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51.  Author reply to the editor 
Annals of Thoracic Medicine  2014;9(1):49-50.
PMCID: PMC3912692  PMID: 24551023
52.  Pediatric pulmonology services in Saudi Arabia: Past, present, and future 
Annals of Thoracic Medicine  2013;8(4):181-182.
PMCID: PMC3821275  PMID: 24250729
53.  Knowledge of thromboprophylaxis guidelines pre- and post-didactic lectures during a venous thromboembolism awareness day at a tertiary-care hospital 
Annals of Thoracic Medicine  2013;8(3):165-169.
Didactic lectures are frequently used to improve compliance with practice guidelines. This study assessed the knowledge of health-care providers (HCPs) at a tertiary-care hospital of its evidence-based thromboprophylaxis guidelines and the impact of didactic lectures on their knowledge.
The hospital launched a multifaceted approach to improve thromboprophylaxis practices, which included posters, a pocket-size guidelines summary and didactic lectures during the annual thromboprophylaxis awareness days. A self-administered questionnaire was distributed to HCPs before and after lectures on thromboprophylaxis guidelines (June 2010). The questionnaire, formulated and validated by two physicians, two nurses and a clinical pharmacist, covered various subjects such as risk stratification, anticoagulant dosing and the choice of anticoagulants in specific clinical situations.
Seventy-two and 63 HCPs submitted the pre- and post-test, respectively (62% physicians, 28% nurses, from different clinical disciplines). The mean scores were 7.8 ± 2.1 (median = 8.0, range = 2-12, maximum possible score = 15) for the pre-test and 8.4 ± 1.8 for the post-test, P = 0.053. There was no significant difference in the pre-test scores of nurses and physicians (7.9 ± 1.7 and 8.2 ± 2.4, respectively, P = 0.67). For the 35 HCPs who completed the pre- and post-tests, their scores were 7.7 ± 1.7 and 8.8 ± 1.6, respectively, P = 0.003. Knowledge of appropriate anticoagulant administration in specific clinical situations was frequently inadequate, with approximately two-thirds of participants failing to adjust low-molecular-weight heparin doses in patients with renal failure.
Education via didactic lectures resulted in a modest improvement of HCPs′ knowledge of thromboprophylaxis guidelines. This supports the need for a multifaceted approach to improve the awareness and implementation of thromboprophylaxis guidelines.
PMCID: PMC3731859  PMID: 23922612
Clinical practice guidelines; continuing medical education; health knowledge; practice guidelines; questionnaires; venous thromboembolism
58.  Authors’ reply 
PMCID: PMC3573563  PMID: 23437020
60.  Authors’ reply 
PMCID: PMC3573565  PMID: 23437022
62.  Chronic obstructive pulmonary disease lost in translation: Why are the inhaled corticosteroids skeptics refusing to go? 
Annals of Thoracic Medicine  2013;8(1):8-13.
A survey of pulmonologists attending a clinical meeting of the Saudi Thoracic Society found that only 55% of responders considered that inhaled corticosteroids (ICS) had a positive effect on quality of life in Chronic Obstructive Pulmonary Disease (COPD). Why the divergence of opinion when all the guidelines have concluded that ICS improve quality of life and produce significant bronchodilation? ICS unequivocally reduce the rate of exacerbations by a modest 20%, but this does not extend to serious exacerbations requiring hospitalization. Bronchodilatation with ICS is now documented to be restricted to some phenotypes of COPD. Withdrawal of ICS trials reported a modest decline of FEV1 (<5%) in half the studies and no decline in the other half. In spite of the guidelines statements, there is no concurrence on whether ICS improve the quality of life and there is no conclusive evidence that the combination of long-acting ß2 agonists (LABA) with ICS is superior to LABA alone in that regard. The explanation for these inconclusive results may be related to the fact that COPD consists of three different phenotypes with divergent responses to LABA and ICS. Therapy tailored to phenotype is the future for COPD.
PMCID: PMC3573567  PMID: 23441006
COPD; inhaled corticosteroids; phenotyping
63.  Abrupt withdrawal of inhaled corticosteroids does not result in spirometric deterioration in chronic obstructive pulmonary disease: Effect of phenotyping? 
Annals of Thoracic Medicine  2012;7(4):238-242.
Some studies show a decline of FEV1 only one month after withdrawal of inhaled corticosteroids (ICS), while others show no decline. We speculate that the presence of an asthma phenotype in the Chronic Obstructive Pulmonary Disease (COPD) population, and that its exclusion may result in no spirometric deterioration.
We performed a prospective clinical observation study on 32 patients who fulfilled the Global Initiative for Chronic Obstructive lung disease definition of COPD (Grade II-IV). They were divided into two phenotypic groups. 1. Irreversible asthma (A and B) (n = 13): A. Asthma: Bronchial biopsy shows diffuse thickening of basement membrane (≥ 6.6 μm). B. Airflow limitation (AFL) likely to be asthma: KCO > 80% predicted if the patient refused biopsy. 2. COPD (A and B) (n = 19): A. COPD: hypercapneic respiratory failure with raised bicarbonate, panlobular emphysema with multiple bullas, or bronchial biopsy showing squamous metaplasia and epithelial/subepithelial inflammation without thickening of the basement membrane. B. AFL likely to be COPD: KCO < 80% predicted.
The asthma phenotype was significantly younger, had a strong association with hypertrophy of nasal turbinates, and registered a significant improvement of FEV1 (350 ml) vs a decline of - 26.5 ml in the COPD phenotype following therapy with budesonide/formoterol for one year. Withdrawal of budesonide for 4 weeks in the COPD phenotype resulted in FEV1 + 1.33% (SD ± 5.71) and FVC + 1.24% (SD ± 5.32); a change of <12% in all patients.
We recorded no spirometric deterioration after exclusion of the asthma phenotype from a COPD group.
PMCID: PMC3506105  PMID: 23189102
Asthma; COPD; radiology and other imaging; respiratory function tests
64.  Budesonide and fluticasone and adrenal suppression 
PMCID: PMC3506108  PMID: 23189105
65.  High resolution computed tomography in cotton-induced lung disease 
Annals of Thoracic Medicine  2012;7(4):253-254.
PMCID: PMC3506109  PMID: 23189106
66.  Sleep medicine: Present and future 
Annals of Thoracic Medicine  2012;7(3):113-114.
PMCID: PMC3425040  PMID: 22924066
67.  Serum hepcidin and chronic obstructive pulmonary disease 
PMCID: PMC3425054  PMID: 22924080
69.  Authors’ reply 
Annals of Thoracic Medicine  2011;6(4):243-244.
PMCID: PMC3183648  PMID: 21977076
70.  Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis 
Annals of Thoracic Medicine  2011;6(3):131-136.
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.
To assess the clinical profile of adult patients with bronchiectasis.
We retrospectively reviewed the clinical, radiologic, and physiologic findings of 304 patients with bronchiectasis confirmed by high-resolution computed tomography.
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.
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.
PMCID: PMC3131755  PMID: 21760844
Asthma; bronchiectasis; chest X-ray; chronic obstructive pulmonary disease; computed tomography; respiratory function test
71.  Microfilaria in pleural fluid 
Annals of Thoracic Medicine  2011;6(3):156-157.
PMCID: PMC3131764  PMID: 21760852
72.  Authors’ reply 
PMCID: PMC2954386
73.  Authors’ reply 
Annals of Thoracic Medicine  2010;5(4):250-251.
PMCID: PMC2954388
75.  Author's reply 
Annals of Thoracic Medicine  2009;4(2):93-94.
PMCID: PMC2700485

Results 51-75 (544)