Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
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  Citation statistics : Table of Contents
   2010| October-December  | Volume 5 | Issue 4  
    Online since September 7, 2010

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Endobronchial cryobiopsy or forceps biopsy for lung cancer diagnosis
Zafer Aktas, Ersin Gunay, Nevin Taci Hoca, Aydin Yilmaz, Funda Demirag, Sibel Gunay, Tugrul Sipit, Emine Bahar Kurt
October-December 2010, 5(4):242-246
DOI:10.4103/1817-1737.69117  PMID:20981186
Background: Invasive procedures such as bronchoscopic biopsy, bronchial washing, and bronchial brushing are widely used in diagnosis of lung cancers. The mean diagnostic rate with bronchoscopic forceps biopsy is 74% in central tumors. This study was designed to evaluate the efficacy of cryobiopsies in histopathological diagnosis. Methods : Forty-one patients who had interventional bronchoscopy were included in this study. Three forceps biopsies and one cryobiopsy with cryorecanalization probe were obtained from each subject. Biopsies interpretations were done by one expert pathologist. Results : Hemorrhage was the only complication in both procedures. There was no significant difference between these two procedures in the incidence of hemorrhage (P > 0.05). Mean diameters of samples taken with forceps biopsy and cryoprobe biopsy were 0.2 and 0.8 cm, respectively (P < 0.001). Thirty-two patients (78%) were diagnosed with forceps biopsies, and 38 patients (92.7%) were diagnosed with cryoprobe biopsies (P = 0.031). Conclusions : We concluded that cryoprobe biopsies were more successful than forceps biopsies in diagnosis. Nevertheless, further investigations are warranted to determine an efficacy of cryoprobe biopsy procedures and a rationale to use as a part of routine flexible bronchoscopy.
  23 10,969 1,658
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.
  13 115,216 3,742
Venous thromboembolism prophylaxis for hospitalized medical patients, current status and strategies to improve
Hikmat Abdel-Razeq
October-December 2010, 5(4):195-200
DOI:10.4103/1817-1737.69104  PMID:20981179
Venous thromboembolism (VTE), comprising life-threatening pulmonary embolism (PE) and its precursor deep-vein thrombosis (DVT), is commonly encountered problem. Although most patients survive DVT, they often develop serious and costly long-term complications. Both unfractionated heparin and low molecular weight heparins significantly reduce the incidence of VTE and its associated complications. Despite the evidence demonstrating significant benefit of VTE prophylaxis in acutely ill medical patients, several registries have shown significant underutilization. This underutilization indicates the need for educational and audit programs in order to increase the number of medical patients receiving appropriate prophylaxis. Many health advocacy groups and policy makers are paying more attention to VTE prophylaxis; the National Quality Forum and the Joint Commission recently endorsed strict VTE risk assessment evaluation for each patient upon admission and regularly thereafter. In the article, all major studies addressing this issue in medical patients have been reviewed from the PubMed. The current status of VTE prophylaxis in hospitalized medical patients is addressed and some improvement strategies are discussed.
  8 9,896 1,439
Prophylactic use of laxative for constipation in critically ill patients
Yasser Masri, Jawed Abubaker, Raees Ahmed
October-December 2010, 5(4):228-231
DOI:10.4103/1817-1737.69113  PMID:20981183
Background : This study was designed to evaluate the use of laxative prophylaxis for constipation in intensive care unit (ICU) and the impact of early versus late bowel movement on patient's outcome. Methods : The study was a prospective, randomized controlled trial in critically ill ventilated adult patients, who were expected to stay on ventilator for >72 h. Control group did not receive any intervention for bowel movement for the first 72 h, whereas interventional group received prophylactic dose of lactulose 20 cc enterally every 12 h for the first 72 h. The parameters measured during the study were admission diagnosis, age, gender, comorbid conditions, admission Simplified Acute Physiologic Score (SAPS II), sedative and narcotic agents with doses and duration, timing and tolerance of nutrition, daily assessment of bowel movement, total use of prokinetic, doses of suppositories, and enema for first bowel movement, total number of days on ventilator, weaning failures, extubation or tracheostomy, ICU length of stay, and death or discharge. Results : A total of 100 patients were enrolled, 50 patients in each control and interventional group. Mean age was 38.8 years, and both groups had male predominance. Mean SAPS II score for both was 35. Mean dose of Fentanyl (323.8 ± 108.89 mcg/h in control and 345.83 ± 94.43 mcg/h in interventional group) and mean dose of Midazolam (11.1 ± 4.04 mg/h in control and 12.4 ± 3.19 mg/h in interventional group). There were only two (4%) patients in control, while nine (18%) patients in interventional group who had bowel movement in <72 h (P < 0.05). Mean ventilator days were 16.19, and 17.36 days in control and interventional groups, respectively. Subgroup analysis showed that the patients who moved bowel in <5 days in both groups had mean ventilator days of 18.5, whereas it was 15.88 days for the patients who moved bowel after 5 days in both groups (P< 0.05). Mean ICU days for control was 21.15 ± 10.44 and 20.77 ± 8.33 days for interventional group. Forty-eight (96%) patients in each group were discharged from the ICU. Two (4%) patients died in ICU in each group. Conclusions : Laxative prophylaxis can be used successfully to prevent constipation in ICU patients. Late bowel movement >5 days is associated with less ventilator days, compared to early <5 days bowel movement.
