2 J Contemp Med Sci | Vol. 2, No. 5, Winter 2016: 2–8 Research Objectives The findings of the study have proved that there is a high significant positive relationship between the parents’ knowledge and their demographic variables (age, educational level, occupation and residential area). In general, knowledge of parents related to measles was low however, the parents applied preventive practices towards their children with measles. A cross-sectional study was conducted in Al-Elwyia paediatric teaching hospital in Baghdad from the middle of June till the end of September 2014, in order to identify parents’ knowledge of their children with measles. Aim To identify the effectiveness of traditional knowledge of parents’ whose children suffer from measles. Methodology Purposive sample of 100 parents who accompanied their children with measles have been selected. The reliability of the instrument was determined through a test and validating through a panel of experts. The data was analysed through the application of descriptive statistical analysis that include frequency, mean, mean of scores, standard deviation and percentage and the application of inferential statistical analysis that include Pearson correlation coefficient, chi-square, and analysis of variance for the differences test of the study group. Results The results of the study indicated a positive effect on the knowledge of parents. Recommendations The researchers recommended preparing and implementing the knowledge for parents with measles, and for medical and nursing staff to give them knowledge about the condition. Keywords measles, children, tradition, parents Parents understanding on measles: a study in Al-Elwyia paediatric hospital in Baghdad province, Iraq Abdul Mahdi A. Hasana & Tareef Fadhil Rahamb ISSN 2413-0516 aPaediatric & Mental Health Nursing, College of Nursing, Babylon University, Babylon, Iraq. bCABP, DCH, Consultant at Al-Elwyia Paediatric Teaching Hospital in Baghdad City. Correspondence to Abdul Mahdi A. Hasan (email: abd_mahdi2003@yahoo.com). (Submitted: 3 November 2015 – Revised version received: 18 December 2015 – Accepted: 12 January 2016 – Published online: 26 March 2016) Introduction Many traditions regarding measles were recognised in many countries. These traditions include traditions regarding red dressings,1 spiritual, supernatural role, herbs and diets.2 These traditions might include amulets or jewellery on it, supernat- ural believes like diviners and marabouts, sea water.3 In gen- eral, ethno pharmacological investigations emphasise the importance of medicinal plants in developing countries, spe- cies used regularly with diet are under-investigation and potentially make greater contributions to health.2 Measles is one of these diseases which is acute and infectious mostly occurring in children, which is marked by fever, cough, nasal stuffiness and discharge, lacrimation, small, bright-red spots on the buccal mucosa and skin rashes. Recently many researchers were done to clarify the role of medical plants in viral diseases including measles,2 further- more studies regarding plant vaccines e.g., lettuce measles vac- cine.4,5 Plant-made oral vaccines have the potential to overcome many of the limitations of traditional vaccines.4 One promising approach is the inhalation of aerosolised vaccine, a study was undertaken to try to immunise very young infants using easily accessible vaccine.6 Lettuce (Lactuca sativa) had been used to treat many dis- eases.7 It has very low calorie content and is composed pri- marily of water, about 90–95%. Some plant foods and medicinal herbs such as lettuce and garlic contain flavonoids. An