, Pediatric Hospital of Béchir Hamza of Tunis, University Tunis El Manar, 1007 Djebel Lakhedher Bab Saadoun, Tunis, Tunisia
| | - Mohamed S. Ladj
- Pediatric Department, Djillali Belkhenchir University Hospital, Algiers, Algeria
- Faculty of Medicine, Algiers University, Algiers, Algeria
| | - Pierre Mouawad
- Pediatric Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Aso F. Salih
- Pediatric Cardiology Department/Children’s Heart Hospital- Sulaimani College of Medicine- Sulaimani University, Al-Sulaimaniyah, Iraq
| | - Rocio G. Rojas
- Clinical Research Program, Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, QC H3T 1C5 Canada
| | - Ashraf S. Harahsheh
- Division of Cardiology, Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine & Health Sciences, 111 Michigan Ave, NW, Washington, DC 20010 USA
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Belaid B, Lamara Mahammed L, Drali O, Oussaid AM, Touri NS, Melzi S, Dehimi A, Berkani LM, Merah F, Larab Z, Allam I, Khemici O, Kirane SY, Boutaba M, Belbouab R, Bekkakcha H, Guedouar A, Chelali A, Baamara B, Noui D, Baaziz H, Rezak R, Azzouz SM, Aichaoui M, Moktefi A, Benhatchi RM, Oussalah M, Benaissa N, Laredj A, Bouchetara A, Adria A, Habireche B, Tounsi N, Dahmoun F, Touati R, Boucenna H, Bouferoua F, Sekfali L, Bouhafs N, Aboura R, Kherra S, Inouri Y, Dib S, Medouri N, Khelfaoui N, Redjedal A, Zelaci A, Yahiaoui S, Medjadj S, Touhami TK, Kadi A, Amireche F, Frada I, Houasnia S, Benarab K, Boubidi C, Ferhani Y, Benalioua H, Sokhal S, Benamar N, Aggoune S, Hadji K, Bellouti A, Rahmoune H, Boutrid N, Okka K, Ammour A, Saadoune H, Amroun M, Belhadj H, Ghanem A, Abbaz H, Boudrioua S, Zebiche B, Ayad A, Hamadache Z, Ouaras N, Achour N, Bouchair N, Boudiaf H, Bekkat-Berkani D, Maouche H, Bouzrar Z, Aissat L, Ibsaine O, Bioud B, Kedji L, Dahlouk D, Bensmina M, Radoui A, Bessahraoui M, Bensaadi N, Mekki A, Zeroual Z, Chan KW, Leung D, Tebaibia A, Ayoub S, Mekideche D, Gharnaout M, Casanova JL, Puel A, Lau YL, Cherif N, Ladj S, Smati L, Boukari R, Benhalla N, Djidjik R. Inborn Errors of Immunity in Algerian Children and Adults: A Single-Center Experience Over a Period of 13 Years (2008–2021). Front Immunol 2022; 13:900091. [PMID: 35529857 PMCID: PMC9069527 DOI: 10.3389/fimmu.2022.900091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 12/11/2022] Open
Abstract
Background Inborn errors of immunity (IEI) predispose patients to various infectious and non-infectious complications. Thanks to the development and expanding use of flow cytometry and increased awareness, the diagnostic rate of IEI has markedly increased in Algeria the last decade. Aim This study aimed to describe a large cohort of Algerian patients with probable IEI and to determine their clinical characteristics and outcomes. Methods We collected and analyzed retrospectively the demographic data, clinical manifestations, immunologic, genetic data, and outcome of Algerian IEI patients - diagnosed in the department of medical immunology of Beni Messous university hospital center, Algiers, from 2008 to 2021. Results Eight hundred and seven patients with IEI (482 males and 325 females) were enrolled, 9.7% of whom were adults. Consanguinity was reported in 50.3% of the cases and a positive family history in 32.34%. The medium age at disease onset was 8 months and at diagnosis was 36 months. The median delay in diagnosis was 16 months. Combined immunodeficiencies were the most frequent (33.8%), followed by antibody deficiencies (24.5%) and well-defined syndromes with immunodeficiency (24%). Among 287 patients tested for genetic disorders, 129 patients carried pathogenic mutations; 102 having biallelic variants mostly in a homozygous state (autosomal recessive disorders). The highest mortality rate was observed in patients with combined immunodeficiency (70.1%), especially in patients with severe combined immunodeficiency (SCID), Omenn syndrome, or Major Histocompatibility Complex (MHC) class II deficiency. Conclusion The spectrum of IEI in Algeria is similar to that seen in most countries of the Middle East and North Africa (MENA) region, notably regarding the frequency of autosomal recessive and/or combined immunodeficiencies.
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Affiliation(s)
- Brahim Belaid
- Department of Medical Immunology, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Lydia Lamara Mahammed
- Department of Medical Immunology, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Ouardia Drali
- Department of Pediatrics B, Hussein Dey University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Aida Mohand Oussaid
- Department of Pediatrics A, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Nabila Souad Touri
- Department of Pediatrics, Blida University Hospital Center, University of Blida, Blida, Algeria
| | - Souhila Melzi
- Department of Pediatrics, Bab El Oued University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Abdelhak Dehimi
- Department of Pediatrics, Setif University Hospital Center, University of Setif 1, Setif, Algeria
| | - Lylia Meriem Berkani
- Department of Medical Immunology, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Fatma Merah
- Department of Medical Immunology, Beni Messous University Hospital Center, Algiers, Algeria
| | - Zineb Larab
- Department of Medical Immunology, Beni Messous University Hospital Center, Algiers, Algeria
| | - Ines Allam
- Department of Medical Immunology, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Ouarda Khemici
- Department of Pediatrics B, Beni Messous University Hospital Center, Algiers, Algeria
| | - Sonya Yasmine Kirane
- Department of Pediatrics B, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Mounia Boutaba
- Department of Pediatrics A, Hussein Dey University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Reda Belbouab
- Department of Pediatrics, Mustapha Pacha University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Hadjira Bekkakcha
- Department of Pediatrics A, Hussein Dey University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Assia Guedouar
- Department of Pediatrics A, Hussein Dey University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Abdelhakim Chelali
- Department of Pediatrics, Djelfa Public Hospital Institution, Djelfa, Algeria
| | - Brahim Baamara
- Department of Pediatrics, Djelfa Public Hospital Institution, Djelfa, Algeria
| | - Djamila Noui
- Department of Pediatrics, Batna University Hospital center, University of Batna, Batna, Algeria
| | - Hadda Baaziz
- Department of Pediatrics, Batna University Hospital center, University of Batna, Batna, Algeria
| | - Radia Rezak
- Department of Pediatric Gastroenterology and Nutrition, Canastel Children’s Hospital, Oran, Algeria
| | - Sidi Mohamed Azzouz
- Department of Pediatric Gastroenterology and Nutrition, Canastel Children’s Hospital, University of Oran, Oran, Algeria
| | - Malika Aichaoui
- Department of Pediatric Pneumo-Allergology, Canastel Children’s Hospital, Oran, Algeria
| | - Assia Moktefi
- Department of Pediatric Pneumo-Allergology, Canastel Children’s Hospital, Oran, Algeria
| | | | - Meriem Oussalah
- Department of Pediatric Pneumo-Allergology, Canastel Children’s Hospital, University of Oran, Oran, Algeria
| | - Naila Benaissa
- Department of Children’s Infectious Diseases, Canastel Children’s Hospital, University of Oran, Oran, Algeria
| | - Amel Laredj
- Department of Children’s Infectious Diseases, Canastel Children’s Hospital, University of Oran, Oran, Algeria
| | - Assia Bouchetara
- Department of Children’s Infectious Diseases, Canastel Children’s Hospital, University of Oran, Oran, Algeria
| | - Abdelkader Adria
- Department of Pediatric Hematology, Canastel Children’s Hospital, Oran, Algeria
| | - Brahim Habireche
- Department of Pediatrics, El Bayadh Public Hospital Institution, EL Bayadh, Algeria
| | - Noureddine Tounsi
- Department of Pediatrics, El Bayadh Public Hospital Institution, EL Bayadh, Algeria
| | - Fella Dahmoun
- Department of Pediatrics, Bejaia University Hospital Center, University of Bejaia, Bejaia, Algeria
| | - Rabah Touati
- Department of Pediatrics, Bejaia University Hospital Center, University of Bejaia, Bejaia, Algeria
| | - Hamza Boucenna
- Department of Pediatrics A, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Fadila Bouferoua
- Department of Pediatrics A, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Lynda Sekfali
- Department of Pediatrics A, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Nadjet Bouhafs
- Department of Pediatrics, Bab El Oued University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Rawda Aboura
- Department of Pediatrics, Bab El Oued University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Sakina Kherra
