Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
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REVIEW ARTICLES
Imaging lung manifestations of HIV/AIDS
Carolyn M Allen, Hamdan H AL-Jahdali, Klaus L Irion, Sarah Al Ghanem, Alaa Gouda, Ali Nawaz Khan
October-December 2010, 5(4):201-216
DOI:10.4103/1817-1737.69106  PMID:20981180
Advances in our understanding of human immunodeficiency virus (HIV) infection have led to improved care and incremental increases in survival. However, the pulmonary manifestations of HIV/acquired immunodeficiency syndrome (AIDS) remain a major cause of morbidity and mortality. Respiratory complaints are not infrequent in patients who are HIV positive. The great majority of lung complications of HIV/AIDS are of infectious etiology but neoplasm, interstitial pneumonias, Kaposi sarcoma and lymphomas add significantly to patient morbidity and mortality. Imaging plays a vital role in the diagnosis and management of lung of complications associated with HIV. Accurate diagnosis is based on an understanding of the pathogenesis of the processes involved and their imaging findings. Imaging also plays an important role in selection of the most appropriate site for tissue sampling, staging of disease and follow-ups. We present images of lung manifestations of HIV/AIDS, describing the salient features and the differential diagnosis.
  99,305 2,650 13
REVIEW ARTICLE
Pathogenesis, etiology and treatment of bronchiectasis
Nehad AL-Shirawi, Hamdan H AL-Jahdali, Abdullah Al Shimemeri
January-June 2006, 1(1):41-51
DOI:10.4103/1817-1737.25870  
Bronchiectasis is a chronic lung disease, defined pathologically as irreversible dilatation of the bronchi. The clinical course of the disease is chronic and progressive and in most cases, causes lung damage over many years. There is usually an initial event, which causes impairment of mucociliary clearance of the bronchial tree. The respiratory tract becomes colonized by bacteria that inhibit the ciliary function and promote further lung damage. The hallmark of bronchiectasis, is a chronic cough with mucopurulent or purulent sputum, lasting for months to years and may progress to chronic respiratory failure. Diagnosis of bronchiectasis is suspected on the basis of clinical manifestations. In order to confirm the diagnosis and underlying causes, appropriate investigations must be performed. In this comprehensive review, we discuss the etiology, pathogenesis, clinical presentation, appropriate investigations and management of bronchiectasis.
  66,104 3,033 6
REVIEW ARTICLES
The calcified lung nodule: What does it mean?
Ali Nawaz Khan, Hamdan H Al-Jahdali, Carolyn M Allen, Klaus L Irion, Sarah Al Ghanem, Shyam Sunder Koteyar
April-June 2010, 5(2):67-79
DOI:10.4103/1817-1737.62469  PMID:20582171
The aim of this review is to present a pictorial essay emphasizing the various patterns of calcification in pulmonary nodules (PN) to aid diagnosis and to discuss the differential diagnosis and the pathogenesis where it is known. The imaging evaluation of PN is based on clinical history, size, distribution and the gross appearance of the nodule as well as feasibility of obtaining a tissue diagnosis. Imaging is instrumental in the management of PN and one should strive not only to identify small malignant tumors with high survival rates but to spare patients with benign PN from undergoing unnecessary surgery. The review emphasizes how to achieve these goals. One of the most reliable imaging features of a benign lesion is a benign pattern of calcification and periodic follow-up with computed tomography showing no growth for 2 years. Calcification in PN is generally considered as a pointer toward a possible benign disease. However, as we show here, calcification in PN as a criterion to determine benign nature is fallacious and can be misleading. The differential considerations of a calcified lesion include calcified granuloma, hamartoma, carcinoid, osteosarcoma, chondrosarcoma and lung metastases or a primary bronchogenic carcinoma among others. We describe and illustrate different patterns of calcification as seen in PN on imaging.
