Publications by authors named "B Jayakrishnan"

30 Publications

  • Page 1 of 1

A critical analysis of 57 cases of Hughes-Stovin syndrome (HSS). A report by the HSS International Study Group (HSSISG).

Int J Cardiol 2021 Jan 30. Epub 2021 Jan 30.

Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerlolaan 5, 7522NB Enschede, the Netherlands.

Background: Hughes-Stovin syndrome (HSS) is a systemic disease characterized by widespread vascular thrombosis and pulmonary vasculitis with serious morbidity and mortality. The HSS International Study Group is a multidisciplinary taskforce aiming to study HSS, in order to generate consensus recommendations regarding diagnosis and treatment.

Methods: We included 57 published cases of HSS (43 males) and collected data regarding: clinical presentation, associated complications, hemoptysis severity, laboratory and computed tomography pulmonary angiography (CTPA) findings, treatment modalities and cause of death.

Results: At initial presentation, DVT was observed in 29(33.3 %), thrombophlebitis in 3(5.3%), hemoptysis in 24(42.1%), and diplopia and seizures in 1 patient each. During the course of disease, DVT occurred in 48(84.2%) patients, and superficial thrombophlebitis was observed in 29(50.9%). Hemoptysis occurred in 53(93.0%) patients and was fatal in 12(21.1%). Pulmonary artery (PA) aneurysms (PAAs) were bilateral in 53(93%) patients. PAA were located within the main PA in 11(19.3%), lobar in 50(87.7%), interlobar in 13(22.8%) and segmental in 42(73.7%). Fatal outcomes were more common in patients with inferior vena cava thrombosis (p = 0.039) and ruptured PAAs (p < 0.001). Death was less common in patients treated with corticosteroids (p < 0.001), cyclophosphamide (p < 0.008), azathioprine (p < 0.008), combined immune modulators (p < 0.001). No patients had uveitis; 6(10.5%) had genital ulcers and 11(19.3%) had oral ulcers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2021.01.056DOI Listing
January 2021

Persistent Pneumothorax: Alveolar pleural fistula due to a hole in a bulla.

Sultan Qaboos Univ Med J 2019 May 8;19(2):e164-e165. Epub 2019 Sep 8.

Department of Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18295/squmj.2019.19.02.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736266PMC
May 2019

Sarcoidosis in the Middle East.

Ann Thorac Med 2019 Apr-Jun;14(2):106-115

College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman.

Sarcoidosis, a systemic granulomatous disease of unknown cause, has been described worldwide and in all populations with notable differences in clinical characteristics, organ involvement, disease severity, and prognosis among different ethnic and racial groups. While the exact prevalence of sarcoidosis in the Middle East is unknown, studies from various countries in the region have reported the clinical characteristics of affected patients, along with a few anecdotal reports. A search of the MEDLINE and Google Scholar databases was conducted for relevant English-language articles using the terms "sarcoidosis" and "Middle East" or "sarcoidosis" and "Arabs." Subsequently, the names of individual countries were used as search terms, replacing "Middle East." Overall, the clinical picture of patients with sarcoidosis in the Middle East is similar to that reported elsewhere; for example, the disease was more frequent among females and respiratory complaints were the predominant symptoms. Within the region, most patients from Oman were older and female, with arthralgia, hypercalcemia, and eye involvement being more common. Constitutional symptoms were frequent, especially among patients from Iran. Cough was more common among patients from Kuwait and Iran, while dyspnea was the predominant symptom for Saudi patients. Erythema nodosum was more common in the Turkish population. Clustering was seen in patients with Stage I and II of the disease in all countries except Oman. Apart from those in Iran, the prognosis of most patients from the Middle East was excellent.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/atm.ATM_227_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467024PMC
April 2019

Hypercalcaemia: A portent of sarcoidosis in cystic fibrosis.

Sultan Qaboos Univ Med J 2018 Nov 28;18(4):e533-e536. Epub 2019 Mar 28.

Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.

The coexistence of cystic fibrosis (CF) and sarcoidosis is rare. We report a 22-year-old male cystic fibrosis patient who presented multiple times to the Sultan Qaboos University Hospital, Muscat, Oman, in 2013. He was diagnosed with non-parathyroid-related hypercalcaemia and anterior uveitis, while computed tomography revealed mediastinal and abdominal lymphadenopathy and mild hepatosplenomegaly. These findings, in addition to the presence of calciuria and a high angiotensin-converting enzyme (ACE) level, confirmed a clinical diagnosis of sarcoidosis. The patient responded well to treatment with oral prednisolone which, over the course of two years, resulted in the near-complete resolution of parenchymal nodular infiltrates, regression of hilar lymphadenopathy, resolution of hypercalcaemia and the normalisation of his ACE levels. Diagnosing pulmonary sarcoidosis in CF can be challenging as most adult patients already have extensive lung disease. Physicians should be aware that hypercalcaemia may be an early manifestation of sarcoidosis in such cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18295/squmj.2018.18.04.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443288PMC
November 2018

Clinical features of Sarcoidosis in Oman: A report from the Middle East region.

