OBJECTIVES: 1) To determine the prevalence of respiratory diseases and the length of stay among hospitalized patients with respiratory disorders 2) To detect the medical disorders commonly associated with respiratory diseases. MATERIALS AND METHODS: A retrospective review was done for 810 patients hospitalized with respiratory diseases in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, over 5 years (January 1996 to December 2000). A special form was used to collect information from patient medical records including demographic data (such as age, sex and nationality), discharge diagnosis with other associated diseases and length of stay during hospitalization. RESULTS: Fifty-five percent of patients were males and 56.3% were Saudis. The mostly affected age group was 46-65 years (41.8%). Asthma (38.6%), chronic obstructive pulmonary disease (COPD) (17.2%), pneumonia (11.5%), lung cancer (8.4%) and tuberculosis (TB) (7.2%) had the highest prevalence among hospitalized patients. Asthma was higher among females (63.3%) than males (36.7%). In contrast, lung cancer, COPD and TB were higher among males (88.2, 66.9 and 74.1%) than females (11.8, 33.1 and 25.9%) respectively ( P < 0.001). The mostly affected age groups among asthma and TB were 26-45 years and 46-65 years respectively, while the mostly affected age group in lung cancer and COPD patients was 46-65 years ( P < 0.001). Diabetes mellitus (22.8%) and hypertension (15.1%) were the most prevalent associated diseases. In 75% of the patients, the length of stay ranged from 1-7 and 8-14 days. CONCLUSION: Asthma, COPD and pneumonia were the leading causes of hospitalization among patients with respiratory disorders, while diabetes and hypertension were the most commonly associated diseases.
Bronchiectasis is a chronic lung disease, defined pathologically as irreversible dilatation of the bronchi. The clinical course of the disease is chronic and progressive and in most cases, causes lung damage over many years. There is usually an initial event, which causes impairment of mucociliary clearance of the bronchial tree. The respiratory tract becomes colonized by bacteria that inhibit the ciliary function and promote further lung damage. The hallmark of bronchiectasis, is a chronic cough with mucopurulent or purulent sputum, lasting for months to years and may progress to chronic respiratory failure. Diagnosis of bronchiectasis is suspected on the basis of clinical manifestations. In order to confirm the diagnosis and underlying causes, appropriate investigations must be performed. In this comprehensive review, we discuss the etiology, pathogenesis, clinical presentation, appropriate investigations and management of bronchiectasis.
Bronchial stents are mostly used as a Palliative relief of symptoms often caused by airway obstruction, It is also used for sealing of stump fistulas after pneumonectomy and dehiscence after bronchoplastic operations. Advances in airway prosthetics have provided a variety of silicone stents, expandable metal stents, and pneumatic dilators, enabling the correction of increasingly complex anatomical problems. Several series have been published describing the application and results of these techniques. This manuscript reviews the historical development of stents, types, indication, outcome, and complications. Alternative therapies for tracheobronchial stenting were also reviewed
BACKGROUND: Six minutes walk test (6MWT), is a sub-maximal exercise test, used as a clinical indicator of the functional capacity, in patients with cardiopulmonary diseases. Its safety, validity, reliability and its correlation with several physiological instruments, are well studied. However, there are no published data on 6MWT, in the Saudi population. We are reviewing our experience with 6MWT and assessing its safety and its correlation with pulmonary function variables, in patients with pulmonary diseases, in our local population. MATERIALS AND METHODS: We consecutively studied patients with pulmonary diseases, who underwent 6MWT and pulmonary function test in King Khalid University Hospital, from June 2003 to December 2004. The 6MWTs were conducted according to the American Thoracic Society guidelines. Spirometry, lung volumes and diffusion capacity measurements were correlated with the absolute walked distance. RESULTS: One hundred and twenty nine tests were performed. All patients were of the Saudi community (59% female), with mean age of 43±15 years. Out of 129 patients, 65 patients had proven respiratory diagnosis. In all patients, the test were performed with no serious complications. The six minute walk distance (6MWD) had correlation with patient′s height (r=+0.40, P < 0.001), but not with patients′ weight, BMI, borg scale, or oxygen saturation. The 6MWD correlated significantly with Dlco (r=+0.52, P < 0.01), FVC (r=+0.46, r< 0.001) and had a weaker relation with FEV1 (r=+0.31, P < 0.05). The test had no significant correlation with lung volumetric parameters (TLC, FRC and RV). CONCLUSION: 6MWT is simple and safe test in evaluating patients with chronic pulmonary diseases in the Saudi population. In our study, 6MWD showed correlation with spirometric parameters and diffusion capacity. Further studies are needed to evaluate 6MWT in a more homogenous patients′ population.
