Prevalence of respiratory distress syndrome in neonates

Background: Acute respiratory distress syndrome is defined as acute diffuse inflammatory lung injury causing increased pulmonary vascular permeability with increased lung weight, loss of aerated lung tissues leading to hypoxemia and bilateral radiographic opacities associated with increased venous admixture, increased physiological dead space and decreased lung compliance

Aim of work: to determine the prevalence rates of respiratory distress syndrome [RDS] in neonates in King Abdulaziz Hospital, Taif city, Saudi Arabia and to find out the most important causes of RDS in preterm babies in Taif city

Methods: a cross-sectional questionnaire based study carried out in Saudi Arabia, Taif city, King Abdulaziz Hospital from January to June 2016 [6 months period] on preterm neonates

Results: 57.1% of newborn were male gender and 42.9% were female, 4.4% of babies were extreme preterm, 86.5% were preterm, 4.4% were late preterm and 4.7% were full term, the prevalence rate of RDS in newborn was 54.7% in the 6 months of this study

Conclusion: RDS is one of the major problems among newborns and a major reason for increased morbidity and mortality among infants. Preterm babies are the main risk factor for development of RDS. Mother's illnesses, especially hypertension and Diabetes are very strong risk factors for the disease in preterm babies. Cesarean delivery, especially in preterm babies and male gender stays other important risk factors for RDS

prevalence of acute myocardial infarction [AMI] in Taif city province and its participating factors

Background: Myocardial infarction [MI] is a fatal disease caused by block in the oxygen supply of blood vessels of the heart muscles, leading to permanent heart muscle damage and death of its cells

Aim of work: to assess the relationship between incidence of acute myocardial infarction and its participating factors

Patients and methods: observational, descriptive correlation questionnaire based study on 50 Saudi and non Saudi patients with acute myocardial infarction who were admitted in cardiac intensive care unit [CICU], medical ward and followed in out-patient department [OPD]. They were chosen from King Faisal Medical Center, cardiology department, Taif, Saudi Arabia from the first of March 2016 to the end of April 2016 [2 months duration]

Results: Prevalence of MI patients in the 2 months of research was 1.4%. MI was precipitated by a number of factors in Saudi Arabia as old age, increased body mass index, stress, obesity and consumption of high caloric rich diet

Conclusion: The main risk factors of ACS in our patients were hypertension, Stress, obesity; high cholesterol diet and positive family history of cholesterol in addition to old age and smoking

Recommendations: Combating precipitating factors of MI in Saudi Arabia can decrease the prevalence of the disease

Incidence of pulmonary embolism in CCU at King Faisal hospital, Taif, Saudi Arabia

Background: Pulmonary embolism [PE] is a frequent cause of death and serious disability with a risk extending far beyond the acute phase of the disease. Despite advances in diagnosis and treatment, high mortality rates are still a common problem

Aim of the work: was to assess the incidence rate of pulmonary embolism among patients attending CCU of King Faisal hospital in Taif, Saudi Arabia and the most common risk factors of pulmonary embolism in these patients

Patients and methods: a cross sectional study for 6 month duration, in the period from June 2016 to December 2016. Patients were chosen from CCU of King Faisal hospital, Taif, Saudi Arabia. The study includes 20 patients diagnosed as pulmonary embolism from both sexes [male/female =10/10] with mean age 58.9+/-19.9 years old and 20 healthy control volunteers [male/female =14/6] with mean age 52.1+/-19.5 years old were chosen for comparison; incidence rate of pulmonary embolism was calculated and the related risk factors in these patients were evaluated via a questionnaire done to each patient and control

Results: 80% and 70% of patients and control lived in Taif, respectively. Incidence rate of pulmonary embolism was 5.5%. 25% of patients were smoker and 15% of control group were smoker

Conclusion: the presented study assessed the incidence of pulmonary embolism and its risk factors in King Faial hospital in Taif, Saudi Arabia. All risk factors of pulmonary embolism mentioned in international researches were emphasized in this research particularly travelling history, oral contraceptive therapy and cancer with respect to other risk factors

Assessment of asthma control in a sample of asthmatic patients in Taif city, Saudi Arabia

Background: Asthma Control Test [ACT] Questionnaire is developed to meet the guidelines internationally accepted for asthma management by measuring adequacy and any alteration in control of asthma, occurring spontaneously or after starting asthma management

Objectives: to assess control of asthma in a sample of patients diagnosed as asthmatics in Taif City based on Asthma Control Test [ACT]

