Restless legs syndrome among Saudi end-stage renal disease patients on hemodialysis

To determine the prevalence of restless legs syndrome [RLS] in Saudi patients with end-stage renal disease [ESRD] on hemodialysis. A cross-sectional study was carried out in 3 hemodialysis centers in Jeddah, Saudi Arabia, between June 2012 and September 2013. All patients were individually interviewed and data was collected on the following: demographic features, medical history, laboratory test, the International Restless Legs Syndrome Study Group questionnaire, Epworth Sleepiness Scale [ESS], and Berlin Questionnaire. Three hundred and fifty-five patients were recruited. The prevalence of RLS among ESRD patients was 19.4%, with most patients having moderate to severe disease. The RLS was significantly associated with obstructive sleep apnea [p<0.0001] and excessive daytime sleepiness based on the ESS [p=0.009]. The RLS showed no correlation with hemodialysis adequacy, chronicity, frequency per week, and hemodialysis duration per session; however, there was a weak negative relation between adequacy of hemodialysis and RLS severity. None of the comorbidities showed any association with RLS. The odds of developing RLS increased significantly with an increasing body mass index [p=0.001]. Administration of aspirin [p=0.037] and anticoagulants [p=0.035] were also associated with increased risk of RLS. Restless legs syndrome is common in ESRD patients on hemodialysis, and it is an important source of sleep disruption. In addition to body mass index, Aspirin and anticoagulants may be important risk factors

Prevalence of obstructive sleep apnea among patients with coronary artery disease in Saudi Arabia

Despite the association between obstructive sleep apnea [OSA] and coronary artery disease [CAD], few studies have investigated this issue in Saudi Arabia. This study aimed to identify the prevalence of OSA among CAD patients. This was a cross-sectional [descriptive] study conducted at King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia from April 2012 to December 2013. All consecutive patients referred to the cardiac catheterization lab for coronary angiography who exhibited evidence of CAD were included in this study. This study was conducted in two stages. During the first stage, each participant was interviewed individually. The administered interview collected data pertaining to demographics, comorbidities, and the STOP-BANG questionnaire score. The second stage of this study consisted of a diagnostic overnight polysomnography [PSG] of 50% of the subjects at high risk for OSA according to the STOP-BANG questionnaire. Among the patients with CAD [N = 156], 128 [82%] were categorized as high risk for developing OSA. PSG was conducted on 48 patients. The estimated prevalence of OSA in the study sample was 56.4%. Approximately 61% of the documented sleep apnea patients suffered from moderate to severe OSA. This local study concurs with reports in the literature indicating that OSA is very common among CAD patients

Idiopathic pulmonary fibrosis in Saudi Arabia: Demographic, clinical, and survival data from two tertiary care hospitals

Idiopathic pulmonary fibrosis [IPF] is rare and can be challenging to diagnose. Limited data is available from the Middle Eastern region, especially Saudi Arabia. This was a retrospective study that looked at all the patients diagnosed with IPF between 2007 and 2012 at two tertiary care hospitals in Saudi Arabia. We collected the demographical, clinical, laboratory and radiological data from the patients' medical records. Medications administered and 1 year survival was also assessed. Between 2007and 2012, 134 IPF patients were identified. Their baseline characteristics [Mean +/- SD] included: age 64 +/- 13 years, body mass index 29 +/- 8 kg/m 2, FEV 1 56 +/- 15 percent of predicted, FVC 53 +/- 13 percent of predicted, FEV 1 /FVC 0.81 +/- 0.09, total lung capacity 75 +/- 13 percent of predicted, diffusing capacity of the lung for carbon monoxide 57 +/- 15 percent of predicted, on home oxygen at presentation 71 [53%], mean ejection fraction 0.50 +/- 0.07, mean pulmonary artery systolic pressure [via echocardiogram] 40 + 22 mmHg, presentation mean S pO2 92 +/- 7%, presentation 6-min walk distance 338 +/- 64 m and lowest S pO2 during 6-min walk test 88 +/- 5%. Patients were predominantly female [56%], and 42% of patients had diabetes and were active smokers. The IPF patients' frequency of hospital admission [n = 99] was 2.4 +/- 1.7 per year and duration of hospital stay [n = 99] was 17.4 +/- 23.8 days. Overall 1 year survival in all IPF patients was good, 93% [124] patients remained alive after 1 year. In Saudi Arabia, IPF patients tended to be slightly older and the disease progression was somewhat slower than reported IPF cohorts in other populations. They had frequent hospital admissions and a long hospital length of stay. The influence of genetics and co-morbid diseases on the incidence and outcome of IPF should be explored further

