Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
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   2012| July-September  | Volume 7 | Issue 3  
    Online since July 21, 2012

 
 
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ORIGINAL ARTICLES
Comparison of the effect of high-dose inhaled budesonide and fluticasone on adrenal function in patients with severe chronic obstructive pulmonary disease
Ahmed Fahim, Shoaib Faruqi, Caroline E Wright, Jack A Kastelik, Alyn H Morice
July-September 2012, 7(3):140-144
DOI:10.4103/1817-1737.98846  
Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of respiratory-related morbidity and mortality. Inhaled steroids are frequently used in patients with moderate to severe disease and may lead to adrenal suppression. Objectives: The aim of this study was to compare the effect of inhaled budesonide/formoterol with inhaled fluticasone/salmeterol in severe COPD. Methods: It was a prospective open-label crossover study of 22 patients. Adrenal suppression was measured by overnight urinary cortisol/creatinine ratio. The measurements were taken while patients were on either combination for at least 4 weeks. Results: A total of 12 patients completed the study. The mean age was 64 years (8 males, 4 females). The mean FEV1 was 1 L (range, 0.5-1.8). There was no significant difference in adrenal suppression measured by overnight urinary cortisol/creatinine ratio (budesonide 5.2 ± 4.3, fluticasone 4.7 ± 3.1; 95% CI -2.2 to 1.2; P = 0.52) and urinary cortisol concentration (budesonide 51 ± 53, fluticasone 43 ± 31 [nmol/l]; 95% CI -35 to 20; P = 0.56). Conclusion: Inhaled budesonide and fluticasone have no significantly different effect on adrenal function in moderate to severe COPD. The adverse event profile of high-dose inhaled steroids should not influence the choice of medication.
  7 3,929 590
REVIEW ARTICLE
Role of ATP binding and hydrolysis in the gating of the cystic fibrosis transmembrane conductance regulator
Taras Gout
July-September 2012, 7(3):115-121
DOI:10.4103/1817-1737.98842  
The CFTR gene is unique within the ATP-binding cassette (ABC) protein family, predominantly of transporters, by coding a chloride channel. The gating mechanism of ABC proteins has been characterized by the ATP Switch model in terms cycles of dimer formation and dissociation linked to ATP binding and hydrolysis, respectively. It would be of interest to assess the extent that Cystic Fibrosis Transmembrane Conductance Regulator (CFTR), a functional channel, fits the ATP Switch model for ABC transporters. Additional transporter mechanisms, namely those of Pgp and HlyB, are discussed for perspective. Literature search of databases selected key references in comparing and contrasting the gating mechanism. CFTR is a functional chloride channel facilitating transmembrane anion flow down electrochemical gradients. A dysfunctional CFTR protein results in cystic fibrosis, a fatal pleiotropic disease currently managed symptomatically. Understanding the gating mechanism will help target drug development aimed at alleviating and curing the disease.
  6 6,875 596
ORIGINAL ARTICLES
Prevalence of short sleep duration and its association with obesity among adolescents 15- to 19-year olds: A cross-sectional study from three major cities in Saudi Arabia
Hazzaa M Al-Hazzaa, Abdulrahman O Musaiger, Nada A Abahussain, Hana I Al-Sobayel, Dina M Qahwaji
July-September 2012, 7(3):133-139
Background: Adequate sleep has been considered important for the adolescent's health and well being. On the other hand, self-imposed sleep curtailment is now recognized as a potentially important and novel risk factor for obesity. The present study aimed to assess the prevalence of short sleep duration and its association with obesity among Saudi adolescents. Methods: This is a school-based cross-sectional study with self-reported sleep questionnaires. It was conducted during the years 2009/2010 in three cities in Saudi Arabia; Al-Khobar, Jeddah, and Riyadh. Participants were 2868 secondary-school males (1379) and females (1389) aged 15 to 19 years, randomly selected using a multistage stratified sampling technique. Measurements included weight, height, waist circumference, BMI, and sleeping duration. Logistic regression analysis while adjusted for age, gender, and location was used to examine the associations between sleep duration and obesity measures. Results: The mean (SD) of sleep duration was 7.2 (1.6) hours/day with no significant differences between males and females. About 31% of the participants obtain less than 7 hours of sleep per day, while approximately 50% of the sample gets less than 8 hours of daily sleep. Two-way ANCOVA results while controlling for the effect of age revealed a significant gender by school-type interaction (P<0.001). In addition, adequate sleep duration increased the odds of having normal weight (adjusted odds ratios = 1.28, 95% CI = 1.08-1.50, P = 0.003). Conclusion: The present study observed a high prevalence of short sleep duration among Saudi adolescents 15- to 19-year olds and that short sleep duration was significantly associated with increased risk of overweight and obesity. Future interventions should investigate whether adopting a healthy lifestyle by adolescents with short sleep duration would improve their sleeping habits or not.