antiviral action of some flavonoids has been observed in a number of test tube experiments.8–11 Quercetin is found in green tea, onionskins, kale, red cab- bage, green beans, tomatoes, potatoes, lettuce, strawberries, cherries and grapes. It is found in especially high amounts in broccoli, red onions and garlic. One study found that quercetin produced this effect against Herpes simplex, polio virus and various respiratory viruses, including influenza.12–14 In addition, lettuce has 7% of vit. A. Vitamin A supplementa- tion reduced deaths from measles respiratory infection by 70%.15 Also lettuce contains Zinc (Zn; 0.16 mg per 100 g). Zinc is another mineral antioxidant nutrient that the immune system requires. Zinc deficiency results in lowered immune defenses, and zinc supplementation increases immune activity in people with certain illnesses.16 As with vitamin A, zinc levels have been observed to fall during the early stages of measles infec- tion and to return to normal several days later.17 There is evi- dence that zinc supplements are helpful in specific viral infections,18–20 but there are no data on the effect of zinc on childhood exanthemas infections. Selenium (Se) content in lettuce is 0.5 (µ per 100g): Sele- nium is a mineral known to have antioxidant properties and to be involved in healthy immune system activity. Recent animal and human research suggests that selenium deficiency increases the risk of viral infection and that supplementation prevents viral infection.21–24 In a controlled trial, children with a specific viral infection (respiratory syncytial virus) who received a single supplement of 1 mg (1,000 mcg) of sodium selenite (a form of selenium) recov- ered more quickly than children who did not receive selenium.25 Vitamin C (ascorbic acid) content in lettuce is 3.9 mg per 100 g: Vitamin C has been demonstrated in test tube, animal and human studies to have immune-enhancing and direct antiviral properties.26 Preliminary observations made on the effect of vitamin C on viral infections have involved both mea- sles and chicken pox.27,28 Vitamin E (alpha-tocopherol) content in lettuce is 0.03 (µg per 100g): Healthy immune function also requires adequate http://www.answers.com/topic/kale http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21570 http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21573 http://www.naturesbounty.com/vf/healthnotes/HN77/HN77_English/Supp/Zinc.htm http://www.naturesbounty.com/vf/healthnotes/HN77/HN77_English/Supp/Selenium.htm http://www.naturesbounty.com/vf/healthnotes/HN77/HN77_English/Supp/Selenium.htm http://www.naturesbounty.com/vf/healthnotes/HN77/HN77_English/Supp/Vitamin_C.htm 3J Contemp Med Sci | Vol. 2, No. 5, Winter 2016: 2–8 Research Parents understanding on measlesAbdul Mahdi A. Hasan et al. amounts of vitamin E. Vitamin E deficiency is associated with increased severity of viral infections in mice.29–31 Supplementation with vitamin E during viral infections has been shown to increase immune cell activity32 and reduce virus activity33 in mice. Research into the effects of vitamin E supple- mentation on childhood exanthemas has not been done.34 The aim of this study is to know social believes about measles and to know which plants applied in its treatment in local traditional medicine. Material and Methods The study is cross-sectional and information were taken from 100 mothers whose children were admitted to Al-Elwyia Paedi- atric hospital in Baghdad from June to September during an epidemic in 2009. Information includes age, gender, vaccina- tion status, residence, educational status and social habits and believes regarding measles