A Single-Center Study of the Utility of Bronchoalveolar Lavage in Critically Ill Patients With Haematological Malignancy or Stem Cell Transplants.

INTRODUCTION: The aim of this study was to evaluate the yield of bronchoscopy-guided bronchoalveolar lavage (BAL) and decisions on management of antimicrobials in critically ill patients with hematological malignancy and/or hematological stem cell transplant (HSCT). The safety and tolerance of bronchoscopy were also reported. METHODS: A retrospective cohort study was conducted by reviewing health charts of all adult patients with a hematological malignancy and/or an HSCT who were admitted to the intensive care unit and underwent bronchoscopy and BAL over four years from April 2016 to April 2020 at King Abdulaziz Medical City, Riyadh.  Results: The cohort included 75 critically ill patients. Of these 75 patients, 53 (70.7%) had HSCT (allogenic 66%, autologous 32.1%, haplogenic 3.8%). Computed tomography of the chest was abnormal in all patients. Predominant findings included airspace abnormalities, ground glass opacities, and others. The positive yield was found to be 20% for bacterial, 22% for viral, 21% for fungal, and other organisms were identified in 2%. Although cytology was not performed in 18 patients, malignant cells were identified on BAL in two patients. While the overall mortality of the cohort was high (46.7%), the vast majority (94.7%) tolerated bronchoscopy and BAL without any complications. However, three patients (4%) developed a pneumothorax and one patient bled and developed the acute respiratory distress syndrome post bronchoscopy. CONCLUSIONS: BAL can identify and detect microorganisms directly influencing the clinical care of patients who have received non-invasive diagnostic tests that yielded negative culture results. Bronchoscopy and BAL are generally safe and well tolerated by critically ill patients with hematological malignancy or HSCT.

Curriculum development for the Saudi sleep medicine fellowship program.

Objectives: Given the rapid global development of sleep medicine, well-qualified sleep medicine physicians are necessary to meet the demand. Although sleep medicine was accredited as an independent specialty in KSA in 2012, national data suggest that the number of trained and accredited sleep medicine specialists remains comparatively low. A structured sleep medicine fellowship programme was established in KSA in 2009. However, universities issued training and certification without a national training programme under the auspices of the Saudi Commission for Health Specialties (SCFHS). Therefore, plans have been made to establish a national interdisciplinary sleep medicine training programme to serve the whole country. Methods: In 2020, the SCFHS mandated the Specialty Curriculum Development Committee of the Sleep Medicine Fellowship Program to develop the National an adult sleep medicine national program. Results: The committee developed an adult sleep medicine fellowship programme curriculum and requirements to ensure that trainees become competent at assessing, diagnosing, and managing various sleep disorders. The curriculum was approved by the head of the Curricula Editorial Board of the SCFHS. Conclusions: This paper presents the curriculum and admission requirements for the newly developed Saudi Sleep Medicine Fellowship Program.

Influence of Elbow Angle on Erosion-Corrosion of 1018 Steel for Gas-Liquid-Solid Three Phase Flow.

Erosive wear due to the fact of sand severely affects hydrocarbon production industries and, consequently, various sectors of the mineral processing industry. In this study, the effect of the elbow geometrical configuration on the erosive wear of carbon steel for silt-water-air flow conditions were investigated using material loss analysis, surface roughness analysis, and microscopic imaging technique. Experiments were performed under the plug flow conditions in a closed flow loop at standard atmospheric pressure. Water and air plug flow and the disperse phase was silt (silica sand) with a 2.5 wt % concentration, and a silt grain size of 70 µm was used for performing the tests. The experimental analysis showed that silt impact increases material disintegration up to 1.8 times with a change in the elbow configuration from 60° to 90° in plug flow conditions. The primary erosive wear mechanisms of the internal elbow surface were sliding, cutting, and pit propagation. The maximum silt particle impaction was located at the outer curvature in the 50° position in 60° elbows and the 80° position in 90° elbows in plug flow. The erosion rate decreased from 10.23 to 5.67 mm/year with a change in the elbow angle from 90° to 60°. Moreover, the microhardness on the Vickers scale increased from 168 to 199 in the 90° elbow and from 168 to 184 in the 60° elbow.

The burden of asthma among children and adolescents in Saudi Arabia: A national cross-sectional survey.

