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.

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Purpose: Asthma control test (ACT) has been devised to assess the degree of asthma control in out-patients setting. The aim of this study is to validate the Arabic version of ACT. Materials and Methods: Patients completed the Arabic version of ACT during regular visit to one of two asthma specialists. Spirometry was obtained. The asthma specialist rated asthma control using a 5-point scale and indicated modification in management as step up, same or step down of asthma treatment. Results: 40 patients completed the study, the mean age was 32.6 + 14.0 years, mean FEV1 was 2.7 + 1.0 L (89.2% + 23.6% of predicted). The mean ACT score was 15.9 + 5.8; mean of specialist asthma control rating was 3.4 + 1.0. The internal consistency reliability of the 5-item ACT survey was alpha = 0.92. The correlation was moderate between ACT and specialists rating ( r = 0.482, P = 0.002) and between ACT and treatment modification ( r = -0.350, P = 0.027). The correlation between FEV1 and ACT was low ( r = 0.185, P = 0.259). ACT distinguished between patients with different specialist rating ( F = 3.37, P = 0.02) and the need to change therapy ( F = 3.62, P = 0.037). The areas under the curve (ROC) for ACT, FEV1, and ACT and FEV1 as independent variables were 0.720, 0.721, and 0.766 respectively. All results were comparable to the initial work for development of ACT. Conclusion: The Arabic version of the ACT is a valid tool to assess asthma control. ACT correlates better with asthma specialist rating of asthma control than with FEV1.

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Hypogenetic lung syndrome is more popularly known as a scimitar syndrome (SS). It is a rare developmental lung malformation which almost always occurs on the right side. The two most constant features of this syndrome are anomalous pulmonary venous return into systemic circulation, most frequently via inferior vena cava (IVC), and lung hypoplasia. We are reporting such a case illustrating most typical and some uncommon features on chest radiograph and multislice computer tomography (MSCT) of chest. Focal herniation of liver through a diaphragmatic defect presenting as an ovoid soft tissue mass in right lower paraspinal region on chest X ray mimicking sequestration is an interesting but rare finding.

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Objectives: Unconventional therapy (UT) is a therapeutic practice of alternative and complementary medicine that is not currently considered an integral part of modern medical practice. The aim of this article is to investigate the experience of Saudi patients with UT modalities in the treatment of asthma. Materials and Methods: We carried out a cross-sectional study of asthma patients referred to King Abdulaziz Medical City, Riyadh, Saudi Arabia, during the year 2004. Information was collected using a pre-designed questionnaire administered through interviews. Results: Two hundred consecutive patients with a mean age of 52.3 years (±18.7) were included in this study. Sixty-nine (34.5%) of those patients used some form of UT in the previous year. There was a tendency to use UT among the older age group ( P = 0.029) and among those with longer duration of disease ( P = 0.009). However, there was no significant correlation observed between the use of UT and gender, FEV ₁ , or disease control. The most commonly used form of UT was recitation of Holy Quran (9%), honey (24.5%), herbs (23.5%), cautery (12%), and blackseed (10%). There was no significant correlation between disease control and the use of modalities. Conclusion: Unconventional therapy is frequently practiced by asthma patients in Saudi Arabia, who commonly believe that UT will lead to improvement. The lack of evidence necessitates the fostering of a national project to address the practice of UT.

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There is a high prevalence of consanguinity and bronchial asthma in Saudi Arabia. The objective of this study is to explore the effect of parental consanguinity on the occurrence of bronchial asthma in children. The study sample was determined by multistage random probability sampling of Saudi households. The families with at least one child with asthma were matched with an equal number of families randomly selected from a list of families with healthy children, the latter families being designated as controls. There were 103 families with children having physician-diagnosed bronchial asthma, matched with an equal number of families with no children with asthma. This resulted in 140 children with bronchial asthma and 295 children from controls. The age and gender distribution of the children with bronchial asthma and children from controls were similar. There were 54/103 (52.4%) and 61/103 (59.2%) cases of positive parental consanguinity in asthmatic children and children from controls respectively ( P = 0.40). Analysis of consanguinity status of the parents of children with asthma and parents among controls indicates that 71/140 (51%) of the children with asthma and 163/295 (55.3%) of the children from controls had positive parental overall consanguinity ( P = 0.43). The results of this study suggest that parental consanguinity does not increase the risk of bronchial asthma in children.