treatment. All cases were diagnosed on clinical and lab bases these children who were admitted to hospital because they had one or more of the following: pneumonia, diarrhea or encephalitis. All cases are confirmed by anti-measles IgM antibodies by ELISA [DAD Behringer] non-confirmed cases or equivocal results are excluded from the study. Residence of patients in this study was classified according to health sectors of Alrusafa Health Directorate. Statistical methods used in analysing and assessing results include: 1. Descriptive statistics inform of: A - statistical tables included observed frequencies and percentages. B - Contingency coefficient for the cross tabs (causes cor- relation ship of the contingency tables). 2. Inferential statistics: in order to accept or reject statistical hypotheses they include: A: Fissure exact probability (FEP) test for testing the interaction (in depen dency among two factors in the 2 × 2 ranks of the contingency tables. B: χ2-test for testing the interaction otherwise in the contingency tables. C: testing the correlation of con- tingency coefficient. Results are considered as highly significant at P < 0.01, significant results at P < 0.05 and non-significant results at P > 0.05. Results Table 1 shows that 1–4-year-old children constitute 52% of the sample and those bellow 1 year 32% of patient sample. Age dis- tribution of mothers is also shown: highest group is 20–29 years age group which compromise 33% of mothers. Males constitute 52% of the patient sample. Regarding education level of mothers 25% completed college. Table 1 also shows that 69% of mothers believe on vaccination while 54% of children were vaccinated and that 53% of mothers believe bad belief treatment. Table 1. Frequencies and percentages with comparison significant of the studied parameters toward measles’s mother’s believes of treatment Variables Groups Frequency Percent Cumulative percent C.S. P-value Age of child <1 yr 32 32 32 (Chi-square) 57.12 P = 0.000 HS 1–4 52 52 84 5–9 14 14 98 10> 2 2 100 Age of mother <20 yrs 7 7 7 (Chi-square) 24.2 P = 0.000 HS 20–29 33 33 40 30–39 28 28 68 40–49 21 21 89 50> 11 11 100 Gender Male 58 58 58 (Binomial) P = 0.134 NSFemale 42 42 100 Education level of mother House wife 21 21 21 (Chi-square) 21.8 P = 0.001 HS Illiterate 4 4 25 Primary school 10 10 35 Intermediate school 13 13 48 Secondary school 10 10 58 Institute 17 17 75 College 25 25 100 Mother knowledge for vaccination profit Profit 69 69 69 (Binomial) P = 0.000 HSNon-profit 31 31 100 vaccination status Vaccinated 46 46 46 (Binomial) P = 0.484 NSNon-vaccinated 54 54 100 Mother’s believes on bad belief treatment Yes 53 53 53 (Binomial) P = 0.617 NSNo 47 47 100 http://www.naturesbounty.com/vf/healthnotes/HN77/HN77_English/Supp/Vitamin_E.htm 4 J Contemp Med Sci | Vol. 2, No. 5, Winter 2016: 2–8 Parents understanding on measles Research Abdul Mahdi A. Hasan et al. Table 2 shows that there is significant association between age and gender of children and mothers belief, while mean- ingful association at confidence 93.9% observed at mothers age group >50 years of age and constitute 90.9% within posi- tive mother’s belief while college level of education observed to be meaningful at confidence 92.7% and were 28.3% for this level. Both vaccination status of the child and mothers knowl- edge of effectiveness of vaccination were insignificantly asso- ciated with mother’s belief on traditional treatment and believes. Table 3 shows the sample, wearing red clothes was 35% and lettuce soup drink 8%. Table 2. Significant association between age and gender of children and mothers believes Studied Parameters Groups Count & percentages