Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
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   2011| July-September  | Volume 6 | Issue 3  
    Online since June 29, 2011

 
 
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ORIGINAL ARTICLES
Metabolic syndrome, insulin resistance, fibrinogen, homocysteine, leptin, and C-reactive protein in obese patients with obstructive sleep apnea syndrome
Ozen K Basoglu, Fulden Sarac, Sefa Sarac, Hatice Uluer, Candeger Yilmaz
July-September 2011, 6(3):120-125
DOI:10.4103/1817-1737.82440  
Objective: The prevalence of obstructive sleep apnea syndrome (OSAS) and metabolic syndrome is increasing worldwide, in part linked to epidemic of obesity. The purposes of this study were to establish the rate of metabolic syndrome and to compare fibrinogen, homocysteine, high-sensitivity C-reactive protein (hsCRP), leptin levels, and homeostasis model assessment insulin resistance (HOMA-IR) in the obese patients with and without OSAS. Methods: The study population included 36 consecutive obese patients with OSAS (23 males; mean age, 50.0 ±19.7 years), and 34 obese patients without OSAS (17 males; mean age, 49.7±11.1 years) were enrolled as control group. Metabolic syndrome was investigated; fibrinogen, homocysteine, CRP, and leptin levels were measured, and IR was assessed. Results: Metabolic syndrome was found in 17 (47.2%) obese OSAS patients, whereas only 29.4% of obese subjects had metabolic syndrome (P > 0.05). Obese patients with OSAS had significantly higher mean levels of triglyceride (P< 0.001), total-cholesterol ( P = 0.003), low-density lipoprotein-cholesterol ( P = 0.001), fasting glucose ( P = 0.01), HOMA-IR ( P<0.001), thyroid-stimulating hormone ( P = 0.03), fibrinogen ( P < 0.003), hsCRP ( P <0.001), and leptin ( P = 0.03) than control group . Besides, leptin level was positively correlated with waist ( r = 0.512, P = 0.03) and neck circumferences ( r = 0.547, P = 0.03), and fasting glucose (r = 0.471, P = 0.04) in OSAS patients, but not in obese subjects. Conclusion: This study demonstrated that obese OSAS patients may have an increased rate of metabolic syndrome and higher levels of serum lipids, fasting glucose, IR, leptin, fibrinogen, and hsCRP than obese subjects without sleep apnea. Thus, clinicians should be encouraged to systematically evaluate the presence of metabolic abnormalities in OSAS and vice versa.
  44 6,782 1,040
Prevalence and characteristics of cigarette smoking among 16 to 18 years old boys and girls in Saudi Arabia
Mohammed O Al Ghobain, Mohamed S Al Moamary, Sulieman N Al Shehri, Mohamed S AL-Hajjaj
July-September 2011, 6(3):137-140
DOI:10.4103/1817-1737.82447  
Objective: To study the prevalence and characteristics of cigarette smoking among secondary school students (16- to 18-year-old boys and girls) in Riyadh city, Saudi Arabia. Methods: We applied a standard two-stage, cross-sectional study design. Secondary schools for both boys and girls in Riyadh city were randomly selected using a cluster sampling method. We used the global youth tobacco survey (GYTS) tool to achieve our objectives. Results: Among 1272 students (606 boys and 666 girls), the prevalence of those ever smoked cigarettes was 42.8% (55.6% of boys and 31.4% of girls). The prevalence of current smoking was 19.5% (31.2% of boys and 8.9% of girls). Despite the fact that the majority of students think smoking is harmful, most do not wish to stop smoking, and they had not tried to stop in the past year. Cigarette smoking is significantly associated with the male gender, having friends who smoke, and having parents who smoke, but is not significantly associated with the type of school attended. Conclusion: Smoking prevalence among secondary schools students in Saudi Arabia is high and alarming. There is a need to implement an education program about the risks of smoking and to include parents and friends as healthy models to prevent students from beginning to smoke.