Background: Asthma disease is one of the most common chronic diseases of childhood. Studies assessing asthma prevalence in Saudi Arabia have been variable and not recently updated. Objectives: We sought to assess asthma prevalence, severity, and related risk factors among children and adolescents in Saudi Arabia. Methods: A national, cross-sectional design was used following the Global Asthma Network phase I design. A total of 3817 children aged 6 to 7 years and 4138 adolescents aged 13 to 14 years were recruited from 137 primary and 140 intermediate schools across 20 regions by using a multistage stratified cluster sampling technique. Standardized written questionnaires were answered by the adolescents and by the parents or guardians of the children. The adolescents also answered a video-based questionnaire. Results: Overall, the prevalences of current wheeze were 10.4% and 13.3% and the prevalences of asthma ever were 13.8% and 15.7%, % in children and adolescents, respectively. Of all the children and adolescents, 5.2% and 5.6% had symptoms of severe asthma, respectively. Among those who reported asthma, 86.0% of the children and 74.8% of the adolescents had their asthma confirmed by a doctor, and 53.0% and 32.4%, respectively, were provided with a written plan to control their asthma. The main risk factors associated with current wheeze included antibiotic use in the first year of life, a history of being diagnosed with pneumonia in children, paracetamol use, and having a cat at home during the past 12 months in adolescents. Conclusions: The prevalence of asthma in children and adolescents in Saudi Arabia is within the average international range and is at a plateau phase.

Modeling, Optimization and Performance Evaluation of TiC/Graphite Reinforced Al 7075 Hybrid Composites Using Response Surface Methodology.

The tenacious thirst for fuel-saving and desirable physical and mechanical properties of the materials have compelled researchers to focus on a new generation of aluminum hybrid composites for automotive and aircraft applications. This work investigates the microhardness behavior and microstructural characterization of aluminum alloy (Al 7075)-titanium carbide (TiC)-graphite (Gr) hybrid composites. The hybrid composites were prepared via the powder metallurgy technique with the amounts of TiC (0, 3, 5, and 7 wt.%), reinforced to Al 7075 + 1 wt.% Gr. The microstructural characteristics were investigated by optical microscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD) and energy dispersive X-ray spectroscopy (EDS) elemental mapping. A Box Behnken design (BBD) response surface methodology (RSM) approach was utilized for modeling and optimization of density and microhardness independent parameters and to develop an empirical model of density and microhardness in terms of process variables. Effects of independent parameters on the responses have been evaluated by analysis of variance (ANOVA). The density and microhardness of the Al 7075-TiC-Gr hybrid composites are found to be increased by increasing the weight percentage of TiC particles. The optimal conditions for obtaining the highest density and microhardness are estimated to be 6.79 wt.% TiC at temperature 626.13 °C and compaction pressure of 300 Mpa.

Sleep quality and insomnia during the COVID-19 lockdown among the Saudi public: A cross-sectional study.

OBJECTIVES: To measure the Saudi population's sleep quality during the lockdown of COVID-19. METHODS: An internet-based questionnaire that was performed during the lockdown of the COVID-19 pandemic among the Saudi population over 2 weeks from April 1 to April 15, 2020. We used the instant messaging application WhatsApp and Twitter to reach the targeted population. Saudi citizens and non-Saudi residents who can read and understand the questionnaire were recruited. Data were analyzed using Stata and SPSS. RESULTS: A total of 790 responses were included. The majority of participants were the Saudi population 735 (92.9%). The prevalence of insomnia and poor sleep quality were 54.4% and 55.5%, respectively. Saudi citizenship was associated with longer sleep duration (p=0.031). Female gender and being married were associated with worse global PSQI, sleep quality, sleep distribution, sleep latency, and daytime dysfunction. CONCLUSION: Our findings showed that during the COVID-19 pandemic, the Saudi population had a high prevalence of insomnia and poor sleep quality. Routine monitoring of the psychological impact of life-threatening outbreaks and the adoption of effective early mental health actions should be considered.

Outcome of treatment of MDR-TB or drug-resistant patients treated with bedaquiline and delamanid: Results from a large global cohort.