Methods: Fifty asthmatic patients, from those attending the out patients clinic in King Abdul Aziz Specialized hospital and chest hospital in Taif city, were included in this study in the period from July to December, 2013. Patients were subjected to: full clinical history and examination for clinical classification of the disease and to recognize controlled from uncontrolled patients; review for the treatment plan for each patient; [ACT] questionnaire was used to identify patients with poorly controlled asthma

Results: clinical classification of asthma showed that 20% of patients had intermittent asthma, 24% had mild persistent asthma, 32% had moderately persistent asthma and 24% of patients got severe persistent asthma. According to ACT only 24% of patients were controlled, while the rest of patients 76% were considered uncontrolled

Conclusion: ACT was found to be a reliable tool for assessment of uncontrolled asthmatic patients when implemented in Taif city

Recommendations: conduct more studies in different geographical areas to assess effectiveness of the AST questionnaire in different situations and different asthmatic patients

Prognostic roles of endostatin, matrix metalloproteinase-2 and 9 and tissue inhibitors of metalloproteinase-1 in advanced non-small cell lung cancer

Background and aim of the work: Previous studies verified that Endostatin, matrix metalloproteinase [MMP] -2 and -9, in addition to tissue inhibitors of metalloproteinase [TIMP] -1 may play a crucial role in prognosis of non-small cell lung cancer [NSCLC]. In this study we will investigate the changes in the pretreatment serum levels of these factors and to evaluate their clinical implication in patients with advanced non-small cell lung cancer [NSCLC]

Patients and methods: Pretreatment serum samples were collected from 25 patients and 10 control healthy individuals. The levels of Endostatin, MMP-2, MMP-9, and TIMP-1 were measured using a sandwich enzyme immunoassay kit

Results: The pretreatment serum levels of Endostatin and TIMP1 were significantly elevated and correlated with their stages and survival [P< 0.05], where, the serum level of Endostatin in healthy subjects was 81.20 +/- 23.99 ng/ml and in patients with NSCLC was 354.40 +/- 164.01 ng/ml. The serum level of TIMP1 in healthy subjects was 1.49 +/- 0.29 ng/ml and in patients with NSCLC was 2.96 +/- 0.58 ng/ml. The serum level of MMP2 and 9 were non-significantly decreased in serum of NSCLC patients [P > 0.05], where the serum activity of MMP2 in healthy subjects was 0.14 +/- 0.03 ng/ml and in patients with NSCLC was 0.09 +/- 0.03% and the serum activity of MMP9 in healthy subjects was 0.13 +/- 0.019 ng/ml and in patients with NSCLC was 0.10 +/- 0.03%

Conclusions: Our results indicated that the circulating levels of Endostatin, and TIMP-1 in patients with NSCLC may be valuable future tools for treatment planning and monitoring of treatment, however, these blood tests need to be standardized and validated in large-scale prospective clinical trials

Evaluation of the biological effects of radiations on pulmonary functions of NMA employees in the black sand project at Rashid and Abou-Khashaba sites year 2012

Background: Almost all workers in the Black Sand Project at Rashid and Abou-Khashaba sites of NMA [Nuclear Materials Authority] are obligatorily exposed to ionizing radiations during their routine work. The most apparent harmful effects in Rasheed employees were reflected easily on pulmonary function tests which may occur due to increase registered dust radio activities than the accepted level for air concentration

Objectives: This study was done mainly to evaluate the biological effects of ionizing radiations on lung and pulmonary functions of workers in the Black Sand Project at Rashid and Abou-Khashaba sites of NMA in the year 2012 and to start follow up of these workers

Measurements: This research was done on 30 male workers aging 25 - 56 years to measure pulmonary function tests. Certain radiological measurements were also performed to assess the levels of exposure to radiations

Results: Out of the 30 members; regarding the radiological measurements all levels measured were within the reference range accepted internationally, except radioactive dust levels were elevated mildly above the reference range accepted internationally this results in deterioration of pulmonary function of some workers

Conclusions: Generally, workers of the Black Sand Project at Rashid and Abou-Khashaba sites were receiving a good radiological protection protocol. Radioactive dust levels were elevated mildly above the reference range accepted internationally this result in pulmonary function disorders in some workers

Improving health status of bronchial asthma patients in nuclear materials authority

Background: Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness and shortness of breath. Asthma can result in variable restriction in the physical, emotional, and social aspects of the patient's life

Setting: out patient clinic in Nuclear materials Authority

Objectives: This study was done mainly to Improve health status including symptoms and quality of life in bronchial asthma patients in Nuclear Materials Authority