- Department of Pediatrics A, Hussein Dey University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Yacine Inouri
- Department of Pediatrics, Central Hospital of the Army, University of Algiers 1, Algiers, Algeria
| | - Saadeddine Dib
- Department of Pediatrics, Mother & Child Hospital of Tlemcen, University of Tlemcen, Tlemcen, Algeria
| | - Nawel Medouri
- Department of Pediatrics, Saida Public Hospital Institution, Saida, Algeria
| | | | - Aicha Redjedal
- Department of Pediatrics, Saida Public Hospital Institution, Saida, Algeria
| | - Amara Zelaci
- Department of Pediatrics, El Oued Public Hospital Institution, El Oued, Algeria
| | - Samah Yahiaoui
- Department of Pediatrics, Barika Public Hospital Institution, Batna, Algeria
| | - Sihem Medjadj
- Department of Pediatrics, Ghardaia Public Hospital Institution, Ghardaia, Algeria
| | | | - Ahmed Kadi
- Department of Pneumology A, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Fouzia Amireche
- Department of Pediatrics, Mother & Child Hospital of EL Mansourah, University of Constantine 3, Constantine, Algeria
| | - Imane Frada
- Department of Pediatrics, Biskra Public Hospital Institution, Biskra, Algeria
| | - Shahrazed Houasnia
- Department of Pediatrics, El Harrouche Public Hospital Institution, Skikda, Algeria
| | - Karima Benarab
- Department of Pediatrics, Tizi Ouzou University Hospital Center, University of Tizi Ouzou, Tizi Ouzou, Algeria
| | - Chahynez Boubidi
- Department of Pediatrics A, Hussein Dey University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Yacine Ferhani
- Department of Pediatrics, Mustapha Pacha University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Hayet Benalioua
- Department of Pediatrics, Mustapha Pacha University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Samia Sokhal
- Department of Pediatrics, Mustapha Pacha University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Nadia Benamar
- Department of Pediatrics, Tighennif Public Hospital Institution, Mascara, Algeria
| | - Samira Aggoune
- Department of Pediatrics, El-Harrach Public Hospital Institution, University of Algiers 1, Algiers, Algeria
| | - Karima Hadji
- Department of Pediatrics, Ain Oulmene Public Hospital Institution, Setif, Algeria
| | - Asma Bellouti
- Department of Pediatrics, Ain Azel Public Hospital Institution, Setif, Algeria
| | - Hakim Rahmoune
- Department of Pediatrics, Setif University Hospital Center, University of Setif 1, Setif, Algeria
| | - Nada Boutrid
- Department of Pediatrics, Setif University Hospital Center, University of Setif 1, Setif, Algeria
| | - kamelia Okka
- Department of Pediatrics, Setif University Hospital Center, University of Setif 1, Setif, Algeria
| | - Assia Ammour
- Department of Pediatrics, Mother & Child Hospital of Touggourt, Touggourt, Algeria
| | - Houssem Saadoune
- Department of Pneumology, Mila Public Hospital Institution, Mila, Algeria
| | - Malika Amroun
- Department of Pediatrics, Central Hospital of the Army, University of Algiers 1, Algiers, Algeria
| | - Hayet Belhadj
- Department of Pediatrics, Central Hospital of the Army, University of Algiers 1, Algiers, Algeria
| | - Amina Ghanem
- Department of Pediatrics, Khenchela Public Hospital Institution, Khenchela, Algeria
| | - Hanane Abbaz
- Department of Pediatrics, Khenchela Public Hospital Institution, Khenchela, Algeria
| | - Sana Boudrioua
- Department of Pediatrics, El Khroub Public Hospital Institution, Constantine, Algeria
| | - Besma Zebiche
- Department of Pediatrics, Kolea Public Hospital Institution, Tipaza, Algeria
| | - Assia Ayad
- Department of Pediatrics, Kolea Public Hospital Institution, Tipaza, Algeria
| | - Zahra Hamadache
- Department of Pediatrics, Kolea Public Hospital Institution, Tipaza, Algeria
| | - Nassima Ouaras
- Department of Infectious Diseases, EL Kettar Specialized Hospital, University of Algiers 1, Algiers, Algeria
| | - Nassima Achour
- Department of Infectious Diseases, EL Kettar Specialized Hospital, University of Algiers 1, Algiers, Algeria
| | - Nadira Bouchair
- Department of Pediatrics, Annaba University Hospital Center, University of Annaba, Annaba, Algeria
| | - Houda Boudiaf
- Department of Pediatric Oncology, Mustapha pacha University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Dahila Bekkat-Berkani
- Department of Pediatrics, Bologhine Public Hospital Institution, University of Algiers 1, Algiers, Algeria
| | - Hachemi Maouche
- Department of Pediatrics, El-Harrach Public Hospital Institution, University of Algiers 1, Algiers, Algeria
| | - Zahir Bouzrar
- Department of Pediatrics, Bab El Oued University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Lynda Aissat
- Department of Pediatrics, Mother & Child Hospital of Tipaza, University of Blida, Algiers, Algeria
| | - Ouardia Ibsaine
- Department of Pediatrics, Ain Taya Public Hospital Institution, University of Algiers 1, Algiers, Algeria
| | - Belkacem Bioud
- Department of Pediatrics, Setif University Hospital Center, University of Setif 1, Setif, Algeria
| | - Leila Kedji
- Department of Pediatrics, Blida University Hospital Center, University of Blida, Blida, Algeria
| | - Djazia Dahlouk
- Department of Pediatrics, Central Hospital of the Army, University of Algiers 1, Algiers, Algeria
| | - Manoubia Bensmina
- Department of Pediatrics B, Douera University Hospital Center, University of Blida, Algiers, Algeria
| | - Abdelkarim Radoui
- Department of Pediatric Pneumo-Allergology, Canastel Children’s Hospital, University of Oran, Oran, Algeria
| | - Mimouna Bessahraoui
- Department of Pediatric Gastroenterology and Nutrition, Canastel Children’s Hospital, University of Oran, Oran, Algeria
| | - Nadia Bensaadi
- Department of Pediatrics, Tizi Ouzou University Hospital Center, University of Tizi Ouzou, Tizi Ouzou, Algeria
| | - Azzeddine Mekki
- Department of Pediatrics B, Hussein Dey University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Zoulikha Zeroual
- Department of Pediatrics A, Hussein Dey University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Koon-Wing Chan
- Department of Pediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Daniel Leung
- Department of Pediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Amar Tebaibia
- Department of Internal Medicine, El Biar Public Hospital Institution, University of Algiers 1, Algiers, Algeria
| | - Soraya Ayoub
- Department of Internal Medicine, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Dalila Mekideche
- Department of Pneumology B, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Merzak Gharnaout
- Department of Pneumology A, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Jean Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Hospital for Sick Children, INSERM UMR 1163, Paris, France
- Imagine Institute, University of Paris, Paris, France
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller University, New York, NY, United States
- Howard Hughes Medical Institute, New York, NY, United States
| | - Anne Puel
- Laboratory of Human Genetics of Infectious Diseases, Necker Hospital for Sick Children, INSERM UMR 1163, Paris, France
- Imagine Institute, University of Paris, Paris, France
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller University, New York, NY, United States
| | - Yu Lung Lau
- Department of Pediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Nacira Cherif
- Department of Pediatrics B, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Samir Ladj
- Department of Pediatrics, El Biar Public Hospital Institution, University of Algiers 1, Algiers, Algeria
| | - Leila Smati
- Department of Pediatrics, Bologhine Public Hospital Institution, University of Algiers 1, Algiers, Algeria
| | - Rachida Boukari
- Department of Pediatrics, Mustapha Pacha University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Nafissa Benhalla
- Department of Pediatrics A, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Reda Djidjik
- Department of Medical Immunology, Beni Messous University Hospital Center, University of Algiers 1, Algiers, Algeria
- *Correspondence: Reda Djidjik,
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Arous R, Djillali IS, Rouis NO, Boudiaf H, Amhis W, Ziane H, Ladj MS, Boukari R. High mortality of COVID-19 in children with cancer in a single center in Algiers, Algeria. Pediatr Blood Cancer 2021; 68:e28898. [PMID: 33605535 PMCID: PMC7995130 DOI: 10.1002/pbc.28898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Radjaa Arous
- Pediatric Oncology DepartmentMustapha Bacha University HospitalAlgiersAlgeria
| | | | - Nassiba Ould Rouis
- Pediatric Oncology DepartmentMustapha Bacha University HospitalAlgiersAlgeria
| | - Houda Boudiaf
- Pediatric Oncology DepartmentMustapha Bacha University HospitalAlgiersAlgeria
| | - Wahiba Amhis
- Medical Microbiology DepartmentMustapha Bacha University HospitalAlgiersAlgeria