  44,109 1,909 20
CASE REPORT
Unusual sternal mass: Adenocarcinoma with unknown primary site
Anshuman Darbari, Shekhar Tandon
July-December 2006, 1(2):84-86
DOI:10.4103/1817-1737.27108  
We are reporting a case of sternal mass-histologically proven high-grade adenocarcinoma. Despite exhaustive investigations, no other primary site was detected. It was difficult to differentiate from metastasis or from primary skin adnexa, but whatever diagnosis is made, wide surgical excision with reconstruction is recommended for improvement of life quality.
  44,318 718 -
ORIGINAL ARTICLE
Impact of an extensive asthma education campaign for physicians on their drug prescription practices
Abdullah Al-Shimemeri, Hend Al-Ghadeer, Hema Giridhar, Hamdan Al-Jahdali, Mohamed Al-Moamary, Javid Khan, Abdullah Al-Mobeireek, Abdullah Al Wazzan
January-June 2006, 1(1):20-25
DOI:10.4103/1817-1737.25866  
OBJECTIVE: To evaluate the impact of an extensive education campaign for physicians, in effecting positive changes, in their asthma prescription practice, in line with the 'Saudi protocol for diagnosis and management of asthma'. MATERIALS AND METHODS : An extensive campaign on asthma management for physicians in Saudi Arabia was conducted in 1995-1996, based on the 'Saudi protocol for asthma diagnosis and management'. During this campaign, one day courses-cum-workshops were held in 19 different cities, for over 2500 physicians (8% of all physicians in the kingdom). To evaluate the changes in asthma prescription, we retrospectively reviewed the charts of 98 asthmatic patients in 1994 and 100 patients in 1997, attending the outpatient department of two tertiary care hospitals, with over 500 beds, each in Riyadh and Jeddah. Data on demographic profile of the patients, Pulmonary function test and medications prescribed, were analysed and compared between the two groups. RESULTS: The mean age and severity of asthma was similar in both the groups.The prescription rate of inhaled steroids and inhaled beta-agonists increased significantly, with decrease in the use of oral beta-agonists, oral steroids, Theophylline, sodium cromoglycate and ketotifen. Conclusion: The use of inhaled steroids and inhaled beta agonists, considerably improved after the asthma education campaign for physicians in Saudi Arabia. Education campaign for physicians may be effective and could help in the improvement of clinical practice towards a specific disease.
  28,694 7,080 6
REVIEW ARTICLE
Bronchiolitis obliterans organizing pneumonia: Pathogenesis, clinical features, imaging and therapy review
Sara Al-Ghanem, Hamdan Al-Jahdali, Hanaa Bamefleh, Ali Nawaz Khan
April-June 2008, 3(2):67-75
DOI:10.4103/1817-1737.39641  PMID:19561910
Bronchiolitis obliterans organizing pneumonia (BOOP) was first described in the early 1980s as a clinicopathologic syndrome characterized symptomatically by subacute or chronic respiratory illness and histopathologically by the presence of granulation tissue in the bronchiolar lumen, alveolar ducts and some alveoli, associated with a variable degree of interstitial and airspace infiltration by mononuclear cells and foamy macrophages. Persons of all ages can be affected. Dry cough and shortness of breath of 2 weeks to 2 months in duration usually characterizes BOOP. Symptoms persist despite antibiotic therapy. On imaging, air space consolidation can be indistinguishable from chronic eosinophilic pneumonia (CEP), interstitial pneumonitis (acute, nonspecific and usual interstitial pneumonitis, neoplasm, inflammation and infection). The definitive diagnosis is achieved by tissue biopsy. Patients with BOOP respond favorably to treatment with steroids.
  30,759 2,995 18
GUIDELINES
The Saudi initiative for asthma - 2012 update: Guidelines for the diagnosis and management of asthma in adults and children
Mohamed S Al-Moamary, Sami A Alhaider, Mohamed S Al-Hajjaj, Mohammed O Al-Ghobain, Majdy M Idrees, Mohammed O Zeitouni, Adel S Al-Harbi, Maha M Al Dabbagh, Hussain Al-Matar, Hassan S Alorainy
October-December 2012, 7(4):175-204
This an updated guidelines 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 updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on "difficult-to-treat asthma." Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient-doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment.
