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Ann Thorac Med 2019 Apr-Jun;14(2):161-163

Department of Medicine, Division of Pulmonary, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNEC) is an abnormal proliferation of pulmonary neuroendocrine cells that occur without underlying etiology. Here, we report a unique case of 55-year-old female with unusual presentation of DIPNECH and thymoma and on the background history of Crohn's disease that might point toward an autoimmune phenomenon. To the best of our knowledge, there were no previous reports of DIPNECH with either thymoma or Crohn's disease. Read More

Ann Thorac Med 2019 Apr-Jun;14(2):155-160

Ministry of Interior, General Department of Criminal Evidence, Department of Forensic Medicine, Farwaniyah, Kuwait.

Background: Reports of thunderstorm asthma in the Middle East are few. This study is the first to report on cases of near-fatal and fatal thunderstorm asthma in Kuwait on December 1, 2016.

Methods: We conducted a chart review and interview with adult patients admitted to Mubarak Al-Kabir Hospital with near-fatal asthma, defined as an exacerbation requiring intubation and mechanical ventilation or hypercapnia with a PaCO≥6 kPa. Read More

Ann Thorac Med 2019 Apr-Jun;14(2):148-154

King Fahad Specialist Hospital, Dammam, KSA.

Context: Asthma control is suboptimal in the Middle East and North Africa (MENA).

Aims: The aim of this study is to assess the level of asthma control in Saudi patients as per the Global Initiative for Asthma 2012 classification and explore its potential predictive factors.

Settings And Design: Epidemiological Study on the Management of Asthma in Asthmatic Middle East Adult Population (ESMAA) is a multicentric, descriptive, epidemiological study assessing asthma management in the MENA region. Read More

Ann Thorac Med 2019 Apr-Jun;14(2):141-147

Department of Internal Medicine, American University of Beirut Medical Center, Lebanon, USA.

Background: Chronic obstructive pulmonary disease (COPD) patients are at an increased risk of postoperative pulmonary complications (PPCs). The purpose of this study is to evaluate the risks and benefits associated with preoperative steroids in COPD patients.

Methods: The National Surgical Quality Improved Program database was used to identify 92 COPD patients who underwent surgery at the American University of Beirut Medical Center between 2009 and 2013. Read More

Ann Thorac Med 2019 Apr-Jun;14(2):134-140

Department of Respiratory Medicine, Provincial Hospital Affiliated to Shandong University, Shandong, People's Republic of China.

Objective: The objective of this retrospective study was to assess the efficacy of medical thoracoscopy in diagnosing of tuberculous pleurisy and characterize tuberculous pleurisy with medical thoracoscopy.

Methods: A total of 575 patients with tuberculous pleurisy who underwent medical thoracoscopy were included in the study. Demographic data, clinical manifestations, and routine and biochemical tests on pleural fluid, cultures of pleural fluid, sputum, and pleural biopsy for the detection of and pathological findings were evaluated. Read More

Ann Thorac Med 2019 Apr-Jun;14(2):127-133

Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA.

Introduction: E-cigarettes have emerged as the most commonly used tobacco or nicotine products among youth in the United States (US), and usage with other products (dual use) is not well understood. This study assessed dual use and identified associated factors of usage in school-going youth in the high tobacco burdened region of rural Appalachian Tennessee.

Methods: Two waves of data for the same cohort of students were collected in 2014 (Wave 1) and 2016 (Wave 2). Read More

Ann Thorac Med 2019 Apr-Jun;14(2):122-126

Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.

Ann Thorac Med 2019 Apr-Jun;14(2):116-121

Medical Research Center, Research Affairs, Hamad Medical Corporation, Doha, Qatar.

This paper aims to cover the current status of asthma and obesity in the Middle East, as well as to introduce the various studies tying the two diseases; further expanding on the proposed mechanisms. Finally, the paper covers recent literature related to sphingolipids and its role in asthma, followed by recommendations and future directions. In preparation of this paper, we searched PubMed and Google Scholar, with no restrictions, using the following terms; asthma, obesity, Middle East, sphingolipids. Read More

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. Read More

Ann Thorac Med 2019 Apr-Jun;14(2):101-105

College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.

