Respiratory disorders in the Middle East: a review

Perceptions of the effectiveness of non-pharmacological management of respiratory disorders among CRD patients

Chronic respiratory diseases (CRDs) are among the leading cause of mortality worldwide. While pharmacological approaches are commonly used to manage symptoms, non-pharmacological management of CRDs is considered crucial in preventing disease progression and improving patient self-efficacy. To describe the perceived effectiveness of non-pharmacological management of CRDs among CRD patients and determine whether the CRD patients perceptions of the effectiveness of non-pharmacological management are associated with their demographic characteristics. An analytic cross-sectional study design was utilized. The non-pharmacological management practices of CRD patients and their perception of the effectiveness of these therapeutic measures were assessed using a researcher-developed questionnaire. Data collection took place in primary healthcare centers in Al Ahsa, Saudi Arabia from October 2021 to March 2022. The proportion of CRD patients who perceived that non-pharmacological interventions were effective was computed. Binary logistic regression was performed to determine the association between the demographic characteristics of the respondents and their perception of the effectiveness of non-pharmacological management. Among the 390 respondents, 42% perceived that non-pharmacological measures were effective. Half of the respondents believed that smoking cessation, influenza vaccination, improving physical activity, and nutrition support helped alleviate CRD symptoms, while less than half of the respondents considered pulmonary rehabilitation, educational programs, and oxygen therapy effective measures to control symptoms. Women were found to be 3.24 times more likely to perceive non-pharmacological interventions as effective (P < .0000) compared to men. Those with university-level education were 66.6% less likely to consider non-pharmacological interventions to be effective (P < .0000) than those who completed preuniversity-level education. Age and marital status did not significantly influence perceptions of effectiveness. Differences in the perceptions of the effectiveness of various non-pharmacological measures to alleviate CRD symptoms existed among the CRD patients of Al Ahsa. The perception of effectiveness was significantly associated with the patient's gender and educational attainment.

Experience of Health Professionals in Caring for Patients With Chest Trauma: A Qualitative Study

BACKGROUND

The variation in the implementation of chest trauma (CT) management's guidelines led to inconsistent and mixed experiences toward CT management by the health care team. Moreover, there is a scarcity of studies exploring factors that enhance CT management experiences worldwide and in Jordan.

OBJECTIVES

The aims of this study were (1) to explore emergency health professionals' attitudes and experiences toward CT management and (2) to understand factors that affect the care for patients with CTs among emergency health professionals.

METHODS

A qualitative exploratory approach was adopted in this study. Individual, semistructured, face-to-face interviews were conducted with 30 emergency health professionals (physicians, nurses, and paramedics) from government emergency departments, military, private hospitals, and paramedics from the Civil Defense in Jordan.

RESULTS

The results showed that emergency health professionals had negative attitudes toward caring for patients with CTs due to a lack of knowledge and clarity in their job description and duties assigned to them. Moreover, some organizational and training factors were discussed for their impact on the attitudes of emergency health professionals toward caring for patients with CTs.

CONCLUSIONS

Lack of knowledge, absence of clear guidelines and job descriptions for dealing with traumas, and lack of continuous training on caring for patients with CTs were the most common reasons for negative attitudes. These findings can assist stakeholders, managers, and organizational leaders in understanding health care challenges and provoke a more focused strategic plan to diagnose and treat patients with CT.

The ethnomedicinal evidences pertaining to traditional medicinal herbs used in the treatment of respiratory illnesses and disorders in Saudi Arabia: A review

Due to their prevalence, respiratory diseases have attained great attention from the historical time. Furthermore, it has been explored in a new dimension due to recent viral outbreaks such as COVID-19. Even though modern medicine treats the majority of respiratory ailments, it is reported that the majority of people (≥80 %) who suffer from respiratory disorders do not take medication for their conditions, and a considerable number of people still believe in and use herbal medicines. Herbal therapies have been utilized all over the world for thousands of years. Traditional herbal treatment has long been seen as a valuable practice in Saudi Arabia, long before modern medicine. Due to its location in the desert and humid climate, Saudi Arabia suffers from a high rate of respiratory illnesses caused by dust, pollens, and viruses. Several published literature have employed different plants and plant products for respiratory problems, but there has yet to be a single, complete study centered on Saudi Arabia. In this review, 41 plants were identified, which has complete details regarding their usage in traditional practice for respiratory disorders. A thorough investigation was conducted and the results were detailed.