  31,644 1,373 2
ORIGINAL ARTICLES
Assessment of visual evoked potentials in stable COPD patients with no visual impairment
Prem Parkash Gupta, Sushma Sood, Atulya Atreja, Dipti Agarwal
October-December 2010, 5(4):222-227
DOI:10.4103/1817-1737.69111  PMID:20981182
Objective : To assess whether patients having stable chronic obstructive pulmonary disease (COPD) with no clinical evidence of visual impairment or peripheral neuropathy have visual evoked potentials (VEP) abnormalities on electrophysiologic evaluation. Methods : In the present study, 80 male subjects with no clinical neuropathy or visual impairment were included; 40 COPD patients and 40 age-matched healthy volunteers. The characteristics of subjects including age, quantum of smoking, duration of illness (in COPD patients only), and spirometric indices {forced expiratory volume in first second (FEV 1 ), FEV 1 /forced vital capacity (FVC) %, and peak expiratory flow rate (PEFR)} were assessed. The mental status was assessed using a questionnaire Mini-Mental State Examination (MMSE) Questionnaire. Electrophysiologic studies for the evaluation of VEP were carried out on computerized equipment. Latency and amplitude of P100 wave were analyzed from the VEP wave patterns obtained through a standardized protocol in both the groups to detect abnormalities in the COPD group. For the COPD group, correlations of P100 parameters with patient characteristics, spirometric indices, and MMSE scores were assessed. Significant abnormality was defined as a variation beyond healthy volunteer mean ΁ 3 standard deviation. Results : We observed significantly prolonged latency and decreased amplitude of P100 in both eyes of the patients in COPD group compared with healthy volunteers. Twenty-two of the 40 COPD patients (55%) had significant abnormalities in P100 latency, and three COPD patients (7.5%) had abnormalities in P100 amplitude. The latency of P100 on the right side had statistically significant inverse correlation with FEV 1 /FVC% and MMSE score. Conclusions : Twenty-three of the 40 stable COPD patients (compared with healthy volunteers) were observed to have significant VEP abnormality detected on electrophysiologic evaluation: 21/40 having prolonged P100 latency and only 2/40 with decreased P100 amplitude. The statistically significant correlations were observed only between P100 latency (right eye) and FEV1/FVC as well as MMSE scores. The rest of the correlations were not statistically significant.
  30,800 484 3
EDITORIAL
Classification of asthma according to revised 2006 GINA: Evolution from severity to control
Emad A Koshak
April-June 2007, 2(2):45-46
DOI:10.4103/1817-1737.32228  PMID:19727344
  22,234 1,571 23
GUIDELINES
Saudi guidelines on diagnosis and treatment of pulmonary arterial hypertension
Majdy M Idrees, Mohammed Al-Hajjaj, Javeed Khan, Manal Al-Hazmi, Mohammed Alanezi, Sarfraz Saleemi, Faisal Sanai, Tarek Kashour, Siraj Wali, Robyn Barst
January 2008, 3(5):1-57
  21,318 1,525 5
REVIEW ARTICLE
Bronchial stents
Emad Ibrahim
July-December 2006, 1(2):92-97
DOI:10.4103/1817-1737.27110  
Bronchial stents are mostly used as a Palliative relief of symptoms often caused by airway obstruction, It is also used for sealing of stump fistulas after pneumonectomy and dehiscence after bronchoplastic operations. Advances in airway prosthetics have provided a variety of silicone stents, expandable metal stents, and pneumatic dilators, enabling the correction of increasingly complex anatomical problems. Several series have been published describing the application and results of these techniques. This manuscript reviews the historical development of stents, types, indication, outcome, and complications. Alternative therapies for tracheobronchial stenting were also reviewed
