Bronchial asthma and airway remodeling markers

Abstract: Asthma is an inflammatory disease with extracellular matrix remodeling and collagen deposition. Vascular alterations have been suggested to contribute to airway hyper responsiveness. Vascular endothelial growth factors and metalloproteinases are mediators of airway inflammation and remodeling in asthma. There are few data regarding the potential effects of anti-asthma treatment on indices of air way remodeling

Objective: This study investigates the role of VEGF, MMP-9 in the pathogenesis of asthma and their role as index of remodeling, markers of inflammation in symptomatic bronchial asthma on low dose ICS. Also we evaluate the role of adding long acting B[2] agonist for 6 weeks in airway remodeling for the symptomatic asthmatic patients on low dose ICS

Methods: VEGF and MMP-9 were measured in sputum of healthy control, and bronchial asthma patients before and after the addition of long acting B[2] agonists. Also we evaluated whether VEGF correlated with MMP-9 in symptomatic bronchial asthma receiving low or moderate dose of ICS

Results: Levels of VEGF and MMP-9 are significantly higher in sputum of bronchial asthma than in healthy controls. The mean level of VEGF, MMP-9 in sputum of bronchial asthma patients on low to moderate dose of ICS was 2500 pg/ml +/- 750, 33.3 ng/ml +/- 16.7. After 6 weeks of treatment with long acting B[2] agonists there was a reduction in the mean levels of both VEGF, MMP-9 1750 pg/ml +/- 250, 27.4 ng/ml +/- 13. Also there was a significant correlation between the levels of VEGF and MMP-9 in healthy subjects and patients with bronchial asthma. There was a significant correlation between both VEGF MMP-9 and the sputum eosinophils and neutrophil in patients with bronchial asthma before adding long acting B[2] agonists

Conclusion: Symptomatic patients with bronchial asthma on a low dose ICS have elevated levels of VEGF, MMP-9. There was an interrelationship between VEGF and MMP-9, this finding suggests that VEGF signaling regulates MMP-9 expression, and plays a critical role in the maintenance of asthma. VEGF, MMP-9 could be considered as important markers of airway remodeling in asthma. The addition of regular long acting B[2] agonist to low or moderate dose ICS in symptomatic bronchial asthma patients had a beneficial effect on the air way remodeling markers in a way that they may potentate the anti-inflammatory effects of ICS on inflammatory cells

Posters as a tool for disseminating health related information in a developing country: a pilot experience

To investigate the effectiveness of posters as a tool, for imparting information related to high blood pressure. The intervention involved hanging posters conveying information about blood pressure, in the waiting rooms of 339 health facilities. The impact of this intervention was assessed after 30 days of hanging the posters with the main assessment component of the survey aimed at the target audience at the facilities. 1017 people attending the facilities were interviewed. Mean age of this population was 40.4 [SD 11.06] years. There were 79% males and 21% females. 80.2% [n=816] of the respondents had noticed the posters. 84.5% of the people were of the opinion that the poster was good. 63.7% of the people understood the overall message of the poster correctly. Regarding change in behaviour, 96.7% [n=789] of the people thought that the poster was asking them to do something; 85.9% [n=501] of these got their blood pressure checked compared to 60.9% [n=14] of those who did not think the poster was asking them to do anything [p=0.004]. Of those who said that the poster was asking them to do something, there were varied responses as to what they thought the poster was asking them to do. If the response was that they should have their blood pressure checked, it was taken as a correct response. 87.3% of those who said that the poster was asking them to get their blood pressure checked, actually got their blood pressure checked compared to 83.7% of those who did not understand this message [p= 0.241]. Given the limitations of the study it is difficult to assess the effectiveness of the poster in changing people's behaviour regarding blood pressure check up. This experience will serve as a pilot for a larger prospective study to assess poster as a tool for prompting people to get their blood pressure checked

Accessory spleen in splenectomized patients of idiopathic thrombocytopenic purpura in relopse

We describe two patients with idiopathic thrombocytopenia who relapsed after splenectomy due to the presence of accessory spleens. This report highlights the usefulness of 99m Technetium scans especially with heat denatured red blood cells, in the detection of accessory spleens