  14 5,780 536
Gait speed as a functional capacity indicator in patients with chronic obstructive pulmonary disease
Duygu Ilgin, Sevgi Ozalevli, Oguz Kilinc, Can Sevinc, Arif H Cimrin, Eyup S Ucan
July-September 2011, 6(3):141-146
DOI:10.4103/1817-1737.82448  
Aim: Walking distance is generally accepted as a functional capacity determinant in chronic obstructive pulmonary disease (COPD). However, the use of gait speed in COPD patients has not been directly investigated. Thus, the aim of our study was to assess the use of gait speed as a functional capacity indicator in COPD patients. Methods: A total 511 patients with mild-to-very severe COPD and 113 healthy controls were included. The lung functions (pulmonary function test), general health- and disease-related quality of life (Medical Outcomes Study 36-Item Short-Form of Health Survey, St George's Respiratory Questionnaire), and gait speed (6-minute walk test) were assessed. Results: The mean gait speed values were slower in moderate (75.7 ± 14.0 m/min), severe (64.3 ± 16.5 m/min), and very severe (60.2 ± 15.5 m/min) COPD patients than controls (81.3 ± 14.3 m/min). There were significant correlations between gait speed and age, dyspnea-leg fatigue severities, pulmonary function test results (FEV 1 , FVC, FVC%, FEV 1 /FVC ratio, PEF, PEF%), and all subscores of Medical Outcomes Study 36-Item Short-Form of Health Survey and activity, impact and total subscores of St George's Respiratory Questionnaire in patients with moderate, severe, and very severe COPD. However, these correlations were higher especially in patients with severe and very severe COPD. Conclusions: As a conclusion, according to our results gait speed slows down with increasing COPD severity. Also, gait speed has correlations with age, clinical symptoms, pulmonary functions, and quality of life scores in COPD patients. Thus, we consider that gait speed might be used as a functional capacity indicator, especially for patients with severe and very severe COPD.
  13 6,186 709
Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis
Mehmet Ali Habesoglu, Aylin Ozsancak Ugurlu, Fusun Oner Eyuboglu
July-September 2011, 6(3):131-136
DOI:10.4103/1817-1737.82443  
Background: Bronchiectasis continues to be one of the major causes of morbidity and mortality in developing countries, with a probably underestimated higher prevalence than in developed countries. Objective: To assess the clinical profile of adult patients with bronchiectasis. Methods: We retrospectively reviewed the clinical, radiologic, and physiologic findings of 304 patients with bronchiectasis confirmed by high-resolution computed tomography. Results: Mean age of participants (45.7% males, 54.3% females) was 56 ± 25 years and 65.8% of them were lifetime non-smokers. Most common identified causes of bronchiectasis were childhood disease (22.7%), tuberculosis (15.5%), and pneumonia (11.5%). The predominant symptoms were productive cough (83.6%), dyspnea (72%), and hemoptysis (21.1%). The most common findings on chest examination were crackles (71.1%) and rhonchi (28.3%). Types of bronchiectasis were cylindrical in 47%, varicose in 9.9%, cystic in 45.1%, and multiple types in 24.3%. Involvement was multilobar in 75.3% and bilateral in 62.5%. Of 274 patients, 20.8% displayed normal pulmonary function test results, whereas 47.4%, 8% and 23.7% showed obstructive, restrictive, and mixed pattern, respectively. Patients with cystic disease had a higher frequency of hemoptysis (42%) and a greater degree of functional impairment, compared to other types. Conclusion: In patients with bronchiectasis from southern Turkey, generally presenting with recurrent productive cough, hemoptysis, dyspnea, and persistent bibasilar rales, the etiology remains mainly idiopathic. Post-infectious bronchial destruction is one of the major identified underlying pathological processes. The clinical picture and the deterioration of the pulmonary function test might be more severe in patients with cystic type bronchiectasis.
