Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 15 | Issue 3
Page Nos. 103-182

Online since Thursday, June 18, 2020

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EDITORIALS  

In the coronavirus disease-19 era, is the care of noncoronavirus disease-19 patients being compromised? p. 103
Abdullah Mobeireek, Hana Alzamil
DOI:10.4103/atm.ATM_176_20  
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Spread of coronavirus disease-19 among devotees during religious congregations p. 105
Syed Lal Badshah, Asad Ullah
DOI:10.4103/atm.ATM_162_20  
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HOT TOPIC Top

Hospital preparedness and management of pediatric population during COVID-19 outbreak Highly accessed article p. 107
Yasser M Kazzaz, Hamad Alkhalaf, Musaed Alharbi, Mohammed Al Shaalan, Maha Almuneef, Ali Alshehri, Hamza Alali, Talal AlHarbi, Nezar Alzughaibi, Abdulaleem Alatassi, Ahmed Haroun Mahmoud, Talal Aljuhani, Ahmad AlSaad, Jubran Alqanatish, Mohammed Aldubayee, Amna Malik, Asma Al Amri, Saleh Al Shebil, Milfi Al Onazi, Abdullah F Al Mutrafy, Mohamed S Al Moamary
DOI:10.4103/atm.ATM_212_20  
With the recent pandemic of Coronavirus disease-2019 (COVID-19), there has been a higher number of reported cases in children more than to the prior Corona Virus-related diseases, namely, severe acute respiratory syndrome and the Middle East respiratory syndrome. The rate of COVID-19 in children is lower than adults; however, due to high transmission rate, the number of reported cases in children has been increasing. With the rising numbers among children, it is imperative to develop preparedness plans for the pediatric population at the hospital level, departmental level, and patient care areas. This paper summarizes important considerations for pediatric hospital preparedness at the hospital level that includes workforce, equipment, supply; capacity planning, and infection prevention strategies, it also span over the management of COVID-19 pediatric patients in high-risk areas such as critical care areas, Emergency Department and operative rooms.
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REVIEW ARTICLES Top

Amphotericin B as antiviral drug: Possible efficacy against COVID-19 p. 118
Falah Hasan Obayes AL-Khikani
DOI:10.4103/atm.ATM_147_20  
Since its discovery, amphotericin B (AmB) is still one of the most common first-line choices in treatment pulmonary mycoses for over seventh decades from discovery. AmB which is belonged to the polyene group has a wide spectrum in vitro and in vivo antimicrobial activity against fungi and parasites, resistance to AmB is rare despite extensive use. Recently, some studies focused on the potential antimicrobial action of AmB against some enveloped viruses such as human immunodeficiency virus, Japanese encephalitis virus, and rubella virus. Coronaviruses are enveloped positive-sense RNA nucleic acid viruses that have club-like spikes, characterized by a distinctive replication strategy; they are round and sometimes pleomorphic shapes. COVID-19 is regarding the new genera of coronaviridae that appear the first time in Wuhan, China, in early December 2019. Due to the continuous spreading of the novel COVID-19 with the exponential rise in death numbers, new therapeutic development is urgent, in general, there are no specific antiviral drugs or vaccines for 2019-novel coronavirus. Hence, this review may serve as an impetus for researchers working in the field of medical microbiology, vaccination, and antiviral drug design by discussion the most recent information about the antiviral action of AmB against COVID-19 infection as well as trying to a deep understanding of major properties, mechanisms of action, immune system responses, and antimicrobial efficiency of AmB. Since AmB is expected to alter the structure of the viral envelope, membrane integrity of cells, and internal cellular organelles, besides its other unique properties such as host immunomodulatory effects, so this review suggested that AmB as an effective anti-fungi drug thus may hold the promise of formulating a novel therapeutic option to treat COVID-19.
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Ramadan intermittent fasting and immunity: An important topic in the era of COVID-19 p. 125
Mo'ez A-Islam E. Faris, Mohamed L Salem, Haitham A Jahrami, Mohamed I Madkour, Ahmed S BaHammam
DOI:10.4103/atm.ATM_151_20  
WITH the growing pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome (SARS)-related coronavirus (SARS-CoV-2) infection, a parallel growing interest arose concerning potential preventive and adjunct therapies, dietary and lifestyle modifications, and remedies that may boost the immunity against SARS-CoV-2 infection. Furthermore, as Ramadan intermittent religious fasting that is practiced by about one and a half billion Muslims throughout the globe is coincide this year with COVID-19 pandemic, a growing debate rose concerning the expected impact of fasting during Ramadan month and the associated dietary and lifestyle behaviors on the body's immunity against the pandemic infection. Published literature was searched to find out how intermittent fasting (IF) and its model of Ramadan affect the various aspects related to the body's immunity against microbial infections. IF was found to impact immunity by changing different related elements, including oxidative stress and inflammation, metabolism, body weight, and body composition. Dietary and lifestyle modifications during Ramadan month and their impact on immunity, such as water intake and hydration status, sleep duration and timing, caloric intake and mealtime, and social and spirtual activities, were addressed. Further research is warranted to figure out how IF during ramadan affects immunity against SARS-CoV-2 infection.
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BRIEF REVIEW Top

