ABSTRACT
The diagnosis of deep venous thrombosis [DVT] may be challenging due to the inaccuracy of clinical assessment and diversity of diagnostic tests. On one hand, missed diagnosis may result in life-threatening conditions. On the other hand, unnecessary treatment may lead to serious complications. As a result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia [KSA], an expert panel led by the Saudi Association for Venous Thrombo-Embolism [SAVTE; a subsidiary of the Saudi Thoracic Society] with the methodological support of the McMaster University Working Group, produced this clinical practice guideline to assist healthcare providers in evidence-based clinical decision-making for the diagnosis of a suspected first DVT of the lower extremity. Twenty-four questions were identified and corresponding recommendations were made following the Grading of Recommendations, Assessment, Development and Evaluation [GRADE] approach. These recommendations included assessing the clinical probability of DVT using Wells criteria before requesting any test and undergoing a sequential diagnostic evaluation, mainly using highly sensitive D-dimer by enzyme-linked immunosorbent assay [ELISA] and compression ultrasound. Although venography is the reference standard test for the diagnosis of DVT, its use was not recommended
ABSTRACT
The Saudi Thoracic Society [STS] launched the Saudi Initiative for Chronic Airway Diseases [SICAD] to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease [COPD]. This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test [CAT] and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation [<2 in the past year] can be classified as either Class I when they have less symptoms [CAT < 10] or Class II when they have more symptoms [CAT >/= 10]. High-risk COPD patients, as manifested with >/= 2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score >/= 10. The article also discusses the diagnosis and management of acute exacerbations in COPD.
Subject(s)
Humans , Male , Female , Pulmonary Disease, Chronic Obstructive/therapy , Practice Guidelines as Topic , Smoking , Risk Factors , Respiratory Function TestsABSTRACT
Pulmonary rehabilitation [PR] is an integral component of the comprehensive management plan of patients with chronic lung diseases by addressing their functional and psychological deficits. PR is generally recommended to symptomatic patients with chronic lung diseases who develop shortness of breath on their own pace at level ground while receiving optimum therapy. From a regional perspective, this review covers the description of a PR program, its establishment and outcome assessment
Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/rehabilitation , Dyspnea/rehabilitation , Treatment Outcome , Chronic Disease , Quality of LifeABSTRACT
This an 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 SINA is to have updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on "difficult-to-treat asthma." Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient-doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment
ABSTRACT
To assess the health-related quality of life [HRQL] of patients with chronic obstructive pulmonary disease [COPD] in 4 Gulf Council Cooperation countries. We conducted a cross-sectional survey between December 2011 and March 2012 in the following countries: Kingdom of Saudi Arabia [Riyadh, Dammam, and Jeddah], Kuwait, Bahrain, and the United Arab Emirates. The HRQL was measured using the COPD Assessment Test [CAT] and the Chronic Respiratory Disease Questionnaire-Self-Administered Standardized questionnaire [CRQ-SAS]. We recruited 120 patients from 6 centers in 4 countries. Their average forced expiratory volume [FEV][1] was 49.3% [+/- 13.4] of predicted, and the ratio of FEV[1] to forced vital capacity was 0.58 [+/- 0.11]. The average COPD Assessment Test [CAT] score was 20.4 +/- 7.6; CAT scores were highest for Riyadh [24.1 +/- 7.7]; and lowest for Kuwait [18.5 +/- 9.2], with no significant difference between the centers. For the CRQ-SAS, the dyspnea domain score was 4.6 +/- 1.6, the fatigue domain score was 4.3 +/- 1.3, the emotional domain was 4.6 +/- 1.2, and the mastery domain was 4.8 +/- 1.4. The correlation coefficients of the association between the CAT score and the 4 domains of the CRQ-SAS for all of the centers combined was statistically significant. The CAT and CRQ-SAS revealed that the patients with COPD experienced a moderate to severe impact from the disease, and a considerably compromised quality of life in the GCC countries
ABSTRACT