| | - Hanifa Ziane
- Medical Microbiology DepartmentMustapha Bacha University HospitalAlgiersAlgeria
| | | | - Rachida Boukari
- Pediatric DepartmentMustapha Bacha University HospitalAlgiersAlgeria
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7
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Aghamohammadi A, Rezaei N, Yazdani R, Delavari S, Kutukculer N, Topyildiz E, Ozen A, Baris S, Karakoc-Aydiner E, Kilic SS, Kose H, Gulez N, Genel F, Reisli I, Djenouhat K, Tahiat A, Boukari R, Ladj S, Belbouab R, Ferhani Y, Belaid B, Djidjik R, Kechout N, Attal N, Saidani K, Barbouche R, Bousfiha A, Sobh A, Rizk R, Elnagdy MH, Al-Ahmed M, Al-Tamemi S, Nasrullayeva G, Adeli M, Al-Nesf M, Hassen A, Mehawej C, Irani C, Megarbane A, Quinn J, Maródi L, Modell V, Modell F, Al-Herz W, Geha RS, Abolhassani H. Consensus Middle East and North Africa Registry on Inborn Errors of Immunity. J Clin Immunol 2021; 41:1339-1351. [PMID: 34052995 PMCID: PMC8310844 DOI: 10.1007/s10875-021-01053-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023]
Abstract
Background Inborn errors of immunity (IEIs) are a heterogeneous group of genetic defects of immunity, which cause high rates of morbidity and mortality mainly among children due to infectious and non-infectious complications. The IEI burden has been critically underestimated in countries from middle- and low-income regions and the majority of patients with IEI in these regions lack a molecular diagnosis. Methods We analyzed the clinical, immunologic, and genetic data of IEI patients from 22 countries in the Middle East and North Africa (MENA) region. The data was collected from national registries and diverse databases such as the Asian Pacific Society for Immunodeficiencies (APSID) registry, African Society for Immunodeficiencies (ASID) registry, Jeffrey Modell Foundation (JMF) registry, J Project centers, and International Consortium on Immune Deficiency (ICID) centers. Results We identified 17,120 patients with IEI, among which females represented 39.4%. Parental consanguinity was present in 60.5% of cases and 27.3% of the patients were from families with a confirmed previous family history of IEI. The median age of patients at the onset of disease was 36 months and the median delay in diagnosis was 41 months. The rate of registered IEI patients ranges between 0.02 and 7.58 per 100,000 population, and the lowest rates were in countries with the highest rates of disability-adjusted life years (DALY) and death rates for children. Predominantly antibody deficiencies were the most frequent IEI entities diagnosed in 41.2% of the cohort. Among 5871 patients genetically evaluated, the diagnostic yield was 83% with the majority (65.2%) having autosomal recessive defects. The mortality rate was the highest in patients with non-syndromic combined immunodeficiency (51.7%, median age: 3.5 years) and particularly in patients with mutations in specific genes associated with this phenotype (RFXANK, RAG1, and IL2RG). Conclusions This comprehensive registry highlights the importance of a detailed investigation of IEI patients in the MENA region. The high yield of genetic diagnosis of IEI in this region has important implications for prevention, prognosis, treatment, and resource allocation. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-021-01053-z.
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Affiliation(s)
- Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Delavari
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Necil Kutukculer
- Department of Pediatric Immunology, Ege University Faculty of Medicine, Bornova-İzmir, Turkey
| | - Ezgi Topyildiz
- Department of Pediatric Immunology, Ege University Faculty of Medicine, Bornova-İzmir, Turkey
| | - Ahmet Ozen
- Faculty of Medicine, Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.,The Isil Berat Barlan Center for Translational Medicine, Istanbul Jeffrey Modell Foundation Diagnostic Center for Primary Immune Deficiencies, Istanbul, Turkey
| | - Safa Baris
- Faculty of Medicine, Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.,The Isil Berat Barlan Center for Translational Medicine, Istanbul Jeffrey Modell Foundation Diagnostic Center for Primary Immune Deficiencies, Istanbul, Turkey
| | - Elif Karakoc-Aydiner
- Faculty of Medicine, Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.,The Isil Berat Barlan Center for Translational Medicine, Istanbul Jeffrey Modell Foundation Diagnostic Center for Primary Immune Deficiencies, Istanbul, Turkey
| | - Sara Sebnem Kilic
- Uludag University, Medical Faculty, Department of Pediatric Immunology and Rheumatology, Bursa, Turkey
| | - Hulya Kose
- Uludag University, Medical Faculty, Department of Pediatric Immunology and Rheumatology, Bursa, Turkey
| | - Nesrin Gulez
- Department of Pediatric Immunology and Allergy, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Ferah Genel
- Department of Pediatric Immunology and Allergy, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Ismail Reisli
- Department of Pediatric Immunology and Allergy, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Kamel Djenouhat
- Laboratory of Immunology, Department of Medical Biology, Rouiba Hospital, Algiers, Algeria
| | - Azzeddine Tahiat
- Laboratory of Immunology, Department of Medical Biology, Rouiba Hospital, Algiers, Algeria
| | - Rachida Boukari
- Department of Pediatrics, Mustapha Pacha University Hospital, University of Algiers, Algiers, Algeria
| | - Samir Ladj
- Department of Pediatrics, Mustapha Pacha University Hospital, University of Algiers, Algiers, Algeria
| | - Reda Belbouab
- Department of Pediatrics, Mustapha Pacha University Hospital, University of Algiers, Algiers, Algeria
| | - Yacine Ferhani
- Department of Pediatrics, Mustapha Pacha University Hospital, University of Algiers, Algiers, Algeria
| | - Brahim Belaid
- Department of Medical Immunology, University Hospital Center of Beni Messous, University of Algiers, Algiers, Algeria
| | - Reda Djidjik
- Department of Medical Immunology, University Hospital Center of Beni Messous, University of Algiers, Algiers, Algeria
| | - Nadia Kechout
- Department of Immunology, Pasteur Institute of Algeria/Faculty of Medicine, Algiers, Algeria
| | - Nabila Attal
- Department of Immunology, Pasteur Institute of Algeria/Faculty of Medicine, Algiers, Algeria
| | - Khalissa Saidani
- Department of Immunology, Pasteur Institute of Algeria/Faculty of Medicine, Algiers, Algeria
| | - Ridha Barbouche
- Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Aziz Bousfiha
- Laboratory of Clinical Immunology, Inflammation and Allergy, Faculty of Medicine and Pharmacy of Casablanca, King Hassan II University, Casablanca, Morocco
| | - Ali Sobh
- Department of Pediatrics, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ragheed Rizk
- Department of Pediatrics, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Marwa H Elnagdy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mona Al-Ahmed
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.,Department of Allergy, Al-Rashid Allergy Center, Kuwait University, Kuwait City, Kuwait
| | - Salem Al-Tamemi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Gulnara Nasrullayeva
- Department Immunology Research Laboratory, Azerbaijan Medical University, Baku, Azerbaijan
| | - Mehdi Adeli
- Allergy and Immunology Division, Pediatrics Department, Sidra Medicine, Doha, Qatar
| | - Maryam Al-Nesf
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Amel Hassen
- Allergy and Immunology Division, Pediatrics Department, Sidra Medicine, Doha, Qatar
| | - Cybel Mehawej
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Carla Irani
- Internal Medicine and Clinical Immunology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Andre Megarbane
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Jessica Quinn
- Jeffrey Modell Foundation (JMF), New York City, NY, USA
| | | | - László Maródi
- PID Clinical Unit and Laboratory, Department of Dermatology, Semmelweis University, Budapest, Hungary.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller University, New York, NY, USA
| | - Vicki Modell
- Jeffrey Modell Foundation (JMF), New York City, NY, USA
| | - Fred Modell
- Jeffrey Modell Foundation (JMF), New York City, NY, USA
| | - Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat 13110, PO Box 24923, Kuwait City, Kuwait. .,Allergy and Clinical Immunology Unit, Pediatric Department, Al-Sabah Hospital, Kuwait City, Kuwait.
| | - Raif S Geha
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, 1 Blackfan Circle, Karp, Bldg, 10th Floor, Boston, MA, 02115, USA.
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. .,Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, 14186, Huddinge, Stockholm, Sweden.