NASAM (National Approach to Standardize and Improve Mechanical Ventilation) is a national collaborative quality improvement project in Saudi Arabia. It aims to improve the care of mechanically ventilated patients by implementing evidence-based practices with the goal of reducing the rate of ventilator-associated events and therefore reducing mortality, mechanical ventilation duration and intensive care unit (ICU) length of stay. The project plans to extend the implementation to a total of 100 ICUs in collaboration with multiple health systems across the country. Read More

Ann Thorac Med 2019 Jan-Mar;14(1):99-100

Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq. E-mail:

Ann Thorac Med 2019 Jan-Mar;14(1):99

Department of 1st Oncology, Theagenio Cancer Hospital, Thessaloniki, Greece.

Ann Thorac Med 2019 Jan-Mar;14(1):94-98

Section of Pulmonary Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Idiopathic Pleuro-Parenchymal Fibroelsatosis (PPFE) is a rare, progressive and recently recognized subtype of idiopathic interstitial lung disease with no recorded successful treatment other than lung transplant. We report a case of idiopathic pleuroparenchymal fibroelastosis from the Middle East, managed successfully by bilateral lung transplant performed on a 26 year old Saudi male. Read More

Ann Thorac Med 2019 Jan-Mar;14(1):90-93

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.

Although accurate identification of is the gold standard for tuberculosis (TB) diagnosis, there have been several reports of false-positive results. After identifying a sudden increase in extensively drug-resistant TB, false-positive mycobacterial culture tests were suspected, and we contacted the supranational reference center for molecular typing. genotyping tests showed that isolates from all five patients had an identical genotype pattern, and all harbored the same Beijing strain based on sequence-based phylogenic analysis and drug-resistant single nucleotide polymorphisms (SNPs) analysis. Read More

Ann Thorac Med 2019 Jan-Mar;14(1):83-89

Department of Medicine, Division of Rheumatology, King Saud University, Riyadh, Saudi Arabia.

Background: Pulmonary arterial hypertension (PAH) is a major cause of morbidity and mortality in patients with systemic sclerosis (SSc). The objective of this study is to describe the clinical characteristics, mortality, and predictors of SSc-PAH in Saudi patients.

Methods: Retrospective chart review study of SSc patients who were followed for at least 1 year in three tertiary care centers in Saudi Arabia was conducted. Read More

Ann Thorac Med 2019 Jan-Mar;14(1):75-82

Chest Disease Clinic, Afyon State Hospital, Afyon, Turkey.

Objective: The purpose of this study is to detect the prevalence and the factors associated with influenza and pneumococcal vaccination and outcomes of vaccination during 2013-2014 season in patients with chronic obstructive pulmonary disease (COPD) in Turkey.

Methods: This was a multicenter retrospective cohort study performed in 53 different centers in Turkey.

Results: During the study period, 4968 patients were included. Read More

Ann Thorac Med 2019 Jan-Mar;14(1):69-74

Department of Medicine, The University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: Many individuals complain of disturbed sleep during the wintertime when their air conditioner (AC) is off. Therefore, we conducted this study to objectively assess the impact of AC sound on sleep latency, sleep duration, and sleep efficiency.

Methods: An experimental study was conducted on 48 healthy young adults, in their homes, to assess the effect of a standardized AC white noise, on sleep latency, duration, and efficiency, while simultaneously monitoring light intensity and room temperature. Read More

Ann Thorac Med 2019 Jan-Mar;14(1):63-68

Department of Medical Biochemistry, Medical Faculty, Yuzuncu Yil University, Van, Turkey.

Background: Obstructive sleep apnea (OSA) is a common sleep problem, in which patients are at increased risk for metabolic and cardiovascular problems, including metabolic syndrome, diabetes mellitus (DM), and dyslipidemia. Betatrophin is a novel protein that regulates fatty acid and triglyceride (TG) metabolism and is related to obesity and metabolic abnormalities, including metabolic syndrome, DM, and dyslipidemia. Although OSA and betatrophin share common abnormalities, their relationship has not been investigated. Read More

Ann Thorac Med 2019 Jan-Mar;14(1):56-62

Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia.