Prevalence, incidence, morbidity and mortality rates of COPD in Saudi Arabia: Trends in burden of COPD from 1990 to 2019

Background

The available data to determine the chronic obstructive pulmonary disease (COPD) burden in Saudi Arabia are scarce. Therefore, this study closely examines and tracks the trends of the COPD burden in Saudi Arabia from 1990 to 2019 using the dataset of the Global Burden of Disease (GBD) 2019.

Methods

This study used the GBD 2019 dataset to analyse the COPD prevalence, incidence, morbidity and mortality rates in the Saudi Arabian population from 1990 to 2019, stratified by sex and age. The age-standardised rate was used to determine the prevalence, incidence, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs) and deaths.

Results

In 2019, an estimated 434,560.64 people (95% Uncertainty Interval (UI) 396,011.72–473,596.71) had COPD in Saudi Arabia, corresponding to an increase of 329.82% compared with the number of diagnosed people in 1990 [101,104.05 (95% UI 91,334.4–111,223.91)]. The prevalence rate of COPD increased by 49%, from 1,381.26 (1,285.35–1,484.96) cases per 100,000 in 1990 to 2,053.04 (1918.06–2194.29) cases per 100,000 in 2019, and this trend was higher in males than females. The incidence rate of COPD in 2019 was 145.06 (136.62–154.76) new cases per 100,000, representing an increase of 43.4% from the 1990 incidence rate [101.18 (95.27–107.86)]. In 2019, the DALYs rate was 508.15 (95% UI 434.85–581.58) per 100,000 population. This was higher in males than females, with a 14.12% increase among males. In 2019, YLLs contributed to 63.6% of DALYs due to COPD. The death rate due to COPD was 19.6 (95% UI 15.94–23.39) deaths per 100 000 in 2019, indicating a decrease of 41.44% compared with the death rate in 1990 [33.55 deaths per 100 000 (95% UI 25.13–47.69)]. In 2019, COPD deaths accounted for 1.65% (1.39–1.88) of the total of deaths in Saudi Arabia and 57% of all deaths caused by chronic respiratory diseases.

Conclusion

Over the period 1990–2019, the prevalence and incidence of COPD in Saudi Arabia have been steadily rising. Even though COPD morbidity and death rates have been decreasing, they remain higher in men and older age. The holistic assessment and interventions with careful attention to optimising the community-based primary care management, such as screening for early diagnosis, smoking cessation programs and pulmonary rehabilitation, are likely to be the most successful strategies to reduce the burden of COPD in Saudi Arabia.

Point-of-care diagnostic lung ultrasound is highly applicable to the practice of medicine in Saudi Arabia but the current skills gap limits its use

CONTEXT

Coronavirus disease 2019 (COVID-19) has put a spotlight on point-of-care diagnostic lung ultrasound (POCDLUS). However, the spectra of respiratory disease and resources available for investigation vary internationally. The applicability of POCDLUS to internal medicine (IM) practice in Saudi Arabia and the current use by Saudi physicians are unknown.

AIMS

The aim of the present study was to determine the applicability of POCDLUS to IM practice in Saudi Arabia and quantify the residents' current skills, accreditation, and use of POCDLUS.

METHODS

A questionnaire was distributed to the IM residents at our institution to assess their knowledge, use of POCDLUS, and their perceptions of its applicability in IM.

STATISTICAL ANALYSIS

Standard descriptive statistical techniques were used. Categorical data, presented as frequency, were compared using the Chi-squared test. The Likert scale responses, presented as mean ± standard deviation, were compared with a Student's t-test.

RESULTS

In total, 100 residents participated (response rate 92.6%) and reported that POCDLUS was applicable to their practice. Identifying pleural effusions was most applicable. A small proportion (n = 7) had received training, nine used POCDLUS regularly, none were accredited and the overall self-reported level of knowledge was poor.

