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

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]

association between estrogen status and other biochemical markers of bone turnover including serum galactosyl hydroxylysine in osteoporosis and osteopenia

Osteoporosis is a chronic worldwide problem.lt is a systemic skeletal disease characterized by low bone mass and structural deterioration of bone tissue leading to-bone fragility. Cessation of ovarian function is the most widespread cause for osteoporosis in postmenopausal women. This study included 37women aged 40 to 60 years. They were categorized into 3 groups according to their bone mineral density [BMD]: Group I: 15 Normal control[T-score up to-1.5], Group II: 12 Osteopenic women[T-score between1.5 to-2.5]and Group Ill:10 Osteoporotic women[T-score below2.5]. For all subjects, dual energy X-ray absorptiometry [DEXA] was performed. Osteocalcin [OC],alkaline phosphatase [ALP], free galactosyl hydroxylysine [GaI-Hyl],calcium [Ca],inorganic phosphorus [P] and estradiol [E2]were measured in serum, whereas, deoxypyridinoline [Dpd] and creatinine levels in urine. Simultaneously both osteopenic and osteoporotic groups showed significant decreases in BMD when compared to the controls. Osteocalcin, ALP and GaI-Hyl showed significant increase [p<0.0001] among the osteopenic and osteoporotic groups versus the control group. Significant decrease in E2 levels were obvious among the osteopenic [p<0. 0001] and" osteoporotic [p<0. 0001] women when judged against the controls. Urinary Dpd was significantly increased in the second and the third group [p<0.001] together in osteoporotic group, significant negative correlations were observed between 00 and BMD. Positive correlations were detected among the osteoporotic group between OC and ALP and between OC and GaI-Hyl. High significant negative correlations were confirmed between E2, and OC among both the osteopenic and the osteoporotic groups. Also, a significant negative correlation was established between E2 and Dpd in the osteoporotic group. In comparing between osteopenic and osteoporotic Otoupa, significant decrease was recognized in BMD and Significant increase was predicted regarding ALP, [p<0.05] Gal-Hyl [p<0.0001] and Dpd [p < 0.001]. In conclusion, the decreasing level of E2 in early and post-menopausal women is the main cause of osteoporosis. Also, the measurement of serum Gal-Hyl may be of clinical value to identify groups at higher risk of osteoporosis and to predict bone loss