Sarcoidosis Vasc Diffuse Lung Dis 2016 Oct 7;33(3):201-208. Epub 2016 Oct 7.

Sultan Qaboos University.

Background: Though clinical features of sarcoidosis follow a similar pattern, some heterogeneity is seen in different ethnic and racial groups.

Objectives: To describe for the first time the clinical characteristics of sarcoidosis patients in the Sultanate of Oman.

Methods: The data on all cases of sarcoidosis followed up in the two tertiary hospitals in Oman were retrieved retrospectively.

Results: Of the 92 patients, for representing the ethnic data only Omani patients (n=83) were included. The mean age was 52.90±12.35 years. Majority were females (72.3%, n=60). Cough (n=44, 53.0%), dyspnea (n=39, 47%), arthralgia (n=26, 31.3%) and fatigue (30.1%) were the major symptoms. Arthralgia was reported by 41.7% of the females and 4.3% of the males (p= 0.001). Uveitis was present in 16 (19.3%), erythema nodosum in 8 (9.6%) and hypercalcemia in 13 (15.7%). The radiological stage at presentation was stage 0, 18.7%; I, 28%; II, 17.3%; III, 24% and IV, 12%. Majority (61.4%) of the patients had tissue diagnosis; intra-thoracic site 70.6%. Pulmonary function showed abnormal diffusion in 75%. Sixty eight received treatment, 81.9% took prednisolone. Based on radiograph good outcome (Resolving) was noted in 20.9%, intermediate (Stable) in 73.1% and poor (Progressive) in 6%. Lung function wise, resolving, stable and progressive disease was seen in 31.4%, 40.0% and 28.6% respectively.

Conclusion: The clinical picture of the patients with sarcoidosis from Oman was similar to that reported from the rest of the world. Region wise, our patients were older and arthralgia and hypercalcemia were more common. The management of sarcoidosis needs a more organized approach in the country with clear guidelines on monitoring and treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2016

Hughes-stovin syndrome and massive hemoptysis: a management challenge.

Oman Med J 2015 Jan;30(1):59-62

Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.

Hughes-Stovin syndrome is a very rare clinical entity characterized by pulmonary artery aneurysms and deep vein thrombosis (DVT). Here we report the case of a 53-year-old man, admitted to Sultan Qaboos University Hospital, Muscat, Oman, with bilateral pulmonary artery aneurysms and lower-limb DVT who developed massive hemoptysis. He was managed successfully with high-dose steroids in combination with cyclophosphamide.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5001/omj.2015.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371468PMC
January 2015

Black pleural effusion.

Lancet 2015 Aug 6;386(9995):e7. Epub 2015 Mar 6.

Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S0140-6736(14)62003-1DOI Listing
August 2015

Varicella zoster virus pneumonitis and brainstem encephalitis without skin rash in an immunocompetent adult.

Open Forum Infect Dis 2014 Sep 6;1(2):ofu064. Epub 2014 Aug 6.

Departments of Neurology ; Microbiology , University of Colorado School of Medicine , Aurora.

Varicella zoster virus (VZV) pneumonitis and brainstem encephalitis developed in an immunocompetent adult without rash. Chest computed tomography exhibited nodularity; lung biopsy revealed multinucleated giant cells, Cowdry A inclusions, VZV antigen, and DNA. Varicella zoster virus central nervous system disease was verified by cerebrospinal fluid (CSF) anti-VZV IgG antibody with reduced serum/CSF ratios.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ofid/ofu064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281813PMC
September 2014

Chronic renal failure presenting for the first time as pulmonary mucormycosis with a fatal outcome.

Case Rep Nephrol 2015 13;2015:589537. Epub 2015 Jan 13.

Department of Medicine, Sultan Qaboos University Hospital, 123 Muscat, Oman.

Pulmonary mucormycosis is an uncommon, but important, opportunistic fungal pneumonia which is often diagnosed late. Renal failure as the predominant presenting feature is not common in mucormycosis. Moreover, sudden, massive hemoptysis is not a usual complication. In this report we describe fatal pulmonary mucormycosis in a young patient with a previously undiagnosed chronic renal failure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2015/589537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309303PMC
February 2015

Asthma control: importance of compliance and inhaler technique assessments.

J Asthma 2014 May 8;51(4):429-34. Epub 2014 Jan 8.

Department of Medicine, Sultan Qaboos University Hospital and College of Medicine and Health Sciences, Sultan Qaboos University , Muscat , Oman.

