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

Ann Thorac Med 2018 Apr-Jun;13(2):114-116

Department of Thoracic Surgery, Ospedale Regionale Bellinzona Valli, Bellinzona, Switzerland.

Trans-esophageal endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is widely used to assess mediastinal masses. Common complications are self-limiting bleeding or pain, but occasionally, more serious accidents have been reported. A 54-year-old woman with a huge mass located in the left middle mediastinum presented 2 days after an EUS-FNA with dyspnea and chest pain. Read More

Ann Thorac Med 2018 Apr-Jun;13(2):108-113

Department of Medicine, College of Medicine, Al Imam Mohammad IBN Saud Islamic University, Riyadh, Saudi Arabia.

Background: Inferior vena cava (IVC) filter is indicated in patients with acute venous thromboembolism (VTE) in whom therapeutic anticoagulation is contraindicated. While prophylactic insertion of an IVC filter may be considered for patients at high risk of VTE, there are significant differences between clinical guidelines on the role of IVC filters. These discrepancies have arisen predominantly because of the paucity of data on the efficacy and safety of IVC filters. Read More

Ann Thorac Med 2018 Apr-Jun;13(2):101-107

Department of Pulmonology, Allergology and Respiratory Oncology, University of Medical Sciences, Poznan, Poland.

Introduction: Radical surgical treatment is the preferred action for patients with early-stage non-small cell lung cancer (NSCLC). Qualification for surgical treatment should consider a risk associated with the effect of comorbidities on the general condition of the patient. The aim of this article was an attempt to identify the risk factors for postoperative complications in patients treated for NSCLC, with a special focus on the coexisting diseases. Read More

Ann Thorac Med 2018 Apr-Jun;13(2):92-100

Department of Internal Medicine, Faculty of Medicine, King Abdul Aziz University, Jeddah, Saudi Arabia.

Aims: The aim of the study was to evaluate the clinical utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with mediastinal and hilar lymphadenopathy and to explicitly describe the utility of this procedure in patient's outcome.

Methods: A retrospective review and analysis was conducted on 52 patients with mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA from June 2012 to June 2016. All the patients were evaluated by computed tomography (CT) chest with contrast before EBUS examination. Read More

Ann Thorac Med 2018 Apr-Jun;13(2):86-91

Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, HI, USA.

Introduction: Treatment-emergent central sleep apnea (TECSA) is observed in some patients when they are treated with positive airway pressure (PAP) after significant resolution of the preexisting obstructive events in patients with obstructive sleep apnea. The objective of this study was to systematically review the literature for studies describing the natural history of TECSA.

Methods: PubMed, Medline, Scopus, Web of Science, and Cochran Library databases were searched through June 29, 2017. Read More

Ann Thorac Med 2018 Apr-Jun;13(2):82-85

Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Objectives: Aspiration of foreign bodies into the tracheobronchial tree is a common accident in children. This study aimed to evaluate the safety and outcome of foreign body removal by flexible bronchoscopy using a retrieval basket in children.

Methods: This was a retrospective study of children treated for foreign bodies in the airway via flexible bronchoscopy using a retrieval basket at a tertiary hospital in Korea between February 2014 and October 2017. Read More

Ann Thorac Med 2018 Apr-Jun;13(2):76-81

Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University, Detroit, Michigan, USA.

Introduction: Survival from lung cancer is improving. There are limited data on the causes of death in 5-year survivors of lung cancer. The aim of this study is to explore the causes of death in long-term survivors of non-small cell lung cancer (NSCLC) and describe the odds of dying from causes other than lung cancer in this patient population. Read More

Ann Thorac Med 2018 Apr-Jun;13(2):72-75

University Sleep Disorders Center and National Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia.