  5 6,563 848
CASE REPORTS
Pulmonary tumor thrombotic microangiopathy caused by gastric cancer
Hiroko Kuwabara, Shuhei Yoshida, Tasaburo Takasu, Masako Yuki, Isao Goto, Toshiaki Hanafusa, Yuro Shibayama
July-September 2012, 7(3):168-169
DOI:10.4103/1817-1737.98853  
Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal cancer-related pulmonary complication with rapidly progressing dyspnea, and occasionally induces sudden death. Here, we describe a postmortem-diagnosed PTTM case caused by gastric cancer, with the complaint of progressing dyspnea for 5 days.He did not have any abdominal symptoms or cancer history. PTTM should be considered in patients with rapidly worsening respiratory conditions, even if there is no cancer history.
  4 3,110 557
ORIGINAL ARTICLES
Predicting tobacco use among high school students by using the global youth tobacco survey in Riyadh, Saudi Arabia
Mohamed S Al Moamary, Mohammed O Al Ghobain, Sulieman N Al Shehri, Ahmed Y Gasmelseed, Mohamed S Al-Hajjaj
July-September 2012, 7(3):122-129
DOI:10.4103/1817-1737.98843  
Objective: To identify the predictors that lead to cigarette smoking among high school students by utilizing the global youth tobacco survey in Riyadh, Kingdom of Saudi Arabia (KSA). Methods: A cross-sectional study was conducted among high school students (grades 10-12) in Riyadh, KSA, between April 24, 2010, and June 16, 2010. Results: The response rate of the students was 92.17%. The percentage of high school students who had previously smoked cigarettes, even just 1-2 puffs, was 43.3% overall. This behavior was more common among male students (56.4%) than females (31.3%). The prevalence of students who reported that they are currently smoking at least one cigarette in the past 30 days was 19.5% (31.3% and 8.9% for males and females, respectively). "Ever smoked" status was associated with male gender (OR = 2.88, confidence interval [CI]: 2.28-3.63), parent smoking (OR = 1.70, CI: 1.25-2.30) or other member of the household smoking (OR = 2.11, CI: 1.59-2.81) who smoked, closest friends who smoked (OR = 8.17, CI: 5.56-12.00), and lack of refusal to sell cigarettes (OR = 5.68, CI: 2.09-15.48). Conclusion: Several predictors of cigarette smoking among high school students were identified.
  4 3,723 498
MMP1-1607(1G>2G) polymorphism and the risk of lung cancer in Lebanon
Hana Fakhoury, Sara Noureddine, Hania N Chmaisse, Hani Tamim, Rajaa F Makki
July-September 2012, 7(3):130-132
DOI:10.4103/1817-1737.98844  
Context: Matrix metalloproteinases (MMPs) are a family of enzymes that degrade various components of the extracellular matrix and are involved in the development and progression of cancer. Lung cancer is the most commonly diagnosed cancer in Lebanon. MMP1 is responsible for degrading stromal collagens, which enhance the ability of neoplastic cells to cross basal membrane of both the endothelium and the vascular endothelium. A recent meta-analysis has suggested that the MMP1-1607 2G allele may be associated with an increased risk for certain types of cancers. Aim: This study was undertaken to investigate the association between guanine insertion polymorphism in the MMP1 promoter and the susceptibility to lung cancer in the Lebanese population. Settings and Design: This case-control study was conducted on 41 patients with lung cancer and 51 age-matched healthy controls, recruited from different regions of Lebanon. Methods: Cases were histologically confirmed lung cancer patients obtained from different hospitals in Lebanon. Controls were healthy unrelated individuals with no history of cancer or genetic diseases. All subjects were genotyped for MMP1 -1607(1G>2G) polymorphism using polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFLP). Results: No statistically significant differences were found when genotype and allele distribution of MMP1 -1607(1G>2G) polymorphism were compared between patients with lung cancer and controls [P= 0.6 by chi-squared test on a 3x2 contingency table; allelic P=0.61, OR (95% CI) = 1.18 (0.60-2.31)]. Conclusion: Our data shows that MMP1 promoter polymorphism is not associated with lung cancer susceptibility in the Lebanese population.