The World Health Organization (WHO) recommends countries introduce new anti-TB drugs in the treatment of multidrug-resistant tuberculosis. The aim of the study is to prospectively evaluate the effectiveness of bedaquiline (and/or delamanid)- containing regimens in a large cohort of consecutive TB patients treated globally. This observational, prospective study is based on data collected and provided by Global Tuberculosis Network (GTN) centres and analysed twice a year. All consecutive patients (including children/adolescents) treated with bedaquiline and/or delamanid were enrolled, and managed according to WHO and national guidelines. Overall, 52 centres from 29 countries/regions in all continents reported 883 patients as of January 31st 2021, 24/29 countries/regions providing data on 100% of their consecutive patients (10-80% in the remaining 5 countries). The drug-resistance pattern of the patients was severe (>30% with extensively drug-resistant -TB; median number of resistant drugs 5 (3-7) in the overall cohort and 6 (4-8) among patients with a final outcome). For the patients with a final outcome (477/883, 54.0%) the median (IQR) number of months of anti-TB treatment was 18 (13-23) (in days 553 (385-678)). The proportion of patients achieving sputum smear and culture conversion ranged from 93.4% and 92.8% respectively (whole cohort) to 89.3% and 88.8% respectively (patients with a final outcome), a median (IQR) time to sputum smear and culture conversion of 58 (30-90) days for the whole cohort and 60 (30-100) for patients with a final outcome and, respectively, of 55 (30-90) and 60 (30-90) days for culture conversion. Of 383 patients treated with bedaquiline but not delamanid, 284 (74.2%) achieved treatment success, while 25 (6.5%) died, 11 (2.9%) failed and 63 (16.5%) were lost to follow-up.

Pseudo-Ductility, Morphology and Fractography Resulting from the Synergistic Effect of CaCO3 and Bentonite in HDPE Polymer Nano Composite.

Polymeric materials such as High density polyethylene(HDPE) are ductile in nature, having very low strength. In order to improve strength by non-treated rigid fillers, polymeric materials become extremely brittle. Therefore, this work focuses on achieving pseudo-ductility (high strength and ductility) by using a combination of rigid filler particles (CaCO3 and bentonite) instead of a single non-treated rigid filler particle. The results of all tensile-tested (D638 type i) samples signify that the microstructural features and surface properties of rigid nano fillers can render the required pseudo-ductility. The maximum value of tensile strength achieved is 120% of the virgin HDPE, and the value of elongation is retained by 100%. Furthermore, the morphological and fractographic analysis revealed that surfactants are not always going to obtain polymer-filler bonding, but the synergistic effect of filler particles can carry out sufficient bonding for stress transfer. Moreover, pseudo-ductility was achieved by a combination of rigid fillers (bentonite and CaCO3) when the content of bentonite dominated as compared to CaCO3. Thus, the achievement of pseudo-ductility by the synergistic effect of rigid particles is the significance of this study. Secondly, this combination of filler particles acted as an alternative for the application of surfactant and compatibilizer so that adverse effect on mechanical properties can be avoided.

The effect of the body mass index on the types of urinary tract stones.

OBJECTIVES: Urinary tract stones are a common public health problem worldwide. In addition, identifying the composition of stones is important for the further metabolic evaluation of patients. We conducted this study to further correlate the relationship between body mass index (BMI) and different compositions of urinary tract stones. MATERIALS AND METHODS: A retrospective study of 433 patients who underwent urinary tract stone analysis via Fourier-transform infrared spectroscopy at King Khalid University Hospital in Riyadh from May 2015 to June 2017 was performed. Their BMI at the time of stone analysis was recorded. RESULTS: A total of 433 stones were analyzed by the statistical data analysis software. The BMI was classified according to the WHO classification. We divided our patients into seven age groups. Most patients were between the age group of 35 and 44 years and were overweight. The incidence of calcium oxalate, carbonate apatite, and uric acid stones was higher in patients with a BMI above thirty than in patients with a lower BMI. However, cystine stones were more common in normal-weight patients. CONCLUSIONS: In this study, we found that the incidence of certain types of stones, such as calcium oxalate, cystine, and uric acid stones, in Saudi Arabia can be predicted by BMI measurement.

Erosion-Corrosion of 30°, 60°, and 90° Carbon Steel Elbows in a Multiphase Flow Containing Sand Particles.