Objectives: The available assessment tools to determine asthma control do not include components assessing factors that may directly affect control. Our aim was to evaluate the relationship between patient compliance, inhaler technique and the level of asthma control.

Methods: Scores from the Asthma Control Test, individual inhaler device checklists and a novel questionnaire on the patient's medication regimen were used to measure control, inhaler technique and compliance, respectively, in patients with asthma attending Sultan Qaboos University Hospital, Muscat, Oman during a 3-month period.

Results: All of the 218 patients were receiving inhaled steroids, either in combination with long-acting beta agonists (86.2%) or alone. Asthma control was good in 92 (42.2%) patients; with 38 males (50%) and 54 females (38%), respectively (p = 0.059). Compliance and inhaler technique were poor in 40.8% (89) and 18.3% (40) of the patients. 60% (36) of the patients with good and 59.4% (41) with partial compliance had good control while 83.1% (74) with poor compliance had poor control (p < 0.001). Of the 92 patients with good control, 86 (93.5%) exhibited good inhaler techniques. In contrast, 85% (34) of the patients with poor inhaler techniques demonstrated poor control (odds ratio [OR] = 5.3; 95% confidence interval [CI]: 2.05-14.8; p < 0.001). A total of 93.3% (56) with good and 89.9% (62) with partial compliance demonstrated good inhaler techniques (p < 0.001). In patients with good control, 35 (38%) exhibited both good inhaler techniques and compliance and 38 (41.3%) had a good technique and partial compliance.

Conclusion: Patients with good inhaler techniques and compliance have better control of their asthma. Asthma control will remain suboptimal unless the reasons for this lack of control are identified, assessed and eliminated. We recommend that inhaler technique assessment and measurements of patient compliance with their prescribed treatments should be considered for inclusion in the current assessment tools.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/02770903.2013.871558DOI Listing
May 2014

Severe Pulmonary Involvement in Leptospirosis: Alternate antibiotics and systemic steroids.

Sultan Qaboos Univ Med J 2013 May 9;13(2):318-22. Epub 2013 May 9.

Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.

Pulmonary complications in leptospirosis, though common, are often unrecognized in a non-endemic area. We report here a patient with leptospirosis and severe pulmonary involvement who was treated with meropenem (1 g every 8 hours), moxifloxacin (400 mg once daily), and high doses of corticosteroids. Systemic steroids were continued for 3 months because of persistent pulmonary lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706125PMC
http://dx.doi.org/10.12816/0003241DOI Listing
May 2013

Is Clinical Judgment of Asthma Control Adequate?: A prospective survey in a tertiary hospital pulmonary clinic.

Sultan Qaboos Univ Med J 2013 Feb 27;13(1):63-8. Epub 2013 Feb 27.

Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.

Objectives: Asthma control is often difficult to measure. The aim of this study was to compare physicians' personal clinical assessments of asthma control with the Global Initiative for Asthma (GINA) scoring.

Methods: Physicians in the adult pulmonary clinics of a tertiary hospital in Oman first documented their subjective judgment of asthma control on 157 consecutive patients. Immediately after that and in the same proforma, they selected the individual components from the GINA asthma control table as applicable to each patient.

Results: The same classification of asthma control was achieved by physicians' clinical judgment and GINA classification in 106 cases (67.5%). In the other 32.5% (n = 51), the degree of control by clinical judgment was one level higher than the GINA classification. The agreement was higher for the pulmonologists (72%) as compared to non-pulmonologists (47%; P = 0.009). Physicians classified 76 patients (48.4%) as well-controlled by clinical judgment compared to 48 (30.6%) using GINA criteria (P <0.001). Conversely, they classified 34 patients (21.7%) as uncontrolled as compared to 57 (36.3%) by GINA criteria (P <0.001). In the 28 patients who were clinically judged as well-controlled but, by GINA criteria, were only partially controlled, low peak expiratory flow rate (PEFR) (46.7%) and limitation of activity (21.4%) were the most frequent parameters for downgrading the level of control.

Conclusion: Using clinical judgment, physicians overestimated the level of asthma control and underestimated the uncontrolled disease. Since management decisions are based on the perceived level of control, this could potentially lead to under-treatment and therefore sub-optimal asthma control.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616802PMC
http://dx.doi.org/10.12816/0003197DOI Listing
February 2013

Acute drug overdose: clinical profile, etiologic spectrum and determinants of duration of intensive medical treatment.

Oman Med J 2012 Nov;27(6):501-4

Department of Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.

Objectives: Acute drug overdosing is an important cause of organ dysfunction and metabolic derangements and the patients often require intensive care. This study aims to determine the clinical pattern of severe drug overdose as well as the factors influencing the duration of intensive care

Methods: The clinical characteristics and course of consecutive adult patients admitted with a diagnosis of acute drug poisoning in the ICU of a tertiary hospital in Oman from January 2007 to December 2008 were reviewed retrospectively from the electronic case records.

