Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary hypertension due to left heart disease

Pulmonary hypertension in the developing world: Local registries, challenges, and ways to move forward

Pulmonary hypertension (PH) is a disease that can only be appropriately managed in the ‘rich’ developed countries, as both diagnostic and therapeutic interventions are extremely expensive and expectations for these to be adopted by the developing, economically-challenged countries are neither practical nor realistic. Furthermore, most of the enormous advances in understanding the pathobiology of PH and the subsequent evidence-based diagnostic and complex treatment algorithms came from the developed world.

Estimation of Endostatin level in pulmonary arterial hypertension patients and its relation with some parameters

Biomarkers are attractive non-invasive tools for estimating and monitoring pulmonary arterial hypertension (PAH) disease and for predicting survival in patients with PAH; therefore, many studies encouraged the investigation of new biomarkers to facilitate the diagnosis of PAH. Endostatin (ES) is an endogenous inhibitor of angiogenesis. It is produced by proteolytic cleavage of the collagen XVIII that is present in both normal and cancerous tissue. In vitro examination shows that ES can manage endothelial cells (EC) physiology in ways that could influence angiogenesis. For example, solvent ES hinders EC movement and prompts improvements of the cytoskeleton that incorporate the loss of Actin stretch strands and central grips. This effect embraces restrictions on the α5β1integrins, Tropomyosin, and putative heparan sulfate proteoglycans. Consequences for the human EC cytoskeleton include Es-induced down-regulation of Mitogen-actuated Protein Kinase (MAPK), Focal Adhesion Kinase (FAK), the Urokinase Plasminogen Activator (uPA) System, and the RhoA GTPase. Human ES has likewise been shown in a few investigations to repress EC multiplication. Moreover, ES-instigated cell cycle capture in the G1 stage is joined by Cyclin D1 down-regulation. Of note, ES blocks the proliferation and organization of endothelial cells into new blood vessels, and in animal studies, ES also inhibits angiogenesis and the growth of both primary tumors and secondary metastasis. ES was initially identified by its capacity to inhibit tumor angiogenesis in vitro and also in vivo. It can also be found in both healthy and patient’ serum, and has been detected in peripheral circulation. ES could be an attractive, non-invasive prognostic marker for some diseases, notably PAH. Therefore, the presented work is aimed at investigating the ES level in blood serum as a biomarker for detection, diagnosis and early treatment of PAH patients. In doing so, the association is ascertained between gender, age, body mass index (BMI), waist circumferences, smoking, types of PAH (primary and secondary) and this potential biomarker is assessed in PAH patients.

Assessment of noggin level in pulmonary arterial hypertension patients

Noggin (NOG) is a protein that is involved in the development of many body tissues, including nerve tissue, muscles, and bones. The NOG protein plays a role in germ layer-specific derivation of specialized cells. Via NOG, the formation of neural tissues, the notochord, hair follicles, and eye structures arise from the ectoderm germ layer, while noggin activity in the mesoderm gives way to the formation of cartilage, bone and muscle growth. In the endoderm, NOG is involved in the development of the lungs.

NOG dimerizes by a core body, while two pairs of strands extend from it preceding by an N-terminal segment (called a clip segment) with approximately 20 amino acids. This clip twists around the BMP ligand and obstructs the growth factor surfaces from binding to both BMP receptors type I and type II. NOG binding to some BMPs inhibits these from combining and thus activating receptors of BMP, therefore, blocking non-Smad and Smad-dependent signaling.

The anti-proliferative noggin has particular effects in pulmonary arterial smooth muscle cells (PASMCs) that are exposed to specifically down regulated hypoxia. This occurs together with the BMP4 up-regulation levels of protein, and this imbalance between NOG and BMP4 consequence results in the activation and development of PAH disease. Our study consists of numerous examinations so as to explore new biomarkers in order to determine onset of PAH, and to discover the relationship between NOG serum level and gender, age, body mass index (BMI), waist circumferences (WC), smoking, types of PAH primaries and secondaries, as well as their grade.

Erratum: Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: Pulmonary hypertension due to left heart disease

[This corrects the article on p. 47 in vol. 9.].

The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children

This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan.