Annals of Thoracic Medicine最新文献

{"title":"The optimal oral body temperature cutoff and other factors predictive of sepsis diagnosis in elderly patients.","authors":"Majid Alsalamah,&nbsp;Bashaer Alrehaili,&nbsp;Amal Almoamary,&nbsp;Abdulrahman Al-Juad,&nbsp;Mutasim Badri,&nbsp;Ashraf El-Metwally","doi":"10.4103/atm.atm_52_22","DOIUrl":"https://doi.org/10.4103/atm.atm_52_22","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to identify the optimal oral temperature cut-off value and other factors predictive of sepsis in elderly patients presenting to emergency department.</p><p><strong>Methods: </strong>A hospital-based retrospective study was performed on all elderly patients who presented to the Adult Emergency Department at King Abdulaziz Medical City in Riyadh (January to December 31, 2018).</p><p><strong>Results: </strong>Of total of 13,856 patients, 2170 (15.7%) were diagnosed with sepsis. The associated area under the curve estimate was 0.73, 95% confidence interval (CI) 0.72-0.74. Body temperature ≥37.3 was found as optimal cut-point with sensitivity = 50.97% and specificity = 87.22% and 82.39% of patients with sepsis will be correctly classified using this cut-off. An increase of 1° in body temperature was associated with an odds ratio of 9.95 (95% CI 8.95-11.06, <i>P</i> < 0.0001). Those aged ≥100 years having 11.12 (95% CI 2.29-20.88, <i>P</i> < 0.0001) times the likelihood for sepsis diagnosis compared with those aged 60-69 years. People admitted in weather such as winter, spring, or autumn were more likely to develop sepsis than people admitted in summer.</p><p><strong>Conclusion: </strong>The risk factors of sepsis such as age, temperature, and seasonal variation inform important evidence-based decisions. The hospitals dealing with sepsis patients should assess older patients for other severe illnesses or co-morbid that might lead to sepsis if left untreated. Therefore, older patients need to be prioritized over younger patients. The body temperature of patients admitted to hospitals needs to be monitored critically and it is important to consider seasonal fluctuations while managing cases of sepsis and allocating resources. Our findings suggest that clinicians should explore the possibility of sepsis in elderly patients admitted to emergency units with oral temperature ≥37.3°C. Risk factors for sepsis reported in this study could inform evidence-based decisions.</p>","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":"17 3","pages":"159-165"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/f2/ATM-17-159.PMC9374123.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40615212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of three-dimensional reconstruction technology combined with three-dimensional printing in the treatment of pectus excavatum.","authors":"Yibo Shan,&nbsp;Guiping Yu,&nbsp;Yi Lu,&nbsp;Hao Kong,&nbsp;Xuewei Jiang,&nbsp;Zhiming Shen,&nbsp;Fei Sun,&nbsp;Hongcan Shi","doi":"10.4103/atm.atm_506_21","DOIUrl":"https://doi.org/10.4103/atm.atm_506_21","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the clinical value of three-dimensional (3D) reconstruction technology combined with 3D printing in the treatment of pectus excavatum (PE).</p><p><strong>Methods: </strong>The clinical data of 10 patients with PE in our department from June 2018 to December 2020 were analyzed retrospectively. All patients underwent thin-layer computed tomography examination before the operation, and then 3D reconstruction was performed with Mimics 20.0 software. The radian and curvature of the pectus bar were designed according to the reconstructed images. Afterward, the images were imported into the light-curing 3D printer in STL format for slice printing. Hence that the personalized operation scheme, including the size of the pectus bar and the surgical approach, can be made according to the 3D printed model. The thoracoscopic-assisted Nuss operation was completed by bilateral incisions. The operation time, intraoperative blood loss, and postoperative hospitalization were counted and analyzed. The satisfaction of the surgery was evaluated according to the Haller index and the most posterior sternal compression sternovertebral distance.</p><p><strong>Results: </strong>The surgeries were successfully completed in 10 patients without a transfer to open procedure. The average operation time was (56 ± 8.76) min, the intraoperative blood loss was (23.5 ± 11.07) mL, and the postoperative hospitalization was (7.2 ± 0.92) d. There were no serious complications or death during the perioperative period. Compared with the data before the operation, the most posterior sternal compression sternovertebral distance was larger, and the Haller index was lower, the differences were statistically significant (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>3D reconstruction technology combined with 3D printing, which can be used before operation, contributes to the operator performing thoracoscopic-assisted Nuss operation safely and effectively, which has productive clinical application value for the treatment of pectus excavatum.</p>","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":"17 3","pages":"173-179"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/93/ATM-17-173.PMC9374120.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40615216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study of intraoperative intercostal nerve block during uniportal thoracoscopic wedge resection of the lung.","authors":"Do Kyun Kang,&nbsp;Min Kyun Kang","doi":"10.4103/atm.atm_128_22","DOIUrl":"https://doi.org/10.4103/atm.atm_128_22","url":null,"abstract":"<p><strong>Background and aims: </strong>Uniportal thoracoscopic surgery has been reported to result in alleviating the postoperative pain when compared with traditional video-assisted thoracoscopic surgery (VATS). However, postoperative pain is still the main concerns associated with thoracic surgeries. The objective of this study is to evaluate the postoperative pain of patients undergoing uniportal VATS, especially wedge resection, with the use of intraoperative intercostal nerve block.</p><p><strong>Methods: </strong>All consecutive patients undergoing the uniportal VATS wedge resection between January 2019 and March 2020 were reviewed retrospectively. Twenty consecutive patients in Group A underwent the uniportal VATS wedge resection without intraoperative intercostal nerve block. The other 20 consecutive patients in Group B underwent the uniportal VATS wedge resection with intraoperative intercostal nerve block. The numeric pain rating scale (NRS) scores were recorded at 1, 12, and 24 h, postoperatively. The number of opioid consumption was also recorded until the time to chest tube removal.</p><p><strong>Results: </strong>There was no difference between groups with regard to sex, age, chest tube duration, length of stay, operative time, laterality time, and diagnosis. There was a significant difference in postoperative NRS scores at 1 h (<i>P</i> = 0.001) and 12 h (<i>P</i> = 0.022) between the groups. The opioid consumption was significantly in Group B lower than those in Group A (<i>P</i> = 0.025).</p><p><strong>Conclusion: </strong>The intraoperative intercostal nerve block with bupivacaine provided immediate postoperative pain relief with reducing the postoperative opioid consumption compared in patients who underwent uniportal VATS, especially wedge resection of the lung.</p>","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":"17 3","pages":"180-183"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0c/31/ATM-17-180.PMC9374124.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40615210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of radial endobronchial ultrasound-guided transbronchial lung biopsy with distance measurement versus with guide sheath in diagnosing peripheral pulmonary lesions with a diameter ≥3 cm by thin bronchoscope.","authors":"Shuhong Guan,&nbsp;Jun Zhou,&nbsp;Qiudi Zhang,&nbsp;Qianqian Xu,&nbsp;Xiong Xu,&nbsp;Sujuan Zhang","doi":"10.4103/atm.atm_495_21","DOIUrl":"https://doi.org/10.4103/atm.atm_495_21","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore the diagnostic values of radial endobronchial ultrasound-guided transbronchial lung biopsy with distance (rEBUS-D-TBLB) measurement and with guide sheath (rEBUS-GS-TBLB) for peripheral pulmonary lesions (PPLs) with a diameter ≥3 cm by thin bronchoscope.</p><p><strong>Patients and methods: </strong>Six hundred and three patients with PPL (diameter ≥3 cm) were enrolled in this study. The subjects were divided into the rEBUS-D-TBLB and rEBUS-GS-TBLB groups by the random number table method. Patients were assigned to undergo rEBUS-D-TBLB or rEBUS-GS-TBLB, respectively. The histopathology, positive diagnosis rates, duration of the procedure, and postoperative adverse effects between the two groups were examined.</p><p><strong>Results: </strong>A total of 569 patients were included in this study according to the inclusion and exclusion criteria, with 282 cases in the rEBUS-D-TBLB group and 287 cases in the rEBUS-GS-TBLB group. For malignant diseases, the positive diagnosis rates of PPL in the outer/inner-middle lung bands and the right-upper/-lower lung lobes by rEBUS-D-TBLB were noninferior to those of rEBUS-GS-TBLB. The duration of the procedure of rEBUS-D-TBLB was longer than that of rEBUS-GS-TBLB. There were 14 cases of hemorrhage >50 mL, 1 case of postoperative chest pain in the rEBUS-D-TBLB group, and 3 cases of hemorrhage >50 mL in the rEBUS-GS-TBLB group.</p><p><strong>Conclusion: </strong>REBUS-D-TBLB by thin bronchoscope has a high diagnostic value for PPL with a diameter ≥3 cm, which may be considered a useful alternative for rEBUS-GS-TBLB in the clinic.</p>","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":"17 3","pages":"151-158"},"PeriodicalIF":2.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/ee/ATM-17-151.PMC9374119.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40615215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of risk stratification and adherence to venous thromboembolism prophylaxis among hospitalized obstetric women: Retrospective case file review at East Jeddah Hospital during 2018-2019.","authors":"Ghadeer Mattar,&nbsp;Nada Al Sahafi,&nbsp;Lujain Al Hazmi,&nbsp;Nadia Al Hazmi,&nbsp;Hanaa Elsayed Abozeid,&nbsp;Intessar Sultan","doi":"10.4103/atm.atm_79_21","DOIUrl":"https://doi.org/10.4103/atm.atm_79_21","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE) is associated with substantial mortality as well as morbidity and is largely preventable among hospitalized obstetric women. However, thromboprophylaxis is underutilized in most hospitalized patients.</p><p><strong>Objectives: </strong>To evaluate VTE risk and adherence to local thromboprophylaxis protocol among hospitalized pre- and postnatal women.</p><p><strong>Methods: </strong>This retrospective study was conducted at East Jeddah Hospital, Jeddah, Saudi Arabia, in 2020. The electronic record database of the hospitalized pregnant Saudi women during the years 2018 and 2019 was reviewed. Based on the local hospital protocol, the risk stratification was reassessed by researchers, and the hospital adherence to the prophylaxis was reviewed separately for antenatal and postnatal women.</p><p><strong>Results: </strong>One thousand and ninety-five electronic records (539 antenatal and 556 postnatal) were reviewed. The postnatal group showed a significantly higher risk compared with an antenatal group (62.2% vs. 11.7%) (<i>P</i> = 0.000). There was a highly significant difference between risk categories assessment by the physicians and the researchers in both groups (<i>P</i> = 0.000). Thromboprophylaxis was overutilized in the low risk (5% heparin and 41.4% heparin and mechanical devices for antenatal and 17.08% heparin and 6.1% heparin and a mechanical device for the postnatal group) and underutilized in intermediate groups (50% no prophylaxis in antenatal and 51.5% mechanical devices in the postnatal group). There was less adherence to documentation in postnatal as compared to antenatal group (83.6% vs. 95%, <i>P</i> = 0.000) for risk documentation and 85.3% versus 91.5% for physician signature (<i>P</i> = 0.001). Thromboprophylaxis was ordered for 21.3% of antenatal (12.2 heparin, 3.5% mechanical, and 5.6% both) and 23.7% of postnatal patients (16.5 heparin, 2% mechanical, and 5.2% both). There were no reported VTE events or bleeding complications.</p><p><strong>Conclusion: </strong>There was a considerable VTE risk among hospitalized obstetric patients which peaked during the postnatal period. Physicians showed good compliance to local VTE protocol with no reported VTE events or drug-induced bleeding. However, the implementation of prophylaxis is associated with both under and overutilization. There is a need for increasing the physicians' awareness of optimizing VTE risk assessment and documentation for hospitalized obstetric patients.</p>","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":"17 2","pages":"94-101"},"PeriodicalIF":2.3,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/92/ATM-17-94.PMC9150665.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10619351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of timing of pharmacological prophylaxis and venous thromboembolism in patients with moderate-to-severe traumatic brain injury: A retrospective cohort study","authors":"H. Al-Dorzi, Ghadah Al-Yami, Fatima Al-Daker, Muhannad Q Alqirnas, Moustafa S. Alhamadh, R. Khan","doi":"10.4103/atm.atm_174_21","DOIUrl":"https://doi.org/10.4103/atm.atm_174_21","url":null,"abstract":"OBJECTIVES: Patients with traumatic brain injury (TBI) have an increased risk for venous thromboembolism (VTE). The current guidelines recommend pharmacologic prophylaxis, but its timing remains unclear. METHODS: In this retrospective cohort study, patients with moderate-to-severe TBI admitted to a tertiary care intensive care unit between 2016 and 2019 were categorized into two groups according to the timing of pharmacologic prophylaxis: early if prophylaxis was given within 72 h from hospital admission and late if after 72 h. RESULTS: Of the 322 patients in the cohort, 46 (14.3%) did not receive pharmacological prophylaxis, mainly due to early brain death; 152 (47.2%) received early pharmacologic prophylaxis and 124 (38.5%) received late prophylaxis. Predictors of late pharmacologic prophylaxis were lower body mass index, intracerebral hemorrhage (odds ratio [OR], 3.361; 95% confidence interval [CI], 1.269–8.904), hemorrhagic contusion (OR, 3.469; 95% CI, 1.039–11.576), and lower platelet count. VTE was diagnosed in 43 patients on a median of 10 days after trauma (Q1, Q3: 5, 15): 6.6% of the early prophylaxis group and 26.6% of the late group (P < 0.001). On multivariable logistic regression analysis, the predictors of VTE were Acute Physiology and Chronic Health Evaluation II score, subarachnoid hemorrhage, and late versus early pharmacologic prophylaxis (OR, 3.858; 95% CI, 1.687–8.825). The late prophylaxis group had higher rate of tracheostomy, longer duration of mechanical ventilation and stay in the hospital, lower discharge Glasgow coma scale, but similar survival, compared with the early group. CONCLUSIONS: Late prophylaxis (>72 h) was associated with higher VTE rate in patients with moderate-to-severe TBI, but not with higher mortality.","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":"8 1","pages":"102 - 109"},"PeriodicalIF":2.3,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90423271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 reinfection: A multicenter retrospective study in Saudi Arabia","authors":"N. Shaheen, R. Sambas, MahaA. Alenezi, N. Alharbi, O. Aldibasi, M. Bosaeed","doi":"10.4103/atm.atm_74_22","DOIUrl":"https://doi.org/10.4103/atm.atm_74_22","url":null,"abstract":"INTRODUCTION: There are limited direct data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) long-term immune responses and reinfection. This study aimed to evaluate the rate, risk factors, and severity of COVID-19 reinfection. METHODS: This retrospective cohort study included five hospitals across Saudi Arabia. All subjects who were presented or admitted with positive SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) tests were evaluated between March 2020 and August 2021. Reinfection was defined as a patient who was infected followed by clinical recovery, and later became infected again 90 days post first infection. The infection was confirmed with a positive SARS-CoV-2 (RT-PCR). Four hundred and seventeen recovered cases but with no reinfection were included as a control. RESULTS: A total of 35,288 RT-PCR-confirmed COVID-19 patients were observed between March 2020 and August 2021. Based on the case definition, (0.37%) 132 patients had COVID-19 reinfection. The mean age in the reinfected cases was 40.95 ± 19.48 (range 1–87 years); Females were 50.76%. Body mass index was 27.65 ± 6.65 kg/m2; diabetes and hypertension were the most common comorbidities. The first infection showed mild symptoms in 91 (68.94%) patients; and when compared to the control group, comorbidities, severity of infection, and laboratory investigations were not statistically different. Hospitalization at the first infection was higher, but not statistically different when compared to the control group (P = 0.093). CONCLUSION: COVID-19 reinfection is rare and does not carry a higher risk of severe disease. Further studies are required, especially with the continuously newly emerging variants, with the unpredictable risk of reinfection.","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":"53 1","pages":"81 - 86"},"PeriodicalIF":2.3,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76251545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and recommendations for the management of asthma in the Middle East and Africa.","authors":"Mohamed Omar Zeitouni,&nbsp;Mohamed Saad Al-Moamary,&nbsp;Marie Louise Coussa,&nbsp;Moussa Riachy,&nbsp;Bassam Mahboub,&nbsp;Fatma AlHuraish,&nbsp;Mohamed Helmy Zidan,&nbsp;Mohamed Mostafa Metwally,&nbsp;Kurtuluş Aksu,&nbsp;Erdinç Yavuz,&nbsp;Ismail Sikander Kalla,&nbsp;Jeremiah Chakaya,&nbsp;Snouber Abdelmadjid,&nbsp;Habib Ghedira","doi":"10.4103/atm.atm_469_21","DOIUrl":"https://doi.org/10.4103/atm.atm_469_21","url":null,"abstract":"<p><p>Clinical presentation of asthma is variable, and its diagnosis can be a major challenge in routine health-care practice, especially in low-and-middle-income countries. The aim of asthma management is to achieve optimal asthma control and to reduce the risk of asthma exacerbations and mortality. In the Middle East and in Africa (MEA), several patient- and physician-related factors lead to misdiagnosis and suboptimal management of asthma. A panel of experts comprising of specialists as well as general health-care professionals met to identify challenges and provide recommendations for the management of asthma in MEA. The major challenges identified for diagnosis of asthma were lack of adequate knowledge about the disease, lack of specialized diagnostic facilities, limited access to spirometry, and social stigma associated with asthma. The prime challenges for management of asthma in MEA were identified as overreliance on short-acting β-agonists (SABAs), underprescription of inhaled corticosteroids (ICS), nonadherence to prescribed medications, and inadequate insurance coverage for its treatment. The experts endorsed adapting the Global Initiative for Asthma guidelines at country and regional levels for effective management of asthma and to alleviate the overuse of SABAs as reliever medications. Stringent control over SABA use, discouraging over-the-counter availability of SABA, and using as-needed low-dose ICS and formoterol as rescue medications in mild cases were suggested to reduce the overreliance on SABAs. Encouraging SABA alone-free clinical practice in both outpatient and emergency department settings is also imperative. We present the recommendations for the management of asthma along with proposed regional adaptations of international guidelines for MEA.</p>","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":"17 2","pages":"71-80"},"PeriodicalIF":2.3,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1b/14/ATM-17-71.PMC9150662.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10307326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of bronchoscopy in sputum-negative pulmonary tuberculosis patients and its correlation with clinicoradiological features","authors":"S. Imtiaz, E. Batubara","doi":"10.4103/atm.atm_487_21","DOIUrl":"https://doi.org/10.4103/atm.atm_487_21","url":null,"abstract":"CONTEXT: Tuberculosis (TB) remains endemic in Saudi Arabia. Little local data have been reported on bronchoscopic evaluation of sputum-negative pulmonary TB patients, which poses a significant diagnostic and therapeutic challenge. AIMS: To determine the diagnostic value of bronchoscopy and bronchoalveolar lavage (BAL) and its correlation