CONCLUSIONS

Whilst POCDLUS is applicable to IM practice in Saudi Arabia, the significant skills gap preclude the provision of a POCDLUS service. As COVID-19 can cause an interstitial syndrome, our pandemic preparation response should include POCDLUS training. The current study is supported by a similar Canadian study and the international standardisation of POCDLUS training may be feasible. The findings of the current study may facilitate the development of POCDLUS training programs for internists throughout Saudi Arabia.

Focused Cardiac Ultrasound is Applicable to Internal Medicine and Critical Care but Skill Gaps Currently Limit Use

Context

Coronavirus Disease 2019 (COVID-19) put a spotlight on focused cardiac ultrasound (FoCUS). However, the spectra of cardiac disease, and the resources available for investigation vary internationally. The applicability of FoCUS to internal medicine (IM) and critical care medicine (CCM) practice in Saudi Arabia and their current use of FoCUS are unknown.

Aims

To determine the applicability of FoCUS to IM and CCM practice in Saudi Arabia and quantify the residents’ current proficiency, accreditation and use of FoCUS.

Methods

A questionnaire was distributed to the residents in IM and CCM at our institution to determine their proficiency, use of FoCUS, and perceptions of its applicability.

Results

In total, 110 residents (IM 100/108; CCM 10/10) participated (Response rate 93.2%) and reported that FoCUS was very applicable to their practice, most specifically for pericardial effusion, right heart strain, and left ventricular function. Two IM residents had received postgraduate training, ten used FoCUS regularly, none were accredited and overall self-reported proficiency was poor. In contrast all CCM residents had received postgraduate training and reported regular use of FoCUS. Two were accredited.

Conclusions

Whilst FoCUS is applicable to IM practice in Saudi Arabia, significant skills gaps exist. The skills gap in CCM is lower but unaccredited practice is common. Our residents’ responses were similar to those from Canada. Thus, international standardization of FoCUS training could be considered.

National trends in incidence, prevalence and disability-adjusted life years of invasive aspergillosis in Iran: a systematic review and meta-analysis

Objectives: We aimed to study the epidemiology, prevalence, incidence, clinical manifestations, underlying diseases, treatments, outcomes, and societal impact through disability-adjusted life years (DALYs) of IA in Iran. Methods: A random-effect meta-analytic model was fitted to estimate the prevalence and incidence of IA in Iran. We also calculated DALYs. Results: Out of 79 published studies during the past 25 years from Iran, 23 met the inclusion criteria. A total of 2947 patients were included, of whom 396 (13.4%) patients were diagnosed with IA according to EORTC/MSG and ICU criteria. The main underlying condition for IA was hematologic disorders (39.4%). A. flavus 86 (43%) was the most common isolate. The pooled prevalence and incidence rates were 20.5 (95% CI 12.5 to 29.9) and 4.8 (95% CI 2.3-8.2) per 100,000 population, respectively. Total DALYs was estimated 164.13 per 100,000 population. YLLs constitute the majority of IA burden compared to YLDs (162.80 YLLs/100,000 population vs 1.33 YLDs per 100,000 population). The highest YLL rates were found in people aged 45-49 (62.9 YLLs/100,000 population) and 30-34 years (45.2 YLLs/100,000 population), respectively. Conclusion: This study indicates an increasing burden of IA in Iran, despite the extensive use of prophylaxis, challenging the public health, especially immunocompromised patients.

Sarcoidosis in the Middle East

Sarcoidosis, a systemic granulomatous disease of unknown cause, has been described worldwide and in all populations with notable differences in clinical characteristics, organ involvement, disease severity, and prognosis among different ethnic and racial groups. While the exact prevalence of sarcoidosis in the Middle East is unknown, studies from various countries in the region have reported the clinical characteristics of affected patients, along with a few anecdotal reports. A search of the MEDLINE and Google Scholar databases was conducted for relevant English-language articles using the terms “sarcoidosis” and “Middle East” or “sarcoidosis” and “Arabs.” Subsequently, the names of individual countries were used as search terms, replacing “Middle East.” Overall, the clinical picture of patients with sarcoidosis in the Middle East is similar to that reported elsewhere; for example, the disease was more frequent among females and respiratory complaints were the predominant symptoms. Within the region, most patients from Oman were older and female, with arthralgia, hypercalcemia, and eye involvement being more common. Constitutional symptoms were frequent, especially among patients from Iran. Cough was more common among patients from Kuwait and Iran, while dyspnea was the predominant symptom for Saudi patients. Erythema nodosum was more common in the Turkish population. Clustering was seen in patients with Stage I and II of the disease in all countries except Oman. Apart from those in Iran, the prognosis of most patients from the Middle East was excellent.