Erosion-corrosion in flow changing devices as a result of sand transportation is a serious concern in the hydrocarbon and mineral processing industry. In this work, the flow accelerated erosion-corrosion mechanism of 90°, 60°, and 30° long radius horizontal-horizontal (H-H) carbon steel elbows with an inner diameter of 50.8 mm were investigated in an experimental closed-flow loop. For these geometrical configurations, erosion-corrosion was elucidated for erosive slug flow regimes and the extent of material degradation is reported in detail. Qualitative techniques such as multilayer paint modeling and microscopic surface imaging were used to scrutinize the flow accelerated erosion-corrosion mechanism. The 3D roughness characterization of the surface indicates that maximum roughness appears in downstream adjacent to the outlet of the 90° elbow. Microscopic surface imaging of eroded elbow surfaces disseminates the presence of corrosion pits on the exit regions of the 90° and 60° elbows, but erosion scars were formed on the entry regions of the 30° elbow. Surface characterization and mass loss results indicated that changing the elbow geometrical configuration from a small angle to wide angle significantly changed the mechanical wear mechanism of the tested elbows. Moreover, the maximum erosive location was identified at the top of the horizontally-oriented elbow for slug flow.

Histopathology of Middle East respiratory syndrome coronovirus (MERS-CoV) infection - clinicopathological and ultrastructural study.

AIMS: The pathogenesis, viral localization and histopathological features of Middle East respiratory syndrome - coronavirus (MERS-CoV) in humans are not described sufficiently. The aims of this study were to explore and define the spectrum of histological and ultrastructural pathological changes affecting various organs in a patient with MERS-CoV infection and represent a base of MERS-CoV histopathology. METHODS AND RESULTS: We analysed the post-mortem histopathological findings and investigated localisation of viral particles in the pulmonary and extrapulmonary tissue by transmission electron microscopic examination in a 33-year-old male patient of T cell lymphoma, who acquired MERS-CoV infection. Tissue needle biopsies were obtained from brain, heart, lung, liver, kidney and skeletal muscle. All samples were collected within 45 min from death to reduce tissue decomposition and artefact. Histopathological examination showed necrotising pneumonia, pulmonary diffuse alveolar damage, acute kidney injury, portal and lobular hepatitis and myositis with muscle atrophic changes. The brain and heart were histologically unremarkable. Ultrastructurally, viral particles were localised in the pneumocytes, pulmonary macrophages, renal proximal tubular epithelial cells and macrophages infiltrating the skeletal muscles. CONCLUSION: The results highlight the pulmonary and extrapulmonary pathological changes of MERS-CoV infection and provide the first evidence of the viral presence in human renal tissue, which suggests tissue trophism for MERS-CoV in kidney.

Materno-foetal leptin and insulin-like growth factor in low birth weight neonates.

Low birth weight (LBW) is a health concern in developing countries. Leptin and insulin-like growth factor-I (IGF-I) are factors that influence LBW. A case-control study was conducted at Medani hospital, Sudan. Cases were women who had LBW deliveries ( 2,500 g) and controls were women with normal-weight babies ( 2.500 ­ 4,000 g). Sociodemographic and obstetrical characteristics were gathered from both groups and leptin and IGF-I levels were measured by ELISA. Cases and controls (45 in each arm) were matched in their basic data. The median (interquartile) of maternal leptin levels [9.9 (1.9 ­ 21.8) vs. 16.0 (9.6 ­ 20.8), ng/ml; P0.001] and IGF-I [1.6 (0.7 ­ 20.0) vs. 6.1 (4.3 ­ 7.1) ng/ml ; P 0.001] were significantly lower in cases than in controls. Likewise, cord serum leptin [5.8 (2.1 ­ 12.6) vs. 20.0 (5.1 ­ 37.8) ng/ml; P0.001] and cord serum IGF-I [1.7 (1.3 ­ 2.0) vs. 6.9 (5.9 ­ 7.4) ng/ml; P0.001] levels were significantly lower in cases than in controls. Significant positive correlation was found between birth weight and cord leptin ( r0.398), maternal ( r0.795) and cord ( r0.863) IGF-I levels. Maternal and cord leptin and IGF-I levels were significantly lower in LBW babies.

Hourglass bladder after ileocystoplasty (case report).

Narrowing of the anastomotic area between the bowel segment and urinary bladder is known as "hourglass bladder." This report describes a rare case of hourglass bladder deformity occurring post-ileocystoplasty in a 14-year-old male. We describe the essential steps that should be taken during bladder augmentation to avoid such a complication, along with a discussion of the relevant literature. This case emphasizes the need to strictly adhere to the steps of augmentation cystoplasty to avoid this technical complication.