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8
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Tahiat A, Yagoubi A, Ladj MS, Belbouab R, Aggoune S, Atek L, Bouziane D, Melzi S, Boubidi C, Drali W, Bendahmane C, Iguerguesdaoune H, Taguemount S, Soufane A, Oukil A, Ketfi A, Messaoudi H, Boukhenfouf N, Ifri MA, Bencharif Madani T, Belhadj H, Benhala KN, Khiari M, Cherif N, Smati L, Arada Z, Zeroual Z, Bouzerar Z, Ibsaine O, Maouche H, Boukari R, Djenouhat K. Diagnostic and Predictive Contribution of Autoantibodies Screening in a Large Series of Patients With Primary Immunodeficiencies. Front Immunol 2021; 12:665322. [PMID: 33868317 PMCID: PMC8047634 DOI: 10.3389/fimmu.2021.665322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate the diagnostic and predictive contribution of autoantibodies screening in patients with primary immunodeficiencies (PIDs). Methods In the present study, PID patients and healthy controls have been screened for 54 different autoantibodies. The results of autoantibodies screening in PID patients were correlated to the presence of autoimmune diseases. Results A total of 299 PID patients were included in this study with a predominance of antibody deficiencies (27.8%) followed by immunodeficiencies affecting cellular and humoral immunity (26.1%) and complement deficiencies (22.7%). Autoimmune manifestations were present in 82 (27.4%) patients. Autoimmune cytopenia (10.4%) was the most common autoimmune disease followed by gastrointestinal disorders (10.0%), rheumatologic diseases (3.7%), and endocrine disorders (3.3%). Autoantibodies were found in 32.4% of PID patients and 15.8% of healthy controls (P < 0.0005). Anti-nuclear antibodies (ANA) (10.0%), transglutaminase antibody (TGA) (8.4%), RBC antibodies (6.7%), anti-smooth muscle antibody (ASMA) (5.4%), and ASCA (5.0%) were the most common autoantibodies in our series. Sixty-seven out of the 82 patients with autoimmune manifestations (81.7%) were positive for one or more autoantibodies. Eleven out of the 14 patients (78.6%) with immune thrombocytopenia had positive platelet-bound IgM. The frequencies of ASCA and ANCA among patients with IBD were 47.4% and 21.0% respectively. All patients with celiac disease had TGA-IgA, while six out of the 11 patients with rheumatologic diseases had ANA (54.5%). Almost one third of patients (30/97) with positive autoantibodies had no autoimmune manifestations. ANA, rheumatoid factor, ASMA, anti-phospholipid antibodies and ANCA were often detected while specific AID was absent. Despite the low positive predictive value of TGA-IgA and ASCA for celiac disease and inflammatory bowel disease respectively, screening for these antibodies identified undiagnosed disease in four patients with positive TGA-IgA and two others with positive ASCA. Conclusion The present study provides valuable information about the frequency and the diagnostic/predictive value of a large panel of autoantibodies in PIDs. Given the frequent association of some AIDs with certain PIDs, screening for corresponding autoantibodies would be recommended. However, positivity for autoantibodies should be interpreted with caution in patients with PIDs due to their low positive predictive value.
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Affiliation(s)
- Azzeddine Tahiat
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Abdelghani Yagoubi
- Pediatric Gastroenterology, Centre Algérois de Pédiatrie, Algiers, Algeria
| | - Mohamed Samir Ladj
- Department of Pediatrics, Mustapha University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Reda Belbouab
- Department of Pediatrics, Mustapha University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Samira Aggoune
- Department of Pediatrics, El-Harrach Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Laziz Atek
- Department of Pediatrics, El-Harrach Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Djamila Bouziane
- Department of Pediatrics, Ain Taya Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Souhila Melzi
- Department of Pediatrics, Bab El-Oued University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Chahinez Boubidi
- Department of Pediatrics A, Hussein Dey University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Warda Drali
- Department of Pediatrics B, Hussein Dey University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | | | - Hamza Iguerguesdaoune
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Sihem Taguemount
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Asma Soufane
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Asma Oukil
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Abdalbasset Ketfi
- Department of Pneumology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Hassen Messaoudi
- Department of Internal Medicine, Mustapha University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | | | | | | | - Hayet Belhadj
- Department of Pediatrics, Central Hospital of the Army, Algiers, Algeria
| | - Keltoum Nafissa Benhala
- Department of Pediatrics A, Beni Messous University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Mokhtar Khiari
- Department of Pediatrics A, Beni Messous University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Nacera Cherif
- Department of Pediatrics B, Beni Messous University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Leila Smati
- Department of Pediatrics, Bologhine Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Zakia Arada
- Department of Pediatrics B, Hussein Dey University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Zoulikha Zeroual
- Department of Pediatrics A, Hussein Dey University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Zair Bouzerar
- Department of Pediatrics, Bab El-Oued University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Ouardia Ibsaine
- Department of Pediatrics, Ain Taya Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Hachemi Maouche
- Department of Pediatrics, El-Harrach Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Rachida Boukari
- Department of Pediatrics, Mustapha University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Kamel Djenouhat
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
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9
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Kechout N, Touri N, Saidani K, Dehimi A, Ladj S, Ferhani Y, Sedfi S, Benmesbah N, Abdellaoui N, Hadji H, Okka K, Kedji L, Boukari R, Attal N. Leukocyte adhesion deficiency type1 in Algeria. Meta Gene 2020. [DOI: 10.1016/j.mgene.2020.100746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Ben-Ali M, Kechout N, Mekki N, Yang J, Chan KW, Barakat A, Aadam Z, Gamara J, Gargouri L, Largueche B, BelHadj-Hmida N, Nedri A, Ameur HB, Mellouli F, Boukari R, Bejaoui M, Bousfiha A, Ben-Mustapha I, Lau YL, Barbouche MR. Genetic Approaches for Definitive Diagnosis of Agammaglobulinemia in Consanguineous Families. J Clin Immunol 2019; 40:96-104. [PMID: 31696364 DOI: 10.1007/s10875-019-00706-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
Autosomal recessive agammaglobulinemia (ARA) is a primary immunodeficiency characterized by absent peripheral B cells, severe hypogammaglobulinemia, and absent BTK gene mutations. In ARA, mutations occur in genes encoding the pre-B cell receptor (pre-BCR) or downstream signaling proteins. In this work, we used candidate gene and whole-exome sequencing to investigate the molecular basis of ARA in 6 patients from 4 consanguineous North-African families. Sanger sequencing of candidate genes encoding the pre-BCR components (ΙGΗΜ, CD79A, CD79B, IGLL1, and VPREB1) was initially performed and determined the genetic defect in five patients. Two novel mutations in IGHM (p.Val378Alafs*1 and p.Ile184Serfs*21) were identified in three patients from two unrelated kindred and a novel nonsense mutation was identified in CD79A (p.Trp66*) in two siblings from a third kindred. Whole-exome sequencing (WES) was performed on the sixth patient who harbored a homozygous stop mutation at position 407 in the RAG2 gene (p.Glu407*). We concluded that conventional gene sequencing, especially when multiple genes are involved in the defect as is the case in ARA, is costly and time-consuming, resulting in delayed diagnosis that contributes to increased morbidity and mortality. In addition, it fails to identify the involvement of novel and unsuspected gene defects when the phenotype of the patients is atypical. WES has the potential to provide a rapid and more accurate genetic diagnosis in ARA, which is crucial for the treatment of the patients.
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Affiliation(s)
- Meriem Ben-Ali
- Laboratory of Transmission, Control and Immunobiology of Infections, LR11IPT02 (LTCII), Institut Pasteur de Tunis, 13, place Pasteur, BP74, 1002, Tunis-Belvédère, Tunisia.,Université Tunis El Manar, 1068, Tunis, Tunisia
| | - Nadia Kechout
- Department of Immunology, Institut Pasteur d'Algérie, Algiers, Algeria.,Faculty of Medicine of Algiers, Algiers, Algeria
| | - Najla Mekki
- Laboratory of Transmission, Control and Immunobiology of Infections, LR11IPT02 (LTCII), Institut Pasteur de Tunis, 13, place Pasteur, BP74, 1002, Tunis-Belvédère, Tunisia.,Université Tunis El Manar, 1068, Tunis, Tunisia
| | - Jing Yang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Koon Wing Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Abdelhamid Barakat
- Laboratory of Molecular and Human Genetics, Department of Scientific Research, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Zahra Aadam
- Laboratory of Molecular and Human Genetics, Department of Scientific Research, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Jouda Gamara
- Laboratory of Transmission, Control and Immunobiology of Infections, LR11IPT02 (LTCII), Institut Pasteur de Tunis, 13, place Pasteur, BP74, 1002, Tunis-Belvédère, Tunisia.,Université Tunis El Manar, 1068, Tunis, Tunisia
| | - Lamia Gargouri
- Department of Paediatrics, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Beya Largueche
- Laboratory of Transmission, Control and Immunobiology of Infections, LR11IPT02 (LTCII), Institut Pasteur de Tunis, 13, place Pasteur, BP74, 1002, Tunis-Belvédère, Tunisia.,Université Tunis El Manar, 1068, Tunis, Tunisia
| | - Nabil BelHadj-Hmida
- Laboratory of Transmission, Control and Immunobiology of Infections, LR11IPT02 (LTCII), Institut Pasteur de Tunis, 13, place Pasteur, BP74, 1002, Tunis-Belvédère, Tunisia.,Université Tunis El Manar, 1068, Tunis, Tunisia
| | - Amel Nedri
- Department of Paediatrics, Medenine Hospital, Medenine, Tunisia
| | | | - Fethi Mellouli
- National Bone Marrow Transplantation Center, Jebel Lakhdar, Tunis, Tunisia
| | - Rachida Boukari
- Department of Pediatrics, CHU Mustapha-Bacha, Faculty of Medicine of Algiers, Algiers, Algeria
| | - Mohamed Bejaoui
- National Bone Marrow Transplantation Center, Jebel Lakhdar, Tunis, Tunisia
| | - Aziz Bousfiha
- Clinical Immunology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Ibn Rochd, King Hassan II University, Casablanca, Morocco
| | - Imen Ben-Mustapha
- Laboratory of Transmission, Control and Immunobiology of Infections, LR11IPT02 (LTCII), Institut Pasteur de Tunis, 13, place Pasteur, BP74, 1002, Tunis-Belvédère, Tunisia.,Université Tunis El Manar, 1068, Tunis, Tunisia
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Mohamed-Ridha Barbouche
- Laboratory of Transmission, Control and Immunobiology of Infections, LR11IPT02 (LTCII), Institut Pasteur de Tunis, 13, place Pasteur, BP74, 1002, Tunis-Belvédère, Tunisia. .,Université Tunis El Manar, 1068, Tunis, Tunisia.