  20,547 1,104 7
Approach to acute exacerbation of idiopathic pulmonary fibrosis
Hammad Bhatti, Ankur Girdhar, Faisal Usman, James Cury, Abubakr Bajwa
April-June 2013, 8(2):71-77
DOI:10.4103/1817-1737.109815  PMID:23741267
Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial pneumonia with a median survival of 3 years after diagnosis. Acute exacerbation of IPF (AE-IPF) is now identified as a life-threatening complication. It presents as worsening dyspnea with new ground glass opacities superimposed upon a radiographic usual interstitial pneumonia (UIP) pattern. It is a diagnosis of exclusion. The prognosis of AE-IPF is poor and treatment strategies lack standardization. In order to rule out any reversible etiology for an acute decompensation of a previously stable IPF patient diagnostic modalities include computerized tomographic angiogram (CTA) coupled with high-resolution computerized tomography (HRCT) imaging of the chest, bronchoalveolar lavage (BAL) and echocardiogram with bubble study. Avoiding risk factors, identifying underlying causes and supportive care are the mainstays of treatment. Anti-inflammatory and immunosuppressant medications have not shown to improve survival in AE-IPF. Most of the patients are managed in a critical care setting with mechanical ventilation. Lung transplantation is a promising option but most institutions are not equipped and not every patient is a candidate.
  18,857 1,616 2
ORIGINAL ARTICLE
Manifestation of tuberculosis in patients with human immunodeficiency virus: A large Indian study
S Rajasekaran, A Mahilmaran, S Annadurai, S Kumar, K Raja
April-June 2007, 2(2):58-60
DOI:10.4103/1817-1737.32231  PMID:19727347
Background: Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Chennai, is the largest HIV-care center in South East Asia. As many as 29,300 HIV patients visited this center at least once in the year 2005 for care and support. Objectives: Clinical manifestations and the modes of presentation of tuberculosis were assessed among 12,750 adult and adolescent patients with human immunodeficiency virus (HIV) attending the hospital for the first time. Materials and Methods: Database of Hospital Information System, specially evolved for managing patients afflicted with tuberculosis and HIV, was utilized. The particulars confined to patients with tuberculosis and HIV co-infection who visited the hospital for the first time from January to December 2005 were considered for the analysis. Proportion test and Chi-square test with Yates correction were done. Results: As many as 12,750 adult and adolescent HIV-confirmed patients were screened for the possible presence of tuberculosis. Out of them, 4,383 (34.4%) patients had tuberculosis. Among them, 2,448 (55.9%) had pulmonary tuberculosis, and the remaining 1,935 (44.1%) had either disseminated or extra-pulmonary tuberculosis (P<0.001). Positive sputum-smear microscopy for acid fast bacilli was evident in 1,363 (31.1%) patients; however, it was significantly lower compared to positive smear rate of 44% in HIV patients (P< 0.001). Conclusion: Tuberculosis was found to be the predominant co-infection among the symptomatic patients infected with HIV attending the largest care center for the first time in India. Advanced tuberculosis, disseminated tuberculosis and sputum smear negative pulmonary tuberculosis were the presenting clinical manifestations in 44% of the patients, as they had moderate to advanced immunosuppression. Early detection of tuberculosis co-infection is absolutely necessary.