Background: Electronic cigarette (E-cigarette) is an electronic nicotine delivery device that has been advocated as a safe alternative for cigarette smokers. Since the introduction of E-cigarette internationally and in the Kingdom of Saudi Arabia (KSA), it gained popularity, particularly among the youth and young adults. Moreover, many nonsmoker (nicotine-naïve) youth started to use E-cigarette as a new social habit. Read More

Ann Thorac Med 2019 Jan-Mar;14(1):49-55

Astria Health Center, Euclid, Grandview, Washington, USA.

Introduction: Nonbenzodiazepine (non-BZD) sedative hypnotics (NBSH) refer to non-BZD sedatives that act as BZD receptor agonists such as zolpidem, zaleplon, and eszopiclone. Today, there is a high prevalence of insomnia with or without concurrent obstructive sleep apnea (OSA). Our goal was to study how NBSH use impacts the baseline apnea-hypopnea index (AHI) in patients with or without OSA. Read More

Ann Thorac Med 2019 Jan-Mar;14(1):3-48

Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.

This is the fourth version of the updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up to date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA panel approach is mainly based on the assessment of symptom control and risk for both adults and children. Read More

Ann Thorac Med 2019 Jan-Mar;14(1):1-2

Department of Pediatric, Imperial College, London, UK.

Ann Thorac Med 2018 Oct-Dec;13(4):258

Department of Oncology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh 11426, Kingdom of Saudi Arabia. E-mail:

Ann Thorac Med 2018 Oct-Dec;13(4):257

Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Ibaraki, Japan E-mail:

Ann Thorac Med 2018 Oct-Dec;13(4):254-256

Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

Cutis laxa (CL) is a rare connective tissue disease characterized by a loose, wrinkled, and inelastic skin. Here, we report an unusual presentation in a 15-year-old male patient who is a known patient of CL who presented with bilateral pneumothorax. He was successfully managed initially by chest tube insertion and then he was treated surgically with bilateral staged thoracoscopy, apical bullectomy, and pleurodesis with full uneventful recovery. Read More

Ann Thorac Med 2018 Oct-Dec;13(4):251-253

Department of Pathology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea.

Pulmonary pleomorphic carcinoma is defined as a nonsmall cell lung carcinoma (NSCLC) that contains at least 10% sarcomatoid components. We report a case of pulmonary pleomorphic carcinoma of which only the sarcomatoid component metastasized to the small bowel and adenocarcinoma was identified on percutaneous transthoracic needle biopsy (PTNB). We suggest that if an NSCLC is diagnosed by PTNB and a sarcoma is found at another site, or vice versa, pulmonary pleomorphic carcinoma with a single metastasis should be considered as a differential diagnosis to establish the best effective treatment plan. Read More

Ann Thorac Med 2018 Oct-Dec;13(4):243-250

Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.

Objective: The objective of this study was to compare the efficacy and safety of radiofrequency ablation (RFA), cryoablation, and microwave ablation (MWA) for patients with lung malignancies.

Methods: We performed a network meta-analysis to identify both direct and indirect evidence from relevant trials by searching PubMed, Embase, and the Cochrane Library to December 31, 2017, for the treatment of malignant lung tumors with the use of RFA, MWA, or cryoablation. We extracted the relevant information from the published studies with a predefined data sheet and assessed the risk of bias with the Cochrane risk of bias tool. Read More

Ann Thorac Med 2018 Oct-Dec;13(4):237-242

Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia.

Introduction: Noninvasive ventilation (NIV) has been extensively used globally and is often administered as the first-line treatment. Currently, data regarding the utilization of NIV in the Kingdom of Saudi Arabia (KSA) is scarce. The present study aimed to assess and quantify the utilization of NIV in clinical practice across the KSA and investigate obstacles that may cause NIV underutilization. Read More

Ann Thorac Med 2018 Oct-Dec;13(4):230-236

Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.

Background: The clinical relevance of positive human rhinovirus (HRV) in hospitalized patients is unclear. Our objective was to describe the clinical characteristics and outcomes of HRV positivity in a heterogeneous population of hospitalized children, compared to those positive for another respiratory virus and those where no respiratory virus was detected.

Methods: A retrospective case-control study of children hospitalized between January 2014 to April 2015 who had a respiratory viral specimen collected. Read More

Ann Thorac Med 2018 Oct-Dec;13(4):226-229

Department of Cardiothoracic Surgery, Limoges Teaching Hospital, Limoges, France.

