Chronic obstructive pulmonary disease and associated healthcare resource consumption in the Middle East and North Africa: The BREATHE study

SummaryData on COPD-related healthcare resources use are rarely documented in developing countries. This article presents data on COPD-related healthcare resource consumption in the Middle East, North Africa and Pakistan and addresses the association of this variable with illness severity. A large survey of COPD was conducted in eleven countries of the region, namely Algeria, Egypt, Jordan, Lebanon, Morocco, Pakistan, Saudi-Arabia, Syria, Tunisia, Turkey and United Arab Emirates, using a standardised methodology. A total of 62,086 subjects were screened. This identified 2,187 subjects fulfilling the “epidemiological” definition of COPD. A detailed questionnaire was administered to document data on COPD-related healthcare consumption. Symptom severity was assessed using the COPD Assessment Test (CAT). 1,392 subjects were analysable. Physician consultations were the most frequently used healthcare resource, ranging from 43,118 [95% CI: 755–85,548] consultations in UAE to 4,276,800 [95% CI: 2,320,164–6,230,763] in Pakistan, followed by emergency room visits, ranging from 15,917 [95% CI: 0–34,807] visits in UAE to 683,697 [95% CI: 496,993–869,737] in Turkey and hospitalisations, ranging from 15,563 [95% CI: 7,911–23,215] in UAE to 476,674 [95% CI: 301,258–652,090] in Turkey. The use of each resource increased proportionally with the GOLD 2011 severity groups and was significantly (p < 0.0001) higher in subjects with more symptoms compared to those with lower symptoms and in subjects with exacerbations to those without exacerbations. The occurrence of exacerbations and the CAT score were independently associated with use of each healthcare resource. In conclusion, the BREATHE study revealed that physician consultation is the most frequently COPD-related healthcare resource used in the region. It showed that the deterioration of COPD symptoms and the frequency of exacerbations raised healthcare resource consumption

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Effect of crop management on soil bacterial communities in organic and conventional farming systems. Elabed, N., Bouri, M., Rhouma, A., Ben Kheder, M., and M'Hamdi, M. (Tunisia)

The aim of the present study was to assess the population of bacteria isolated from organic and conventional soils and to identify antagonistic ones with a potential antifungal activity against some pathogenic fungi (Rhizoctonia solani and Fusarium oxysporum). All cultivable bacterial isolates were evaluated for their antifungal activity and the most effective ones were identified based on 16S rDNA sequence analysis. The results showed that among a total number of 100 bacteria isolated from soil, eight isolates displayed antifungal activity against F. oxysporum and twenty four isolates had suppressed R. solani growth. The results indicated that tested bacterial species exhibited varying degree of antagonistic potential against pathogenic fungi which ranged from 22.7% using AB95 isolate to 77.2% with AB40 and AB8 tested against F. oxysporum and from 22.7% using AB51 and AB5 to 68.1% with AB75 and AB64 tested against R. solani. DNA sequencing reaction of purified PCR amplicon was carried out using 16sF and 16sR primers. Sequence alignment with the reference sequences of the databases using BLAST was performed. The most dominant genuswas Bacillus. Phylogenetic tree was built

Burden of Chronic Respiratory Diseases (CRD) in Middle East and North Africa (MENA)

Chronic respiratory diseases involve a heterogenous group of diseases, including, chronic obstructive pulmonary disease (COPD), asthma, sleep apnea syndrome, pulmonary hypertension, and many occupational diseases. They affect more than one billion people worldwide. Their medical, social, and economic impacts are heavy, especially in developing countries such as Middle East and North Africa countries, where they represent a public health problem. They are essentially represented by COPD, asthma, and allergic diseases. Chronic respiratory diseases are increasing in frequency, morbidity, and mortality. In addition, their economic and social impact is increasing rapidly in this region. Main risk factors are represented by tobacco smoking and exposure to biomass fuel. Smoking prevention and standardized management programs for asthma and COPD are now available but prompt actions are needed to make them more effective in this region and thus avoid an adverse impact on national economic development. Keywords: chronic respiratory diseases, chronic obstructive pulmonary disease, asthma, epidemiology, tobacco, burde

Management of chronic obstructive pulmonary disease in the Middle East and North Africa: Results of the BREATHE study

SummaryChronic obstructive pulmonary disease (COPD) is a potentially severe chronic progressive respiratory condition requiring long-term treatment and frequently involving episodic hospitalisations to manage exacerbations. The objective of this analysis was to document diagnosis, evaluation, treatment and management of COPD-related respiratory symptoms in 1,392 subjects fulfilling an epidemiological definition of COPD identified in a general population sample of 62,086 individuals aged ⩾ 40 years in ten countries in the Middle East and North Africa region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan. 442 subjects (31.8%) claimed to have received a diagnosis of COPD from a physician and 287 (20.6%) had undergone spirometry in the previous year. Use of specific treatments for respiratory symptoms was reported by 218 subjects (15.7%). Use of inhaled long-acting bronchodilators together with corticosteroids (53 subjects; 3.8%) and use of oxygen therapy (31 subjects; 2.3%) was very low. 852 subjects (61.2%) had consulted a physician about their respiratory condition at least once in the previous year, with a mean number of consultations of 3.4±3.6. Moreover, 284 subjects (20.4%) had been hospitalised overnight for their COPD, with a mean of 2.3±3.7 hospitalisations per year. Use of all healthcare resources was significantly higher (p < 0.001) in subjects with CAT scores ⩾10 than in those with scores < 10, and greater in those with exacerbations than in those without. In conclusion, COPD in the region is under-diagnosed, inadequately evaluated and inadequately treated. Nonetheless, COPD symptoms are responsible for considerable healthcare consumption, with high levels of physician consultation and hospitalisation