Simulation role in preparing for COVID-19 p. 134
Sara S Aldekhyl, Yaseen M Arabi
DOI:10.4103/atm.ATM_114_20  
During the current COVID-19 global pandemic, the major efforts are channeled toward containing and minimizing the spread and maintaining the healthcare providers' safety. One of the major aspects of effective infection control and prevention is healthcare team training and system troubleshooting. Simulation-based education appears to be a practical and flexible instructional design to achieve variable levels of knowledge, skills, and attitude training. In this paper, we aim is to provide a brief scheme on how simulation-based training can be employed in COVID-19 pandemic preparedness efforts. In addition, we will be sharing our multidisciplinary simulation experience in critical care at the National Guard Health Affairs, Saudi Arabia.
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COVID-19: Lessons in laboratory medicine, pathology, and autopsy p. 138
Khaldoon Aljerian, Ahmed S BaHammam
DOI:10.4103/atm.ATM_173_20  
Because coronavirus disease 2019 (COVID-19) is relatively new, health-care organizations and researchers have been publishing guidelines and recommendations to help health-care providers proceed safely with various aspects of disease management and investigation. Most of the published papers have addressed clinical presentation, diagnostic tests, mitigation measures, and hospital preparedness. Pathological and laboratory issues, including autopsy procedures and the handling of dead bodies, have not yet been well characterized. We reviewed the recent literature for guidelines and reports related to COVID-19 and anatomic pathology, specifically laboratory services, the handling of dead bodies, the conduct of autopsies, and postmortem pathological investigations, to synthesize relevant knowledge to ensure that clinicians are aware of the most recent recommendations for precautions and safety measures, and to support the development of standards in health-care facilities.
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ORIGINAL ARTICLES Top