  18,457 1,011 7
ORIGINAL ARTICLES
Using arm span to derive height: Impact of three estimates of height on interpretation of spirometry
SK Chhabra
July-September 2008, 3(3):94-99
DOI:10.4103/1817-1737.39574  PMID:19561887
Background: When standing height required to calculate forced vital capacity (FVC) cannot be measured, it can be derived from arm span using different methods. Objectives: To compare three different estimates of height derived from arm span and investigate their impact on interpretation of spirometric data. Methods: In a cross-sectional study, 517 subjects aged 7 to 76 years, with various respiratory diseases underwent spirometry. Three estimates of height were obtained from arm span: (a) by direct substitution (Ht AS ); (b) estimated height (Ht est ), obtained from the mean arm span:standing height ratio; and (c) predicted height (Ht pred ), obtained from arm span by linear regression analysis. Predicted values of forced vital capacity (FVC) obtained from these estimates were compared with those obtained from actual standing height (Ht act ), followed by Bland Altman analysis of agreement in the patterns of ventilatory impairment. Results: The arm span was 5%-6% greater than the height. The difference increased with increasing height. Ht AS and the FVC predicted from it were significantly greater than the other measures of height and the related predicted FVCs respectively. Compared to Ht act , Ht AS gave a misclassification rate of 23.7% in taller subjects (Ht act > 150 cm) and 14.2% in shorter subjects in the patterns of ventilatory impairment. Misclassification rates were 6%-8% with Ht est and Ht pred . Agreement analysis showed that FVCs predicted from Ht pred had the best agreement with the FVC predicted from Ht act . Conclusions: Among several methods of estimating height from the arm span, prediction by regression is most appropriate as it gives least errors in interpretation of spirometric data
  18,154 799 9
GUIDELINES
The Saudi guidelines for the diagnosis and management of COPD
Javed H Khan, Hani M. S. Lababidi, Mohamed S Al-Moamary, Mohammed O Zeitouni, Hamdan H AL-Jahdali, Omar S Al-Amoudi, Siraj O Wali, Majdy M Idrees, Abdullah A Al-Shimemri, Mohammed O Al Ghobain, Hassan S Alorainy, Mohamed S Al-Hajjaj
April-June 2014, 9(2):55-76
DOI:10.4103/1817-1737.128843  PMID:24791168
The Saudi Thoracic Society (STS) launched the Saudi Initiative for Chronic Airway Diseases (SICAD) to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD). This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT) and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (<2 in the past year) can be classified as either Class I when they have less symptoms (CAT < 10) or Class II when they have more symptoms (CAT ≥ 10). High-risk COPD patients, as manifested with ≥2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score ≥10. The article also discusses the diagnosis and management of acute exacerbations in COPD.
  17,777 731 2
REVIEW ARTICLE
Pulmonary vascular complications of chronic liver disease: Pathophysiology, imaging, and treatment
Ali Nawaz Khan, Hamdan Al-Jahdali, Khalid Abdullah, Klaus L Irion, Quratulain Sabih, Alaa Gouda
April-June 2011, 6(2):57-65
DOI:10.4103/1817-1737.78412  PMID:21572693
To review the pathogenesis of pulmonary vascular complications of liver disease, we discuss their clinical implications, and therapeutic considerations, with emphasis on potential reversibility of the hepatopulmonary syndrome after liver transplantation. In this review, we also discuss the role of imaging in pulmonary vascular complications associated with liver disease.
  15,680 1,423 5
Pulmonary embolism: A diagnostic approach
Muntasir M Abdelaziz, Siraj O Wali, Mahir M.A Hamad, Ayman B Krayem, Yaseen S Samman
January-June 2006, 1(1):31-40
DOI:10.4103/1817-1737.25869  
Despite the availability of many diagnostic modalities and the advent of new tests, the diagnosis of pulmonary embolism (PE) remains a challenge. Clinical manifestations can be notoriously deceptive and there is not a single test, that can be relied on solely, to exclude PE. Although it has been regarded as the gold standard test, pulmonary angiography has not been tested against a reference standard and thromboembolic events have been reported after a normal study. Therefore the diagnosis of PE depends on judicious utilization of the available tests in the right clinical setting, as the accuracy of the results of the investigations, depends largely on the pretest clinical probability. Simple investigations such as chest radiograph, electrocardiogram and arterial blood gas, are used to enhance the clinical probabilities, rather than confirming or refuting the diagnosis of PE. On the other hand, Perfusion ventilation (VQ) scan and computerized tomographic pulmonary angiography (CTPA), are the main screening tests used for patients with suspected PE. Recently CTPA has largely replaced VQ scan, in many centres. As both VQ scan and CTPA have their limitations, other diagnostic modalities, such as D-dimer and Compression ultrasound of the legs (CUS), are used as adjunctive diagnostic investigations. High probability and normal VQ scan, especially when combined with the concordant clinical probability, has a high positive and negative predicative value, respectively. On the other hand, CTPA is more sensitive and specific than VQ scan, though it has to be combined with CUS and clinical probability, to reduce the chance of missing PE. Although many diagnostic algorithms have been advocated, the discretion of the clinician and clinical experience, still has a major role to play in the diagnosis of PE. In this article, we try to come with a plausible approach to the diagnosis of PE, based on the current literature.