Effect of orthodontic treatment with preadjusted edgewise appliances on the buccolingual inclination of mandibular canines: a CBCT study.

OBJECTIVES: To assess the effects of treatment with preadjusted edgewise appliances on the buccolingual inclination of mandibular canines and the intercanine distance. SETTING AND SAMPLE POPULATION: The Division of Orthodontics at the University of Minnesota. Thirty patients whose treatment included extraction of mandibular first premolars and 30 patients whose treatment did not include extractions. MATERIAL AND METHODS: The buccolingual inclination of mandibular canines and their linear distance were measured on cone beam computed tomograms before and after treatment in both patient groups. Differences between extraction and non-extraction groups and between pre- and post-treatment measurements were tested for statistical significance, and the correlation between the buccolingual inclination and the intercanine distance was computed. RESULTS: Post-treatment, the buccolingual inclination of mandibular canines was significantly greater in the non-extraction group than in the extraction group. In both groups, the canines became more lingually inclined with treatment (non-extraction group: -2.1°; extraction group: -4.1°). The intercanine distance increased significantly in the extraction group (+1.2 mm) but not in the non-extraction group (-0.5 mm). While there was a significant positive correlation between the buccolingual inclination and the mandibular intercanine distance in both groups before treatment, after treatment this correlation was significant only in the non-extraction group. CONCLUSION: Orthodontic treatment with preadjusted edgewise appliances results in more lingually inclined mandibular canines together with an increased intercanine distance, especially in patients whose treatment involves the extraction of mandibular first premolars.

Laparoscopic retroperitoneoscopic nephrectomy and partial nephrectomy in children.

OBJECTIVES: The aim was to evaluate our experience in the retroperitoneal laparoscopic approach in total and partial nephrectomies in children. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 41 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from 2004 to 2012. We looked at the demographic data, age at surgery, indication, operative time, surgical complications, conversion to open surgery and operative complications. RESULTS: Thirty-five total and six partial nephrectomies (upper pole) were performed. The mean age was 84 months (7-175). Vesicoureteric reflux, pelviureteric junction obstruction, and multicystic dysplastic kidney disease were the main underlying pathologies. The mean operative time was 158 min (60-280). There were no intraoperative complications (surgical and anesthetic), and no significant blood loss was observed. Conversion to open surgery was necessary in two cases caused by failure to progress due to difficult anatomy during the partial nephrectomies. No major postoperative complications were noted. The mean hospital stay was 2.5 days (1-5). A drain was used in 12 cases and was removed after a mean of 2 days. CONCLUSIONS: Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children. Still, this procedure is more challenging and requires an excellent image of the retroperitoneal space, especially when partial nephrectomies are concerned.

Hospital acquired blood stream infection as an adverse outcome for patients admitted to hospital with other principle diagnosis.

BACKGROUND: Hospital acquired infections (HAI) have emerged as an important public health problem and are a leading cause of morbidity and mortality worldwide. They affect both developed and resource-poor countries and constitute a significant burden both for the patient and for the health care system. Specific objectives in this study are assessment of HAI rate among patients admitted with other principle diagnosis, to identifying the causative agents of hospital acquired infections and to identify some possible risk factors associated with each type of infection, both health related and non-health related. PATIENTS AND METHODS: The study was done on selected diagnosis groups during year 2010. The infections were found among 250 patients (43.6% males) have been exposed to episodes of infections. Median age of patients was 56. Data were abstracted from the archived patients' files in medical record department using the annually infection control log-book prepared by the infection control department. The Data collected were demographic information about the patients (age and sex), clinical condition (diagnosis and the length of hospital stay) and possible risk factors for infection as smoking, diabetes mellitus, hypertension and exposure to invasive devices or exposure to surgical procedures. RESULTS: Liver diseases 22.8%, cardiac diseases 22.8%, Gastro-Intestinal System diseases 20%, urinary system diseases 13.6%, and endocrinal disorder 13.6% Prostate gland diseases 7.2%. Episodes of infections caused by 9 types of organisms divided into 47.2% for blood stream infection and 52.8% for other types. 66% acquired blood stream infection were exposed to central venous line. CONCLUSION: Most common type of HAIs was blood stream infections. Liver, cardiac diseases and gastro-intestinal diseased patients show more proportion of HAIs while urinary system and prostate disease patients show less proportion of HAIs. Gram negative bacilli were the most common organisms found in our study (60%).