Mother’s belief on bad belief treatment Total C.S. P-value Yes No Age of child <1 yr Count 15 17 32 χ2 = 3.293 P = 0.349 C.C. = 0.179 P = 0.349 NS % within age of child 46.9% 53.1% 100.0% % within mother’s belief 28.3% 36.2% 32.0% % of total 15.0% 17.0% 32.0% 1–4 Count 30 22 52 % within age of child 57.7% 42.3% 100.0% % within mother’s belief 56.6% 46.8% 52.0% % of total 30.0% 22.0% 52.0% 5–9 Count 8 6 14 % within age of child 57.1% 42.9% 100.0% % within mother’s belief 15.1% 12.8% 14.0% % of total 8.0% 6.0% 14.0% 10> Count 2 2 % within age of child 100.0% 100.0% % within mother’s belief 4.3% 2.0% % of total 2.0% 2.0% Gender Male Count 30 28 58 F.E.P.T. P = 0.461 C.C. = 0.030 P = 0.764 NS % within gender 51.7% 48.3% 100.0% % within mother’s belief 56.6% 59.6% 58.0% % of total 30.0% 28.0% 58.0% Female Count 23 19 42 % within gender 54.8% 45.2% 100.0% % within mother’s belief 43.4% 40.4% 42.0% % of total 23.0% 19.0% 42.0% Age of mother <20 yrs Count 2 5 7 χ2 = 9.023 P = 0.061 C.C. = 0.288 P = 0.061 NS Confidence 93.9% meaningful % within age of mother 28.6% 71.4% 100.0% % within mother’s belief 3.8% 10.6% 7.0% % of total 2.0% 5.0% 7.0% 20–29 Count 15 18 33 % within age of mother 45.5% 54.5% 100.0% % within mother’s belief 28.3% 38.3% 33.0% % of total 15.0% 18.0% 33.0% 30–39 Count 14 14 28 % within age of mother 50.0% 50.0% 100.0% % within mother’s believes 26.4% 29.8% 28.0% % of total 14.0% 14.0% 28.0% 40–49 Count 12 9 21 % within age of mother 57.1% 42.9% 100.0% 5J Contemp Med Sci | Vol. 2, No. 5, Winter 2016: 2–8 Research Parents understanding on measlesAbdul Mahdi A. Hasan et al. Table 2. Continued Studied Parameters Groups Count & percentages Mother’s belief on bad belief treatment Total C.S. P-value Yes No 50> % within mother’s belief 22.6% 19.1% 21.0% % of total 12.0% 9.0% 21.0% Count 10 1 11 % within age of mother 90.9% 9.1% 100.0% % within mother’s believes 18.9% 2.1% 11.0% % of total 10.0% 1.0% 11.0% Education level of mother House wife illiterate Count 13 8 21 χ2 = 11.524 P = 0.073 C.C. = 0.321 P = 0.073 NS Confidence 92.7% meaningful % within education level 61.9% 38.1% 100.0% % within mother’s believes 24.5% 17.0% 21.0% % of total 13.0% 8.0% 21.0% Primary school Count 7 3 10 % within education 70.0% 30.0% 100.0% % within mother’s believes 13.2% 6.4% 10.0% % of total 7.0% 3.0% 10.0% Intermediate school Count 4 9 13 % within education level 30.8% 69.2% 100.0% % within mother’s believes 7.5% 19.1% 13.0% % of total 4.0% 9.0% 13.0% Secondary school Count 3 7 10 % within education level 30.0% 70.0% 100.0% % within mother’s believes 5.7% 14.9% 10.0% % of total 3.0% 7.0% 10.0% Institute Count 7 10 17 % within education level 41.2% 58.8% 100.0% % within mother’s believes 13.2% 21.3% 17.0% % of total 7.0% 10.0% 17.0% College Count 15 10 25 % within education level 60.0% 40.0% 100.0% % within mother’s believes 28.3% 21.3% 25.0% % of total 15.0% 10.0% 25.0% Vaccination status vaccinated Count 25 21 46 F.E.P.T. P = 0.481 C.C. = 0.025 P = 0.803 NS % within vaccination status 54.3% 45.7% 100.0% % within mother’s believes 47.2% 44.7% 46.0% % of total 25.0% 21.0% 46.0% Non vaccinated Count 28 26 54 % within vaccination status 51.9% 48.1% 100.0% % within mother’s believes 52.8% 55.3% 54.0% % of total 28.0% 26.0% 54.0% Mother knowledge for vaccination profit Profit Count 35 34 69 F.E.P.T. P = 0.322 C.C. = 0.068 P = 0.496 NS Continued 6 J Contemp Med Sci | Vol. 2, No. 5, Winter 2016: 2–8 Parents understanding on measles Research Abdul Mahdi A. Hasan et al. Table 3. Social and traditional belief on treatment % within 53 patients Frequency within the 53 patients who believes in traditional treatment Believe 