  15,400 1,147 1
BRIEF REVIEW
Airway pressure release ventilation
Ehab G Daoud
October-December 2007, 2(4):176-179
DOI:10.4103/1817-1737.36556  PMID:19727373
Airway pressure release ventilation was introduced to clinical practice about two decades ago as an alternative mode for mechanical ventilation; however, it had not gained popularity until recently as an effective safe alternative for difficult-to-oxygenate patients with acute lung injury/ acute respiratory distress syndrome This review will cover the definition and mechanism of airway pressure release ventilation, its advantages, indications, and guidance.
  13,954 2,124 4
ORIGINAL ARTICLE
Six minute walk test in respiratory diseases: A university hospital experience
Hatem FS Al Ameri
January-June 2006, 1(1):16-19
DOI:10.4103/1817-1737.25865  
BACKGROUND: Six minutes walk test (6MWT), is a sub-maximal exercise test, used as a clinical indicator of the functional capacity, in patients with cardiopulmonary diseases. Its safety, validity, reliability and its correlation with several physiological instruments, are well studied. However, there are no published data on 6MWT, in the Saudi population. We are reviewing our experience with 6MWT and assessing its safety and its correlation with pulmonary function variables, in patients with pulmonary diseases, in our local population. MATERIALS AND METHODS: We consecutively studied patients with pulmonary diseases, who underwent 6MWT and pulmonary function test in King Khalid University Hospital, from June 2003 to December 2004. The 6MWTs were conducted according to the American Thoracic Society guidelines. Spirometry, lung volumes and diffusion capacity measurements were correlated with the absolute walked distance. RESULTS: One hundred and twenty nine tests were performed. All patients were of the Saudi community (59% female), with mean age of 4315 years. Out of 129 patients, 65 patients had proven respiratory diagnosis. In all patients, the test were performed with no serious complications. The six minute walk distance (6MWD) had correlation with patient's height (r=+0.40, P <0.001), but not with patients' weight, BMI, borg scale, or oxygen saturation. The 6MWD correlated significantly with Dlco (r=+0.52, P <0.01), FVC (r=+0.46, r<0.001) and had a weaker relation with FEV1 (r=+0.31, P <0.05). The test had no significant correlation with lung volumetric parameters (TLC, FRC and RV). CONCLUSION: 6MWT is simple and safe test in evaluating patients with chronic pulmonary diseases in the Saudi population. In our study, 6MWD showed correlation with spirometric parameters and diffusion capacity. Further studies are needed to evaluate 6MWT in a more homogenous patients' population.