Method: The study was carried out on 51 subjects, they were chosen from those attendants of the out patients clinic in Nuclear Materials Authority in el Katamya in the period from January to May 2012, by measurement of lung function and bronchial hyperresponsiveness as supplemental tools in evaluating the efficacy of treatment with inhaled corticosteroids [ICS] and other controller medications in asthmatic employees

Results: the asthmatic patients were 51 patients [36 males and 15 females], their ages ranged from 27-59 [46.2+/-7.3] years, they weredetected from those attendants of the out patient clinic in Nuclear Materials Authority in El Katamya representing [2.1% ] of workers. 15 [29.4%] patients were smoker, and 36 [70.6%] patients never smoked, 21 patients [41.2%] were exposed to radioactive materials in their labs in the form of radioactive substances and30 patients [58.8%]patients were not exposed.19 [37.3%] patients had intermittent asthma, 11 [21.6%] patients had mild persistent asthma 9 [17.6%] patients had moderate persistent asthma and 12[23.5%] patients had sever persistent asthma. 11[21.6%] patient used long acting anti-inflammatory medications, 23 [45.1%] patients received other controller medication in the form of short acting steroids as Clenil inhaler and ketotifen as zaditen while the majority of patients received rescue medication 34[66.7%] in the form of short acting bronchodilators and oral steroids

Conclusion: Patient education, measurement of lung function and review of the treatment plan as supplemental tools in evaluating the efficacy of treatment with inhaled corticosteroids and other controller medications in asthmatic employees improve health status including symptoms and quality of life in bronchial asthma patients in Nuclear Materials Authority

Effect of air pollution, contamination and high altitude on bronchial asthma

Epidemiological studies have shown that the prevalence of asthma has risen dramatically worldwide and evidence suggests that environmental factors have an important role in the etiology of the disease. Most respiratory diseases are caused by airborne agents. Our lungs are uniquely vulnerable to contamination from the air we breathe. Air pollution exposure is associated with increased asthma and allergy morbidity and is a suspected contributor to the increasing prevalence of allergic conditions. Observational studies continue to strengthen the association between air pollution and allergic respiratory disease. The effects of air pollution should be viewed in two different groups: healthy people and people with chronic heart or lung disease. Although the fundamental causes of asthma are not completely understood, the strongest risk factors for developing asthma are inhaled asthma triggers. These include: indoor allergens [for example house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander], outdoor allergens [such as pollens and moulds], tobacco smoke and chemical irritants in the workplace. Other triggers can include cold air, extreme emotional arousal such as anger or fear, and physical exercise. Even certain medications can trigger asthma such as aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers. Urbanization has also been associated with an increase in asthma; however the exact nature of this relationship is unclear. Medication is not the only way to control asthma. It is also important to avoid asthma triggers - stimuli that irritate and inflame the airways. Prevalence of asthma is generally low within the Middle East, although high rates have been recorded in the Kingdom of Saudi Arabia, Kuwait, Lebanon, and Israel. The prevalence of asthma and asthma-related symptoms is high among 16- to 18-year-old adolescents in Saudi Arabia, and the symptoms are more common in boys than in girls, associated with a high rate of rhinitis symptoms and hay fever. In addition to bronchial asthma, prevalence of al ergic diseases in a sample of Taif citizens assessed by an original Arabic questionnaire [phase I] evidenced a high prevalence of allergic diseases as Urticaria, allergic rhinitis with or without other co-morbidities, and atopic dermatitis. Effect of high altitude on bronchial asthma is controversial; at high altitudes, the concentrations of the allergens are reduced due to the reduced amounts of vegetation, animal populations and human influences, high UV light exposure and low humidity could be contributing factors to the benefits of high altitude other than allergen avoidance. On the contrary, Lower altitudes have significant beneficial effects for bronchial asthma patients but lessen with increasing altitudes; the mountain climate can modify respiratory function and bronchial responsiveness of asthmatic subjects. Hypoxia, hyperventilation of cold and dry air and physical exertion may worsen asthma or enhance bronchial hyper-responsiveness while a reduction in pollen and pollution may play an important role in reducing bronchial inflammation. Increasing attention has to be paid to the potential of urban air toxics to exacerbate asthma. Continued emphasis on the identification of strategies for reducing levels of urban air pollutants is warranted to reduce respiratory diseases and other diseases related to pollution. Efforts for reducing the asthma burden must focus on primary prevention to reduce the level of exposure of individuals and populations to common risk factors, particularly tobacco smoke, frequent lower respiratory infections during childhood, and environmental air pollution [indoor, outdoor, and occupational]

Platelet derived growth factor and the extent of skin thickening as potential indicators of pulmonary affection in systemic sclerosis