  4 2,574 447
The use of thoracoscopy to enhance medical students' interest and understanding of thoracic anatomy
Sami A AlNassar, Waseem Hajjar, Salah Rahal, Joanne Clifton, Richard Finley, Ravi Sidhu
July-September 2012, 7(3):145-148
DOI:10.4103/1817-1737.98847  
Aim: To develop a video-based educational tool designed for teaching thoracic anatomy and to examine whether this tool would increase students' stimulation and motivation for learning anatomy. Methods: Our video-based tool was developed by recording different thoracoscopic procedures focusing on intraoperative live thoracic anatomy. The tool was then integrated into a pre-existing program for first year medical students (n = 150), and included cadaver dissection of the thorax and review of clinical problem scenarios of the respiratory system. Students were guided through a viewing of the videotape that demonstrated live anatomy of the thorax (15 minutes) and then asked to complete a 5-point Likert-type questionnaire assessing the video's usefulness. Apart from this, a small group of entirely different set of students was divided into two groups, one group to view the 15-minute video presentation of thoracoscopy and chest anatomy and the other group to attend a 15-minute lecture of chest anatomy using radiological images. Both groups took a 10-item pretest and post-test multiple choice questions examination to assess short-term knowledge gained. Results: Of 150 medical students, 119 completed the questionnaires, 88.6% were satisfied with the thoracoscopic video as a teaching tool, 86.4% were satisfied with the quality of the images, 69.2% perceived it to be beneficial in learning anatomy, 96.2% increased their interest in learning anatomy, and 88.5% wanted this new teaching tool to be implemented to the curriculum. Majority (80.7%) of the students increased their interest in surgery as a future career. Post-test scores were significantly higher in the thoracoscopy group (P = 0.0175). Conclusion: Incorporating live surgery using thoracoscopic video presentation in the gross anatomy teaching curriculum had high acceptance and satisfaction scores from first year medical students. The video increased students' interest in learning, in clinically applying anatomic fact, and in surgery as a future career.
  3 2,777 389
BRIEF REPORT
Novel approach for the management of sub-massive pulmonary embolism
Majdy M Idrees, Enas Batubara, Tarek Kashour
July-September 2012, 7(3):157-161
DOI:10.4103/1817-1737.98850  
Background: Right ventricular (RV) dysfunction has been identified as a poor prognostic indicator in sub-massive pulmonary embolism (SPE). We hypothesized that using selective vasodilator agent is beneficial in improving RV function in patients with this condition. Methods: We used inhaled prostacyclin analogue (Iloprost, Ventavis®) in five patients with SPE. Helical computerized tomography angiogram was confirmatory for pulmonary embolism and echocardiography was used to evaluate the RV status. All patients received inhaled Iloprost, 2.5 to 5 μg every 4 hours for 3 weeks. Results: Patients were prospectively followed for 3 months. They were assessed at baseline before starting Iloprost treatment and at 3 days, 3 weeks, and 3 months after treatment. All patients showed significant improvement in their functional class, Borg dyspnea score, NT pro-BNP level, and echocardiographic parameters. Conclusion: In SPE, directing therapy toward decreasing pulmonary vascular resistance improves the associated pulmonary hemodynamic compromise and improves RV function.
  2 3,375 536
CASE REPORTS
Congenital pulmonary venolobar syndrome: Value of multidetector computed tomography in preoperative assessment
Abdel-Mohsen Mahmoud Hamad
July-September 2012, 7(3):165-167
DOI:10.4103/1817-1737.98852  
A 6-month old baby referred to our department because of recurrent attacks of respiratory distress with chest infection. Chest radiology revealed reduction of the right hemithorax with mediastinal shift to the right. Multidetector computed tomography showed hypoplasia of the right lung and right pulmonary artery, systemic arterial supply to the lung from the abdominal aorta, and and absence of right venous drainage to the left atrium. This picture is consistent with congenital pulmonary venolobar syndrome. The patient underwent right pneumonectomy; the postoperative course was uneventful.