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11
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Derrar F, Izri K, Kaddache C, Boukari R, Hannoun D. Virologic study of acute lower respiratory tract infections in children admitted to the paediatric department of Blida University Hospital, Algeria. New Microbes New Infect 2019; 30:100536. [PMID: 31193119 PMCID: PMC6517316 DOI: 10.1016/j.nmni.2019.100536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023] Open
Abstract
Acute lower respiratory tract infections (ALRTI) such as pneumonia and bronchiolitis are major causes of mortality and morbidity in children under 5 years of age. The main microbial agents responsible for ALRTI are either bacterial agents (Streptococcus pneumoniae, Haemophilus influenzae type b, Mycoplasma pneumoniae) or viruses (respiratory syncytial virus (RSV, also known as human orthopneumovirus), Myxovirus influenzae, Myxovirus parainfluenzae, adenovirus) [1]. More recently, other viruses (rhinovirus, metapneumovirus, coronavirus, bocavirus) have been implicated in ALRTI; their identification has been facilitated by new molecular biology techniques such as real-time PCR. To our knowledge, these emerging viruses have never been the subject of epidemiologic studies in our country.
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Affiliation(s)
- F Derrar
- Viral Respiratory Unit, Virology Department, Institut Pasteur of Algeria, Algiers, Algeria
| | - K Izri
- Viral Respiratory Unit, Virology Department, Institut Pasteur of Algeria, Algiers, Algeria
| | - C Kaddache
- Paediatric Department, University Hospital of Blida, Blida, Algeria
| | - R Boukari
- Paediatric Department, University Hospital of Blida, Blida, Algeria
| | - D Hannoun
- National Institut of Public Health, Algeria
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12
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El-Sayed ZA, Abramova I, Aldave JC, Al-Herz W, Bezrodnik L, Boukari R, Bousfiha AA, Cancrini C, Condino-Neto A, Dbaibo G, Derfalvi B, Dogu F, Edgar JDM, Eley B, El-Owaidy RH, Espinosa-Padilla SE, Galal N, Haerynck F, Hanna-Wakim R, Hossny E, Ikinciogullari A, Kamal E, Kanegane H, Kechout N, Lau YL, Morio T, Moschese V, Neves JF, Ouederni M, Paganelli R, Paris K, Pignata C, Plebani A, Qamar FN, Qureshi S, Radhakrishnan N, Rezaei N, Rosario N, Routes J, Sanchez B, Sediva A, Seppanen MR, Serrano EG, Shcherbina A, Singh S, Siniah S, Spadaro G, Tang M, Vinet AM, Volokha A, Sullivan KE. X-linked agammaglobulinemia (XLA):Phenotype, diagnosis, and therapeutic challenges around the world. World Allergy Organ J 2019; 12:100018. [PMID: 30937141 PMCID: PMC6439403 DOI: 10.1016/j.waojou.2019.100018] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/29/2019] [Accepted: 02/13/2019] [Indexed: 11/17/2022] Open
Abstract
Background X-linked agammaglobulinemia is an inherited immunodeficiency recognized since 1952. In spite of seven decades of experience, there is still a limited understanding of regional differences in presentation and complications. This study was designed by the Primary Immunodeficiencies Committee of the World Allergy Organization to better understand regional needs, challenges and unique patient features. Methods A survey instrument was designed by the Primary Immunodeficiencies Committee of the World Allergy Organization to collect both structured and semi-structured data on X-linked agammaglobulinemia. The survey was sent to 54 centers around the world chosen on the basis of World Allergy Organization participation and/or registration in the European Society for Immunodeficiencies. There were 40 centers that responded, comprising 32 countries. Results This study reports on 783 patients from 40 centers around the world. Problems with diagnosis are highlighted by the reported delays in diagnosis>24 months in 34% of patients and the lack of genetic studies in 39% of centers Two infections exhibited regional variation. Vaccine-associated paralytic poliomyelitis was seen only in countries with live polio vaccination and two centers reported mycobacteria. High rates of morbidity were reported. Acute and chronic lung diseases accounted for 41% of the deaths. Unusual complications such as inflammatory bowel disease and large granular lymphocyte disease, among others were specifically enumerated, and while individually uncommon, they were collectively seen in 20.3% of patients. These data suggest that a broad range of both inflammatory, infectious, and autoimmune conditions can occur in patients. The breadth of complications and lack of data on management subsequently appeared as a significant challenge reported by centers. Survival above 20 years of age was lowest in Africa (22%) and reached above 70% in Australia, Europe and the Americas. Centers were asked to report their challenges and responses (n = 116) emphasized the difficulties in access to immunoglobulin products (16%) and reflected the ongoing need for education of both patients and referring physicians. Conclusions This is the largest study of patients with X-linked agammaglobulinemia and emphasizes the continued morbidity and mortality of XLA despite progress in diagnosis and treatment. It presents a world view of the successes and challenges for patients and physicians alike. A pivotal finding is the need for education of physicians regarding typical symptoms suggesting a possible diagnosis of X-linked agammaglobulinemia and sharing of best practices for the less common complications.
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Affiliation(s)
- Zeinab A El-Sayed
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Irina Abramova
- Department of Immunology, National Medical and Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Juan Carlos Aldave
- Primary Immunodeficiency Unit, Allergy and Immunology Division, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Allergy and Clinical Immunology Unit, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Liliana Bezrodnik
- Immunology Unit Hospital de Niños Ricardo Gutiérrez and CIC (Clinical Immunology Center), CABA, Buenos Aires, Argentina
| | - Rachida Boukari
- Department of Immunology, Institut Pasteur d'Algérie, Faculty of Medicine, Algiers, Algeria
| | - Ahmed Aziz Bousfiha
- Clinical Immunology Unit, P1, Ibn Rushd Hospital, Laboratoire d'Immunologie Clinique, Inflammation et Allergie LICIA and Medicine and Pharmacy Faculty of Hassan II University, Casablanca, Morocco
| | - Caterina Cancrini
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Childrens' Hospital Bambino Gesù, "University of Rome Tor Vergata", Rome, Italy
| | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo - Sp, Brazil
| | - Ghassan Dbaibo
- Division of Pediatric Infectious Diseases and Center for Infectious Diseases Research, Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Beata Derfalvi
- Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Figen Dogu
- Ankara University School of Medicine, Department of Pediatric Immunology and Allergy, Ankara, Turkey
| | - J David M Edgar
- The Royal Hospitals & Queen's University Belfast, United Kingdom
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Rasha Hasan El-Owaidy
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Nermeen Galal
- Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt
| | - Filomeen Haerynck
- Primary Immunodeficiency Research Lab, Ghent University, Belgium.,Centre for Primary Immunodeficiency, Department of Pediatric Pulmonology and Immunology, Ghent University Hospital, Belgium
| | - Rima Hanna-Wakim
- Division of Pediatric Infectious Diseases and Center for Infectious Diseases Research, Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Elham Hossny
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Aydan Ikinciogullari
- Ankara University School of Medicine, Department of Pediatric Immunology and Allergy, Ankara, Turkey
| | - Ebtihal Kamal
- Department of Microbiology, Parasitology and Immunology, Faculty of Medicine, University of Khartoum, Sudan
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Nadia Kechout
- Department of Immunology, Institut Pasteur d'Algérie, Faculty of Medicine, Algiers, Algeria
| | - Yu Lung Lau
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomohiro Morio
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Joao Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central and CEDOC Nova Medical School, Lisboa, Portugal
| | - Monia Ouederni
- Pediatric Immuno-hematology Unit, Bone Marrow Transplantation Center, University Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Roberto Paganelli
- Department of Medicine and Sciences of Aging, University "G. d'Annunzio" of Chieti-Pescara, Italy
| | | | - Claudio Pignata
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Alessandro Plebani
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Farah Naz Qamar
- Department of Pediatric and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Sonia Qureshi
- Department of Pediatric and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Nita Radhakrishnan