Asthma and obesity in the Middle East region: An overview

This paper aims to cover the current status of asthma and obesity in the Middle East, as well as to introduce the various studies tying the two diseases; further expanding on the proposed mechanisms. Finally, the paper covers recent literature related to sphingolipids and its role in asthma, followed by recommendations and future directions. In preparation of this paper, we searched PubMed and Google Scholar, with no restrictions, using the following terms; asthma, obesity, Middle East, sphingolipids. We also used the reference list of retrieved articles to further expand on the pool of articles that were used for this review.

Workforce Considerations, Training, and Diseases in the Middle East

Evaluating and providing global health assistance, humanitarian aid, and medical missions to Middle Eastern countries can be rewarding and challenging. A broad spectrum of financial capabilities supports effective health care delivery and infrastructure. Middle East tension can make obtaining a visa difficult. Personal safety considerations may hinder efforts to develop and carry out clinical and educational programs. Several Middle East countries have sophisticated and modern health care systems. Medical education and specialty training compares with that of Western medicine. The Middle East has a proud heritage as the foundation of many fundamental and modern medical and surgical principles.

Factors influencing management of chronic respiratory diseases in general and chronic obstructive pulmonary disease in particular in Saudi Arabia: An overview

The prevalence of chronic obstructive pulmonary disease in Saudi Arabia is 4.2% among the general population and 14.2% among smokers. Studies showed that management of respiratory diseases is inadequate. In this article, we have elaborated on how factors as health economic factors, lack of health-care providers, culture, attitude, lifestyle (such as smoking and physical inactivity), and lack of adherence to the evidence-based practice guidelines may influence chronic respiratory disease management in Saudi Arabia. We have to conclude that these factors should be taken into account while seeking to improve and optimize the quality of care for patients with respiratory diseases in Saudi Arabia.

Health Impact Assessment of Asian Dust/Cross-border Air Pollutant and Necessary Preventive Measure

The health effects of Asian dust (mineral dust) originating from dry lands such as the Gobi Desert and Taklamakan Desert have recently been a concern. In addition to Asian dust, transboundary airborne microparticles that reach Japan include various types of aerosol, such as artificial air pollutants and smoke from combustion. They originate from densely populated areas and are transported along the same route as Asian dust. We analyzed environmental factors and subjective symptoms involving the respiratory organ, nose, eyes, and skin using a conventional equation for estimation, and found that symptoms with a significant risk of worsening varied according to the type of pollutants reaching Japan. We also analyzed the synergistic effects of Asian dust and pollens on nasal symptoms using a two-pollutant model. The odds ratio for symptoms at the time of arrival of a high concentration of Asian dust was 1.37 (95% confidence interval: 1.19-1.58), but the odds ratio adjusted for pollens was 1.18 (95% confidence interval: 1.04-1.34). Although the influence on nasal symptoms overlapped somewhat between Asian dust and pollens, that of Asian dust remained significant. Regarding preventive measures against symptoms, we examined the rate of particle leakage into masks. We found that it is important to wear a mask that fits an individual's facial features and has no gap between the face and the mask. In addition, we report our attempt to construct models for predicting aerosol arrival and forecasting health to establish preventive measures against aerosols.