Prevalence of chronic obstructive pulmonary disease in Saudi Arabia

To assess the prevalence of epidemiologically defined chronic obstructive pulmonary disease [COPD] in Saudi Arabia. This cross-sectional, observational, population-based survey of COPD was conducted between June 2010 and December 2011 across the country of Saudi Arabia. A total of 56,000 randomly selected telephone numbers were called, which identified 10,001 eligible subjects; of whom 9,779 agreed to participate. A screening questionnaire included 6 questions related to cigarette consumption and water-pipe use was administered to each participant. Subjects with positive screening results were invited to provide input for a detailed COPD questionnaire. The adjusted proportion of subjects who reported a current, or past smoking history was 27.9%. Gender specific smoking rates adjusted by age were 38.7% [95% confidence interval [CI]: 37.5-39.9%] in men, and 7.4% [95% CI: 6.5-8.3%] in women. The epidemiological definition of symptomatic COPD was met by a total of 249 subjects. The age and gender-adjusted prevalence of COPD was 2.4% [95% CI: 2.1-2.7%]. Overall, COPD was more frequently documented [p<0.0001] in men [3.5% [95% CI: 3-4%]] than in women [1% [95% CI: 0.7-1.3%]]. The prevalence of epidemiologically defined COPD in the general population of Saudi Arabia is 2.4%, which is lower than that reported in industrialized countries

Saudi guidelines for the diagnosis and management of COPD

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.

Effect of on-call-related sleep deprivation on physicians' mood and alertness

Physicians may experience periods of acute sleep deprivation while on-call, in addition to baseline chronic sleep deprivation which may affect physicians' performance and patients' safety. The purpose of this study was to determine the effect of acute sleep deprivation due to working long on-call shifts on mood and alertness, both of which may impair physicians' performance. Eighty-eight junior physicians working in one university hospital completed a questionnaire, before and after completion of a shift, that collected data regarding socio-demographic factors, patterns of work and sleep, Profile of Mood States [POMS], and Stanford Sleepiness Scale. Based on duration of sleep the physicians had during on-call in comparison to their usual average sleep, the participants were categorized into group 1 [those who slept many fewer hours], group 2 [those who slept fewer hours], or group 3 [those who slept the same number of hours]. More than 87% of the participant slept 5 or fewer hours while working an on-call shift. Among all participants, the percentage of physicians who were alert post-on-call was significantly reduced compared to the percentage pre-on-call [P= 0.001]. The post-on-call total POMS scores of groups 1 and 2 were significantly worse than their pre-on-call scores [P= 0.001 and 0.038, respectively], while there was no significant difference between the pre- and post-on-call POMS scores of group 3 [P= 0.165]. Acute sleep loss due to working long on-call shifts significantly decreases daytime alertness and negatively affects the mood state of junior physicians

update on the drainage of pyogenic lung abscesses

Most lung abscesses [80-90%] are now successfully treated with antibiotics; however, this conservative approach may occasionally fail. When medical treatment fails, pulmonary resection is usually advised. Alternatively, percutaneous transthoracic tube drainage or endoscopic drainage can be considered, though both remain controversial. In this communication, the medical literature focusing on percutaneous tube drainage efficacy, indications, techniques, complications, and mortality, as well as available data regarding endoscopic drainage are reviewed

Evaluation and management of pneumothorax

Pneumothorax is defined as the presence of air within the pleural space and implicates that either the visceral or parietal pleura have been disrupted. In this article the classification of pneumothorax, incidence, pathogenesis, and the radiological evaluation and different quantitative measures of pneumothorax were reviewed. In this communication, we also explored the goals of therapy and the variable treatment options, and elaborated on re-expansion pulmonary edema as a potentially serious complication of pleural drainage. Finally, air travel as a predisposing factor for secondary pneumothorax, the possible pathogenesis and incidence were discussed

diagnostic challenge and management of pulmonary Kaposi's sarcoma in renal transplant recipients

Kaposi's sarcoma is a multicentric low grade tumor that usually begins with the development of violaceous skin lesions and is associated with the presence of human herpes virus 8. Kaposi's sarcoma has been described in immunocompromised patients, particularly following renal transplantation, with cutaneous involvement being the most salient finding. Infectious and non-infectious pulmonary disorders in immunocompromised patients can simulate the radiological manifestations of pulmonary Kaposi's sarcoma. This report highlights the dilemma in reaching an accurate diagnosis of pulmonary Kaposis sarcoma as a complication of immunosuppression post-renal transplant and reviews the management of immunosuppression related Kaposi's sarcoma