- Department of Pediatric Hematology Oncology, Super Speciality Pediatric Hospital and PG Teaching Institute, Noida, India
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, and Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | | | - John Routes
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Berta Sanchez
- Servicio de Inmunología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Anna Sediva
- Department of Immunology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Mikko Rj Seppanen
- Rare Diseases Center, Children's Hospital and Adult Immunodeficiency Unit, Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Edith Gonzalez Serrano
- The Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
| | - Anna Shcherbina
- Department of Immunology, National Medical and Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Surjit Singh
- Department of Pediatrics and Chief, Allergy Immunology Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sangeetha Siniah
- Paediatric Institute Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia.,Department of Allergy and Immunology, The Royal Children's Hospital Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Mimi Tang
- The University of Melbourne, Australia
| | | | - Alla Volokha
- Department of Pediatric Infectious Diseases and Immunology, Shupyk National Medical Academy of Postgraduate Education and Center for Clinical Immunology, City Children's Hospital N1, Kiev, Ukraine
| | - Kathleen E Sullivan
- Division of Allergy Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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13
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Goga Y, Boukari R, Bensadok M, El Khorassani M, Khelif A, Al Rawas A, Alkasim F, Shaheen NM, Negrier C. REACH: A programme for improving care in haemophilia. Haemophilia 2019; 25:e211-e215. [PMID: 30888109 DOI: 10.1111/hae.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Yasmin Goga
- Department of Paediatrics & Child Health, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Rachida Boukari
- Paediatric Department, University Hospital Mustapha Pacha, Algiers, Algeria
| | - Meriem Bensadok
- Haematology and Blood Bank, Haemophilia Treatment Centre, Beni-Messous University Hospital, Algiers, Algeria
| | - Mohamed El Khorassani
- Haemophilia Treatment Centre, Haematology and Oncology Unit, Mohammed V University Hospital, Rabat, Morocco
| | | | | | | | | | - Claude Negrier
- Louis Pradel Hospital, University Claude Bernard, Lyon, France
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Bousfiha AA, Errami A, Jeddane L, Mellouli F, Reda SM, Adeli M, Al-Herz W, Zyoud R, Erwa N, Suleiman Y, Boukari R, Dakkoune M, Yagoubi A, Al-Mousa H, Arnaout R, Alhamadi S, Bejaoui M, Barbouche MR, AlSaoud B, Al-Dhekri H. Primary Immunodeficiencies: Epidemiology in the Maghreb. Tunis Med 2018; 96:672-677. [PMID: 30746660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Primary Immunodeficiency (PIDs) is a set of 330 rare hereditary diseases that increase susceptibility to infections, allergies, autoimmunity, and neoplasia. North American registries give higher prevalence than Maghreb ones, whereas consanguinity is high. The purpose of this study is to compare prevalence and coverage rate of Maghreb PID registries with estimates based on USA. METHODS We searched the prevalence of PIDs in the Maghreb registers. Next, we estimated the expected values based on recent publications. Finally, we calculated the coverage rate of the Maghreb registries compared to the new estimates and we evaluated the impact of consanguinity. RESULTS The total number is N1 = 2456 patients. The current Maghreb PID Prevalence is 2.56 / 100,000 inhabitants (population of 94,804,694 Million in 2017). Tunisia leads with a prevalence of 8.70 followed by Morocco 2.09, Libya 1.65 and Algeria 1.46/100.000 habitants. We did not find values for Mauritania. If we extrapolate the prevalence of the USA to the Maghreb population, the number of patients in the Maghreb would be N2 = 27,588 and the coverage rate (N1 / N2) would be 8.90%. This low coverage rate is however better than the World average (1.21%), that of Latin America 1.19% and Africa 0.36%. The Maghreb prevalence is close to that of the Arab world 2.04 / 100,000 (population of 391,449,544 in 2017). Using the incidence found in the USA, the number of patients would be 9765 new patients per year in the Maghreb and 40,319 in Arab countries. CONCLUSION PID Maghreb patients number is very low compared to global estimates, whereas consanguinity is very high. Special attention should be given to PIDs by governments and research teams in this region.
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15
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Darmon A, Leduc N, Delaigue S, Ginouves M, Bonini J, Dufour J, Prevot G, Sainte-Marie D, Labbé S, Boukari R, Nacher M, Demar M, Couppié P. Leishmaniose cutanée multilésionnelle en Guyane française : étude comparative. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Benamrouche N, Tali Maamar H, Lazri M, Hasnaoui S, Radoui A, Lafer O, Boukari R, Kaddache C, Arrada Z, Rahal K. Pertussis in north-central and northwestern regions of Algeria. J Infect Dev Ctries 2016; 10:1191-1199. [PMID: 27886031 DOI: 10.3855/jidc.7262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Pertussis outbreaks continue to occur in many countries despite high vaccination coverage. Under-diagnosed cases in adolescents and adults may result in increased transmission to infants, who are at risk of severe pertussis. Additional measures to protect both groups should be considered. METHODOLOGY Nasopharyngeal samples and sera were collected from patients and household contacts with clinically suspected pertussis. Diagnoses were confirmed by culture, real-time polymerase chain reaction (PCR), and serology. Bordetella pertussis isolates were characterized by antimicrobial sensitivity and fimbrial serotyping. RESULTS Of 392 participants, 134/248 patients (54%) and 66/144 contacts (45.8%) had confirmed pertussis infections. B. parapertussis was not detected. All B. pertussis isolates were sensitive to the antibiotics tested, and all expressed the Fim3, not the Fim2, fimbrial serotype. Most patients (81.2%) were <6 months (51.8% of whom were <3 months) of age; 77.6% were unvaccinated, and most positive contacts were mothers 20-40 years of age. CONCLUSIONS Despite high vaccination coverage, pertussis is circulating in Algeria. Most infections occur in unvaccinated infants <6 months of age, with mothers as the main source of infection. An adolescent/adult booster should be considered. Adoption of sensitive and specific laboratory tests would improve pertussis diagnosis and surveillance.
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17
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Aadam Z, Kechout N, Barakat A, Chan KW, Ben-Ali M, Ben-Mustapha I, Zidi F, Ailal F, Attal N, Doudou F, Abbadi MC, Kaddache C, Smati L, Touri N, Chemli J, Gargah T, Brini I, Bakhchane A, Charoute H, Jeddane L, El Atiqi S, El Hafidi N, Hida M, Saile R, Alj HS, Boukari R, Bejaoui M, Najib J, Barbouche MR, Lau YL, Mellouli F, Bousfiha AA. X-Linked Agammagobulinemia in a Large Series of North African Patients: Frequency, Clinical Features and Novel BTK Mutations. J Clin Immunol 2016; 36:187-94. [PMID: 26931785 DOI: 10.1007/s10875-016-0251-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/21/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE X-linked agammagobulinemia (XLA) is a primary immunodeficiency caused by Bruton's tyrosine kinase (BTK) gene defect. XLA patients have absent or reduced number of peripheral B cells and a profound deficiency in all immunoglobulin isotypes. This multicenter study reports the clinical, immunological and molecular features of Bruton's disease in 40 North African male patients. METHODS Fifty male out of 63 (male and female) patients diagnosed with serum agammaglobulinemia and non detectable to less than 2% peripheral B cells were enrolled. The search for BTK gene mutations was performed for all of them by genomic DNA amplification and Sanger sequencing. RESULTS We identified 33 different mutations in the BTK gene in 40 patients including 12 missense mutations, 6 nonsense mutations, 6 splice-site mutations, 5 frameshift, 2 large deletions, one complex mutation and one in-frame deletion. Seventeen of these mutations are novel. This large series shows a lower frequency of XLA among male patients from North Africa with agammaglobulinemia and absent to low B cells compared with other international studies (63.5% vs. 85%). No strong evidence for genotype-phenotype correlation was observed. CONCLUSIONS This study adds to other reports from highly consanguineous North African populations, showing lower frequency of X-linked forms as compared to AR forms of the same primary immunodeficiency. Furthermore, a large number of novel BTK mutations were identified and could further help identify carriers for genetic counseling.
