Eosinophilic pneumonia: experience at two tertiary care referral hospitals in Saudi Arabia

Eosinophilic lung diseases are a diverse group of disorders characterized by pulmonary opacities associated with tissue or peripheral eosinophilia. A retrospective study conducted at two tertiary care hospitals from January 1999 to December 2009. All cases with the diagnosis of pulmonary eosinophilia were reviewed over a period of 10 years. Data on demographic, clinical, and radiologic characteristics were collected. Thirty-five patients with a mean age of 33.9 [16.2] years, of which 20 [57.1%] were male and meeting the criteria of eosinophilic lung disease were identified. Cough and dyspnea were the most frequent symptoms at presentation in 29 [82.9%] and 27 [77.1%] patients, respectively. Reticulonodular and airspace patterns were the most common radiographic findings in 17 [48.6%] and 15 [42.9%] patients, respectively. Peripheral eosinophilia was present in 33 [94.3%] patients. Twenty-four patients [68.6%] were labeled as having idiopathic pulmonary infiltrate with eosinophilia. Complete remission was achieved in 13 [54.2%] of 24 patients, while 10 [41.7%] patients relapsed within a few months of discontinuation of therapy. Specific therapy for a specific disease was administered in 8 patients: 2 patients for pulmonary tuberculosis, 2 for Churg-Strauss syndrome, 1 for lymphoma, 1 for schistosomiasis, 1 for acute eosinophilic pneumonia, and 1 for Wegener granuloma; 3 patients were treated as allergic bronchopulmonary aspergillosis. Pulmonary eosinophilia remains rare but challenging, and it can have the same diverse clinical and radiographic presentations seen with other common pulmonary conditions. Clinicians should be alert to these syndromes and must think of them in any lung disease differential diagnoses

Global hospital bed utilization crisis. a different approach

To test the effect of improved physician availability on hospital bed utilization. A prospective cohort study was conducted from 1 st January 2009 to 31 st March 2009 in the Division of Internal Medicine [DIM], King Abul-Aziz Medical City [KAMC], Riyadh, Kingdom of Saudi Arabia. Two clinical teaching units [CTU]were compared head-to-head. Each CTU has 3 consultants. The CTU-control provides standard care, while the CTU-intervention was designed to provide better physician-consultant availability. Three outcomes were evaluated: patient outsourcing to another hospital, patient discharge during weekends, and overall admissions. Statistical analysis was carried out by electronic statistics calculator from the Center for Evidence-Based Medicine. Three hundred and thirty-four patients were evaluated for admission at the Emergency Room by both CTU's. One hundred and eighty- three patients were seen by the CTU-control, 6 patients were outsourced, and 177 were admitted. One hundred fifty-one patients were seen by the CTU-intervention: 39 of them were outsourced, and 112 were admitted. Forty-eight weekend patient discharges occurred during this period of time: 21 by CTU-control, and 27 by CTU-intervention. Analysis for odds ratio in both the rate of outsourcing, and weekend discharges, showed statistical significance in favor of the intervention group. The continuous availability of a physician-consultant for patient admission evaluation, outsourcing, or discharge during regular weekdays and weekends at DIM, KAMC proved to have a positive impact on bed utilization