Results: Acute drug poisoning (n=29) constituted 3.9% of admissions to the ICU. Mean age was 29.38±7.9 years. They were brought in by their relatives (72%) or the state services (24%). Accidental poisoning was noted in 21 patients (72%) and suicidal overdosing in 6 (21%). The commonest drug was an opioid (65.5%). Glasgow Coma Scale score of ≤8 was recorded in 18 (62.1%). Sixty two percent of patients required mechanical ventilation. The prominent complications were hypotension in 9 (31%), pulmonary in 19 (65.5%), hepatic in 18 (62.1%) and renal in 12 (41.4%) patients. The major electrolytes abnormalities were low bicarbonate in 11 (37.9%), hyponatremia in 5 (17.2%) and hypokalemia in 4 (13.8%). Patients stayed in the ICU for 1 to 20 days (median-2 days). Factors associated with a longer ICU stay included hypotension upon arrival (p=0.048) and the need for mechanical ventilation on the first (p=0.001) and second (p=0.001) days of hospitalization. There was no mortality.

Conclusion: Early and prompt intensive medical therapy in acute drug poisoning can favorably influence the outcome. In addition, the presence of hypotension and requirement of mechanical ventilation on the first two days of hospitalization were responsible for prolonged ICU stay.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5001/omj.2012.120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3515042PMC
November 2012

Stiff-person syndrome (SPS) and anti-GAD-related CNS degenerations: protean additions to the autoimmune central neuropathies.

J Autoimmun 2011 Sep 16;37(2):79-87. Epub 2011 Jun 16.

Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, Davis, CA, USA.

Stiff Person Syndrome (SPS) is a rare autoimmune neurological disease attributable to autoantibodies to glutamic acid decarboxylase (anti-GAD) more usually associated with the islet beta cell destruction of autoimmune type 1 diabetes (T1D). SPS is characterized by interference in neurons with the synthesis/activity of the inhibitory neurotransmitter gamma amino butyric acid (GABA) resulting in the prototypic progressive spasmodic muscular rigidity of SPS, or diverse neurological syndromes, cerebellar ataxia, intractable epilepsy, myoclonus and several others. Remarkably, a single autoantibody, anti-GAD, can be common to widely different disease expressions, i.e. T1D and SPS. One explanation for these data is the differences in epitope engagement between the anti-GAD reactivity in SPS and T1D: in both diseases, anti-GAD antibody reactivity is predominantly to a conformational epitope region in the PLP- and C-terminal domains of the 65 kDa isoform but, additionally in SPS, there is reactivity to conformational epitope(s) on GAD67, and short linear epitopes in the C-terminal region and at the N-terminus of GAD65. Another explanation for disease expressions in SPS includes ready access of anti-GAD to antigen sites due to immune responsiveness within the CNS itself according to intrathecal anti-GAD-specific B cells and autoantibody. Closer study of the mysterious stiff-person syndrome should enhance the understanding of this disease itself, and autoimmunity in general.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaut.2011.05.005DOI Listing
September 2011

An analysis of the cross-reactivity of autoantibodies to GAD65 and GAD67 in diabetes.

PLoS One 2011 Apr 8;6(4):e18411. Epub 2011 Apr 8.

Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia.

Background: Autoantibodies to GAD65 (anti-GAD65) are present in the sera of 70-80% of patients with type 1 diabetes (T1D), but antibodies to the structurally similar 67 kDa isoform GAD67 are rare. Antibodies to GAD67 may represent a cross-reactive population of anti-GAD65, but this has not been formally tested.

Methodology/principal Findings: In this study we examined the frequency, levels and affinity of anti-GAD67 in diabetes sera that contained anti-GAD65, and compared the specificity of GAD65 and GAD67 reactivity. Anti-GAD65 and anti-GAD67 were measured by radioimmunoprecipitation (RIP) using (125)I labeled recombinant GAD65 and GAD67. For each antibody population, the specificity of the binding was measured by incubation with 100-fold excess of unlabeled GAD in homologous and heterologous inhibition assays, and the affinity of binding with GAD65 and GAD67 was measured in selected sera. Sera were also tested for reactivity to GAD65 and GAD67 by immunoblotting. Of the 85 sera that contained antibodies to GAD65, 28 contained anti-GAD67 measured by RIP. Inhibition with unlabeled GAD65 substantially or completely reduced antibody reactivity with both (125)I GAD65 and with (125)I GAD67. In contrast, unlabeled GAD67 reduced autoantibody reactivity with (125)I GAD67 but not with (125)I GAD65. Both populations of antibodies were of high affinity (>10(10) l/mol).

Conclusions: Our findings show that autoantibodies to GAD67 represent a minor population of anti-GAD65 that are reactive with a cross-reactive epitope found also on GAD67. Experimental results confirm that GAD65 is the major autoantigen in T1D, and that GAD67 per se has very low immunogenicity. We discuss our findings in light of the known similarities between the structures of the GAD isoforms, in particular the location of a minor cross-reactive epitope that could be induced by epitope spreading.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0018411PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072979PMC
April 2011

Asthma inhalers and colour coding: universal dots.

Br J Gen Pract 2010 Sep;60(578):690-1

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3399/bjgp10X515449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930224PMC
September 2010

Peripheral rim enhancement in tuberculous mediastinal lymph nodes.

Am J Trop Med Hyg 2009 Oct;81(4):548

Department of Medicine, Sultan Qaboos University Hospital and College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4269/ajtmh.2009.09-0311DOI Listing
October 2009

Management and control of asthma in patients attending a specialist centre in oman.

Sultan Qaboos Univ Med J 2009 Aug 30;9(2):132-9. Epub 2009 Jun 30.

Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman;

Objectives: The management of asthma by specialists is likely to become more evidence-based. This study analysed the characteristics of patients reporting to a specialist clinic including demographics, dispensed medications and the level of asthma control.

Methods: All consecutive stable asthmatics seen in the adult pulmonary clinics of Sultan Qaboos University Hospital, Oman, between December 2005 and November 2006 were prospectively evaluated using a structured assessment protocol.

Results: Of the 207 patients, (mean age 40.64 ±14.8), 72% were females. The majority, 83.1%, had moderate persistent asthma. A positive history of allergic rhinitis, eczema and a family history of asthma were obtained in 58.0%, 11.1%, and 50.7% of patients respectively. Total serum immunoglobulin E (IgE) was elevated in 66.7%. Skin testing was positive for more than 2 antigens in 52.3%, with the house dust antigen being reactive in 49%. Inhaled steroids, long-acting beta agonists (LABA), antihistamines and leukotriene receptor antagonists were prescribed in 94.2%, 85%, 54.5% and 11.6% of cases respectively. The majority (40.1%) was receiving medium dose inhaled steroids. Although asthma was controlled in 162 (78.3%), during the previous month 66 (31.9%) patients had visited the emergency department and 31 (15.0%) patients were hospitalised at least once during the previous year. Only 63 (30.4%) patients were using their inhalers correctly. Good compliance with inhaled steroids was observed in only 53 (25.6%) patients.

Conclusion: Allergic comorbidities and a strong family history of asthma were common. Although the level of asthma control in the previous month was high, it was much lower in the long term. The concepts of short term, long term and total control of asthma need to be explored.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074773PMC
August 2009

Normal spirometric reference values for Omani adults.

Lung 2009 Aug 28;187(4):245-51. Epub 2009 Apr 28.

Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.

International guidelines recommend the use of population-specific reference values to eliminate the well-recognized influence of ethnic variation on lung function. This study was designed to derive spirometric prediction equations for healthy Omani adults. Forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), peak expiratory flow rate (PEFR), and forced expiratory flow at 25% to 75% of FVC (FEF(25-75%)) were measured in 419 "healthy" nonsmoking Omani adults (256 men, 163 women), aged 18-65 years. Multiple linear regression analysis was performed for each spirometric parameter against age, height, and weight for men and women separately, and prediction equations for all the above parameters were derived and compared with values derived using equations published from other populations. All measured spirometric parameters increased with height and decreased with age, and they were all significantly higher in men. In contrast, FEV(1)/FVC% values decreased with height and increased with age and were higher in women. The predicted normal values of FVC and FEV(1) for our subjects using the derived equations were lower by 7-17% compared with respective Caucasian values, with smaller difference in the predicted values of PEFR, FEV(1)/FVC%, and FEF(25-75%). This report presents previously unavailable spirometric reference equations for the Omani adults. Our findings highlight the need to use reference values based on updated data derived from relevant populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00408-009-9148-4DOI Listing
August 2009

Long term prognosis of sarcoidosis in Arabs and Asians: predictors of good outcome.

Sarcoidosis Vasc Diffuse Lung Dis 2006 Oct;23(3):209-14

Department of Medicine, Kuwait University, Kuwait.

Background: The prognosis of sarcoidosis is variable and often difficult to predict. Our aim was to identify predictors of good prognosis in Arabs and Asians with sarcoidosis.

Methods: Data on patients with sarcoidosis followed up for at least 3 years in two major hospitals in Kuwait were collected retrospectively for the period 1983 to 1995 and prospectively from 1995.

Results: Of the total 115 patients, 60% were females and 80% were Arabs. Majority, 86.9%, of the patients had either Stage I or II disease. Forty-five (43.7%) were followed up for 3 to 5 years, 43 (41.7%) for 5 to 9 and 15 (14.6%) for 10 or more years while 12 were lost to follow up. Good prognosis was seen in 53 (51%), intermediate in 33(32%) and poor in 17 (17%) patients. Two patients (1.9%) died. Good prognosis was observed in 74.4% of patients with Stage I, 40% of patients with Stage II and 16.7% with stage III disease, p = 0.001. In addition, presence of arthralgia predicted a good prognosis, p = 0.014. Hypercalcemia was noted only in patients with poor or intermediate outcome. Gender, ethnicity, and presence of erythema nodosum were not predictors of prognosis in our patients. Multivariate logistic regression analysis confirmed that early stage of the disease [OR (95 %CI), 6.1 (2.3-15.7), p = 0.001] and presence of arthralgia, [OR (95%CI), 4.5 (1.3-15.4), p = 0.02] were predictors of good prognosis.

Conclusion: Presence of arthralgia and early stage of the disease were the most important predictors of good prognosis. Sex, age, ethnicity and presence of erythema nodosum did not influence the prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2006

Demographic pattern and clinical characteristics of patients with smear- positive pulmonary tuberculosis in kuwait.

Med Princ Pract 2005 Sep-Oct;14(5):306-12

Department of Medicine, Kuwait University, Safat, Kuwait.

Objective: The aim of this study was to document various clinical factors that are likely to be of help in the control of tuberculosis in Kuwait.

Subjects And Methods: Details of patients with sputum positive for acid-fast bacilli in the period from January 1998 to December 2000 were collected retrospectively from the case records and population statistics from government sources. The data were then tabulated and analyzed.

Results: Of the 526 cases, 83.5% were expatriates and 16.5% Kuwaiti; 373 (70.9%) were male. Of the expatriates, 66.7% were from Asia and the Far East, 5.7% were > or =60 years. The annual incidence was 8.34 per 100,000 population. The lowest incidence was observed in the Jahrah governorate with an overall incidence of 5 (2.0 among Kuwaitis and 6.4 among expatriates) per 100,000 population. The highest incidence overall (10.2) and among Kuwaitis (4.1) was observed in the Farwaniya governorate, while the highest incidence among expatriates was seen in the Capital governorate (13.4). Radiologically, 94 (19.5%) had minimal, 246 (51.5%) had moderately advanced and 141 (29.3%) far-advanced disease. The majority of the patients (72%) had only + status for AFB in the smear. Hypercalcemia (25.7%), hyponatremia (22.15%) and hyperglycemia (29.9%) were common in the patients. Mean serum albumin was low (28.7 +/- 5.5 g/l). Two hundred and forty-seven (47.2%) were declared cured while 116 (22.2%) completed treatment. Comparison between nationals and expatriates showed a significant difference only for age, smoking status, defaulter rate and place of residence.

Conclusion: The lowest regional incidence was found in the Jahrah governorate. Both biochemical abnormalities and radiologically advanced presentations were common. Disease pattern and response to treatment was purely individual and did not differ with respect to nationality or race.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000086927DOI Listing
September 2006

Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait.

Med Princ Pract 2005 Jul-Aug;14(4):235-40

Department of Medicine, Kuwait University, Kuwait.

Objectives: The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia (CAP) in Kuwait.

Subjects And Methods: The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team (PORT) severity index. The microbial etiology was determined using standard methods for bacteria and serological tests for atypical and viral pathogens.

Results: The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3+/-18 years. The severity class distribution was: class I 31%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients (35%), with one pathogen in 31 (25%), two in 9 (7%), and three or more in 4 (3%). The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients (11%), Legionella pneumophila in 10 (8%), Chlamydia pneumoniae in 8 (6%), influenza B virus in 8 (6%), influenza A virus in 5 (4%), Haemophilus influenzae in 4 (3%), Streptococcus pneumoniae in 3 (2%), Staphylococcus aureus in 3 (2%), gram-negative enterobacteria in 5 (4%), Moraxellacatarrhalis in 2 (2%), and viruses in 4 (3%). The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture.

Conclusion: Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait. Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000085741DOI Listing
February 2006

Effect of cigarette smoking on sputum smear conversion in adults with active pulmonary tuberculosis.

Respir Med 2005 Apr;99(4):415-20

Department of Medicine, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait.

Although factors influencing sputum smear conversion in tuberculosis have been studied well, the effect of smoking is largely unknown. Excluding those with incomplete history or drug resistant isolates, 339 patients out of the 526 sputum positive patients registered between 1998 and 2000 were studied. At the end of 2 months, smokers and non-smokers converted with almost the same frequency to a negative sputum status {P=0.065, OR (95%CI) 0.47 (0.21-1.06)}. Although gender or age had no effect on sputum conversion with respect to smoking status, expatriate smokers as a whole showed a significant difference. (P=0.039). On applying logistic regression model, smokers with far advanced radiographic abnormalities (P<0.038) or with 3+ smear status (P=0.011), were found to have a less chance of an early smear conversion. In conclusion smoking did not influence sputum smear conversion in tuberculosis. However, as expatriate smokers and smokers with advanced disease showed a delay in smear conversion, smoking should be discouraged in patients with pulmonary tuberculosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rmed.2004.08.016DOI Listing
April 2005

Flexible fiberoptic bronchoscopy. Diagnostic yield.

Saudi Med J 2004 Oct;25(10):1459-63

Department of Chest Diseases, Al Rasheed Allergy Center, Kuwait.

Objective: Fiberoptic bronchoscopy is a minimally invasive procedure with a high diagnostic yield. The aim of this study was to document the usefulness of the procedure in the diagnosis of various respiratory disorders in a Middle East country.

Methods: Data on all bronchoscopies carried out in Chest Diseases Hospital, Kuwait from January 1996 to December 1998 were retrospectively collected.

Results: Out of 968 cases, only 620 (64%) patients had a full follow up. Suspected pulmonary tuberculosis (TB) (51.6%), unresolving pneumonia (16.1%), hemoptysis with a normal chest radiograph (8.4%), lung mass (7.7%) and hilar lymphadenopathy (3.2%) were the most common indications. Eleven percent of patients who underwent bronchoscopy had a normal chest radiograph, the reason being hemoptysis in 75.4%, inhalation injury in 21.8% and suspected upper airway obstruction in 2.9%. In smear negative suspected TB cases, 22.5% proved to have active disease. Acid fast bacillus was identified in bronchoalveolar lavage, either by smear or culture, in 44 (73.3%) patients with suspected pulmonary TB and in 6 (54.5%) patients with miliary shadows. An underlying cause was identified in 28 (28%) patients with unresolving pneumonia. Ninety-four percent of cases with clinical impression of bronchogenic carcinoma could be diagnosed. Transbronchial biopsy was diagnostic in 79% patients with diffuse parenchymal lung disease. No complications other than transient hypoxemia and controllable bleeding were noticed.

Conclusion: Generally, the indications for flexible fiberoptic bronchoscopy remained similar to elsewhere. Unlike western series, the majority of the cases were for the diagnosis of pulmonary infections especially TB.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2004

Changes in blood levels of eosinophil cationic protein and tryptase after exercise challenge in adolescents with exercise-induced asthma.

East Afr Med J 2004 Jan;81(1):27-33

Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait.

Background: Exercise-induced asthma (EIA) is increasingly encountered among school children in Kuwait. Available evidence has shown that inflammatory mediators may be involved in the pathogenesis of EIA. Studies on release of inflammatory mediators have been carried out in adult patients with asthma in Kuwait, but no study on EIA involving children has taken place in this region.

Objective: To investigate changes in the concentration of some of the mediators involved in EIA in adolescent school children, using exercise challenge.

Design: Prospective, case control study.

Setting: Respiratory and Cardiology units Mubarak Hospital, Kuwait, between January and June 2001.

Subjects: Nine EIA and 14 non-EIA and 10 normal control subjects, designated as groups one, two and three aged between 13 and 17 years, who were non-smokers, were enrolled for the study.

Main Outcome Measures: Blood eosinophils (EOS), eosinophil cationic protein (ECP) and tryptase were estimated pre-exercise, 5 and 30 minutes after exercise. Spirometry was measured at the same period.

Results: In group one, ECP and tryptase levels fell after exercise, but significant difference in the levels were obtained only in tryptase between pre-exercise and 30 minutes after exercise (4.1 microg/L Vs 3.8 microg/L) P <0.05, while the difference for ECP was not significant (P=0.09). In group two, both tryptase (6.0 microg/L Vs 5.7 microg/L) P < 0.05, and ECP (21.8 microg/L Vs 12.1 microg/L) P<0.01, fell after exercise. However, in group three, no appreciable difference was observed between pre and post exercise. Correlation between tryptase and EOS (r=0.770; P<0.05) and between tryptase and ECP (r=0.850; p<0.05) was observed pre-exercise and after exercise in groups one and two.

Conclusion: A fall in the level of the mediators was observed after exercise challenge, but the relevance of this finding in the pathogenesis of EIA remains unclear. Further studies are required to verify this finding.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4314/eamj.v81i1.8791DOI Listing
January 2004

Clinical patterns of diffuse parenchymal lung disease in Kuwait: a prospective study.

Med Princ Pract 2004 Mar-Apr;13(2):78-83

Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.

Objective: To report our experience of the clinicopathological patterns of diffuse parenchymal lung disease (DPLD).

