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1.  Author’s reply 
PMCID: PMC2954383
2.  Authors’ reply 
PMCID: PMC2954386
3.  Authors’ reply 
Annals of Thoracic Medicine  2010;5(4):250-251.
PMCID: PMC2954388
5.  Tobacco consummation: Is it still a dilemma? 
Annals of Thoracic Medicine  2010;5(4):193-194.
PMCID: PMC2954372  PMID: 20981178
6.  H1N1 infection and thyroid storm 
PMCID: PMC2954382  PMID: 20981189
7.  Tobacco smoking by medical students: KAP study 
Annals of Thoracic Medicine  2010;5(4):249-250.
PMCID: PMC2954384  PMID: 20981190
8.  Influenza vaccination program for medical workers 
PMCID: PMC2954387  PMID: 20981193
9.  QuantiFERON-TB gold test versus tuberculin skin test 
PMCID: PMC2883197  PMID: 20582181
11.  Scale of dyspnea in COPD: User friendly? 
PMCID: PMC2841813  PMID: 20351965
12.  Venous thromboembolism prophylaxis for hospitalized medical patients, current status and strategies to improve 
Annals of Thoracic Medicine  2010;5(4):195-200.
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.
PMCID: PMC2954373  PMID: 20981179
Deep vein thrombosis; heparin; low molecular weight heparin; pulmonary embolism; thromboprophylaxis
13.  Imaging lung manifestations of HIV/AIDS 
Annals of Thoracic Medicine  2010;5(4):201-216.
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.
PMCID: PMC2954374  PMID: 20981180
HIV/AIDS; imaging lung; mediastinal manifestations
14.  Asthma insights and reality in the United Arab Emirates 
Annals of Thoracic Medicine  2010;5(4):217-221.
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.
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.
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.
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.
PMCID: PMC2954375  PMID: 20981181
Asthma; burden; Gulf and near east; population; UAE; under treatment
15.  Assessment of visual evoked potentials in stable COPD patients with no visual impairment 
Annals of Thoracic Medicine  2010;5(4):222-227.
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.
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 (FEV1), FEV1/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.
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 FEV1/FVC% and MMSE score.
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.
PMCID: PMC2954376  PMID: 20981182
Chronic obstructive pulmonary disease; Mini Mental State Examination Questionnaire; spirometry; VEP abnormalities; visual evoked potentials
16.  Prophylactic use of laxative for constipation in critically ill patients 
Annals of Thoracic Medicine  2010;5(4):228-231.
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.
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.
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.
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.
PMCID: PMC2954377  PMID: 20981183
Constipation; critically ill patients; prophylaxis
17.  Evaluation of a novel method to assess corticosteroid responsiveness in chronic obstructive pulmonary disease 
Annals of Thoracic Medicine  2010;5(4):232-237.
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.
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.
Analysis of variance model was used. The variability of the median day-to-day forced expiratory volume in 1 s (FEV1) was 72.5 mL (25th percentile of 40 mL and 75th percentile of 130 mL). The daily FEV1 variation was 70 mL (25th percentile of 50 mL and 75th percentile of 100 mL). The overall laboratory FEV1 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.
Twice-daily home measurements of FEV1 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.
PMCID: PMC2954378  PMID: 20981184
COPD; corticosteroids; home spirometry; responsiveness; variability
18.  A case-control study of bidi smoking and bronchogenic carcinoma 
Annals of Thoracic Medicine  2010;5(4):238-241.
To evaluate the risks imposed by tobacco smoking, in particular, bidi smoking, in the development of lung cancer.
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.
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.
Bidi smoking poses a very high risk for lung cancer even more than that of cigarette smoking.
PMCID: PMC2954379  PMID: 20981185
Bidi; cigarette; epidemiology; lung cancer; tobacco
19.  Endobronchial cryobiopsy or forceps biopsy for lung cancer diagnosis 
Annals of Thoracic Medicine  2010;5(4):242-246.
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.
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.
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).
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.