Congenital anterior urethrocutaneous fistula: Two case reports and review of literature.

Congenital anterior urethrocutaneous fistula (CAUF) of the male urethra is a rare anomaly. CAUF can be defined as a urethral fistula in which the urethra and external urethral meatus are intact, typically with intact prepuce and no history of any penile trauma (including surgical trauma).We report 2 cases of CAUF to highlight this pathology with hints of the published similar cases in the literatures and discuss the surgical reconstruction ways for management.

Zinc and selenium levels in women with gestational diabetes mellitus at Medani Hospital, Sudan.

Gestational diabetes is a common medical disorder in pregnancy. There is a growing body of evidence of the association between zinc, selenium status and diabetes mellitus during pregnancy. A case-control study was conducted at Medani Hospital, Sudan, to compare zinc and selenium levels in pregnant women with gestational diabetes and normal pregnant women (controls). The two groups (31 in each arm) were well-matched in age, parity, gestational age, haemoglobin and body mass index. Zinc and selenium levels were measured using atomic absorption spectrophotometry. There were no significant differences in the median (interquartile) zinc (498.9 [395-703] vs 486.4 [404-667] µg/l, p = 0.905) and selenium (164.4 [61-415] vs 204 [68-541] µg/l, p = 0.838) values between the two groups. There were no significant correlations between zinc and selenium, or between these trace elements and body mass index, gestational age and blood glucose levels.

IL-4 receptor alpha single-nucleotide polymorphisms rs1805010 and rs1801275 are associated with increased risk of asthma in a Saudi Arabian population.

BACKGROUND: The IL-4 receptor alpha subunit (IL-4Rα), when associated with the common gamma chain receptor, or the IL-13Rα1 subunit, transduces signals to STAT6 in response to IL-4 and IL-13 stimulations. This results in a number of cell-specific responses including Th2 differentiation, lymphocyte proliferation and IgE production. Given the prominent role of IL-4Rα in allergic disorders, several single-nucleotide polymorphisms (SNPs) have been found associated with asthma and other atopic disorders, including rs1805010 (I75V) and rs1801275 (Q576R) SNPs; however, lack of significant association have also been reported for some ethnic groups. The objective of this study was to determine whether IL-4Rα rs1805010 and rs1801275 polymorphisms are associated with asthma in patients from Saudi Arabia. MATERIALS AND METHODS: One hundred and ninety severe asthmatic patients (11-70 years old) and 194 healthy subjects of equivalent age range were recruited for blood donation. DNA was purified and genotyping for rs1801275 and rs1805010 polymorphisms in the IL-4Rα gene was performed by PCR amplification, followed by cycle sequencing of the purified PCR fragments using BigDye chain terminator and capillary electrophoresis. RESULTS: Pearson's Chi-square tests showed that the minor alleles, G, for both rs1805010 and rs1801275 SNPs, were significantly more frequent in asthmatics than in the healthy group (Yates' P < 0.05); conversely, the major alleles, A, were significantly more frequent in healthy than in asthmatics (P < 0.05). Concerning association analysis, odds for A/G-G/G genotypes were significantly higher to be associated with asthma predisposition (rs1801275: OR = 2.12; 95% CI = 1.39-3.22; P < 0.001*; rs1805010: OR = 1.6; 95% CI = 1.01-2.53; P < 0.05*; dominant model). Analysis of gender-genotype interactions, with genders nested within A/G-G/G, indicated higher odds for females than males of significant association with asthma (rs1801275: OR = 5.19, 95% CI = 2.09-12.94*; rs1805010: OR = 3.73, 95% CI = 2.06-6.74*). Rs1805010 and rs1801275 were in linkage disequilibrium (D' = 0.27; P < 0.0004*), with G-G haplotype being more frequent in asthmatics than in healthy subjects (OR = 2.43, 95% CI = 1.59-3.71*). CONCLUSIONS: The risk alleles, G, of IL-4Rα rs1805010 and rs1801275 SNPs and corresponding A/G-G/G genotypes were significantly associated with asthma predisposition in asthmatics from Saudi Arabia.

The 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.