6635Wearing red cloth 13.27Gold wearing 7.54Red lipstick application 5.33Feather under head or in shoulder 15.18Lettuce soup drinking 3.82Lettuce soup/garlic under head 11.46Others % within mother knowledge 50.7% 49.3% 100.0% % within mother’s believes 66.0% 72.3% 69.0% % of total 35.0% 34.0% 69.0% Non profit Count 18 13 31 % within mother knowl- edge 58.1% 41.9% 100.0% % within mother’s believes 34.0% 27.7% 31.0% % of total 18.0% 13.0% 31.0% Total Count 53 47 100 % within mother knowl- edge 53.0% 47.0% 100.0% % within mother’s believes 100.0% 100.0% 100.0% % of total 53.0% 47.0% 100.0% Table 2. Continued Studied Parameters Groups Count & percentages Mother’s belief on bad belief treatment Total C.S. P-value Yes No Discussion Like other studies this study shows that infants constitute a remarkable proportion of affected children. In this study affected infants were 32% of the sample; 16.3% of cases in another cross-sectional study done in this hospital in 2008 were below 9 months of age.35 According to Muhammad Siddiq’s study 6–9 months of age constitute 12.14% of reported measles cases to Dis- trict Head-quarter Hospital, Bahawalnagar in Pakistan.36 There reported 186 (23%) cases in infants aged <1 year in Measles out- break in the Republic of the Marshall Islands, 2003.37 Males in this study constitute 58% of affected children with measles. Confirmed cases in males are more than females in pre- vious Tareef ’s study35 (62%) which contradict Muhammad Siddiq’s study District Head-quarter Hospital, Bahawalnagar in Pakistan who report female cases more than male cases.36 This study shows that 46% of the sample had been vacci- nated compared to 37 % in previous study done in 200835 in the same hospital. In Muhammad Siddiq’s study only 60 cases (42.86%) were immunised against measles36 compared to (46%) Buenos Aires, Argentina, 1997 and 1998 outbreak38 were not vaccinated. While 37% of confirmed measles cases are vaccinated in Tariff ’s study.35 Measles is an old disease and is managed according to cer- tain traditions and believes including certain herbs and certain diets. In Kasak, the magical properties of the shirt colour were attributed to the fact that its red patches protected from measles, yellow ones from jaundice, and deep blue from whoop- ing-cough.1 In Chinese medicine treatment of late measles include strawberries, deep red, thick yellow dry coat , according to this study red colour (dressing, gold wearing and lip stick) constitute 35%, 7%, and 4% of total social beliefs, respectively. Symbolic function of red colour might be most important of all explanation of widespread among many societies. The most interesting in this study is that 15.1% of mothers believes that lettuce soup drinking is of value in treatment of measles. This might be one good example of accumulative experience of society regarding medical plants and its rule in management of this disease other recognised observation in this study is the odour of lettuce and garlic which constitute 3.8% in frequency in this regard, preliminary studies shows that plant-based inhalational using lettuce is effective for fur- ther studies regarding the efficacy of inhalation therapy in measles management (Fig. 1). Conclusions •   Accounting to the review of literature and the finding of the  study, measles is prevalent among children 6–15 years of age. Parents should not become overwhelmed with feelings of frustration or failure due to their child’s measles. •   Although it is prevalent, measles is seldom a topic of conver- sation among parents due to the private nature of the topic and perhaps to avoid harming the feeling of the child. •   This research