Subjects And Methods: Over a 4-year period, 75 patients (41 males, 34 females), aged 13-76 years, who were referred to Mubarak Al-Kabeer and the Chest Diseases Hospitals, Kuwait with a diagnosis of diffuse lung disease, were included in the study. After a comprehensive history and physical examination, further investigations were done, including hematological and immunological profiles, sputum and bronchoalveolar lavage fluid examination, chest radiograph, high resolution computed tomography (HRCT), pulmonary function test and lung biopsy.

Results: Of the 75 patients 60 (80%) were over 40 years of age. The duration of symptoms in 34 patients (45%) was less than 6 months and longer than 1 year in 28 (37.7%) patients. Twenty-five of the patients were cigarette smokers. The mean forced lung capacity (FVC), total lung capacity and diffusing capacity for carbon monoxide were less than 60% of the predicted values in most patients. There was a significant difference in mean FVC value between smokers and nonsmokers (p < 0.05). The HRCT findings were at an advanced stage in 65 patients, with additional honeycombing in 21 of the 65 patients. Idiopathic pulmonary fibrosis was the most common cause of DPLD, occurring in 52 patients, followed by sarcoidosis and collagen vascular diseases.

Conclusion: DPLD was observed predominantly in middle aged and elderly patients, due probably to increasing industrialization in the country. The role of cigarette smoking as a contributory factor remains unclear.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000075633DOI Listing
June 2004

Clinicopathological and therapeutic patterns of idiopathic pulmonary fibrosis in Kuwait: a prospective study.

Int J Clin Pract 2003 Dec;57(10):879-84

Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.

Though common, the exact incidence and clinical pattern of idiopathic pulmonary fibrosis (IPF) in Gulf countries are not known. The results of a four-year prospective study undertaken in two tertiary hospitals in Kuwait are presented. The mean age at diagnosis of the 52 patients studied was 55.40 +/- 11.87 years. Thirty-two (61.5%) patients were male and 22 (42.3%) were smokers. The mean duration of symptoms at diagnosis was 2.1 +/- 0.92 years. Digital clubbing was found in 34 (65%) patients. The mean FVC, TLC and TLCO were 57%, 64.4% and 55% of predicted normal, respectively. The FVC value showed a significant difference between smokers and non-smokers (p < 0.05). HRCT findings were abnormal in all patients. Typical histological and high-resolution computed tomography findings of usual interstitial pneumonia, desquamative interstitial pneumonia and non-specific interstitial pneumonia were observed. This study revealed that IPF is prevalent in Kuwait, with patterns showing some similarities to those established elsewhere. The response to treatment was not encouraging, especially in the usual interstitial pneumonia subtype.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2003

Chronic lobar consolidation.

Int J Clin Pract 2003 Mar;57(2):112-4

Al Rashed Allergy Centre, Kuwait.

Lobar consolidation in a chest X-ray is often thought to be due to infection. We present the problem of a 66-year-old female with low grade non-Hodgkin's lymphoma of the mucosa associated lymphoid tissue (MALT) type who had features of lobar consolidation that persisted for years. The different causes, both infectious and non-infectious, of this kind of presentation are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2003

Effect of methotrexate on pulmonary function in patients with rheumatoid arthritis--a prospective study.

Rheumatol Int 2002 Sep 16;22(5):204-7. Epub 2002 Jul 16.

Department of Medicine, Faculty of Medicine, Kuwait University, PO Box 24923 Safat 13110, Kuwait.

If given in high doses, methotrexate (MTX), a folate antagonist, could cause pulmonary complications. To evaluate the pulmonary effects of low-dose methotrexate, 55 newly diagnosed patients with rheumatoid arthritis (RA) prescribed with MTX were studied prospectively. A significant reduction in percent predicted values of forced expiratory volume (FEV(1)), forced vital capacity (FVC), total lung capacity (TLC), and functional residual capacity (FRC) was observed after 2 years of MTX treatment. A significant increase in the FEV(1):FVC ratio was also observed. In comparison to the normal annual decline in healthy adults, the actual reduction in observed values in the patients was significantly greater (3.2, 6.3, and 6.7 times normal for FEV(1), FVC, and TLC, respectively). PaO(2) and oxygen saturation showed marginal but significant improvement. It was concluded that low-dose MTX treatment in RA might cause an accelerated decline in lung function. Therefore, periodic monitoring of pulmonary function among RA patients started on MTX could be necessary.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00296-002-0227-6DOI Listing
September 2002

Aerosol systems in asthma: selection and practice.

Authors:
B Jayakrishnan

J Assoc Physicians India 1996 Mar;44(3):186-8

Department of Pulmonology, PSG Institute of Medical Science and Research & PSG Hospitals, Coimbatore, TamilNadu.

View Article and Find Full Text PDF

Download full-text PDF

Source
March 1996