A preliminary clinico-epidemiological portrayal of COVID-19 pandemic at a premier medical institution of North India p. 146
Sudhir Bhandari, Ajit Singh Shaktawat, Raman Sharma, Amitabh Dube, Shivankan Kakkar, S Banerjee, Prakash Keshwani, Shrikant Sharma, Sunil Mahavar, CL Nawal, Sudhir Mehta, Abhishek Agarwal, Vishal Gupta, Ashwin Mathur, Amita Kashyap, AS Dua, Dilip Raj, Kapil Gupta, Jitendra Kumar Gupta, Neeraj Verma, Amit Tak
DOI:10.4103/atm.ATM_182_20  
CONTEXT: The outbreak and spread of severe acute respiratory syndrome coronavirus 2 has led to a global exigency of colossal and monstrous proportions in terms of public health and economic crisis. Till date, no pharmaceutical agent is known to manage in terms of prevention and treatment of coronavirus disease 2019 (COVID-19), the disease caused by a novel virus. AIMS: The aim of the present work was to understand the underlying disease profile and dynamics that could provide relevant inputs and insight into pathophysiology and prevent further spread and evolve management strategies of COVID-19 patients from data-driven techniques. SETTINGS AND DESIGN: A retrospective observational descriptive study was conducted on 29 COVID-19 patients admitted at a premier medical institution of North India in the months of February and March 2020. METHODS: The patients were diagnosed with reverse transcription-polymerase chain reaction test. Demographic, clinical, and laboratory data were collected. RESULTS: The mean age of population was 38.8 years with male preponderance, of which two patients were residents of Italy, and others hailed from semi-arid and Western sandy arid regions of Rajasthan (urban population). The major presenting symptom complex of said COVID-19 sample population included fever (48%), cough (31%), and shortness of breath (17%). Most of the patients (83%) had no comorbidity. No clinical correlation (r) could be appreciated between the duration of test positivity and age of afflicted COVID-19 patients (r = −0.0976). CONCLUSIONS: The present evaluation of various facets of the ongoing global pandemic of COVID-19 is an attempt to portray early clinical and epidemiological parameters of the menace of COVID-19 patients admitted at SMS Medical College and Attached Hospitals, Jaipur.
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The relationship between diagnostic value of chest computed tomography imaging and symptom duration in COVID infection p. 151
Aydın Kant, Uğur Kostakoğlu, Serhat Atalar, Şükrü Erensoy, Tolgahan Sevimli, Barış Ertunç, Enes Dalmanoğlu, İsmail Yılmaz, Ayşe Ertürk, Gürdal Yilmaz
DOI:10.4103/atm.ATM_165_20  
OBJECTIVES: Severe acute respiratory syndrome-coronovirus-2 is a global public health problem, in which early diagnosis is required to prevent the spread of infection. In this study, we aimed to reveal the diagnostic value of chest computed tomography (CT) imaging with respect to symptom duration. METHODS: This retrospective study involved patients from five centers, who were admitted with typical COVID-19 symptoms and found to be positive for COVID-19 real-time reverse transcription-polymerase chain reaction (rtRT-PCR) test. RESULTS: One hundred and five patients with positive COVID-19 rtRT-PCR test were involved in the study. Sixty percent of these patients had chest CT imaging findings consistent with COVID-19 pneumonia. The most common chest CT finding was bilateral and subpleural ground-glass opacity in middle-lower lobes of the lungs. Chest CT findings were detected in 85.1% of the patients with a symptom duration of more than 2 days. In receiver operating characteristic analysis of this parameter, area under the curve (AUC) was 0.869, while sensitivity and specificity were 90.5% and 76.2%, respectively. It was notable that chest CT findings were 7.17 times more common among the patients aged 60 years and older, with AUC, specificity, and positive predictive value of 0.768, 88.1%, and 84.8%, respectively. CONCLUSION: Chest CT imaging is a quite valuable tool in patients with longer than 2 days' duration of symptoms, in whom clinical and epidemiological data support the diagnosis of COVID-19 infection. We suggest that the diagnosis of COVID-19 pneumonia should be made with chest CT imaging when rtRT-PCR test cannot be performed or gives a negative result, which is important for public health and to prevent the spread of infection.
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Hematoidin crystals in sputum smears: Cytopathology and clinical associations p. 155
Rafael Martinez-Giron, Hugo Cornelis van Woerden, Liron Pantanowitz
DOI:10.4103/atm.ATM_69_20  
BACKGROUND: There has been limited correlation of hematoidin crystals (HC) in sputum with clinical and diagnostic characteristics, partly because they are difficult to recognize. The aim of this study was, therefore, to assess these relationships in a consecutive cohort of sputum samples from patients submitted to a cytology laboratory. METHODS: Adequate sputum samples from 489 individuals were enrolled in this study. These were fixed in ethanol, stained by the Papanicolaou method and examined microscopically. The normality of the distribution of the continuous variable (age in years) was examined using the Shapiro–Wilk normality test. As the data were not normally distributed, Kendall rank correlation was used to correlate age with the presence of HC. The Pearson's Chi-square test was used to determine if the proportion of cases with the presence of HC was different among the categorical data variables. A univariate binary logistic regression was used to determine the variables most strongly associated with HC presence. The results include odds ratios, 95% confidence intervals, Wald χ2 statistics, and corresponding P values, with statistical significance assumed at P ≤ 0.05. Analyses were performed using IBM SPSS Statistics 22. RESULTS: The presence of HC in sputum was associated with increasing age (P < 0.01), current smoking (P < 0.001), chronic occupational exposure to dust (P = 0.001), and hemoptysis (P < 0.001). These crystals were most prevalent in patients with a diagnosis of carcinoma (93.9%), bronchiectasis (48%), silicosis (16.0%), and chronic obstructive pulmonary disease (0.8%). Crystals were not found in patients with acute bronchitis, asthma, or lung infections, including viral and bacterial pneumonia. CONCLUSIONS: There are clear associations linked to the finding of HC in sputum that may be helpful in pointing to a specific diagnosis, such as the possibility of underlying carcinoma.
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Prevalence of symptoms and risk of obstructive sleep apnea in Saudi pregnant women p. 163
Aljohara S Almeneessier, Mohammed Alangari, Abdulmalik Aldubayan, Abdulrahman Alsharidah, Aamer Altaki, Awad H Olaish, Yasser S Sabr, Ahmed S BaHammam
DOI:10.4103/atm.ATM_59_20  
BACKGROUND: This case-control study aimed to assess the prevalence of symptoms and risk of obstructive sleep apnea (OSA) among Saudi pregnant women. METHODS: The study included consecutive Saudi pregnant women attending the antenatal service between July 2015 and December 2016. Pregnant women were compared with an age-matched group of nonpregnant women. OSA symptoms and risk were assessed using a validated Arabic version of the Berlin questionnaire (BQ). RESULTS: The study included 742 pregnant women and 742 age-matched nonpregnant women. At the time of the survey, 8.2% were in the first trimester; 33.4% in the second trimester; and 58.4%in third trimester. Snoring was reported by 14% of pregnant women, and 5% reported breathing pauses during sleep. Based on the BQ stratification for risk of OSA, 19.3% of pregnant women and 16.6% of the control group were at high risk for OSA. A comparison between the high OSA-risk and low OSA-risk pregnant women revealed that the pregnant women in high risk group were older (30.9 ± 5.9 years vs. 29 ± 5.4 years, P = 0.001), had a higher body mass index (BMI) (34.3 ± 5.2 kg/m2 vs. 28.7 ± 5.8 kg/m2,P < 0.001), and higher parity (1.9 ± 2 vs. 1.5 ± 1.7, P = 0.020). A multivariate logistic regression analysis revealed the following independent variables, BMI (odds ratio [OR] 1.173 [95% confidence interval [CI] 1.129–1.219],P < 0.001), pregnancy-induced hypertension (OR 7.85 [95% CI 1.691–36.447], P = 0.013), and the presence of restless legs syndrome (OR 2.209 [95% CI 1.332–3.279],P < 0.001). CONCLUSIONS: OSA symptoms and risk were relatively common among Saudi pregnant women. Increasing the awareness among physicians about this association is essential to improve early detection of the disorder.
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CASE REPORTS Top