  10 5,973 891
Use of complementary and alternative medicine among asthmatic patients in primary care clinics in Malaysia
Mustafa Ahmed Alshagga, Sami Abdo Al-Dubai, Siti Summayyah Muhamad Faiq, Ahmad Asmadi Yusuf
July-September 2011, 6(3):115-119
DOI:10.4103/1817-1737.82438  
Objectives: This study aimed to determine the knowledge about asthma and the prevalence, disclosure and evaluation of the use of complementary and alternative medicine (CAM) among asthmatic patients. Methods: This cross-sectional study was conducted on 95 patients diagnosed with asthma in a primary healthcare centre in Kuala Lumpur, Malaysia using a self-administered questionnaire. Results: Ninety-five patients with a mean age of 47.06 years (±12.8) participated, the majority were female (66.7%), Malay (72.6%). The prevalence of ever-CAM use was 61.1%. The non-ever-CAM users' mean age was 51±13.9 years while the ever-CAM users' mean age was 44.5 ±11.5 years ( P = 0.021). Sixty-three females (66.8%) used CAM compared to 14 males (43.8%) ( P = 0.014). Thirty-six (62.1%) CAM users had not discussed use of CAM with their doctors. The main reason of non-disclosure was "the doctor never asked" (55.6%), and the main sources of information about CAM were family and relatives (46.6%). There was no significant difference between use of CAM and knowledge about asthma. The majority of asthmatic patients used rubs (39%), foods (16.9%) and herbs (16.9%). About 76% of asthmatic patients perceived CAM as good for their disease management. On linear multiple regression, Malay race ( P = 0.026) and female gender ( P = 0.006) were significant predictors of CAM use. Conclusion: Use of CAM among asthmatic patients is relatively high, particularly among females. The majority of asthmatic patients valued the use of CAM. Non-disclosure was high in this study. Health education of asthmatic patients about CAM is highly recommended.
  5 5,922 554
CASE REPORTS
Massive hemothorax following administration of intrapleural streptokinase
Feng Yih Chai, Yeh Chunn Kuan
July-September 2011, 6(3):149-151
DOI:10.4103/1817-1737.82451  
The administration of intrapleural streptokinase (IPSK) is widely practiced in the management of loculated empyema thoracis. To our knowledge, there have been only 4 cases of hemorrhagic complications attributed to the administration of IPSK reported in the literature. In this article, we report a case of a 17-year-old girl who received IPSK and developed shock, anemia, coagulopathy and massive hemothorax. Our discussion focuses on the hemorrhagic complication of chest tube insertion and the role of IPSK in blood clot lysis and inhibition of local hemostasis.
  2 6,240 491
LETTERS TO THE EDITOR
Palliative thoracic radiotherapy dose, non-small cell lung cancer with oligometastases and prognosis
Federico L Ampil, Gloria Caldito
July-September 2011, 6(3):154-156
DOI:10.4103/1817-1737.82455  
  2 2,319 386
REVIEW ARTICLE
Evaluation of liver transplant candidates: A pulmonary perspective
Serife Savas Bozbas, Fusun Eyuboglu
July-September 2011, 6(3):109-114
DOI:10.4103/1817-1737.82436  
Chronic liver disease is one of the leading causes of mortality and morbidity in the worldwide adult population. Liver transplant is the gold standard therapy for end-stage liver disease and many patients are on the waiting list for a transplant. A variety of pulmonary disorders are encountered in cirrhotic patients. Pleura, lung parenchyma, and pulmonary vasculature may be affected in these patients. Hypoxemia is relatively common and can be asymptomatic. Hepatopulmonary syndrome should be investigated in hypoxic cirrhotic patients. Gas exchange abnormalities are common and are generally correlated with the severity of liver disease. Both obstructive and restrictive types of airway disease can be present. Abnormal diffusion capacity is the most frequently observed pulmonary function disorder in patients with cirrhosis. Hepatic hydrothorax is another finding which is usually seen in conjunction with, but occasionally without ascites. Portopulmonary hypertension is a complication of long standing liver dysfunction and when severe, is accepted as a containdication to liver transplant. Since respiratory disorders are common and have significant impact on postoperative outcome in patients undergoing liver transplant, a careful preoperative pulmonary assessment is important.