is an attempt to inform the reader of measles  and lists treatment methods and parent practices; it should by no means be a substitute for professional medical care. •   A thorough examination of the child by the family physician  should be done to rule out any medical issues and if neces- sary professional counseling should be sought to help the child overcome their measles behaviour. http://www.pakmedinet.com/author/Muhammad+Siddiq http://www.pakmedinet.com/author/Muhammad+Siddiq http://www.pakmedinet.com/author/Muhammad+Siddiq http://www.pakmedinet.com/author/Muhammad+Siddiq 7J Contemp Med Sci | Vol. 2, No. 5, Winter 2016: 2–8 Research Parents understanding on measlesAbdul Mahdi A. Hasan et al. Fig. 1 Pie chart of the studied parameters toward bad beliefs of Measles’s treatment. •   Based on the present results and the discussion the study has  concluded that parents having minimum level of experi- ences about measles need a specific education programme and training sessions. Recommendations Keep the sample group large. In doing so, the researcher will have a good representation of the population. A specific education programme can be designed and presented to par- ent’s who have minimum level of knowledge in order to improve their level of knowledge. •   The educational programme of the present can be used  as means for knowledge improvement for parents who have children with measles. •   In service, continuous educational programme should  be presented to parents of on a regular base to maintain their level of knowledge. 8 J Contemp Med Sci | Vol. 2, No. 5, Winter 2016: 2–8 Parents understanding on measles Research Abdul Mahdi A. Hasan et al. References 1. Шаханова Н. Миртрадиционнойкультурыказахов. Алматы, 1998 p 54 2. Parker ME, Chabot S, Ward BJ, Johns T. Traditional dietary additives of the Maasai are antiviral against the measles virus. J Ethnopharmacol. 2007;114(2):146–52. PMID: 17870263 3. General Authority for Fish Resources Development. Available at: http:// gafrd.kenanaonline.com/topics/57646/posts/89315GAFRD} accessed in 1 April 2011 4. Webster DE, Smith SD, Pickering RJ, Strugnell RA, Dry IB, Wesselingh SL. Measles virus hemagglutinin protein expressed in transgenic lettuce induces neutralising antibodies in mice following mucosal vaccination. Vaccine. 2006;24:3538–44. PMID: 16519973 5. Huang Z, Dry I, Webster D, Strugnell R, Wesselingh S. Plant-derived measles virus hemagglutinin protein induces neutralizing antibodies in mice. Vaccine. 2001;19:2163–71. PMID: 11228389 6. Ekunwe EO. Immunization by inhalation of aerosolized measles vaccine. Ann Trop Paediatr. 1990;10(2):145–9. PMID: 1699477 7. Alrishahri M. Encyclopedia of medical hadiths p609 (1426H) [in Arabic]. 8. Vrijsen R, Everaert L, Boeye A. Antiviral activity of flavones and potentiation by ascorbate. J Gen Virol. 1988;69:1749–51. PMID: 2839607 9. Debiaggi M, Tateo F, Pagani L, Luini M, Romero E. Effects of propolis flavonoids on virus infectivity and reaplication. Microbiologica. 1990;13:207–13. PMID: 2125682 10. Fesen MR, Kohn KW, Leteurtre F, Pommier Y. Inhibitors of human immunodeficiency virus integrase. Proc Natl Acad Sci USA. 1993;90:2399– 403. PMID: 8460151 11. Amoros M, Simoes CM, Girre L, Sauvager F, Cormier M. Synergistic effect of flavones and flavonols against herpes simplex virus type 1 in cell culture: comparison with the antiviral activity of propolis. J Nat Prod. 1992;55:1732– 40. PMID: 1338212 12. Kaul TN, Middleton E Jr, Ogra PL. Antiviral effect of flavonoids on human viruses. J Med Virol. 1985;15:71–79. PMID: 2981979 13. Musci I, Pragai BM. Inhibition of virus multiplication and alteration of cyclic AMP level in cell cultures by flavonoids. Experientia. 