OBJECTIVE: To evaluate the impact of an extensive education campaign for physicians, in effecting positive changes, in their asthma prescription practice, in line with the ′Saudi protocol for diagnosis and management of asthma′. MATERIALS AND METHODS : An extensive campaign on asthma management for physicians in Saudi Arabia was conducted in 1995-1996, based on the ′Saudi protocol for asthma diagnosis and management′. During this campaign, one day courses-cum-workshops were held in 19 different cities, for over 2500 physicians (8% of all physicians in the kingdom). To evaluate the changes in asthma prescription, we retrospectively reviewed the charts of 98 asthmatic patients in 1994 and 100 patients in 1997, attending the outpatient department of two tertiary care hospitals, with over 500 beds, each in Riyadh and Jeddah. Data on demographic profile of the patients, Pulmonary function test and medications prescribed, were analysed and compared between the two groups. RESULTS: The mean age and severity of asthma was similar in both the groups.The prescription rate of inhaled steroids and inhaled beta-agonists increased significantly, with decrease in the use of oral beta-agonists, oral steroids, Theophylline, sodium cromoglycate and ketotifen. Conclusion: The use of inhaled steroids and inhaled beta agonists, considerably improved after the asthma education campaign for physicians in Saudi Arabia. Education campaign for physicians may be effective and could help in the improvement of clinical practice towards a specific disease.
PURPOSE: To determine the incidence and factors associated with unplanned extubation (UE) in the intensive care unit (ICU) and its relationship with nursing workload. MATERIALS AND METHODS: A retrospective case-control study was carried out within a cohort of ventilated patients in two teaching hospital medical-surgical ICUs. A total of 50 adult patients with UE were studied. Controls were subjects without UE who were matched to the cases on the following Five factors: age, gender, admission diagnostic category, admission date (within 3 months) and duration of mechanical ventilation. Other data including patient demographics, comorbid conditions, APACHE III score, ventilation parameters, use of sedation, re-intubation, mortality rate and ICU/hospital length of stay were collected. Nine equivalents of nursing manpower use score (NEMS) and multiple organ dysfunction score (MODS) were calculated in both, cases and controls, 24 h before and after the event. RESULTS: Sixty-eight episodes of UE occurred in 66 patients during the 24-month study period (1.1%). Patients with UE were more agitated ( P 0.05). The mean NEMS were not significantly different between the two groups 24 h before ( P =0.69) and after ( P =0.99) the extubation event. Also, the mean MODS were similar between both groups 24 h before ( P =0.69) and after ( P =0.74) extubation. CONCLUSION: In this study, agitation and greater use of benzodiazepines were frequently associated with UE and potentially can be used as risk factors for UE. We have found no significant impact of UE on increasing mortality and, in a manner not shown before, nursing workload.
Williams-Campbell syndrome was first described in 1960 as a rare form of bronchiectasis. Its pathogenesis is characterized by the absence of or markedly diminished bronchial cartilage. We describe a case of a 4-year-old male child in whom respiratory symptoms developed in neonatal period and were found to have histopathological changes consistent with Williams-Campbell syndrome. A brief review of literature has been discussed.
We report a young lady, who was labeled as a case of refractory asthma for a few years, based on history of shortness of breath on minimal exertion, noisy breathing and normal chest radiograph. Repeated upper airway exam by an otolaryngologist and computerized tomography scan, were normal. On presentation to our hospital, she was diagnosed to have fixed upper airway obstruction, based on classical flow-volume loop findings. Fibroptic bronchoscopy revealed a web-shaped subglottic stenosis. The histopathology of a biopsy taken from that area, showed non-specific inflammation. No cause for this stenosis could be identified. The patient was managed with rigid bronchoscopy dilatation, without recurrence. We report this case as idiopathic subglottic stenosis, that was misdiagnosed as refractory bronchial asthma, stressing the importance of performing spirometry in the clinic.
STUDY OBJECTIVE: To compare between Abrams and Cope needles pleural biopsy, as regard their diagnostic yield and complications in pleural effusions. STUDY DESIGN: Retrospective chart analysis SETTING: 140 bed community chest hospital, ministry of health, affiliated with teaching hospitals in Riyadh area. MATERIALS AND METHODS: 57 patients (44 males and 13 females), with a mean age of 37.9 years (range, 17-80 years), who were admitted through July 1994 to June 1995, for management of pleural effusion. INTERVENTION: Pleural biopsy was performed for all patients, using either cope needle (group 1: 22 patients), or Abrams needle (group 2: 35 patients). MEASUREMENT: We recorded the type of pleural biopsy needle, final diagnosis and complications. RESULTS: The overall diagnostic sensitivity in pleural effusions for Cope needle was 82% (18/22), compared to 54% (19/35) for Abrams needle. The diagnostic sensitivity in TB pleurisy for Cope needle was 85% (17/20), compared to 57.5 (19/33)% for Abrams needle ( P = 0.08). The incidence of pneumothorax was 18% (4/22) with cope needle, compared to 8% (3/35) with Abrams needle ( P = 0.5) no other complications occurred with both needles. CONCLUSION: Cope needle demonstrates a diagnostic sensitivity equal to that of Abrams needle, without increase in the incidence of pneumothorax.
We are reporting a case of sternal mass-histologically proven high-grade adenocarcinoma. Despite exhaustive investigations, no other primary site was detected. It was difficult to differentiate from metastasis or from primary skin adnexa, but whatever diagnosis is made, wide surgical excision with reconstruction is recommended for improvement of life quality.