Context: To date, there is no gold standard technique for sternum replacement. Current techniques rely on metallic prosthesis, meshes and bars, or bone grafts. However, they have several pitfalls. Read More

Ann Thorac Med 2018 Oct-Dec;13(4):220-225

The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: Polysubstance dependence, stress, and sleep disturbances are inter-related by shared physiological pathways. No study has investigated the relationship between sleep and concurrent use of alcohol and khat.

Objectives: The aim of the study was to assess the effect of the concurrent use of alcohol and khat as well as concurrent alcohol, khat, and tobacco smoking on sleep patterns. Read More

Ann Thorac Med 2018 Oct-Dec;13(4):212-219

Department of Medicine, Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Objective: To ascertain: (i) if elderly patients with fixed airflow obstruction (FAO) due to asthma and chronic obstructive pulmonary disease (COPD) have distinct airway morphologic and physiologic changes; (ii) the correlation between the morphology of proximal/peripheral airways and respiratory impedance.

Methods: Twenty-five asthma cases with FAO and 22 COPD patients were enrolled. High-resolution computed tomography was used to measure the wall area (WA) and lumen area (LA) of the proximal airway at the apical segmental bronchus of the right upper lobe (RB1) adjusted by body surface area (BSA) and bronchial wall thickening (BWT ) of the peripheral airways and extent of expiratory air trapping (AT ). Read More

Ann Thorac Med 2018 Oct-Dec;13(4):205-211

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.

Bronchial Thermoplasty is a procedure that involves the delivery of radiofrequency energy during bronchoscopy to airways in order to selectively ablate airway smooth muscles. Bronchial Thermoplasty was approved by the FDA in 2010 and remains the only device based non-pharmacological treatment approach for severe asthma. We appraise the trials leading to the approval of Bronchial Thermoplasty in light of the FDA approval process. Read More

Ann Thorac Med 2018 Oct-Dec;13(4):198-204

Department of Medicine, Pulmonary, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Background: While lung cancer is the leading cancer cause of death, it is largely preventable. Furthermore, early diagnosis enhances the chance of cure. Therefore, we developed guidelines for lung cancer prevention and early detection. Read More

Ann Thorac Med 2018 Oct-Dec;13(4):197

Thoracic Surgery, Saint Thomas Health, TN, USA.

Ann Thorac Med 2018 Jul-Sep;13(3):195

Division of Internal Medicine, Sesto San Giovanni Hospital, Milan, Italy.

Ann Thorac Med 2018 Jul-Sep;13(3):193-194

Department of Internal Medicine, Division of Pneumology, Memorial Hermann Southwest Hospital, Houston, Texas.

Chronic cough is associated with repetitive injury to the upper airway and trachea, which can lead to an underdiagnosed pathology known as "cough-induced" laryngotracheitis (CILT). In this report, we describe a case of CILT that responded well to dual therapy. Read More

Ann Thorac Med 2018 Jul-Sep;13(3):190-192

Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.

is a parasitic infection that affects many people worldwide. However, pulmonary Schistosomiasis is very rare entity which defined as pulmonary involvement develops in persons living or travelling in endemic areas. We report a rare case of 23-year-old Yamani patient admitted as an emergency with a 1-week history of productive cough, hemoptysis, and chest pain. Read More

Ann Thorac Med 2018 Jul-Sep;13(3):182-189

Department of Chest Diseases, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.

Purpose: The purpose of this study is to investigate the effect of homogeneous/heterogeneous (necrotic) involvement and maximum standardized uptake value (SUVmax) value of the lesion on positron emission tomography-computed tomography (PET-CT) of patients who underwent fiberoptic bronchoscopy (FOB) for prediagnosis of lung cancer and biopsy for endobronchial lesion on the diagnostic success of biopsy procedure.