1985;41:930–1. PMID: 2989000 14. Ohnishi E, Bannai H. Quercetin potentiates TNF-induced antiviral activity. Antiviral Res. 1993;22:327–31. PMID: 8279819 15. Glasziou PP, Mackerras DE. Vitamin A supplementation in infectious diseases: a meta-analysis. BMJ. 1993;306:366–70. PMID: 8461682 16. Fraker PJ, King LE, Laakko T, Vollmer TL. The dynamic link between the integrity of the immune system and zinc status. J Nutr. 2000; 130:1399S–406S. PMID: 10801951 17. Coutsoudis A, Coovadia HM, Broughton M, Salisbury RT, Elson I. Micronutrient utilisation during measles treated with vitamin A or placebo. Int J Vitam Nutr Res. 2001;61:199–204. PMID: 1794947 18. Mocchegiani E, Muzzioli M. Therapeutic application of zinc in human immunodeficiency virus against opportunistic infections. J Nutr. 2000;130:1424S–31S. PMID: 10801955 19. Novick SG, Godfrey JC, Pollack RL, Wilder HR. Zinc-induced suppression of inflammation in the respiratory tract, caused by infection with human rhinovirus and other irritants. Med Hypotheses. 1997;49:347–57. PMID: 9352505 20. Kumel G, Schrader S, Zentgraf H, Brendel M. Therapy of banal HSV lesions: molecular mechanisms of the antiviral activity of zinc sulfate. Hautarzt. 1991;42:439–45 [review; in German]. PMID: 1657829 21. Levander OA, Beck MA. Selenium and viral virulence. Br Med Bull. 1999;55:528–33. PMID: 10746343 22. Beck MA, Levander OA. Host nutritional status and its effect on a viral pathogen. J Infect Dis. 2000;182:S93–S96. PMID: 10944489 23. Beck MA. Nutritionally induced oxidative stress: effect on viral disease. Am J Clin Nutr 2000;71:1676S–81S [review]. PMID: 10837315 24. Beck MA. Selenium and host defence towards viruses. Proc Nutr Soc. 1999;58:707–11. PMID: 10604206 25. Liu X, Yin S, Li G. Effects of selenium supplement on acute lower respiratory tract infection caused by respiratory syncytial virus. Zhonghua Yu Fang Yi Xue Za Zhi. 1997;31:358–61 [in Chinese]. PMID: 9863072 26. Dwyer J, Nicholson LM, Shircore A, et al. Vitamin C intake and progression of carotid atherosclerosis. The Los Angeles Atherosclerosis Study. American Heart Association Annual Meeting. March 2, 2010 [abstract]. 27. Piesse JW. Nutritional factors in calcium-containing kidney stones with particular emphasis on vitamin C. Int Clin Nutr Rev. 1985;5:110–29. 28. Ringsdorf WM, Cheraskin WM. Medical complications from ascorbic acid: a review and interpretation (part one). J Holistic Med. 2011;6:49–63. 29. Wandzilak TR, D’Andre SD, Davis PA, Williams HE. Effect of high dose vitamin C on urinary oxalate levels. J Urol. 1994;151:834–7. PWID: 8126804 30. Levine M. Vitamin C and optimal health. Presented at the February 25, 1999 60th Annual Biology Colloquium, Oregon State University, Corvallis, Oregon. 31. Levine M, Conry-Cantilena C, Wang Y, Welch RW, Washko PW, Dhariwal KR, et al. Vitamin C pharmacokinetics in healthy volunteers: evidence for a recommended dietary allowance. Proc Natl Acad Sci USA. 1996;93:3704–9. PMID: 8623000 32. Han SN, Wu D, Ha WK, Beharka A, Smith DE, Bender BS, et al. Vitamin E supplementation increases T helper 1 cytokine production in old mice infected with influenza virus. Immunology. 2000;100:487–93. PMID: 10929076 33. Hayek MG, Taylor SF, Bender BS, Han SN, Meydani M, Smith DE, et al. Vitamin E supplementation decreases lung virus titers in mice infected with influenza. J Infect Dis. 1997;176:273–6. PMID: 9207381 34. http://www.calorie-counter.net/calories-vegetables/iceberg-lettuce.htm 35. Tareef FR. Case fatality rate and epidemiological features of measles reported in Elwyia Pediatric Hospital from June to September 2008. Risafa Med Digest. 