Hospital admissions among immigrants from low-income and foreign citizens from high-income countries in Spain in 2000-2012

Over the last decade, the number of foreign nationals in Spain has increased. Our aim was to report the trends in hospital admissions, differentiating between foreign nationals from high-income countries (HICs) and from low- and middle-income countries (LMICs) in a public hospital. A retrospective analysis of hospital admissions in patients aged ⩾15 years between 2000 and 2012 was performed by means of hospital information systems at a public hospital in the city of Alicante, Spain. During the period of the study, 387,862 patients were admitted: 32,020 (8.3%) were foreign, 22,446 (5.8%) were from LMICs, and 9574 (2.5%) were from HICs. The number of foreign nationals, foreign nationals from LMICs, and foreign nationals from HICs admitted increased from 1019, 530, and 489 in 2000 to 2925, 2097, and 828, respectively in 2012. A total of 27.5% of patients were admitted for pregnancy, childbirth, and puerperium, especially foreign nationals from LMICs (34.3%), and 14.1% of foreign nationals were admitted for cardiovascular diseases (14.1%), which were more common in those from HICs (26.3%). The number of admissions among foreign nationals from LMICs increased significantly in all the diagnoses, but in pregnancy, childbirth, and puerperium, the increase was higher. In conclusion, nearly one out of 10 adult patients admitted to our hospital was foreign, mainly from LMICs, and the main reason for admission was diagnoses related to pregnancy, childbirth, and puerperium.

Barriers for setting up a pulmonary rehabilitation program in the Eastern Province of Saudi Arabia

BACKGROUND

Pulmonary rehabilitation (PR) programs proven to be one of the most effective treatment options for respiratory diseases; yet, they are not well-established in hospitals in Saudi Arabia.

AIM

To determine the main barriers for setting up PR programs in Saudi Arabia.

METHODS

A cross-sectional study was conducted in the Eastern Province of Saudi Arabia. Health care providers involved in treatment of chronic obstructive pulmonary disease (COPD) patients were recruited from 22 general government hospitals. Data were collected using questionnaires: Full version if they had heard about PR before the study, and a short version if they had not heard about PR before.

RESULTS

A total of 123 health care providers were recruited (physicians [n = 44], nurses [n = 49], and respiratory therapists/technicians [n = 30]). Only 3.2% of the recruited health care providers had heard about PR programs before. According to the health care providers, the main barriers for setting up PR programs were a lack of (1) hospital capacity (75.6%), (2) trained health care providers (72.4%), and (3) funds (48.0%). There were significant differences in barriers reported by the health care providers. Compared to physicians, nurses were more likely to nominate the PR costs as a barrier (18.0% vs. 38.8%; P < 0.05).

CONCLUSION

There is a worrisome lack of knowledge regarding content and benefits of PR programs among Saudi health care providers treating COPD patients. These findings imply that improving awareness and increasing education of the health care providers regarding PR will be required before PR can be more widely implemented as an integral treatment modality for patients with COPD in Saudi Arabia.

The use of Quantiferon-TB gold in-tube test in screening latent tuberculosis among Saudi Arabia dialysis patients

BACKGROUND AND AIM

Screening for tuberculosis (TB) is a key strategy for controlling infection. This study aimed to detect latent TB among dialysis patients.

METHODS

This is a prospective study conducted in King Saud University, Riyadh involving hemodialysis (HD) and peritoneal dialysis (PD) patients aged ≥18 years. Patients were screened for latent TB infection (LTBI) using both TBskin test (TST) and QuantiFERONTB Gold In-Tube test (QFT-GIT). All participants were followed-up clinically and radiologically every 3 months for 2 years.

RESULTS

A total of 243 (181 HD and 62 PD) patients were included and 112(46.1%) were males. 45.3% showed positive QFT in HD patients with sensitivity of 91.7%, specificity of 71.4%, positive predictive value (PPV) of 19.5%, and negative predictive value (NPV) of 91.1%. TST results in HD showed that positive TST was 17.4%, sensitivity was 63.2%, specificity was 95.5%, PPV was 51.5%, and NPV was 91.1%. Five (8.1%) showed positive QFT in PD patients with sensitivity of 7.7%, specificity of 91.8%, PPV of 6.6%, and NPV of 92.3%. TST results in PD showed that positive TST was 9.8%, sensitivity was 35.7%, specificity was 97.9%, PPV was 55.8%, and NPV was 93.3%. Previous TB infection was significantly correlated with QFT only in HD patients, but significantly associated with TST in both HD and PD patients. Also in HD, QFT was significantly associated with TST (P = 0.043).