To identify the predictors that lead to cigarette smoking among high school students by utilizing the global youth tobacco survey in Riyadh, Kingdom of Saudi Arabia [KSA]. A cross-sectional study was conducted among high school students [grades 10-12] in Riyadh, KSA, between April 24, 2010, and June 16, 2010. The response rate of the students was 92.17%. The percentage of high school students who had previously smoked cigarettes, even just 1-2 puffs, was 43.3% overall. This behavior was more common among male students [56.4%] than females [31.3%]. The prevalence of students who reported that they are currently smoking at least one cigarette in the past 30 days was 19.5% [31.3% and 8.9% for males and females, respectively]. "Ever smoked" status was associated with male gender [OR = 2.88, confidence interval [CI]: 2.28-3.63], parent smoking [OR = 1.70, CI: 1.25-2.30] or other member of the household smoking [OR = 2.11, CI: 1.59-2.81] who smoked, closest friends who smoked [OR = 8.17, CI: 5.56-12.00], and lack of refusal to sell cigarettes [OR = 5.68, CI: 2.09-15.48]. Several predictors of cigarette smoking among high school students were identified
ABSTRACT
To identify the prevalence and predictors of the water-pipe [WP] smoking epidemic in the Kingdom of Saudi Arabia [KSA]. A cross-sectional study conducted with 16-18 year-old high school students in Riyadh, Saudi Arabia. Of the 1272 participants, 414 [33.0%] reported having tried WP smoking. Of this group, 141 [34.1%] were female and 273 [65.9%] were male. Further, 129 [10.2%] students were current WP smokers who had used at least one rock in the past month; 20 were female [1.6%] and 120 were male [8.6%]. Regarding age, 276 [68.1%] students who tried WP smoking at least once began when they were over 11 years of age, whereas 129 [31.9%] began WP smoking at or before 11 years of age. Adjusted odds ratios showed that trying WP smoking at least once was associated with smoking after the age of 11 [p = 0.021, OR 7.7; CI: 1.4-43.6] and accepting water-pipes from a friend [p = 0.024, OR 10.6; CI: 1.4-83.4]. A high prevalence of WP smoking exists among male and female high schools students in Riyadh, KSA. WP smoking was reported to begin in early adulthood. WP smoking [water-pipe smoking], KSA [Kingdom of Saudi Arabia], STS [Saudi Thoracic Society], GYTS [Global Youth Tobacco Survey], CI [confidence interval]
ABSTRACT
To produce a conceptually equivalent Arabic version of the Chronic Obstructive Pulmonary Disease [COPD] Assessment Test [CAT], and to assess its reliability. A prospective observational study was carried out from June 2010 to September 2010 at King Abdulaziz Medical City and King Khalid University Hospital, Riyadh, Saudi Arabia. We conducted this study in 2 phases. Phase 1: the translation of the CAT from English to Arabic, through forward and backward translation, as well as pilot testing. Phase 2: assessment of the test-retest reliability of the CAT for 45 patients with COPD who received optimal care by their pulmonologist. This study was conducted on 45 participants. The CAT mean total [ +/- SD] score at the test session was 10.7 +/- 5.8, and 9.2 +/- 4.5 at the re-test session. The interclass correlation of the total score was 0.9 [p=0.000076]. The strongest correlation was for the item of confidence in leaving home with a value of 0.92 [p=0.000082], whereas the weakest was for the item related to sleep with a value of 0.53 [p=0.007]. The Arabic version of the CAT was found to be easy to administer, reliable, and had a strong interclass correlation reflecting stability over time and across the items
Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/diagnosis , Reproducibility of ResultsABSTRACT
To study the prevalence and characteristics of cigarette smoking among secondary school students [16- to 18-year-old boys and girls] in Riyadh city, Saudi Arabia. We applied a standard two-stage, cross-sectional study design. Secondary schools for both boys and girls in Riyadh city were randomly selected using a cluster sampling method. We used the global youth tobacco survey [GYTS] tool to achieve our objectives. Among 1272 students [606 boys and 666 girls], the prevalence of those ever smoked cigarettes was 42.8% [55.6% of boys and 31.4% of girls]. The prevalence of current smoking was 19.5% [31.2% of boys and 8.9% of girls]. Despite the fact that the majority of students think smoking is harmful, most do not wish to stop smoking, and they had not tried to stop in the past year. Cigarette smoking is significantly associated with the male gender, having friends who smoke, and having parents who smoke, but is not significantly associated with the type of school attended. Smoking prevalence among secondary schools students in Saudi Arabia is high and alarming. There is a need to implement an education program about the risks of smoking and to include parents and friends as healthy models to prevent students from beginning to smoke