Methods: Between January 2014 and December 2016, patients with final diagnosis of pulmonary malignancy as determined by FOB biopsy and patients who failed to be diagnosed by FOB biopsy and diagnosed with pulmonary malignancy by a different diagnostic method were examined. These patients were divided into two groups as those with diagnosis by FOB biopsy (Group 1) and those who failed to be diagnosed by this method and diagnosed with pulmonary malignancy by a different diagnostic method (Group 2). Read More

Ann Thorac Med 2018 Jul-Sep;13(3):175-181

Sleep Medicine and Research Center, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

Introduction: Restless legs syndrome (RLS) is etiologically divided into primary and secondary syndromes. However, a comparative description of both types is lacking in the literature. We compared primary and secondary RLS with respect to demographic determinants, associated risk factors, and comorbidities. Read More

Ann Thorac Med 2018 Jul-Sep;13(3):168-174

Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.

Introduction: Recently, sleeping disorders and snoring are being recognized as a public health concern with various risk factors and health consequences. The main objective of the present study was to determine the prevalence of snoring and sleep apnea among adults (20-60 years) in Sharjah (United Arab Emirates, UAE) and assess the major risk factors as well as the general knowledge among the population.

Methods: A self-administrated Questionnaire of five sections including both Berlin questionnaire (BQ) and the Epworth Sleepiness Scales (ESS) were given to a randomly selected population in Sharjah between the ages of 20-60 years. Read More

Ann Thorac Med 2018 Jul-Sep;13(3):163-167

Department of Pathology, Faculty of Medicine, Biruni University, İstanbul, Turkey.

Objective: The aim of the present study was to report our patients with pulmonary siderosis (PS) who were exposed to iron oxide and diagnosed with the minimally invasive surgical technique (video-assisted thoracic surgery [VATS]), and to provide a discussion of the relevant literature.

Methods: Hospital records of seven patients who were diagnosed with PS by VATS between 2008 and 2016 were retrospectively reviewed. VATS was performed for seven patients for whom no definitive diagnosis could be made with other diagnostic techniques. Read More

Ann Thorac Med 2018 Jul-Sep;13(3):156-162

Department of Respiratory Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan.

Background: It is unclear whether inhaled corticosteroids (ICS) have chemopreventive effect on lung cancer (LC) development in humans. We investigated the association between the ICS use in asthma patients and the risk of LC.

Methods: We conducted a nationwide, population-based retrospective cohort study using the National Health Insurance database. Read More

Ann Thorac Med 2018 Jul-Sep;13(3):150-155

King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.

Context And Aim: The skeleton is a frequent site for metastasis in patients with breast, lung, and prostate cancer. Bone metastasis compromises skeletal integrity leading to skeletal-related events (SREs). This study aims at estimating the prevalence of bone metastasis in lung cancer and describing types of bone involvement, management, outcomes, and overall survival. Read More

Ann Thorac Med 2018 Jul-Sep;13(3):144-149

Department of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.

The prevalence of chronic obstructive pulmonary disease in Saudi Arabia is 4.2% among the general population and 14.2% among smokers. Read More

Ann Thorac Med 2018 Jul-Sep;13(3):127-143

College of Medicine, Peadiatric Department, King Saud University, Riyadh, Saudi Arabia.

Bronchiolitis is the leading cause of admissions in children less than two years of age. It has been recognized as highly debated for many decades. Despite the abundance of literature and the well-recognized importance of palivizumab in the high risk groups, and despite the existence of numerous, high-quality, recent guidelines on bronchiolitis, the number of admissions continues to increase. Read More

Ann Thorac Med 2018 Jul-Sep;13(3):125-126

Division of Neonatology and NICU, S. Anna Obstetrics and Neonatology Hospital, Torino, Italy.

Ann Thorac Med 2018 Apr-Jun;13(2):123

Cardiovascular Specialist Centre, Dammam, Kingdom of Saudi Arabia E-mail:

Ann Thorac Med 2018 Apr-Jun;13(2):122-123

Department of Internal Medicine, Interventional Ultrasound Section, Unit of Internal Medicine, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy E-mail:

Ann Thorac Med 2018 Apr-Jun;13(2):117-121

Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Hepatic hydrothorax (HH) is a transudative pleural effusion that complicates advanced liver cirrhosis. Cases refractory to medical treatment in the form of salt restriction and diuretics are labeled refractory hepatic hydrothorax (RHH) and may require transjugular intrahepatic portosystemic shunts (TIPSS) or even liver transplantation. Renal impairment is common in advanced liver disease, worsens its prognosis, and makes the management of HH more challenging. Read More