CONCLUSIONS

Due to high variability of QFT-GIT sensitivity, we recommend its use for its NPV and to use either TST or QFT in screening latent TB.

Current care services provided for patients with COPD in the Eastern province in Saudi Arabia: a descriptive study

BACKGROUND

COPD is a leading cause of morbidity and mortality worldwide. The prevalence rate of COPD in the general Saudi population is estimated to be 2.4% and 14.2% among smokers. Not much is known about current health care services for patients with COPD in Saudi Arabia. The objective of this study was to determine the current care services for patients with COPD provided by government hospitals in the Eastern province of Saudi Arabia.

METHODS

A cross-sectional study was conducted in the Eastern province of Saudi Arabia. Directors of the Department of Internal Medicine from all 22 general government hospitals that are under the responsibility of the Ministry of Health or the Ministry of Higher Education in this region were asked to participate. Data were collected using a questionnaire.

RESULTS

The study results indicated that there are limited hospital facilities for patients with COPD: no respiratory departments in any of the included hospitals, no spirometry in 77.3% of the hospitals, no intensive care units in 63.7% of the hospitals, and no pulmonary rehabilitation program in any of the hospitals. Among the included 22 hospitals, 24 respiratory physicians, 29 respiratory therapists, and three physiotherapists were involved in COPD care.

CONCLUSION

In conclusion, current care services provided by government hospitals in the Eastern province of Saudi Arabia for patients with COPD do not meet international recommendations for COPD management. Increased awareness, knowledge, and implementation of COPD guidelines by health care providers will most probably improve COPD management in Saudi Arabia. In addition, the government could improve dissemination of information about COPD management through national programs and by offering specific education regarding respiratory diseases.

Mucormycosis: a rare fungal infection in tornado victims

This article reviews four immunocompetent patients who developed a rare fungal infection, mucormycosis, secondary to multiple traumatic injuries sustained during an EF-5 tornado in Joplin, MO. Commonly found in soil and decaying organic matter, mucorales are fungi associated with soft tissue and cutaneous infections. Onset of this fungal infection can occur without clinical signs, presenting several days to several weeks after injury, delaying diagnosis. A multidisciplinary treatment approach including aggressive antifungal therapy and aggressive surgical debridement is critical. This diagnosis should be considered in all patients presenting with injuries sustained from high-velocity embedment of debris such as natural disasters or explosions. We present four cases of mucormycosis, species Apophysomyces trapeziformis. Data reported includes predisposing factors, number of days between injury and diagnosis of mucormycosis, surgical treatment, antifungal therapy, outcomes, and potential risk factors that may have contributed to the development of mucormycosis.

Incidence of and risk factors associated with pulmonary and extra-pulmonary tuberculosis in Saudi Arabia (2010-2011)

SETTING

National Tuberculosis Program, Department of Public Health, Ministry of Health, Kingdom of Saudi Arabia (KSA).

OBJECTIVE

To summarize data on the incidence of tuberculosis and associated risk factors for cases reported during 2010-2011.

DESIGN

Retrospective analysis of routinely collected data through an established national disease notification system of the Ministry of Health in KSA.

RESULTS

The estimated incidence of all forms of tuberculosis fell from 15.8/100000 (95% CI: 15.3/100,000-16.3/100,000) in 2010 to 13.8/100,000 (95% CI: 13.4/100,000-14.2/100,000) in 2011. Saudis experienced a decrease from 11.8/100,000 (95% CI: 11.3/100,000 to 12.3/100,000) in 2010 to 9.9/100,000 (95% CI: 9.5/100,000-10.4/100,000) in 2011 while the incidence in non-Saudis declined from 24.7/100,000 (95% CI: 23.6/100,000 to 25.7/100,000) in 2010 to 22.5/100,000 (95% CI: 21.5/100,000 to 23.4/100,000) in 2011. The proportion of Extra Pulmonary TB (EPTB) which increased minimally from 30% in 2010 to 32% in 2011 was higher than global figures and strongly associated with age, sex, nationality and occupation.