Islamic civilization between the 7 and the 15 centuries made great contributions to the development of science and medicine, and discoveries made during this time formed the basis for the emergence of the European Renaissance. Muslims view sleep as one of the great signs of , and a number of Muslim scholars studied and wrote on sleep and dreams. However, Muslim scholars' contributions to this topic have not been adequately represented in modern scholarship. Read More

Ann Thorac Med 2018 Apr-Jun;13(2):67-71

Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Policies addressing limitations of medical therapy in patients with advanced medical conditions are typically referred to as Code Status (No Code) policies or Do-Not-Resuscitate (DNR) status polices. Inconsistencies in implementation, understanding, decision-making, communication and management of No Code or DNR orders have led to delivery of poorer care to some patients. Several experts have called for a change in the current approach. Read More

Ann Thorac Med 2018 Jan-Mar;13(1):63-65

Department of Intensive Care, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Ann Thorac Med 2018 Jan-Mar;13(1):62-63

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

Ann Thorac Med 2018 Jan-Mar;13(1):62

King Faisal Specialist Hospital and Research Centre, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia E-mail:

Ann Thorac Med 2018 Jan-Mar;13(1):59-61

Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.

Alpha-1 antitrypsin deficiency is a rare and often underdiagnosed hereditary disorder, which mainly affects the Caucasian population. We report a case of a noncystic fibrosis bronchiectasis patient in the absence of emphysema associated with low serum alpha-1-antitrypsin (AAT) level, in the absence of the most common defective alleles associated with AAT deficiency (PI*S and PI*Z) but with a new mutation in heterozygosis. This mutation is characterized by the substitution in the coding region of exon 3, of a guanine (G) for a thymine (T), generating the replacement of a glutamine (Gln) by a histidine (His) in codon 212 (cod 212 GlnCAG > HisCAT), corresponds to a new S allelic variant. Read More

Ann Thorac Med 2018 Jan-Mar;13(1):55-58

Department of Cardiology, Saint Joseph's Regional Medical Center, New York Medical College, New Jersey, USA.

Partial anomalous pulmonary venous drainage (PAPVD) is a rare congenital cardiac defect and is associated with sinus venosus atrial septal defect. While most cases are asymptomatic, a patient can present with pulmonary hypertension (PHTN) and it can be difficult to diagnose. Here, we discuss the case of a young female with PHTN who was found to have two right-sided PAPVD. Read More

Ann Thorac Med 2018 Jan-Mar;13(1):48-54

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

Background: Food restriction has been demonstrated to increase the alertness in different species and to increase the levels of the wake-promoting neurotransmitter orexin. We hypothesized that diurnal intermittent fasting (DIF) increases orexin-A levels during fasting. Therefore, we conducted this study to assess the effects of DIF, during the month of Ramadan, on orexin, while controlling for lifestyle changes that may accompany Ramadan such as sleep duration, bedtime and wake time, energy expenditure, light exposure, and food. Read More

Ann Thorac Med 2018 Jan-Mar;13(1):42-47

Department of Respiratory Medicine, Akdeniz University School of Medicine, Antalya, Turkey.

Aim: We aimed to compare the clinical, epidemiological, and polysomnographic features of rapid eye movement (REM)-dependent obstructive sleep apnea syndrome (OSAS) and positional OSAS which are two separate clinical entities.

Methods: Between January 2014 and December 2015, at the Akdeniz University Medical Faculty Hospital, patients who were diagnosed REM-dependent and positional OSAS with polysomnography were retrospectively studied.

Results: In this study, 1727 patients were screened consecutively. Read More

Ann Thorac Med 2018 Jan-Mar;13(1):36-41

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

Objectives: We aimed to evaluate the seasonal variations of acute asthma presentation in children and the utility of the pediatric asthma score (PAS) and its components in early admission prediction.

Methods: As part of a randomized controlled trial addressing the clinical efficacy of budesonide nebulization in the treatment of acute asthma in children, the PAS was measured at baseline, 1, 2, 3, and 4 h from the start of medications. Decision of admission was taken at or beyond the 2 h. Read More

Ann Thorac Med 2018 Jan-Mar;13(1):30-35

Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.

Background: Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare subtype of nonsmall cell lung cancer (NSCLC) predominantly reported in East Asia. We aimed to evaluate clinical characteristics, diagnosis, treatment, and prognosis of PPLELC in Singapore.