PMCID: PMC2954380  PMID: 20981186
Biopsy; cryobiopsy; cryotherapy; interventional bronchoscopy; lung cancer
20.  Nonresolving pleural effusion in an elderly woman: A case report 
Annals of Thoracic Medicine  2010;5(4):247-248.
PMCID: PMC2954381  PMID: 20981187
21.  Role of nitric oxide and its metabolites as potential markers in lung cancer 
Annals of Thoracic Medicine  2010;5(3):123-127.
Nitric oxide (NO) and reactive oxygen species (ROS) play important physiologic roles as mediators of signaling processes. However, high concentrations of NO and ROS result in damage to cellular and extracellular components. Excessive production of endogenous and/or exogenous ROS and NO is implicated in the pathogenesis of lung cancer. NO and its metabolites interact with ROS to generate potent nitrating agents leading to protein nitration, which is one of the several chemical modifications that occur during oxidative/nitrosative stress. Although there is considerable evidence in support of a role for NO in protein modifications and carcinogenesis, recent data suggest that NO has antagonistic cellular effects, leading to either promotion or inhibition of tumor growth. However, the role of NO in tumor biology is still poorly understood. This review demonstrates the role of NO and its metabolites as potential markers in lung cancer.
PMCID: PMC2930648  PMID: 20835304
Carcinogenesis; oxidative stress; lung cancer; nitric oxide; protein modification
22.  Sublingual immunotherapy in allergic asthma: Current evidence and needs to meet 
Annals of Thoracic Medicine  2010;5(3):128-132.
Allergen-specific immunotherapy is aimed at modifying the natural history of allergy by inducing tolerance to the causative allergen. In its traditional, subcutaneous form, immunotherapy has complete evidence of efficacy in allergic asthma. However, subcutaneous immunotherapy (SCIT) has a major flaw in side effects, and especially in possible anaphylactic reactions, and this prompted the search for safer ways of administration of allergen extracts. Sublingual immunotherapy (SLIT) has met such need while maintaining a clinical efficacy comparable to SCIT. In fact, the safety profile, as outlined by a systematic revision of the available literature, was substantially free from serious systemic reactions. A number of meta-analyses clearly showed that SLIT is effective in allergic rhinitis by significantly reducing the clinical symptoms and the use of anti-allergic drugs, while the efficacy in allergic asthma is still debated, with some meta-analyses showing clear effectiveness but other giving contrasting results. Besides the efficacy on symptoms, the preventive activity and the cost-effectiveness are important outcomes of SLIT in asthma. The needs to meet include more data on efficacy in house dust mite asthma, optimal techniques of administration and, as previously done with SCIT, introduction of adjuvants able to enhance the immunologic response and use of recombinant allergens.
PMCID: PMC2930649  PMID: 20835305
Allergic asthma; efficacy; specific immunotherapy; sublingual immunotherapy; safety
23.  Genomic and non-genomic actions of glucocorticoids in asthma 
Annals of Thoracic Medicine  2010;5(3):133-139.
Glucocorticoids are the mainstay of asthma therapy. They are primarily used to suppress airway inflammation, which is the central pathological change in asthmatic patients’ airways. This is achieved by many different mechanisms. The classical mechanism is by suppression of the genetic transcription of many inflammatory cytokines that are key in asthma pathophysiology (transrepression). On the other hand, the transcription of certain inhibitory cytokines is activated by glucocorticoids (transactivation), a mechanism that also mediates many of the adverse effects of glucocorticoids. The onset of action through these mechanisms is often delayed (4-24 hours). Other mechanisms mediated through non-genomic pathways are increasingly appreciated. These are delivered in part by binding of glucocorticoids to nonclassical membrane-bound glucocorticoid receptors or by potentiating the α1-adrenergic action on the bronchial arterial smooth muscles, in addition to other mechanisms. These effects are characterized by their rapid onset and short duration of action. Understanding these different mechanisms will help in the development of new and better drugs to treat this common disease and to develop new improved strategies in our approach to its management. Here, the genomic and non-genomic mechanisms of actions of glucocorticoids in asthma are briefly reviewed, with special emphasis on the current updates of the non-genomic mechanisms.