CONCLUSION

The current estimated incidence of about 14/100,000 in 2011 is less than half its estimated value of 44/100000 in 1990. Without prejudice to any under-reporting, the KSA appeared to be on the course for TB elimination by 2050 having reached the first milestone set by WHO. The proportion of EPTB remains higher than global figure and age, sex, nationality and occupation were significant independent predictors of EPTB.

The most common aeroallergens in a tropical region in Southwestern Iran

Background

Respiratory allergies are the most important public health issues in the world. They are caused by aeroallergens which play great role in pathogenesis of respiratory allergic diseases.

Methods

The current study was conducted to evaluate the prevalence of positive skin test for various aeroallergens among allergic patients in Ahvaz, southwest Iran. 299 participants with allergic rhinitis (seasonal or perennial) were selected. Skin prick test using twenty three common allergen extracts was performed on all patients.

Results

The overall frequency of sensitization to any allergen was 85.6%. In outdoor allergens the most prevalent aeroallergen category was weeds (89%) followed by tree and grasses, and in indoor allergens, mites (43%) were the most prevalent aeroallergen. The mean and median numbers of positive test reactions among those with positive test responses were 11.5 and 13.0, respectively. 84% of patients were poly-sensitised and about 50% of them were sensitised to more than twelve different allergens.

Conclusion

The results of the study revealed that prevalence of the skin prick reactivity to weed pollens is significant in southwest Iran and multiple sensitizations were common.

Gene expression profiling and pathway analysis of human bronchial epithelial cells exposed to airborne particulate matter collected from Saudi Arabia

Epidemiological studies have established a positive correlation between human mortality and increased concentration of airborne particulate matters (PM). However, the mechanisms underlying PM related human diseases, as well as the molecules and pathways mediating the cellular response to PM, are not fully understood. This study aims to investigate the global gene expression changes in human cells exposed to PM(10) and to identify genes and pathways that may contribute to PM related adverse health effects. Human bronchial epithelial cells were exposed to PM(10) collected from Saudi Arabia for 1 or 4 days, and whole transcript expression was profiled using the GeneChip human gene 1.0 ST array. A total of 140 and 230 genes were identified that significantly changed more than 1.5 fold after PM(10) exposure for 1 or 4 days, respectively. Ingenuity Pathway Analysis revealed that different exposure durations triggered distinct pathways. Genes involved in NRF2-mediated response to oxidative stress were up-regulated after 1 day exposure. In contrast, cells exposed for 4 days exhibited significant changes in genes related to cholesterol and lipid synthesis pathways. These observed changes in cellular oxidative stress and lipid synthesis might contribute to PM related respiratory and cardiovascular disease.

Environmental Exposure and Nonadherence with Medicines Directly Correlate with Exacerbations and Hospitalization for Asthma: A Population-Based Survey from UAE

Acute severe exacerbation of asthma is directly related with the uncontrolled asthma including noncompliance with the medicines and exposure to the environmental factors. To our knowledge, none of the community-based study has explored the prevalence of asthma and other factors (namely, pattern of symptoms, environmental/occupational/housing/behavioral pattern/misperception about asthma, and educational factors) contributing to the exacerbation of asthma. We also studied the nonadherence issues related to the management of asthma in the United Arab Emirates (UAE). By using European Community Respiratory Health Survey (ECRHS) questionnaires and pooled data from AIRGNE (UAE) study, we aimed to determine the above-mentioned factors in the general population by means of a cross-sectional assessment of a random sample of 1,229 participants of which 62.97% were male and 20.01% were UAE nationals, with a mean age (±SD) of 32.9 (±14.1) years. Prevalence of individual respiratory symptoms from the ECRHS questionnaire in all participants ranged from 8 to 10%, while those participants aged 20–44 years presented a lower prevalence in all symptoms (P<0.05). Conclusion. Certain specific persistent environmental factor along with nonadherence to the controller medicines is a significant factor leading to uncontrolled asthma with consequent exacerbations, morbidity/mortality, and health care cost in UAE.