with clinical and radiological features in sputum-negative, culture-confirmed pulmonary TB patients. METHODS: We performed a retrospective analysis of patients with definite or probable pulmonary TB with overall negative (smear and/or polymerase chain reaction [PCR]) or scanty sputum that had undergone bronchoscopy with BAL over a period of 5 years. Patients' symptoms, radiological features, lung lobe lavaged, BAL acid-fast bacilli (AFB) stain, Mycobacterium TB (MTB)-PCR, and mycobacterial cultures were analyzed. Mycobacterial cultures (either sputum or BAL) were used as a reference standard. RESULTS: Out of 154 patients, 49 (32%) were overall sputum negative and underwent a diagnostic bronchoscopy. Dry cough and fever were the most common symptoms. Uncontrolled diabetes mellitus was the most frequent comorbidity identified in 15 (31%) patients. Fifty-nine percent of the patients had diffuse lung infiltrates, with consolidation being the most common abnormality (41%), followed by cavitation (39%). Right upper lobe was the most frequent lung lobe lavaged (31%), while transbronchial lung biopsies (TBLB) were obtained in 21 (43%). BAL mycobacterial culture and MTB PCR were positive in 35 (71%) and 23 (47%) patients, respectively. Combined BAL MTB PCR and TBLB provided rapid diagnosis in 28 (57%) patients. CONCLUSIONS: An overall diagnostic yield of 90% was achieved with combined use of BAL MTB PCR, culture, and histopathology. Upper lobe lavage and presence of cavities on chest imaging had a higher diagnostic yield.","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":"17 1","pages":"124 - 131"},"PeriodicalIF":2.3,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73604552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructive sleep apnea in patients with severe asthma: Prevalence and association between severity and asthma control","authors":"Fatema Al-Lawati, Saif Al-Mubaihsi, B. Jayakrishnan, Sayed Rizvi, M. Al-Abri","doi":"10.4103/atm.atm_375_21","DOIUrl":"https://doi.org/10.4103/atm.atm_375_21","url":null,"abstract":"INTRODUCTION: Asthma and obstructive sleep apnea (OSA) are common respiratory disorders that can coexist and cause sleep disturbances. The strength of this association and the impact of OSA on asthma severity and control remain unclear. The study aims to estimate the prevalence of OSA in patients with severe asthma in Oman and to examine whether the severity of OSA contributed to the level of asthma control. METHODS: Adult patients with confirmed diagnosis of severe asthma who attended the respiratory clinic in a tertiary hospital in Oman over a period of 19 months were enrolled in the study. Eligible participants were screened by asthma control test (ACT) and Berlin questionnaire (BQ). Patients with high risk for OSA were subjected further to level 3 sleep study. The prevalence of OSA in patients with severe asthma and the associations between the severity of OSA and asthma control were calculated. RESULTS: We identified 312 adult asthma patients on Global Initiative for Asthma step 4 or 5 management out of 550 who were screened. The mean age of the study population was 56.59 ± 12.40 years and the mean body mass index (BMI) 40.30 ± 12.24 kg/m2. The prevalence of OSA in asthma patients with severe asthma was found to be 32.4%. Out of the 138 well-controlled asthma patients (ACT ≥20), 35 had high risk of OSA based on BQ, and 32 were confirmed to have OSA (23%). Of the 174 uncontrolled patients, 80 patients had high risk of OSA and 69 patients were confirmed to have OSA (39.65%). Severe OSA was seen in 63.8% and 9.4% in uncontrolled and controlled asthma patients, respectively (P = 0.002). The median respiratory event index in the uncontrolled group was 43, and it was significantly higher than 12.5 in the controlled group (P < 0.001). CONCLUSIONS: The prevalence of OSA was high (32.37%) in patients with severe asthma. Uncontrolled severe asthma was significantly associated with severe OSA.","PeriodicalId":50760,"journal":{"name":"Annals of Thoracic Medicine","volume":"16 1","pages":"118 - 123"},"PeriodicalIF":2.3,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73111030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}