Methods: Retrospective review of all patients diagnosed with PPLELC at our center between 2000 and 2014. Read More

Ann Thorac Med 2018 Jan-Mar;13(1):22-29

Department of Community and Environmental Health, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Background: Graphic warning labels have been shown to be effective in smoking initiation and cessation and were implemented in Saudi Arabia in 2012. To date, no study has assessed the effectiveness of these labels and the Saudi population's perceptions on the effectiveness of cigarette health warning labels.

Methods: We used a cross-sectional qualitative study comprising of nine focus groups among 3 different community group members including health-care workers, adult women and adult men. Read More

Ann Thorac Med 2018 Jan-Mar;13(1):14-21

Department of Surgery, Cardiothoracic Surgery Unit, Sultan Qaboos University Hospital, Al Khoud, Muscat, Sultanate of Oman.

Background: Earlier studies showed a short-term impairment of cardio-autonomic functions following coronary artery bypass grafting (CABG). There is a lack of consistency in the time of recovery from this impairment. Studies have attributed the post-CABG atrial fibrillation to preexisting obstructive sleep apnea (OSA) without an objective sleep assessment. Read More

Ann Thorac Med 2018 Jan-Mar;13(1):7-13

Department of Pediatrics, University of Chieti, 66100 Chieti, Italy.

Chronic cough in childhood is associated with a high morbidity and decreased quality of life. Protracted bacterial bronchitis (PBB) seems to be the second most common cause of chronic cough in children under 6 years of age. Its main clinical feature is represented by wet cough that worsens when changing posture and improves after the introduction of antibiotics. Read More

Ann Thorac Med 2018 Jan-Mar;13(1):1-6

Center for Comprehensive Care in Chronic Obstructive Pulmonary Disease, Cleveland Clinic Respiratory Institute, Cleveland, Ohio, USA.

Chronic obstructive pulmonary disease (COPD) is a major health problem which had not received the attention commensurate with the magnitude of its global burden. This is finally changing with the help of a vibrant community of health-care professionals, public officials, and academic researchers. Advances in characterization of the disease, treatment options, imaging modalities, and better understanding of the comorbidities promise to revolutionize how the disease is managed. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):294-297

Department of Medical Specialties, Rheumatology Section, King Fahad Medical City, Riyadh, KSA.

There is increasing interest in rituximab (RTX) as an alternative to cyclophosphamide for the treatment of interstitial lung diseases (ILDs) associated with systemic sclerosis (SSc). However, no report has addressed its efficacy in Saudi patients with SSc-ILD. To assess the efficacy of RTX treatment in Saudi patients with SSc-ILD, hospital records were reviewed between 2013 and 2016. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):290-293

Department of Pathology and Laboratory Medicine, Medical Genetics Unit, American University of Beirut Medical Center, Beirut, Lebanon.

We report the case of a 19-year-old male patient of Palestinian descent, who presented with a 1-year history of recurrent respiratory infections, weight loss, chronic diarrhea, and a normal chloride sweat test. A panel for common cystic fibrosis transmembrane conductance regulator () gene mutations test was also negative. Cystic fibrosis (CF) was still clinically suspected thus, full gene sequencing was performed, which revealed a homozygous unreported mutation c. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):282-289

Department of Surgery, Um Al-Qura University, Makkah, Saudi Arabia.

Introduction: Venous thromboembolism (VTE) during hospitalization is a serious and potentially fatal condition. Despite its effectiveness, evidence-based thromboprophylaxis is still underutilized in many countries including Saudi Arabia.

Objective Of The Study: Our objectives were to determine how often hospital-acquired VTE patients received appropriate thromboprophylaxis, VTE-associated mortality, and the percentage of patients given anticoagulant therapy and adherence to it after discharged. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):278-281

Department of Medicine, Pulmonary Division, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background And Aims: A granuloma is a common pathological diagnosis in lung biopsies and is caused by a variety of etiologies. The aim of this study was to assess the etiology and frequency of different cases of lung granulomas.