Subject(s)
Humans , Female , Male , Prevalence , Tobacco Use DisorderABSTRACT
The present study aimed to analyze the utilization of health care resources among patients with chronic obstructive pulmonary disease [COPD] and to evaluate the effect of adherence to a pulmonary rehabilitation [PR] program on the utilization of these resources. A retrospective review of medical charts of a group of patients with COPD who were enrolled in a standard outpatient PR program at a tertiary care teaching hospital was conducted. Eligible patients were above the age of 18 years with a history of dyspnea, chronic cough and/or exposure to a disease risk factor with a postbronchodilator FEV1/FVC ratio <0.7. Fifty patients were referred to the PR program. The average number of emergency department visits was 1.4 +/- 1.6 days, the length of stay in the hospital was 1.7 +/- 3.8 days, the pulmonary clinic scheduled visits were 3.9 +/- 2.2, the use of combined inhalers was 9.0 +/- 3.9 canisters, the use of short-acting bronchodilator was 9.0 +/- 5.6 canisters, the cumulative prednisone doses were 427.5 +/- 463 mg, and the use of antibiotic courses was 3.1 +/- 2.9. Of the referred patients, 27 [54%] were adherent and 23 [46%] were not. Except for the use of combined inhalers, all parameters were significantly reduced in the adherent group. In contrast, the nonadherent group had increases in use of prednisone and antibiotics [p < 0.05]. There was a reduction in the utilization of health care resources among adherent patients with COPD who completed a PR program as reflected in selected pharmacological and nonpharmacological parameters
Subject(s)
Humans , Male , Female , Health Resources/statistics & numerical data , Program Evaluation , Cost of Illness , Ambulatory Care , Retrospective Studies , Outpatients , Patient ComplianceABSTRACT
The Saudi Initiative for Asthma [SINA] provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and longstanding experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system
Subject(s)
Guidelines as Topic , Health Planning Guidelines , Practice Guidelines as Topic , Evidence-Based Practice , Evidence-Based MedicineABSTRACT
The classic clinical manifestations of bronchiectasis are cough and daily production of purulent sputum for months to years. The most common complications are hemoptysis and respiratory failure. Brain abscess has become rare in the recent antibiotic era. In this report, we present a case of bronchiectasis complicated by brain abscesses. Despite the early diagnosis and appropriate management, and while the condition of the patient was improving, an intraventricular abscess rupture led to rapid coma then death. Presentation and management of this potentially fatal complication of bronchiectasis are discussed
Subject(s)
Humans , Male , Brain Abscess/diagnosis , Central Nervous System Bacterial Infections , Brain Abscess/complications , Cerebral Ventricles , Magnetic Resonance ImagingABSTRACT
Several studies have shown that pulmonary abnormalities are common in patients with end-stage liver disease. However, most of these studies were conducted on patients with heterogeneous etiologies. Therefore, we studied these changes in a homogenous group of hepatitis C cirrhotic patients who were potential candidates for liver transplantation. The charts of 81 patients from King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia with hepatitis C cirrhosis who were evaluated for liver transplantation were reviewed. The following data was retrieved: echocardiography with micro-bubble study, arterial blood gases, and pulmonary function tests of 81 candidates and reviewed over 3 years from 1994 to 1997. The mean age was 53 [ +/- 9] years with male to female ratio of 1.4:1. Echocardiographic micro-bubble study, revealed 4 of 62 [7%] had an intrapulmonary shunt. Arterial blood gases results were pH of 7.44 [ +/- 0.4], partial arterial tension of carbon dioxide of 33 mm Hg [ +/- 4], partial arterial tension of oxygen of 84 mm Hg [ +/- 12], and alveolar-arterial gradient of 30 mm Hg [ +/- 10]. Eleven% had obstructive airway disease, 17% had restrictive lung impairment, and 43% had reduced diffusion capacity. Seventy five% of patients with reduced diffusion capacity had normal lung volumes. Various pulmonary function test abnormalities did not lead to significant differences in arterial blood gases. Pulmonary changes were frequent in liver transplant candidates with hepatitis C virus cirrhosis with reduced diffusion capacity being the most. Apart from the effect of hepatopulmonary syndrome on arterial oxygenation, other pulmonary abnormalities were not significantly different