  7 8,232 1,087
Asthma insights and reality in the United Arab Emirates
Bassam Hassan Saleh Hassan Mahboub, Sonia Santhakumar, Joan B Soriano, Ruby Pawankar
October-December 2010, 5(4):217-221
DOI:10.4103/1817-1737.69109  PMID:20981181
Background : The burden of asthma in the United Arab Emirates (UAE) and the extent to which guidelines are being followed for optimum asthma control are largely unknown. This survey assessed the current level of asthma control, the burden of the disease, and adherence to asthma guidelines by patients. Methods : A face-to-face interview of 200 asthmatics in the UAE was conducted. In addition to the questionnaire administered by expert interviewers, each respondent self-completed an Asthma Control Test. The sample was stratified by region within the country and sampled proportionately. Results : Sudden severe attacks of asthma were reported by 64% in the past year. Day time symptoms and night time symptoms were reported by 57.5% and 35.5%, respectively, in the past 4 weeks. Overall, 52.8% of the children and 17.1% of the adults missed school and work in the past year, respectively. The percentage of asthmatics that had emergency room visits within the past year was 27.5%, and 4% were hospitalized. Only 5.5% used inhaled corticosteroids in the past year and 47.5% were on short-acting beta-2 agonists. Only 17.8% ever owned a peak flow meter and only 30% ever had a lung function test. Only 17% had scheduled follow-up and 66% were followed-up by general practitioners. Conclusion : This survey shows that the current level of asthma control in the UAE is far from optimal. Therefore, it is necessary to increase the awareness among patients and update doctors about asthma control guidelines for attaining optimal asthma control, and thus reducing the burden of the disease.
  6 9,178 663
A case-control study of bidi smoking and bronchogenic carcinoma
R Prasad, RC Ahuja, S Singhal, AN Srivastava, P James, V Kesarwani, D Singh
October-December 2010, 5(4):238-241
DOI:10.4103/1817-1737.69116  PMID:20981185
Objective : To evaluate the risks imposed by tobacco smoking, in particular, bidi smoking, in the development of lung cancer. Methods : Two hundred eighty-four histologically confirmed patients of bronchogenic carcinoma and 852 controls matched for age, sex, and socioeconomic status were interviewed according to a predesigned questionnaire. Effects of individual variables defining the various aspects of tobacco smoking, in particular, bidi smoking, were assessed using logistic regression models. Results : 81.3% cases of bronchogenic carcinoma were ever smokers as compared with 42.2% among controls. The odd ratios for ever smoking, bidi smoking, and cigarette smoking were 5.9 (confidence interval [CI] 4.3, 8.4), 6.1 (CI 4.3, 8.7), and 5.3 (CI 2.7, 10.4), respectively. Conclusion : Bidi smoking poses a very high risk for lung cancer even more than that of cigarette smoking.
  5 5,379 541
Tobacco consummation: Is it still a dilemma?
Mohamed S Al Moamary
October-December 2010, 5(4):193-194
DOI:10.4103/1817-1737.69103  PMID:20981178
  3 3,856 583
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.
  3 34,004 714
Nonresolving pleural effusion in an elderly woman: A case report
R Garg, R Sodhi, P Jabeed, A Rastogi
October-December 2010, 5(4):247-248
DOI:10.4103/1817-1737.69118  PMID:20981187
  2 4,686 535
H1N1 infection and thyroid storm
Viroj Wiwanitkit
October-December 2010, 5(4):249-249
DOI:10.4103/1817-1737.69119  PMID:20981189
  1 2,377 401
Author's reply
Salim Baharoon
October-December 2010, 5(4):249-249
  1 2,265 281
Tobacco smoking by medical students: KAP study
Sourabh Aggarwal
October-December 2010, 5(4):249-250
DOI:10.4103/1817-1737.69121  PMID:20981190
  1 3,016 469
Authors' reply
Ali I Al-Haqwi, Hani Tamim, Ali Asery
October-December 2010, 5(4):250-250
  1 2,339 303
Influenza vaccination program for medical workers
Viroj Wiwanitkit
October-December 2010, 5(4):250-250
DOI:10.4103/1817-1737.69123  PMID:20981193
  1 2,380 331
Authors' reply
Aiman El-Saed, Badriah Al-Otaibi, Hanan H Balkhy
October-December 2010, 5(4):250-251
  - 2,346 258
Evaluation of a novel method to assess corticosteroid responsiveness in chronic obstructive pulmonary disease
Fahad A Al-Ghimlas, Andrew McIvor
October-December 2010, 5(4):232-237
DOI:10.4103/1817-1737.69114  PMID:20981184
Background : Some patients with chronic obstructive pulmonary disease (COPD) may benefit from oral steroid therapy. These steroid-responsive patients are diagnosed based on laboratory spirometry. We hypothesize that daily, home-based spirometry is a better tool. Methods : Thirty patients with COPD underwent a single-blinded study, with a crossover design. They received 2 weeks of placebo followed by 2 weeks of prednisone therapy (40 mg/day). Laboratory spirometry was done at the beginning and end of the study and daily home-based spirometry was done twice a day. Results : Analysis of variance model was used. The variability of the median day-to-day forced expiratory volume in 1 s (FEV 1 ) was 72.5 mL (25th percentile of 40 mL and 75th percentile of 130 mL). The daily FEV 1 variation was 70 mL (25th percentile of 50 mL and 75th percentile of 100 mL). The overall laboratory FEV 1 variability was larger after the steroid course (P < 0.001), but not clinically significant. The variability was not significant postplacebo treatment compared with the baseline values. For home-based spirometry, steroid treatment was not significantly different. The majority (97%) completed more than 80% of the measurements. Ninety percent of the performed tests were considered acceptable. Only 53% of the tests were considered accurate. Overall both laboratory and home-based measurements did not show significant association between airway responsiveness and dyspnea or exercise capacity. Conclusion : Twice-daily home measurements of FEV 1 might be better than the conventional approach to identify steroid responsive COPD patients. However, this finding was only statistically but not clinically significant. Therefore, we would not recommend this approach to identify COPD patients with steroid responsiveness.
  - 4,150 503
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