PMCID: PMC2930650  PMID: 20835306
Asthma; genomic action; glucocorticoids; mechanism of action; non-genomic action
24.  Reactive oxygen metabolites can be used to differentiate malignant and non-malignant pleural efffusions 
Annals of Thoracic Medicine  2010;5(3):140-144.
Increase in reactive oxygen metabolites (ROM) and free radicals is an important cause of cell injury. In this study, we investigated whether determination of ROM in pleural fluids of patients with malignant and non-malignant pleural effusions can be used as a tumor marker indicating malignant effusions in the differential diagnosis.
Sixty subjects with exudative pleural effusion and 25 healthy individuals as the control group were included in the study. Of the subjects with pleural effusion, 50% were malignant and 50% were non-malignant. ROM was studied in the pleural fluids and sera of the subjects with pleural effusion and in the sera of those in the control group. The ROM values of smokers and non-smokers were compared in each group. The Student’s t-test and the Mann-Whitney U test were used in order to detect differences between groups for descriptive statistics in terms of pointed features. The statistical significance level was set at 5% in computations, and the computations were made using the SPSS (ver.13) statistical package program
It was determined that the difference between the ROM values of subjects with malignant and non-malign pleural effusions and the sera of the control group was significant in the malignant group compared to both groups (P = 0.0001), and the sera ROM values of patients with non-malignant pleural effusion were significant compared to the control group (P = 0.0001), and the ROM values of smokers were significant compared to non-smokers in each of the three groups (P = 0.0001).
These findings indicate that sera ROM levels are increased considerably in patients with exudative effusions compared to that of the control group. This condition can be instructive in terms of serum ROM value being suggestive of exudative effusion in patients with effusions. Furthermore, the detection of pleural ROM values being significantly higher in subjects with malignant pleural effusions compared to non-malignant subjects suggests that ROM can be used as a tumor marker in the differential diagnosis of pleural effusions of unknown origin.
PMCID: PMC2930651  PMID: 20835307
Malignant pleural effusion; non-malignant pleural effusion; reactive oxygen metabolites
25.  Knowledge, attitude and practice of tobacco smoking by medical students in Riyadh, Saudi Arabia 
Annals of Thoracic Medicine  2010;5(3):145-148.
Tobacco consumption is associated with considerable negative impact on health. Health professionals, including future doctors, should have a leading role in combating smoking in the community.
The aims of the study were to assess the prevalence of smoking among medical students of newly established medical colleges in Riyadh city, the capital of Saudi Arabia, as well as to assess students' attitude, practice and their knowledge on the risk factors of tobacco consumption.
A cross-sectional, questionnaire-based study of students from two medical colleges in Riyadh, Saudi Arabia was carried out. The questionnaire used was anonymous, self-administered and developed mainly from Global Adult Tobacco Survey (GATS).
A total of 215 students participated in this study. Forty students (19%) indicated that they smoke tobacco at the time of the study. All of them were males, which raise the prevalence among male students to 24%. Tobacco smoking was practiced by males more than females (P value <0.0001) and by senior more than junior students (<0.0001). About 94% of the study sample indicated that smoking could cause serious illnesses. About 90% of the students indicated that they would advice their patients to quit smoking in the future and 88% thought that smoking should be banned in public areas. Forty-four students (20%) thought that smoking has some beneficial effects, mainly as a coping strategy for stress alleviation.
Despite good knowledge about the hazards of tobacco consumption, about 25% of the medical students in this study continue to smoke. The main reported reasons should be addressed urgently by policy-makers. Special efforts should be taken to educate medical students on the effective strategies in managing stress during their study as they thought that tobacco smoking could be used as a coping strategy to face such a stress.
PMCID: PMC2930652  PMID: 20835308
Medical students; Saudi Arabia; smoking

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