Methods: The medical records of all patients who had lung granulomas between 2005 and 2013 were retrospectively reviewed. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):272-277

Department of Pulmonary Medicine, Faculty of Medicine, Baskent University, Ankara, Turkey.

Study Objectives: Obstructive sleep apnea (OSA) is common in adult populations. Accumulating data indicate that it is independently associated with a variety of cardiovascular diseases and has prognostic importance in affected cases. In this study, we aimed to evaluate coronary flow reserve (CFR) in patients with OSA and controls. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):266-271

Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.

Background And Objectives: Pleuropulmonary (PP) involvement in rheumatoid arthritis (RA) is associated with high morbidity and mortality. Nevertheless, limited data are available regarding lung complications in the Middle East, especially in Saudi Arabia. The objectives of the current study were to determine the prevalence of PP manifestations and to identify the associated risk factors. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):259-265

Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh 11426, Saudi Arabia.

Rationale: Acute respiratory failure (ARF) may complicate the course of hematologic malignancies (HMs). Our objective was to study the characteristics, outcomes and predictors of mortality of patients with HMs who required intubation for ARF.

Methods: This retrospective cohort study evaluated all patients with HMs who were admitted to the Intensive Care Unit (ICU) of King Abdul-Aziz Medical City-Riyadh between 2008 and 2013 and required invasive mechanical ventilation. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):252-258

Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.

Introduction: Prevention and effective treatment of radiation-induced pneumonitis (RP) could facilitate greater use of radiation therapy (RT) for lung cancer. The purpose of this study was to determine clinical parameters useful for early prediction of RP.

Methods: Blood sampling, pulmonary function testing, chest computed tomography, and bronchoalveolar lavage (BAL) were performed in patients with pathologically confirmed lung cancer who had completed ≥60 Gy of RT, at baseline, shortly after RT, and at 1 month posttreatment. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):247-251

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

Khat () is a evergreen flowering shrub that is cultivated at high altitudes, especially in East Africa and the southwest of the Arabian Peninsula. The plant contains alkaloids, of which cathinone and cathine have structural similarity and pharmacological action similar to amphetamines. The leaves are, therefore, consumed in some regions as a psychoactive stimulant due to cultural beliefs and misperceptions on the health benefits of khat consumption. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):221-246

Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background: Lung cancer management is getting more complex due to the rapid advances in all aspects of diagnostic and therapeutic options. Developing guidelines is critical to help practitioners provide standard of care.

Methods: The Saudi Lung Cancer Guidelines Committee (SLCGC) multidisciplinary members from different specialties and from various regions and healthcare sectors of the country reviewed and updated all lung cancer guidelines with appropriate labeling of level of evidence. Read More

Ann Thorac Med 2017 Oct-Dec;12(4):219-220

Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.

Ann Thorac Med 2017 Jul-Sep;12(3):217-218

Department of Intensive Care, College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia E-mail:

Ann Thorac Med 2017 Jul-Sep;12(3):216-217

Department of Internal Medicine, Interventional Ultrasound Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy.

Ann Thorac Med 2017 Jul-Sep;12(3):213-215

Genetic Department, Henri Mondor Hospital, France.

Defects in the surfactant biosynthesis are associated with respiratory distress syndrome, commonly occurring in premature infants due to lung immaturity. However, interstitial lung diseases have also been observed in full-term infants with mutations in the SFTPC, SFTPB, NKX2-1, or ABCA3 genes, involved in the surfactant metabolism. Herein, we report a newborn baby with neonatal respiratory distress and diffuse lung disease caused by ABCA3 mutation. Read More

Ann Thorac Med 2017 Jul-Sep;12(3):209-212

Department of Cardiac Sciences, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Fibrosing mediastinitis (FM), also known as sclerosing mediastinitis, is an uncommon but serious disease involving the mediastinal structures. A high index of suspicion is essential to establish the diagnosis of FM and starting the appropriate therapy for patients. Here, we report a case of a young female who presented with chest symptoms and subsequently underwent different laboratory and radiologic investigations and an excisional biopsy. Read More

Ann Thorac Med 2017 Jul-Sep;12(3):204-208

Department of Chest, Faculty of Medicine, Assiut University Hospital, Assuit, Egypt.