Systemic sclerosis is a multisystem disease that has considerable variability in its presentation, course, and prognosis. The aim of this study was to determine serum levels of platelet-derived growth factor [PDGF A/B] in patients with systemic sclerosis [SSc] and to correlate these levels with the extent of skin sclerosis and presence of pulmonary affection. Moreover, the efficiency of PDGF and skin score in early detection of pulmonary affection were assessed. The study included 22 female patients with SSc [according to the American College of Rheumatology] [Masi et al., 1980] and 15 age-matched healthy control females. According to the classification by LeRoy et al. [1988], we divided our patients into limited SSc [10 patients-45.5%] and diffuse SSc [12 patients-54.5%]. The extent of skin sclerosis was assessed by the modified Rodnan total skin thickness scoring [TSS] system [Clements et al., 1995]. In our study, patients with limited SSc had a skin score <25, while those with diffuse SSc had skin score >25. Five diffuse SSc patients had associated pulmonary affection, diagnosed by history taking, clinical examination, chest x-ray, arterial blood gases, spirometry and diffusing capacity of the lung for carbon monoxide [DLCO]. Serum levels of PPGF were determined in SSc patients and healthy controls using quantitative sandwich ELISA technique. Serum PDGF mean and standard deviation in healthy subjects was 5.2 +/- 2.466 ug/l. PDGF values showed continuous significant increment with progression of the disease. Mean PDGF serum levels in limited SSc, diffuse SSc without pulmonary affection and with pulmonary affection were 15.8 +/- 2.3, 20.86 +/- 2.41 and 32 +/- 3.08 ug/l, respectively. Furthermore, the results revealed that PDGF value <10 ugh, tend to exclude the diagnosis of SSc with 100% sensitivity and specificity, respectively. Moreover, all patients with diffuse SSc and having pulmonary affection had PDGF values >25 ug/l. This value provided a diagnostic sensitivity and specificity of 100%. As regards the total skin score, a statistical significance was found between limited and diffuse SSc but did not show a statistically significant difference between SSc patients with [32.2 +/- 4.49] and without [29.71 +/- 3.25] pulmonary affection [p>0.05]. However, in patients with diffuse SSc, PDGF levels tended to correlate positively with the skin score [p=0.05]. ROC plot showed that skin score at a value of 29 was the best cut-off level to diagnose pulmonary affection in patients with diffuse SSc with a diagnostic sensitivity of 80% and specificity of 71.4%. PDGF is a simple and easy laboratory test that tends to exclude the presence of SSc at a cut-off value of 10ng/ml with 100% sensitivity and specificity, respectively. PDGF correlates positively with extent of skin involvement and significantly with pulmonary affection. PDGF and skin scoring system are simple laboratory and physical measures for evaluating patients with systemic sclerosis with cut-off levels of 25 ug/l, and 29 respectively in detecting pulmonary affection. However, further studies are recommended on larger population to ensure the diagnostic efficiency of PDGF and to test the applicability of our obtained cut-off values

Renal function reserve in chronic obstructive pulmonary disease with type II respiratory failure

Increase in renal blood flow in response to certain stimuli such as dopamine infusion, oral protein load, and amino acid infusion. Reduced or absent renal functional reserve [RFR] is an early index of renal impairment. Our work studies the [RFR] in Chronic Obstructive Pulmonary Disease [COPD] patients with chronic compensated type II respiratory failure. Our study included 15 COPD patients with compensated type II respiratory failure and 5 normal controls. The patient group had mean Pa O[2] 56.5 +/- 6.4 and Pa CO[2] 56.5 +/- 3.2, while in normal controls the mean Pa 02 was 97.4 +/- o.3 and Pa CO[2] was 42.3 +/- 1.2. Hypoxic patients [Pa O[2]< or =59mm Hg] allowed to receive low flow oxygen by nasal prongs to keep their Pa O[2] >or = 60 mm Hg and Sa O[2] > or = 90% without rise of Pa CO[2] within 2 hours before and during the study. The pulsatility index [PI], an index of reno-vascular resistance [RVR], was measured non invasively by Doppler Ultrasonograghy at baseline and 20 minutes after infusion of dopamine in diuretic dose. The baseline PT was nearly similar in the control group and in COPD patients [no significant difference], the PI fell significantly in the control group after dopamine infusion from 1.03 +/- 0.14 to 0.83 +/- 0.1[P< 0.05], but increased significantly in COPD patients from 1.02 +/- 0.12 tol.18 +/- 0.13 [P<0.05] after dopamine infusion. Renal functional reserve is impaired in hypercapnic COPD patients and this may be a factor in the development of edema frequently seen in these patients