effect of sand storms on acute asthma in Riyadh, Saudi Arabia

Major sand storms are frequent in the Middle East. This study aims to investigate the role of air particulate matter [PM] level in acute asthma in children in Riyadh, Saudi Arabia. An aerosol spectrometer was used to evaluate PM < 10microm in diameter [PM 10] and PM < 2.5 microm in diameter [PM 2.5] concentrations in the air every 30 minutes throughout February and March 2012 in Riyadh. Data on children 2-12 years of age presenting to the emergency department of a major children's hospital with acute asthma during the same period were collected including their acute asthma severity score. The median with interquartile range [IQR] levels of PM 10 and PM 2.5 were 454 microg/m[3] [309, 864] and 108 microg/m[3] [72,192] respectively. There was no correlation between the average daily PM 10 levels and the average number of children presenting with acute asthma per day [r = -0.14, P = 0.45], their daily asthma score [r = 0.014, P = 0.94], or admission rate [r= -0.08, P = 0.65]. This was also true for average daily PM 2.5 levels. In addition, there was no difference in these variables between days with PM 10 >1000 microg/m[3], representing major sand storms, plus the following 5 days and other days with PM 10 < 1000 microg/m[3]. Sand storms, even major ones, had no significant impact on acute asthma exacerbations in children in Riyadh, Saudi Arabia. The very high levels of PM, however, deserve further studying especially of their long-term effects

Corticosteroids in the treatment of acute asthma

Asthma is a prevalent chronic disease of the respiratory system and acute asthma exacerbations are among the most common causes of presentation to the emergency department [ED] and admission to hospital particularly in children. Bronchial airways inflammation is the most prominent pathological feature of asthma. Inhaled corticosteroids [ICS], through their anti-inflammatory effects have been the mainstay of treatment of asthma for many years. Systemic and ICS are also used in the treatment of acute asthma exacerbations. Several international asthma management guidelines recommend the use of systemic corticosteroids in the management of moderate to severe acute asthma early upon presentation to the ED. On the other hand, ICS use in the management acute asthma has been studied in different contexts with encouraging results in some and negative in others. This review sheds some light on the role of systemic and ICS in the management of acute asthma and discusses the current evidence behind their different ways of application particularly in relation to new developments in the field

Characteristics of patients presenting to the emergency department with anaphylaxis in Riyadh, Saudi Arabia

To investigate the characteristics of patients presenting to the emergency department with anaphylaxis in Saudi Arabia. Records of adults and children who presented to the emergency department of a major tertiary health care center in Riyadh from 2009 to 2012 with a diagnosis of "allergy" or "allergic reaction" were reviewed to identify patients with symptoms and signs fulfilling the criteria of the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network for anaphylaxis. Out of 1522 records, 62 patients fulfilled the criteria for anaphylaxis. Among them 39 [63%] were adults and 23 [37%] were children [

Menetrier's disease in a Saudi child

Menetrier's disease is a rare form of acquired gastropathy that presents mostly during adulthood, but is extremely rare in children. It is a clinicopathological diagnosis that typically presents with abdominal pain, vomiting, and edema secondary to hypoalbuminemia. Endoscopy usually shows giant gastric mucosal folds, and gastric biopsy shows foveolar hyperplasia and decreased oxyntic glands. Here, we describe a 5-year-old boy from Saudi Arabia with typical presentation of Menetrier's disease and serological evidence of acute cytomegalovirus infection

Genomic and non-genomic actions of glucocorticoids in asthma

Glucocorticoids are the mainstay of asthma therapy. They are primarily used to suppress airway inflammation, which is the central pathological change in asthmatic patients' airways. This is achieved by many different mechanisms. The classical mechanism is by suppression of the genetic transcription of many inflammatory cytokines that are key in asthma pathophysiology [transrepression]. On the other hand, the transcription of certain inhibitory cytokines is activated by glucocorticoids [transactivation], a mechanism that also mediates many of the adverse effects of glucocorticoids. The onset of action through these mechanisms is often delayed [4-24 hours]. Other mechanisms mediated through non-genomic pathways are increasingly appreciated. These are delivered in part by binding of glucocorticoids to nonclassical membrane-bound glucocorticoid receptors or by potentiating the alpha 1-adrenergic action on the bronchial arterial smooth muscles, in addition to other mechanisms. These effects are characterized by their rapid onset and short duration of action. Understanding these different mechanisms will help in the development of new and better drugs to treat this common disease and to develop new improved strategies in our approach to its management. Here, the genomic and non-genomic mechanisms of actions of glucocorticoids in asthma are briefly reviewed, with special emphasis on the current updates of the non-genomic mechanisms

Intravenous immunoglobulin utilization in a tertiary care teaching hospital in Saudi Arabia

To evaluate the effect of intravenous immunoglobulin [IVIG] utilization at King Khalid University Hospital, an 850 bed tertiary care academic center, over a-3-year period. Patients who received IVIG in the period from January 2003 to December 2005 at King Khalid University Hospital were identified retrospectively using the hospital computer system. Their charts were subsequently reviewed. We collected data pertaining to patients' demographics, indication of IVIG, dose regimen and physician specialty. Indications were categorized into 4 different categories: US Food and Drug Administration [FDA]-labeled; off-label recommended as first line; off-label recommended as alternative; and not recommended. A total of 305 patients were identified. Intravenous immunoglobulin was given to 109 [35.7%] patients for FDA-labeled indications, 29 [9.5%] patients for off-label recommended as first line indications, 97 [31.8%] for off-label recommended as alternative indications, and 70 [23%] for not recommended indications. The amount of IVIG consumed during the study period was 43.65 Kgs with an estimated cost of $1.75 million, 24.4% of which was considered inappropriate use. Hematologists and neurologists were the most frequent prescribers. A significant amount of IVIG was prescribed for inappropriate indications. This had a large financial burden on an already strained hospital budget