Background: Although hypothyroidism has an insidious onset and relatively asymptomatic, exertional dyspnea and fatigue can be the presenting complaints.

Objectives: The aim is to assess functional lung impairment in hypothyroid patients both at rest and during exercise.

Methods: A case-control study was carried out on 42 patients with newly diagnosed hypothyroidism and 12 control subjects. Read More

Ann Thorac Med 2017 Jul-Sep;12(3):199-203

Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background: Venous thromboembolism (VTE) can be encountered by 60% of hospitalized patients. Anticoagulants have been recommended to reduce the risk of VTE in patients with risk factors. However, no specific dosing recommendations for obese patients are provided in the current practice guidelines. Read More

Ann Thorac Med 2017 Jul-Sep;12(3):191-198

Institute of Pathology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.

Introduction: Lung cancer is among leading causes of death worldwide. Different histological types of the lung carcinoma show significant differences in behavior.

Objectives: The aim of this study is to determine the distribution patterns of metastases of different lung cancer histological types in autopsied individuals. Read More

Ann Thorac Med 2017 Jul-Sep;12(3):183-190

Department of Physiology, King Saud University, Riyadh, Saudi Arabia.

Aims: We hypothesized that if we control for food composition, caloric intake, light exposure, sleep schedule, and exercise, intermittent fasting would not influence the circadian pattern of melatonin. Therefore, we designed this study to assess the effect of intermittent fasting on the circadian pattern of melatonin.

Methods: Eight healthy volunteers with a mean age of 26. Read More

Ann Thorac Med 2017 Jul-Sep;12(3):177-182

Celal Bayar University Medical Faculty, Department of Chest Diseases, Manisa, Turkey.

Introduction: Patient examinations performed in a limited time period may lead to impairment in patient and physician relationship, defective and erroneous diagnosis, inappropriate prescriptions, less common use of preventive medicine practices, poor patient satisfaction, and increased violent acts against health-care staff.

Objective: This study aimed to determine the appropriate minimal duration of patient examination in the pulmonary practice.

Methods: A total of 49 researchers from ten different study groups of the Turkish Thoracic Society participated in the study. Read More

Ann Thorac Med 2017 Jul-Sep;12(3):171-176

Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tukiji Chou-ku, Japan.

Introduction: Since the National Lung Screening Trial demonstrated the utility of low-dose computed tomography screening for lung cancer, the detection rate of ground-glass nodules (GGNs) has increased. Endobronchial ultrasound with a guide sheath (EBUS-GS) is widely performed to diagnose peripheral pulmonary lesions, but there are not enough reports on the predictive ability of EBUS-GS in diagnosing GGNs. The aim of this study is to investigate the predictive factors for a successful diagnostic bronchoscopy for GGNs. Read More

Ann Thorac Med 2017 Jul-Sep;12(3):162-170

1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Globally, lung cancer remains the leading cause of cancer-related death. Annual low-dose computed tomography has been recommended as a screening test for early detection of lung cancers. Implementing this screening strategy is expected to challenge pulmonologist to confirm the nature of the increasing number of detected pulmonary nodules. Read More

Ann Thorac Med 2017 Jul-Sep;12(3):135-161

International Reviewer, Department of Pathophysiology and Transplantation, University of MilanInternal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Via Francesco Sforza 35, 20122, Milan, Italy.

This is the first guideline developed by the Saudi Thoracic Society for the diagnosis and management of noncystic fibrosis bronchiectasis. Local experts including pulmonologists, infectious disease specialists, thoracic surgeons, respiratory therapists, and others from adult and pediatric departments provided the best practice evidence recommendations based on the available international and local literature. The main objective of this guideline is to utilize the current published evidence to develop recommendations about management of bronchiectasis suitable to our local health-care system and available resources. Read More

Ann Thorac Med 2017 Jul-Sep;12(3):133-134

Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Australia.

Ann Thorac Med 2017 Apr-Jun;12(2):132

[This corrects the article on p. 11 in vol. 12, PMID: 28197216. Read More