Anti-interleukin-6 monoclonal antibody for cytokine storm in COVID-19 p. 171
Steven Douedi, Moiuz Chaudhri, Jeffrey Miskoff
DOI:10.4103/atm.ATM_286_20  
Novel coronavirus disease 2019 (COVID-19) is known to cause severe pneumonia and acute respiratory distress syndrome which may lead to death. Several treatments have been tested in the race to find a treatment regimen for this deadly viral infection. Tocilizumab, a recombinant humanized anti-interleukin-6 receptor monoclonal antibody, has been used and found to be beneficial in patients with COVID-19 and in cytokine storm. We present the case of a young, otherwise healthy male, presenting with COVID-19 and successfully treated in the intensive care unit with tocilizumab.
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Pulmonary blastomycosis in rural Upstate New York: A case series and review of literature p. 174
Nancy W Bethuel, Nadir Siddiqui, Lee Edmonds
DOI:10.4103/atm.ATM_86_20  
In a rural medical center in Upstate New York, we observed an increase in pulmonary blastomycosis cases. Herein, we highlight the increased prevalence of blastomycosis in our region, and our experience with the diagnostic dilemma resulting in delayed diagnosis. This delay may have resulted in an increased mortality. A high index of suspicion may help hasten the diagnosis in an otherwise nonendemic area. A single-center retrospective case series of all patients diagnosed with culture-proven blastomycosis is reported at the Bassett Medical Center from 2007 to 2019. Eight cases of confirmed pulmonary blastomycosis were identified. All patients resided in a rural area along the Susquehanna River Basin. Only one case had a travel history to an endemic state. Males accounted for 100% of cases. There was a 50% mortality rate from acute respiratory distress syndrome. Bronchoalveolar lavage (BAL) reliably made the diagnosis. About 40% of patients had a false-negative blastomycosis serology. There was an average delay of 2.5 months from presentation to correct diagnosis due to a lack of consideration for blastomycosis. BAL resulted in a correct diagnosis, while serology was not reliable to exclude the diagnosis. Physicians should include blastomycosis in the diagnostic differential cases of nonresolving pneumonia in Upstate New York, an area not previously considered as endemic. Bronchoalveolar remains the evaluation method of choice if blastomycosis is suspected.
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LETTERS TO THE EDITOR Top

Significance of physiotherapy in “SARS-CoV-2/COVID-19: An Epidemic” p. 179
Mandeep Kumar Jangra, Akanksha Saxena
DOI:10.4103/atm.ATM_169_20  
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Smoking in users of a cervical cancer screening center of the Mexican government at Mexico City p. 180
Carlos Manuel Ortiz-Mendoza
DOI:10.4103/atm.ATM_102_20  
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Polymorphonuclear-rich and lymphocyte-rich tuberculous pleural effusion p. 182
Shinichiro Okauchi, Katsunori Kagohashi, Toshihiro Shiozawa, Kunihiko Miyazaki, Hiroaki Satoh
DOI:10.4103/atm.ATM_172_20  
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