2009;2(3):55–60. 36. Siddiq M, Saeed M. A study of measles cases reported to District Head- quarter Hospital, Bahawalnagar. Pak Paed J. 2006;30(1):16–22. 37. Hyde TB, Dayan GH, Langidrik JR, Nandy R, Edwards R, Briand K, et al. Measles outbreak in the Republic of the Marshall Islands, 2003. Int J Epidemiol. 2006;35(2):299–306. PMID: 16299123 38. Bilkis MD, Barrero PR, Mistchenko AS. Measles resurgence in Argentina: 1997–8 outbreak. Epidemiol Infect. 2000;124:289–93. PMID: 10813155 http://www.sciencedirect.com/science/journal/03788741 http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%235084%232007%23998859997%23670722%23FLA%23&_cdi=5084&_pubType=J&view=c&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=158be8ba41cc2f131d7efe040a5a999e http://gafrd.kenanaonline.com/topics/57646/posts/89315 http://gafrd.kenanaonline.com/topics/57646/posts/89315 http://www.ncbi.nlm.nih.gov/pubmed/?term=Strugnell RA%5BAuthor%5D&cauthor=true&cauthor_uid=16519973 http://www.ncbi.nlm.nih.gov/pubmed/?term=Dry IB%5BAuthor%5D&cauthor=true&cauthor_uid=16519973 http://www.ncbi.nlm.nih.gov/pubmed/?term=Wesselingh SL%5BAuthor%5D&cauthor=true&cauthor_uid=16519973 http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ekunwe EO%22%5BAuthor%5D file://192.168.1.244/Etype/Journal%20of%20Contemporary%20Medical%20Sciences/03_Edited%20MSS/04-04-2016/New%20folder/javascript:AL_get(this, 'jour', 'Ann Trop Paediatr.'); http://www.ncbi.nlm.nih.gov/pubmed/?term=Luini M%5BAuthor%5D&cauthor=true&cauthor_uid=2125682 http://www.ncbi.nlm.nih.gov/pubmed/?term=Romero E%5BAuthor%5D&cauthor=true&cauthor_uid=2125682 http://www.ncbi.nlm.nih.gov/pubmed/?term=Sauvager F%5BAuthor%5D&cauthor=true&cauthor_uid=1338212 http://www.ncbi.nlm.nih.gov/pubmed/?term=Cormier M%5BAuthor%5D&cauthor=true&cauthor_uid=1338212 http://www.ncbi.nlm.nih.gov/pubmed/?term=Salisbury RT%5BAuthor%5D&cauthor=true&cauthor_uid=1794947 http://www.ncbi.nlm.nih.gov/pubmed/?term=Elson I%5BAuthor%5D&cauthor=true&cauthor_uid=1794947 http://www.ncbi.nlm.nih.gov/pubmed/?term=Effects+of+selenium+supplement+on+acute+lower+respiratory+tract+infection+caused+by+respiratory+syncytial+virus http://www.ncbi.nlm.nih.gov/pubmed/?term=Effects+of+selenium+supplement+on+acute+lower+respiratory+tract+infection+caused+by+respiratory+syncytial+virus http://www.ncbi.nlm.nih.gov/pubmed/?term=Welch RW%5BAuthor%5D&cauthor=true&cauthor_uid=8623000 http://www.ncbi.nlm.nih.gov/pubmed/?term=Washko PW%5BAuthor%5D&cauthor=true&cauthor_uid=8623000 http://www.ncbi.nlm.nih.gov/pubmed/?term=Dhariwal KR%5BAuthor%5D&cauthor=true&cauthor_uid=8623000 http://www.ncbi.nlm.nih.gov/pubmed/?term=Dhariwal KR%5BAuthor%5D&cauthor=true&cauthor_uid=8623000 http://www.ncbi.nlm.nih.gov/pubmed/?term=Beharka A%5BAuthor%5D&cauthor=true&cauthor_uid=10929076 http://www.ncbi.nlm.nih.gov/pubmed/?term=Smith DE%5BAuthor%5D&cauthor=true&cauthor_uid=10929076 http://www.ncbi.nlm.nih.gov/pubmed/?term=Bender BS%5BAuthor%5D&cauthor=true&cauthor_uid=10929076 http://www.ncbi.nlm.nih.gov/pubmed/?term=Han SN%5BAuthor%5D&cauthor=true&cauthor_uid=9207381 http://www.ncbi.nlm.nih.gov/pubmed/?term=Meydani M%5BAuthor%5D&cauthor=true&cauthor_uid=9207381 http://www.ncbi.nlm.nih.gov/pubmed/?term=Smith DE%5BAuthor%5D&cauthor=true&cauthor_uid=9207381 http://www.pakmedinet.com/author/Muhammad+Siddiq http://www.pakmedinet.com/author/Muddassir+Saeed http://www.pakmedinet.com/PPJ http://www.ncbi.nlm.nih.gov/pubmed/?term=Nandy R%5BAuthor%5D&cauthor=true&cauthor_uid=16299123 http://www.ncbi.nlm.nih.gov/pubmed/?term=Edwards R%5BAuthor%5D&cauthor=true&cauthor_uid=16299123 http://www.ncbi.nlm.nih.gov/pubmed/?term=Briand K%5BAuthor%5D&cauthor=true&cauthor_uid=16299123