BACKGROUND: Proper structural foundations for asthma care at primary health care centers [PHCCs], are of essential importance, regarding its management. OBJECTIVE: To assess the adherence of PHCCs to the recommended structural foundation for asthma care. MATERIALS AND METHODS: 35 PHCCs were selected in a cluster random fashion. A questionnaire for structural standards was designed, based on the Saudi national protocol for the management of asthma (SNPMA). A physician and a nurse, each from PHCC, were trained for data collection. Structural facilities deficiency was arbitrarily classified into: least deficient (>75%), moderate to severe deficient (25-75%) and most deficient (< 25%). RESULTS: The total population registered, was 131190 [urban: 85701 (65.4%), rural: 45489 (34.6%)]. Total registered asthmatics was 4093 [urban: 2585 (63.1%), rural: 1508 (36.9%)]. The asthma prevalence rate did not differ significantly between urban (3%) and rural (3.3%) areas . Structural facilities distribution for asthma care, did not significantly vary among urban and rural PHCCs and none of them fulfilled 100% of the desired standards. The least deficient, were the availability of asthma register and salbutamol, in its various forms. The moderately to severely deficient were the SNPMA, peak flow meter (PFM), nebulizer system, Theophylline and systemic corticosteroid. However, they were most deficient in trained doctors and nurses, record charts for Peak flow meter, spacer, educational material and inhalers of corticosteroid or cromoglycate. CONCLUSION: Proper structural foundations for asthma care at PHCCs, at AL-Qassim region, were below the desired national standards. They were most deficient in trained doctors and nurses, record charts for PFM, spacers, educational material and anti-inflammatory inhalers. Future health directorate strategies have to provide such beneficial interventions for proper asthma care.
Emerging literature about venous thromboembolism (VTE) increased our understanding of the risk factors, diagnosis, therapy and prophylaxis of this serious medical condition. In this review, we examine new studies on the incidence and the risk factors for VTE in the critically ill patients, diagnostic approaches to VTE, the relation between VTE and cardiovascular risk and duration of therapy. Also, we will review the new evidence on the use of electronic reminders to improve the adherence to VTE prophylaxis and the risk of heparin-induced thrombocytopenia in patients receiving pharmacologic prophylaxis for VTE.
Despite the availability of many diagnostic modalities and the advent of new tests, the diagnosis of pulmonary embolism (PE) remains a challenge. Clinical manifestations can be notoriously deceptive and there is not a single test, that can be relied on solely, to exclude PE. Although it has been regarded as the gold standard test, pulmonary angiography has not been tested against a reference standard and thromboembolic events have been reported after a normal study. Therefore the diagnosis of PE depends on judicious utilization of the available tests in the right clinical setting, as the accuracy of the results of the investigations, depends largely on the pretest clinical probability. Simple investigations such as chest radiograph, electrocardiogram and arterial blood gas, are used to enhance the clinical probabilities, rather than confirming or refuting the diagnosis of PE. On the other hand, Perfusion ventilation (VQ) scan and computerized tomographic pulmonary angiography (CTPA), are the main screening tests used for patients with suspected PE. Recently CTPA has largely replaced VQ scan, in many centres. As both VQ scan and CTPA have their limitations, other diagnostic modalities, such as D-dimer and Compression ultrasound of the legs (CUS), are used as adjunctive diagnostic investigations. High probability and normal VQ scan, especially when combined with the concordant clinical probability, has a high positive and negative predicative value, respectively. On the other hand, CTPA is more sensitive and specific than VQ scan, though it has to be combined with CUS and clinical probability, to reduce the chance of missing PE. Although many diagnostic algorithms have been advocated, the discretion of the clinician and clinical experience, still has a major role to play in the diagnosis of PE. In this article, we try to come with a plausible approach to the diagnosis of PE, based on the current literature.
BACKGROUND : Leukotrienes B4 (LTB4) and eotaxin-1 are thought to play a pivotal role in the pathogenesis of asthma. This study investigates the plasma levels of LTB4 and eotaxin-1 in symptom-free asthmatics on inhaled corticosteroids (ICS) and long-acting β2 (LABA) . MATERIALS AND METHODS : Twenty asthmatic patients treated with ICS and LABA for 3 months and 17 matched healthy subjects were recruited. LTB4 and eotaxin-1 were measured in the serum by a specific enzyme immunoassay kit. RESULTS : Treatment resulted in significant improvement in FEV1 and disappearance of symptoms. LTB4 levels were significantly lower in the treated asthmatics compared to the healthy subjects (19.17 ± 0.8 pg/ml versus 23.34 ± 0.82 pg/ml respectively, P < 0.001). However, there was no significant difference in the levels of eotaxin-1 between healthy subjects and asthmatic patients. CONCLUSION : Asthmatics treated with ICS and LABA showed significantly lower levels of LTB4 compared to healthy subjects. Regular use of inhaled corticosteroids and long-acting β2 may help in controlling the inflammatory process in asthma. Further studies are needed to confirm these findings and assess the association between clinical and physiological parameters and circulating chemokines and cytokines.