  2 2,874 356
EDITORIAL
Sleep medicine: Present and future
Ahmed S BaHammam
July-September 2012, 7(3):113-114
DOI:10.4103/1817-1737.98841  
  2 2,303 494
LETTERS TO THE EDITOR
Serum hepcidin and chronic obstructive pulmonary disease
Beuy Joob, Viroj Wiwanitkit
July-September 2012, 7(3):171-171
DOI:10.4103/1817-1737.98855  
  1 1,621 321
ORIGINAL ARTICLES
Micrometastasis in non-small-cell lung cancer: Detection and staging
Gholamreza Mohajeri, Mohammad Hossein Sanei, Sayyed Abbas Tabatabaee, Sayyed Mozaffar Hashemi, Elham Amjad, Mohammad Reza Mohajeri, Hamid Shemshaki, Amir Hosein Davarpanah Jazi, Mohsen Kolahdouzan
July-September 2012, 7(3):149-152
DOI:10.4103/1817-1737.98848  
Background: The clinical relevance of bone marrow micrometastasis (BMM) in non-small-cell lung cancer is undetermined, and the value of such analyses in advanced stage patients has not been clearly assessed previously. This study was conducted to estimate the accuracy of both polymerase chain reaction (PCR) and immunohistochemistry (IHC) in micrometastases detection and determine the best site for bone marrow biopsy in order to find micrometastasis. Methods: This prospective cross-sectional study was performed in the Department of Thoracic Surgery, Alzahra University Hospital from September 2008 to June 2009. To evaluate the bone marrow, a 3-cm rib segment and an aspirated specimen from the iliac bone prior to tumor resection were taken. PCR and IHC were performed for each specimen to find micrometastasis. Results: Of 41 patients, 14 (34%) were positive for BMM by PCR compared with two positive IHC (4.8%). All BMMs were diagnosed in rib segments, and iliac specimens were all free from metastatic lesion. Our data showed no significant association between variables such as age, sex, histology, tumor location, side of tumor, involved lobe, smoking, or weight loss and presence of BMM. Conclusion: PCR could use as a promising method for BMM detection. BMM in a sanctuary site (rib) is not associated with advanced stages of lung cancer. In addition, when predictor variables such as age, sex, histology, tumor location, smoking, or weight loss are analyzed, no correlation can be found between micrometastasis prevalence and any of those variables.
  1 2,991 436
Effect of drinking Arabian Qahwa on fractional exhaled nitric oxide levels in healthy nonsmoking Saudi adults
Syed Shahid Habib, Shaikh Mujeeb Ahmed, Ahmad Al Hadlaq, Amir Marzouk
July-September 2012, 7(3):153-156
DOI:10.4103/1817-1737.98849  
Objectives: Fractional exhaled nitric oxide (FENO) is an emerging marker of inflammation in respiratory diseases. However, it is affected by a number of confounding factors. We aimed to study the effect of drinking Arabian Qahwa on FENO in non-smoking Saudi healthy adults. Methods: We recruited 12 nonsmoker healthy male adults aged 36.6 ± 2.7 (21-50) years. All subjects were free from acute respiratory infections or allergies and had normal ventilatory functions and serum IgE levels. At 8 am in the morning, their baseline values of FENO were recorded. They had not taken tea or coffee in the morning and had taken similar light breakfast. They were given three cups of Arabian Qahwa to drink and then after every 30 minutes, serial levels of FENO were recorded. Results: Average FENO levels at baseline were 28.73 ± 9.33 (mean ± SD) parts per billion (ppb). The mean FENO levels started to decrease significantly after 30 minutes of drinking Arabian Qahwa (P=0.002). This decrease in FENO level was further observed till two hours after Qahwa drinking and then it started to increase in next 90 minutes but still was significantly lower than the baseline (P=0.002). The mean FENO level recorded after 4 hours was 27.22 ± 10.22 (P=0.039). Conclusions: FENO levels were significantly lowered by intake of Arabian Qahwa and this effect remains for about 4 hours. Therefore, history of recent Qahwa intake and abstinence is essential before performance of FENO and its interpretation.
  1 3,778 354
POSTGRADUATE CLINICAL SECTION
An unusual interstitial lung disease
Dipti Gothi, Jyotsna M Joshi
July-September 2012, 7(3):162-164
DOI:10.4103/1817-1737.98851  
  1 3,640 457
LETTERS TO THE EDITOR
Palliative radiotherapy for superior vena caval obstruction by lung cancer: A major issue about timing and a minor issue about efficacy
Federico Ampil, Gloria Caldito, Carlos Previgliano
July-September 2012, 7(3):170-171
DOI:10.4103/1817-1737.98854  
  - 2,232 374
Authors' reply
Sadik ArdiÁ
July-September 2012, 7(3):171-172
  - 723 118
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