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Hereditary spherocytosis (HS) is a common inherited hemolytic anemia due to red cell membrane defects. Extramedullary hematopoiesis is a compensatory response to insufficient bone marrow blood cell production. The preferred sites of extramedullary hematopoietic involvement are the spleen, liver and lymph nodes; but in HS, the posterior paravertebral mediastinum is also commonly involved. We report a case of a 50-year-old male who presented to us in respiratory distress and with bilateral paravertebral posterior mediastinal masses, which on trucut biopsy were found to be extra-hematopoietic masses; and the patient was found to have hereditary spherocytosis.

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Objective: Hypocalcemia has been a common abnormality in the West, seen in patients admitted to the intensive care unit (ICU). It has also been linked with disease severity. We undertook this study to determine the frequency of hypocalcemia in patients admitted to the intensive care unit. Materials and Methods: In a retrospective chart review from January 2004 till December 2004, patients admitted to our ICU were reviewed. Patients' age, sex, diagnosis, acute physiology and chronic health score APACHE II and ionized calcium were recorded. Patients were divided into three groups based on disease severity as measured by APACHE II. Hypocalcemia was defined as ionized Ca level less than 1.18 mmol/L. Frequency was determined in each group and correlation of hypocalcemia with disease severity was explored. Results: Hypocalcemia was seen in 22.2% in group A (APACHE II < 10), 40.4% in group B (APACHE II 10-19) and 53.9% in group C (APACHE II > 19). Hypocalcemia and disease severity (APACHE II scores) were negatively correlated ( P = 0.02). Mean ionized Ca levels in groups A, B and C were 1.22 mmol/L (±0.10), 1.19 mmol/L (±0.11) and 1.25 mmol/L (±0.24) respectively. Conclusions: Hypocalcemia is a common finding in critically ill patients. It is correlated with worsening disease severity. Mechanisms underlying hypocalcemia and the possible relationship of hypocalcemia with mortality need further consideration.

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Background: Spirometry is the most basic, widely used and effort-dependent pulmonary function test. It assesses the lung volumes and flows, and is ideally suited to describe the effects of restriction or obstruction on lung function. Therefore, keeping in view the clinical applications of spirometry, this study attempts to explore the knowledge and practice about spirometry among pediatricians. Materials and Methods: A questionnaire-based study was conducted across multiple centers in various hospitals in Riyadh, Saudi Arabia. The structured questionnaire, based upon knowledge and practice of spirometry, was distributed to 150 pediatricians in the various tertiary care hospitals in the metropolitan area of Riyadh. Results: Ninety-four percent of 113 pediatricians agreed that spirometry is a valuable tool in pediatric clinical practice. However, knowledge relating to spirometry was lacking among pediatricians, and about 86% of the study population did not demonstrate up-to-date knowledge of spirometry in pediatrics. Only 11% of pediatricians were very confident in interpreting spirometry results. No statistically significant association was observed between the distribution of responses relating to knowledge and practice of spirometry and the study variables including academic position, duration of practicing experience and number of patients attended daily. Conclusion: The results indicated that pediatricians in Riyadh were lacking adequate knowledge about the clinical applications of spirometry in their daily clinical practice. Hence, it was suggested that pediatricians should attend periodical training, workshops and continuous medical education programmes to enhance their knowledge. This should especially be performed during their pediatric residency training programmes, as spirometry is one of the essential components in clinical practice.

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