  2 8,164 1,161
ORIGINAL ARTICLES
Predictors of malignancy in EUS-guided FNA for mediastinal lymphadenopathy in patients without history of lung cancer
Leticia P Luz, Daniel M Moreira, Mahboob Khan, Mohamad A Eloubeidi
July-September 2011, 6(3):126-130
DOI:10.4103/1817-1737.82442  
Background: Mediastinal lymphadenopathy (ML) poses a great diagnostic challenge. Objective: To investigate the predictors of malignancy in endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of ML in patients without known lung cancer. Design: Retrospective study. Setting: Tertiary referral center. Methods: One hundred eight patients without known lung cancer who underwent EUS guided-FNA for ML between 2000 and 2007. All subjects underwent EUS-guided FNA. Data was collected on patients' demographics, and lymph node (LN) characteristics. Diagnosis of LN malignancy was based on FNA findings and clinical follow-up. Results: One hundred eight patients were analyzed; 58 (54%) were men and 87 (79%) were Caucasian. Mean age was 55 years. Prior malignancy was present in 48 (43%) patients. A total of 126 FNA samples from 126 distinct LNs were performed. Twenty-five (20%) LNs were positive for malignancy. Mean short and long-axis for LNs were 13 and 29 mms respectively. Round shape and sharp borders were found in 29 (15%) and 25 (22%) LNs, correspondingly. Independent predictors of a malignant FNA were: Prior cancer (OR 13.10; 95% CI 2.7-63.32; P = 0.001), short axis (OR 1.10; 95% CI 1.00-1.22; P = 0.041) and sharp LN borders (OR 5.47; 95% CI 1.01-29.51; P = 0.048). Age, race, gender, long axis, round shape were not associated with cancer in our cohort. Limitations: Retrospective design and lack of surgical gold standard. Conclusions: Increased risk of malignancy was associated with prior history of cancer, larger LN short axis and presence of LN sharp borders. These predictors may help guide endoscopists perform FNA in malignant LNs, increasing the overall efficiency of EUS-FNA for ML.
  1 4,274 439
POSTGRADUATE CLINICAL SECTION
Pulmonary hamartoma with tuberculosis masquerading as metastasis
Tarun Jindal, Neeraj Sharma, Arvind Kumar, Venkateswaran K Iyer
July-September 2011, 6(3):152-153
DOI:10.4103/1817-1737.82452  
  1 2,565 339
ABSTRACTS
Abstracts from Gulf Thoracic Conference in Dubai 2011

July-September 2011, 6(3):159-183
  - 7,139 474
CASE REPORTS
Refractory recurrent bleeding as a late mortal complication of chest wall irradiation
Leonardo Gilardi
July-September 2011, 6(3):147-148
DOI:10.4103/1817-1737.82450  
Radiation therapy is used to treat breast malignancies. Old external radiotherapy protocols included high-dose schedules and were associated with late complications. We describe the case of a 72-year-old woman who was admitted with recurrent bleeding from chest wall. Arteriovenous fistulae were diagnosed. Embolization therapy was initially successful, even though the bleeding episodes became recurrent. Arteriovenous fistulae should be included among differential diagnosis of thoracic bleeding in patients with history of local radiation therapy. The prognosis is poor and endovascular treatment may be considered a first-line treatment.
  - 2,719 305
EDITORIAL
Venous thromboembolism prophylaxis: Solutions are in our hands
Fahad M Al-Hameed
July-September 2011, 6(3):105-106
DOI:10.4103/1817-1737.82434  
  - 2,757 559
HOT TOPIC
Pulmonary disorder and present nuclear denotation: A brief summary
Viroj Wiwanitkit
July-September 2011, 6(3):107-108
DOI:10.4103/1817-1737.82435  
There are many health effects caused by leaked radiation from damaged reactors of a nuclear power plant. However, the effect on pulmonary system is not reported much. Focusing on the present nuclear denotation crisis in Japan, it is wise to review on the specific issue of pulmonary disorder and nuclear denotation. Several disorders of interest, including malignancy and non-malignancy disorders, are mentioned in the literature.
  - 3,351 376
LETTERS TO THE EDITOR
Agreement and differences between venous and arterial gas analysis
Sunil K Chhabra
July-September 2011, 6(3):154-154
DOI:10.4103/1817-1737.82454  
  - 3,460 462
Bronchiectasis: Is there a role for video-assisted thoracic surgery?
Nikolaos Barbetakis, Christos Asteriou, Athanassios Kleontas, Eleftheria Konstantinou
July-September 2011, 6(3):156-156
DOI:10.4103/1817-1737.82457  
  - 1,566 327
Microfilaria in pleural fluid
Viroj Wiwanitkit
July-September 2011, 6(3):156-157
DOI:10.4103/1817-1737.82458  
  - 1,340 256
Cilazapril-induced pleural effusion: A case report and review of the literature
Syed Ahmed Zaki, Angadi Rajasab Nilofer
July-September 2011, 6(3):157-158
DOI:10.4103/1817-1737.82459  
  - 2,733 299
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