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Affiliation(s)
- Zahra Aadam
- Laboratory of Biology and Health URAC34-Metabolic and Immunologic pathology Research Team, Faculty of Science of BenM'sik, King Hassan II University, Casablanca, Morocco
- Institut Pasteur, Human Molecular Genetic Laboratory, Casablanca, Morocco
| | - Nadia Kechout
- Department of Immunology, Institut Pasteur d'Algérie, Faculty of Medicine, Algiers, Algeria
| | - Abdelhamid Barakat
- Institut Pasteur, Human Molecular Genetic Laboratory, Casablanca, Morocco.
| | - Koon-Wing Chan
- Departments of Pediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Meriem Ben-Ali
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, and University Tunis El Manar, Tunis, Tunisia
| | - Imen Ben-Mustapha
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, and University Tunis El Manar, Tunis, Tunisia
| | - Fethi Zidi
- Department of Pediatrics, Regional Hospital of Tozeur, Tozeur, Tunisia
| | - Fatima Ailal
- Clinical Immunology Unit, Ibn Rochd Hospital, King Hassan II University-AinChok, Casablanca, Morocco
| | - Nabila Attal
- Department of Immunology, Institut Pasteur d'Algérie, Faculty of Medicine, Algiers, Algeria
| | - Fatouma Doudou
- Department of Immunology, Institut Pasteur d'Algérie, Faculty of Medicine, Algiers, Algeria
| | - Mohamed-Cherif Abbadi
- Department of Immunology, Institut Pasteur d'Algérie, Faculty of Medicine, Algiers, Algeria
| | | | - Leila Smati
- Department of Pediatrics, EPH Bologhine, Faculty of Medicine, Algiers, Algeria
| | - Nabila Touri
- Department of Pediatrics, CHU Blida, Blida, Algeria
| | - Jalel Chemli
- Department of Pediatrics, Sahloul Hospital, Sousse, Tunisia
| | - Tahar Gargah
- Department of Pediatrics, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ines Brini
- Department of Pediatrics B, Children's Hospital of Tunis, Tunis, Tunisia
| | - Amina Bakhchane
- Institut Pasteur, Human Molecular Genetic Laboratory, Casablanca, Morocco
| | - Hicham Charoute
- Institut Pasteur, Human Molecular Genetic Laboratory, Casablanca, Morocco
| | - Leila Jeddane
- Clinical Immunology Unit, Ibn Rochd Hospital, King Hassan II University-AinChok, Casablanca, Morocco
| | - Sara El Atiqi
- Clinical Immunology Unit, Ibn Rochd Hospital, King Hassan II University-AinChok, Casablanca, Morocco
| | - Naïma El Hafidi
- Department of Pediatric Infectious Diseases, Avicenne University Hospital, Rabat, Morocco
| | - Mustapha Hida
- Department of Pediatrics, Hassan II University Hospital, Fez, Morocco
| | - Rachid Saile
- Laboratory of Biology and Health URAC34-Metabolic and Immunologic pathology Research Team, Faculty of Science of BenM'sik, King Hassan II University, Casablanca, Morocco
| | - Hanane Salih Alj
- Laboratory of Biology and Health URAC34-Metabolic and Immunologic pathology Research Team, Faculty of Science of BenM'sik, King Hassan II University, Casablanca, Morocco
| | - Rachida Boukari
- Department of Pediatrics, CHU Mustapaha Bacha, Faculty of Medicine, Algiers, Algeria
| | - Mohamed Bejaoui
- National Bone Marrow Transplantation Center, Jebel Lakhdar, Tunis, Tunisia
| | - Jilali Najib
- Clinical Immunology Unit, Ibn Rochd Hospital, King Hassan II University-AinChok, Casablanca, Morocco
| | - Mohamed-Ridha Barbouche
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, and University Tunis El Manar, Tunis, Tunisia
| | - Yu-Lung Lau
- Departments of Pediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Fethi Mellouli
- National Bone Marrow Transplantation Center, Jebel Lakhdar, Tunis, Tunisia
| | - Ahmed Aziz Bousfiha
- Clinical Immunology Unit, Ibn Rochd Hospital, King Hassan II University-AinChok, Casablanca, Morocco
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Giovannini-Chami L, Blanc S, Hadchouel A, Baruchel A, Boukari R, Dubus JC, Fayon M, Le Bourgeois M, Nathan N, Albertini M, Clément A, de Blic J. Eosinophilic pneumonias in children: A review of the epidemiology, diagnosis, and treatment. Pediatr Pulmonol 2016; 51:203-16. [PMID: 26716396 DOI: 10.1002/ppul.23368] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/24/2015] [Accepted: 12/02/2015] [Indexed: 12/19/2022]
Abstract
Pediatric eosinophilic pneumonias (EPs) are characterized by a significant infiltration of the alveolar spaces and lung interstitium by eosinophils, with conservation of the lung structure. In developed countries, EPs constitute exceptional entities in pediatric care. Clinical symptoms may be transient (Löffler syndrome), acute (<1 month and mostly <7 days), or chronic (>1 month). Diagnosis relies on demonstration of alveolar eosinophilia on bronchoalveolar lavage, whether or not associated with blood eosinophilia. EPs are a heterogeneous group of disorders divided into: (i) secondary forms (seen mainly in parasitic infections, allergic bronchopulmonary aspergillosis, and drug reactions); and (ii) primary forms (eosinophilic granulomatosis with polyangiitis, hypereosinophilic syndrome, idiopathic chronic eosinophilic pneumonia, and idiopathic acute eosinophilic pneumonia). Despite their rarity, the etiological approach to EP must be well-defined as some causes can be rapidly life-threatening without initiation of the proper treatment. This approach (i) eliminates secondary forms, with comprehensive history taking and minimal biological assessment, (ii) is oriented in primary forms by the acute or chronic setting, and the existence of extrapulmonary symptoms. Treatment of primary forms has traditionally relied on corticosteroids, usually with a dramatic response. Specific treatments or the adjunction of corticosteroid-sparing treatment or immunosuppressors are currently being evaluated in order to improve the prognosis and the side effects associated with corticosteroid treatment in a pediatric setting.
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Affiliation(s)
- Lisa Giovannini-Chami
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.,Université de Nice Sophia Antipolis, Nice, France
| | - Sibylle Blanc
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Alice Hadchouel
- Department of Pediatric Pulmonology, AP-HP, Hôpital Necker Enfants Malades, Paris, France.,Université Paris Descartes-Paris 5, Paris, France
| | - André Baruchel
- Department of Pediatric Hematology, AP-HP, Hôpital Robert Debré, Paris, France.,Université Paris Diderot VII, Paris, France
| | - Rachida Boukari
- Department of Pediatric Pulmonology, Centre Hospitalier Universitaire Mustapha, Alger, Algérie
| | - Jean-Christophe Dubus
- Department of Pediatric Pulmonology, Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - Michael Fayon
- Department of Pediatric Pulmonology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Département de Pédiatrie, Centre d'Investigation Clinique, Bordeaux, France
| | - Muriel Le Bourgeois
- Department of Pediatric Pulmonology, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Nadia Nathan
- Department of Pediatric Pulmonology, AP-HP, Hôpital Trousseau, Paris, France.,Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Marc Albertini
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.,Université de Nice Sophia Antipolis, Nice, France
| | - Annick Clément
- Department of Pediatric Pulmonology, AP-HP, Hôpital Trousseau, Paris, France.,Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Jacques de Blic
- Department of Pediatric Pulmonology, AP-HP, Hôpital Necker Enfants Malades, Paris, France.,Université Paris Descartes-Paris 5, Paris, France
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Salhi A, Slaouti M, Laadjal M, Hasnaoui A, Aitbelkacem F, Djéridane A, Lebane J, Benkaidali I, Mani S, Ammarkhodja A, Bouadjar B, Boukari R, Belkaid Z, Aitbenamar A, Syed S, Enjolras O. Phénomène de Kasabach-Merritt réfractaire traité par sirolimus : réponse inconstante (3 cas). Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Hadji A, Sokhal S, Cherif S, Kaabouche L, Boukari R. CO-46 – Aspects cliniques, génotypiques et évolutifs de la maladie de gaucher chez l'enfant algérien. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Khelafi N, Baghdali N, Boukari R. P-291 – Syndrome de munschausen par procuration a propos d'un cas. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30471-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Bousfiha AA, Jeddane L, Erwa N, Dieye TN, Mellouli F, Reda SM, Esser M, Boukari R. Development of Primary Immunodeficiencies in Africa. J Clin Immunol 2015; 35:329-30. [DOI: 10.1007/s10875-015-0162-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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24
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Atif ML, Sadaoui F, Bezzaoucha A, Kaddache CA, Boukari R, Djelato S, Boubechou N. Prolongation of Hospital Stay and Additional Costs Due to Nosocomial Bloodstream Infection in an Algerian Neonatal Care Unit. Infect Control Hosp Epidemiol 2015; 29:1066-70. [DOI: 10.1086/591858] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Previous studies from developed countries reported that nosocomial bloodstream infection (BSI) in neonatal care units (NCUs) increases length of stay and costs. However, no such information is available for Algerian NCUs.Objective.To evaluate the influence of BSI in neonates on additional charges and length of hospital stay.Design.Prospective, nested case-control study.Setting.The 47-bed NCU of the University Hospital of Blida, Algeria.Patients and Methods.A total of 83 neonates with BSIs (case patients) and 166 neonates without BSIs (control patients), admitted to the NCU during the study period (April 2004 through December 2007), were matched for sex, birth weight, length of NCU stay, and year of hospital admission. Each patient's length of stay in the NCU was obtained prospectively on daily rounds. The estimated cost of each NCU-day was provided by the hospital's finance department. The cost of antibiotics prescribed was provided by the hospital's pharmacy department.Results.The mean additional length of NCU stay for case patients, compared with control patients, was 9.2 days (24.3 vs 15.1 days). The mean additional cost of antibiotics was $546. The mean cumulative additional cost was $1,315.Conclusion.This study highlights the effect of BSI on extra costs for NCU patients, especially costs due to prolongation of hospital stay and increased antibiotic use, and suggests that NCUs in Algeria have a financial interest in reducing the rate of BSI.
