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1.  Idiopathic pulmonary fibrosis in Saudi Arabia: Demographic, clinical, and survival data from two tertiary care hospitals 
Annals of Thoracic Medicine  2014;9(3):168-172.
BACKGROUND:
Idiopathic pulmonary fibrosis (IPF) is rare and can be challenging to diagnose. Limited data is available from the Middle Eastern region, especially Saudi Arabia.
METHODS:
This was a retrospective study that looked at all the patients diagnosed with IPF between 2007 and 2012 at two tertiary care hospitals in Saudi Arabia. We collected the demographical, clinical, laboratory and radiological data from the patients’ medical records. Medications administered and 1 year survival was also assessed.
RESULTS:
Between 2007and 2012, 134 IPF patients were identified. Their baseline characteristics (Mean ± SD) included: age 64 ± 13 years, body mass index 29 ± 8 kg/m2, FEV1 56 ± 15 percent of predicted, FVC 53 ± 13 percent of predicted, FEV1/FVC 0.81 ± 0.09, total lung capacity 75 ± 13 percent of predicted, diffusing capacity of the lung for carbon monoxide 57 ± 15 percent of predicted, on home oxygen at presentation 71 (53%), mean ejection fraction 0.50 ± 0.07, mean pulmonary artery systolic pressure (via echocardiogram) 40 + 22 mmHg, presentation mean SpO292 ± 7%, presentation 6-min walk distance 338 ± 64 m and lowest SpO2 during 6-min walk test 88 ± 5%. Patients were predominantly female (56%), and 42% of patients had diabetes and were active smokers. The IPF patients’ frequency of hospital admission (n = 99) was 2.4 ± 1.7 per year and duration of hospital stay (n = 99) was 17.4 ± 23.8 days. Overall 1 year survival in all IPF patients was good, 93% (124) patients remained alive after 1 year.
CONCLUSIONS:
In Saudi Arabia, IPF patients tended to be slightly older and the disease progression was somewhat slower than reported IPF cohorts in other populations. They had frequent hospital admissions and a long hospital length of stay. The influence of genetics and co-morbid diseases on the incidence and outcome of IPF should be explored further.
doi:10.4103/1817-1737.134073
PMCID: PMC4073575  PMID: 24987477
Characteristics; idiopathic pulmonary fibrosis; survival; Saudi Arabia
2.  The Saudi Guidelines for the Diagnosis and Management of COPD 
Annals of Thoracic Medicine  2014;9(2):55-76.
The Saudi Thoracic Society (STS) launched the Saudi Initiative for Chronic Airway Diseases (SICAD) to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD). This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT) and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (<2 in the past year) can be classified as either Class I when they have less symptoms (CAT < 10) or Class II when they have more symptoms (CAT ≥ 10). High-risk COPD patients, as manifested with ≥2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score ≥10. The article also discusses the diagnosis and management of acute exacerbations in COPD.
doi:10.4103/1817-1737.128843
PMCID: PMC4005164  PMID: 24791168
Chronic bronchitis; chronic obstructive pulmonary disease; emphysema; guidelines; Saudi Arabia
3.  Effect of on-call-related sleep deprivation on physicians’ mood and alertness 
Annals of Thoracic Medicine  2013;8(1):22-27.
BACKGROUND AND OBJECTIVE:
Physicians may experience periods of acute sleep deprivation while on-call, in addition to baseline chronic sleep deprivation which may affect physicians’ performance and patients’ safety. The purpose of this study was to determine the effect of acute sleep deprivation due to working long on-call shifts on mood and alertness, both of which may impair physicians’ performance.
METHODS:
Eighty-eight junior physicians working in one university hospital completed a questionnaire, before and after completion of a shift, that collected data regarding socio-demographic factors, patterns of work and sleep, Profile of Mood States (POMS), and Stanford Sleepiness Scale. Based on duration of sleep the physicians had during on-call in comparison to their usual average sleep, the participants were categorized into group 1 (those who slept many fewer hours), group 2 (those who slept fewer hours), or group 3 (those who slept the same number of hours).
RESULTS:
More than 87% of the participant slept 5 or fewer hours while working an on-call shift. Among all participants, the percentage of physicians who were alert post-on-call was significantly reduced compared to the percentage pre-on-call (P = 0.001). The post-on-call total POMS scores of groups 1 and 2 were significantly worse than their pre-on-call scores (P = 0.001 and 0.038, respectively), while there was no significant difference between the pre- and post-on-call POMS scores of group 3 (P = 0.165).
CONCLUSION:
Acute sleep loss due to working long on-call shifts significantly decreases daytime alertness and negatively affects the mood state of junior physicians.
doi:10.4103/1817-1737.105715
PMCID: PMC3573553  PMID: 23439930
Acute sleep deprivation; alertness; profile of mood states; sleepiness
4.  An update on the drainage of pyogenic lung abscesses 
Most lung abscesses (80–90%) are now successfully treated with antibiotics; however, this conservative approach may occasionally fail. When medical treatment fails, pulmonary resection is usually advised. Alternatively, percutaneous transthoracic tube drainage or endoscopic drainage can be considered, though both remain controversial. In this communication, the medical literature focusing on percutaneous tube drainage efficacy, indications, techniques, complications, and mortality, as well as available data regarding endoscopic drainage are reviewed.
doi:10.4103/1817-1737.91552
PMCID: PMC3277038  PMID: 22347342
Percutaneous drainage; pyogenic lung abscess; endoscpoic drainage
5.  The presence of atypical mycobacteria in the mouthwashes of normal subjects: Role of tap water and oral hygiene 
BACKGROUND:
The nontuberculous mycobacteria (NTM) have been found in different environmental sources. They tend to colonize different body surfaces and secretions. The purpose of this study is to evaluate the presence of NTM in the oral cavity of healthy individuals and its relationship to tap water or oral hygiene.
MATERIALS AND METHODS:
One hundred sixty-seven healthy subjects were recruited. Three consecutive early morning mouthwashes using tap water were performed and examined for the presence of Mycobacterium tuberculosis (MTB) and NTM. In addition we obtained mouthwashes from 30 control healthy individuals with good oral hygiene using sterile water and examined these for the presence of MTB and NTM.
RESULTS:
NTM was isolated from the mouthwash of 44 (26.3%) subjects that used tap water. On the other hand, NTM was isolated from the mouthwash of 10 (33%) subjects that used sterile water. Age, gender, social class oral hygiene and the regular use of toothbrush made no statistically significant differences in the isolation rate of NTM.
CONCLUSION:
The rate of isolation of NTM from mouthwash is high in normal subjects. It is independent of oral hygiene, the use of tap water or teeth brushing. Smear-positive sputum could be NTM rather than M. tuberculosis. Tuberculosis polymerase chain reaction or culture confirmation is essential in developing countries to avoid the unnecessary use of antituberculosis therapy when the clinical suspicion is very low.
doi:10.4103/1817-1737.37890
PMCID: PMC2700426  PMID: 19561875
Mycobacterial isolates; nontuberculous mycobacteria; oral flora; oral hygiene

Results 1-5 (5)