  14,692 1,334 6
BRIEF REVIEW
Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials
Mitrakrishnan Chrishan Shivanthan, Senaka Rajapakse
April-June 2014, 9(2):77-80
DOI:10.4103/1817-1737.128844  PMID:24791169
The efficacy of magnesium sulphate in chronic obstructive pulmonary disease (COPD) was assessed by conducting a systematic review of published randomized clinical trials through extensive searches in MEDLINE and SCOPUS with no date limits, as well as manual review of journals. Outcome measures varied depending on route(s) of administration of magnesium sulphate and medications co-administered. Risk of bias was evaluated and quality of evidence was graded. Four (4) randomized trials were included. All trials had a moderate risk of bias and were of average methodological quality. Magnesium sulphate given intravenously did not seem to have an immediate bronchodilatory effect; however it appears to potentiate the bronchodilatory effect of inhaled beta-2 agonists. Increase in peak expiratory flow rate (PEFR) at 30 and 45 min was greater in those who received magnesium sulphate compared to placebo (P = 0.03), although the mean percentage change in PEFR was just 24%, without significant differences in dyspnoea scores, hospital admission rates, or emergency department readmission rates compared to placebo. Nebulized magnesium sulphate with salbutamol versus nebulized salbutamol with saline placebo showed no significant differences is forced expiratory volume in 1 s (FEV 1 ) measured at 90 min after adjustment for baseline FEV 1 (P = 0.34) or differences in the need for hospital admission. Combined inhalational and intravenous magnesium sulphate versus intravenous saline placebo and nebulized ipratropium bromide were comparable in terms of hospital admission, intubation and death, but the ipratropium bromide group showed better bronchodilator effect and improvement in arterial blood gas parameters. Overall, trial evidence for trial evidence for magnesium sulphate in acute exacerbation of COPD is poor, and further well-designed trials are needed.
  14,421 796 1
REVIEW ARTICLES
Pulmonary manifestations of gastroesophageal reflux disease
Gajanan S Gaude
July-September 2009, 4(3):115-123
DOI:10.4103/1817-1737.53347  PMID:19641641
Gastroesophageal reflux disease (GERD) may cause, trigger or exacerbate many pulmonary diseases. The physiological link between GERD and pulmonary disease has been extensively studied in chronic cough and asthma. A primary care physician often encounters patients with extra esophageal manifestations of GERD in the absence of heartburn. Patients may present with symptoms involving the pulmonary system; noncardiac chest pain; and ear, nose and throat disorders. Local irritation in the esophagus can cause symptoms that vary from indigestion, like chest discomfort and abdominal pain, to coughing and wheezing. If the gastric acid reaches the back of the throat, it may cause a bitter taste in the mouth and/or aspiration of the gastric acid into the lungs. The acid can cause throat irritation, postnasal drip and hoarseness, as well as recurrent cough, chest congestion and lung inflammation leading to asthma and/or bronchitis/ pneumonia. This clinical review examines the potential pathophysiological mechanisms of pulmonary manifestations of GERD. It also reviews relevant clinical information concerning GERD-related chronic cough and asthma. Finally, a potential management strategy for GERD in pulmonary patients is discussed.
  12,732 1,737 31
GUIDELINES
The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children
Mohamed S Al-Moamary, Sami A Alhaider, Majdy M Idrees, Mohammed O Al Ghobain, Mohammed O Zeitouni, Adel S Al-Harbi, Abdullah A Yousef, Hussain Al-Matar, Hassan S Alorainy, Mohamed S Al-Hajjaj
January-March 2016, 11(1):3-42
DOI:10.4103/1817-1737.173196  PMID:26933455
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.