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Atif M, Sadaoui F, Boubechou N, Bezzaoucha A, Kaddache C, Boukari R. Mortalité attribuable à une gastro-entérite acquise dans un service de réanimation néonatale, Blida, Algérie. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Boufersaoui A, Smati L, Benhalla KN, Boukari R, Smail S, Anik K, Aouameur R, Chaouche H, Baghriche M. WITHDRAWN : Corps étrangers respiratoires chez l’enfant : expérience algérienne de 2624 cas. Arch Pediatr 2014:S0929-693X(14)00329-7. [PMID: 25149659 DOI: 10.1016/j.arcped.2014.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/07/2014] [Accepted: 07/16/2014] [Indexed: 11/21/2022]
Affiliation(s)
- A Boufersaoui
- Service de pédiatrie, EPH Bologhine Ibn Ziri, Algérie
| | - L Smati
- Service de pédiatrie, EPH Bologhine Ibn Ziri, Algérie
| | - K N Benhalla
- Service de pédiatrie, EPH Bologhine Ibn Ziri, Algérie
| | - R Boukari
- Service de pédiatrie, EPH Bologhine Ibn Ziri, Algérie
| | - S Smail
- Service de pédiatrie, EPH Bologhine Ibn Ziri, Algérie
| | - K Anik
- Service de réanimation, EPH Bologhine Ibn Ziri, Algérie
| | - R Aouameur
- Service de réanimation, EPH Bologhine Ibn Ziri, Algérie
| | - H Chaouche
- Service de chirurgie thoracique, CHU Mustapha, Algérie
| | - M Baghriche
- Service de pédiatrie, EPH Bologhine Ibn Ziri, Algérie.
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Boufersaoui A, Smati L, Benhalla KN, Boukari R, Smail S, Anik K, Aouameur R, Chaouche H, Baghriche M. Foreign body aspiration in children: experience from 2624 patients. Int J Pediatr Otorhinolaryngol 2013; 77:1683-8. [PMID: 23962764 DOI: 10.1016/j.ijporl.2013.07.026] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective of this study is to analyze the epidemiological, clinical, radiological and endoscopic characteristics of pediatric foreign body aspiration in Algeria. METHODS In this retrospective study, the results of 2624 children younger than 18 years admitted in our department for respiratory foreign body removal between 1989 and 2012, were presented. Most of them had an ambulatory rigid bronchoscopy. RESULTS The children (62.34% males and 37.65% females) were aged 4 months to 18 years with 66% between 1 and 3 years. Choking was related in 65% of cases. The delay between aspiration and removal was 2-8 days in 65.8% and within 24 h in 9.2%. In the most cases, the children arrived with cough, laryngeal or bronchial signs and unilateral reduction of vesicular murmur. The examination was normal in 13%. The most common radiologic finding was pulmonary air trapping (40.7%). The aspirated bodies were organic in 66.7%, dominated by peanuts, while sunflower seeds, beans and ears of wheat were the most dangerous. In the other cases, they were metallic or plastic as pen caps and recently scarf pins. The endoscopic removal by rigid bronchoscopy was successful and complete in 97%. Cases with extraction failure (3%) limited to certain FBs, all of them inorganic were assigned to surgery. The complications related to the endoscopic procedure were 0.29% with a mortality of 0.26%. CONCLUSION Foreign body aspiration is a real public health problem in Algeria. The best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff. The prevention of this domestic accident should consider the population lifestyle and cultural habits to be more effective.
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Affiliation(s)
- A Boufersaoui
- Department of Pediatrics, Bologhine Ibn Ziri Hospital, Algiers, Algeria
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Lamine AM, Sadaoui F, Boubechou N, Bezzaoucha A, Kaddache CA, Boukari R. P094: Impact of antibiotics changes on the incidence of bloodstream infection due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an Algerian neonatal intensive care unit. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688501 DOI: 10.1186/2047-2994-2-s1-p94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kechout N, Attal N, Doudou F, Boukari R, Ardjoun M, Abbadi MC. Study of primary immunodeficiencies in Algeria. BMC Proc 2011. [PMCID: PMC3019460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Nadia Kechout
- Department of Immunology, Institut Pasteur d’Algérie, Algiers, Algeria
| | - Nabila Attal
- Department of Immunology, Institut Pasteur d’Algérie, Algiers, Algeria
| | - Fetouma Doudou
- Department of Immunology, Institut Pasteur d’Algérie, Algiers, Algeria
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Atif ML, Sadaoui F, Bezzaoucha A, Kaddache CA, Boukari R, Djelato S, Boubechou N. Reduction of nosocomial pneumonia using surveillance and targeted interventions in an Algerian neonatal intensive care unit. Infect Control Hosp Epidemiol 2009; 30:712-3. [PMID: 19496652 DOI: 10.1086/598337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Mohamed Lamine Atif
- Department of Epidemiology and Preventive Medicine, University Hospital of Blida, Blida, Algeria.
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Atakouma Dzayissé Y, Tsolenyanu E, Gbadoe A, Boukari R, Lawson-Evi K, Agbèrè A, Tatagan-Agbi A, Assimadi J. [Usefulness of integrated management of childhood illness for caring children less than 5 years in peripheral health centres at Lome (Togo)]. Arch Pediatr 2006; 13:1552-3. [PMID: 17046220 DOI: 10.1016/j.arcped.2006.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Accepted: 09/05/2006] [Indexed: 10/24/2022]
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Niel F, Legendre M, Bienvenu T, Bieth E, Lalau G, Sermet I, Bondeux D, Boukari R, Derelle J, Levy P, Ruszniewski P, Martin J, Costa C, Goossens M, Girodon E. A new large CFTR rearrangement illustrates the importance of searching for complex alleles. Hum Mutat 2006; 27:716-7. [PMID: 16786510 DOI: 10.1002/humu.9431] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The p.Val754Met variant, described in 1996 in a CF patient, has been considered a CF mutation. However, biochemical aspects, results of functional studies and, finally, the identification of a complex deletion removing exons 3 to 10 and 14b to 16 in cis of p.Val754Met in a CF patient, argue against a strong deleterious effect. An inventory through the French CF network of patients carrying p.Val754Met led to the registration of seven patients (CF: n=4; idiopathic chronic pancreatitis: n=3) and six healthy individuals, all heterozygous for the variation. Extensive CFTR gene analysis was carried out, including the search for large rearrangements and other possible mutations. The complex deletion, whose breakpoints are described here, was found only in the four CF patients, in association with the same haplotype. This data, added to the fact that the p.[Phe508del]+[Val754Met] genotype was found in a healthy individual, bring further arguments against the association of p.Val754Met with CF. We thus suggest looking for a possible complex allele whenever p.Val754Met is detected and considering it neutral regarding genetic counseling when found in isolation.
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Affiliation(s)
- F Niel
- Service de Biochimie-Génétique, Hôpital Henri Mondor AP-HP, Créteil, France
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Smati-Bourtel I, Boukari R, Benhaila-Djadoun N, Benhassine F, Arbia-Bennaceur M, Bekhoucha F, Maghricbe M. Les deficits immunitaires de l'enfant: Aspects diagnostics et problemes therapeutiques. Arch Pediatr 1999. [DOI: 10.1016/s0929-693x(99)81621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Boukari R, Smati-Bourtel L, Benhalla-Djadoun K, Boufersaoui A, Benhassine F, Arbia-Bennaceur M, Baghriche M. Corps etrangers tracheobronchiques chez l'enfant: experience de 11 annees. Arch Pediatr 1999. [DOI: 10.1016/s0929-693x(99)81818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Benhalla-Djadoun N, Smati-Bourtel L, Benhassine F, Bennaceur M, Loumi O, Boukari R, Baghriche M. Problemes poses par la muccoviscidose en algerie. Arch Pediatr 1999. [DOI: 10.1016/s0929-693x(99)81796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Boukari R, Trang H, Grossi Y, Bernard A, Gaultier C. Reproductibilite de la mesure des resistances respiratoires par la methode de l'interruption du debit aerien chez l'enfant. Arch Pediatr 1996. [DOI: 10.1016/0929-693x(96)86139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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