  13,117 1,018 -
ORIGINAL ARTICLE
Unplanned extubation in the ICU: Impact on outcome and nursing workload
Ayman Krayem, Ron Butler, Claudio Martin
July-December 2006, 1(2):71-75
DOI:10.4103/1817-1737.27105  
PURPOSE: To determine the incidence and factors associated with unplanned extubation (UE) in the intensive care unit (ICU) and its relationship with nursing workload. MATERIALS AND METHODS: A retrospective case-control study was carried out within a cohort of ventilated patients in two teaching hospital medical-surgical ICUs. A total of 50 adult patients with UE were studied. Controls were subjects without UE who were matched to the cases on the following Five factors: age, gender, admission diagnostic category, admission date (within 3 months) and duration of mechanical ventilation. Other data including patient demographics, comorbid conditions, APACHE III score, ventilation parameters, use of sedation, re-intubation, mortality rate and ICU/hospital length of stay were collected. Nine equivalents of nursing manpower use score (NEMS) and multiple organ dysfunction score (MODS) were calculated in both, cases and controls, 24 h before and after the event. RESULTS: Sixty-eight episodes of UE occurred in 66 patients during the 24-month study period (1.1%). Patients with UE were more agitated ( P <0.001) and required higher doses of benzodiazepines ( P =0.023) than their controls. UE was associated with a higher rate of re-intubation compared to the control group ( P <0.001) but was not associated with a longer length of stay in ICU or hospital or excess mortality ( P >0.05). The mean NEMS were not significantly different between the two groups 24 h before ( P =0.69) and after ( P =0.99) the extubation event. Also, the mean MODS were similar between both groups 24 h before ( P =0.69) and after ( P =0.74) extubation. CONCLUSION: In this study, agitation and greater use of benzodiazepines were frequently associated with UE and potentially can be used as risk factors for UE. We have found no significant impact of UE on increasing mortality and, in a manner not shown before, nursing workload.
  11,895 1,038 5
Prevalence of respiratory diseases in hospitalized patients in Saudi Arabia: A 5 years study 1996-2000
Omer S Alamoudi
July-December 2006, 1(2):76-80
DOI:10.4103/1817-1737.27106  
OBJECTIVES: 1) To determine the prevalence of respiratory diseases and the length of stay among hospitalized patients with respiratory disorders 2) To detect the medical disorders commonly associated with respiratory diseases. MATERIALS AND METHODS: A retrospective review was done for 810 patients hospitalized with respiratory diseases in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, over 5 years (January 1996 to December 2000). A special form was used to collect information from patient medical records including demographic data (such as age, sex and nationality), discharge diagnosis with other associated diseases and length of stay during hospitalization. RESULTS: Fifty-five percent of patients were males and 56.3% were Saudis. The mostly affected age group was 46-65 years (41.8%). Asthma (38.6%), chronic obstructive pulmonary disease (COPD) (17.2%), pneumonia (11.5%), lung cancer (8.4%) and tuberculosis (TB) (7.2%) had the highest prevalence among hospitalized patients. Asthma was higher among females (63.3%) than males (36.7%). In contrast, lung cancer, COPD and TB were higher among males (88.2, 66.9 and 74.1%) than females (11.8, 33.1 and 25.9%) respectively ( P <0.001). The mostly affected age groups among asthma and TB were 26-45 years and 46-65 years respectively, while the mostly affected age group in lung cancer and COPD patients was 46-65 years ( P <0.001). Diabetes mellitus (22.8%) and hypertension (15.1%) were the most prevalent associated diseases. In 75% of the patients, the length of stay ranged from 1-7 and 8-14 days. CONCLUSION: Asthma, COPD and pneumonia were the leading causes of hospitalization among patients with respiratory disorders, while diabetes and hypertension were the most commonly associated diseases.
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REVIEW ARTICLE
Obesity hypoventilation syndrome
Laila Al Dabal, Ahmed S BaHammam
April-June 2009, 4(2):41-49
DOI:10.4103/1817-1737.49411  PMID:19561923
Obesity is becoming a major medical concern in several parts of the world, with huge economic impacts on health- care systems, resulting mainly from increased cardiovascular risks. At the same time, obesity leads to a number of sleep-disordered breathing patterns like obstructive sleep apnea and obesity hypoventilation syndrome (OHS), leading to increased morbidity and mortality with reduced quality of life. OHS is distinct from other sleep- related breathing disorders although overlap may exist. OHS patients may have obstructive sleep apnea/hypopnea with hypercapnia and sleep hypoventilation, or an isolated sleep hypoventilation. Despite its major impact on health, this disorder is under-recognized and under-diagnosed. Available management options include aggressive weight reduction, oxygen therapy and using positive airway pressure techniques. In this review, we will go over the epidemiology, pathophysiology, presentation and diagnosis and management of OHS.
  9,975 1,644 11
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