Annals of Thoracic Medicine最新文献

The Saudi Thoracic Society (STS) developed an updated evidence-based guideline for diagnosing and managing chronic obstructive pulmonary disease (COPD) in Saudi Arabia. This guideline aims to provide a comprehensive and unbiased review of current evidence for assessing, diagnosing, and treating COPD. While epidemiological data on COPD in Saudi Arabia are limited, the STS panel believes that the prevalence is increasing due to rising rates of tobacco smoking. The key objectives of the guidelines are to facilitate accurate diagnosis of COPD, identify the risk for COPD exacerbations, and provide recommendations for relieving and reducing COPD symptoms in stable patients and during exacerbations. A unique aspect of this guideline is its simplified, practical approach to classifying patients into three classes based on symptom severity using the COPD Assessment Test and the risk of exacerbations and hospitalizations. The guideline provides the reader with an executive summary of recommended COPD treatments based on the best available evidence and also addresses other major aspects of COPD management and comorbidities. This guideline is primarily intended for use by internists and general practitioners in Saudi Arabia.

Objective: The objective of the study was to systematically evaluate and perform a meta-analysis on the adherence to high-flow nasal cannula (HFNC) humidified oxygen therapy and its influencing factors in elderly patients with stable chronic obstructive pulmonary disease (COPD).

Methods: Relevant literature on HFNC and COPD was retrieved from PubMed, EMbase, Web of Science, and Cochrane Library databases. Cross-sectional studies, case-control studies, and cohort studies were included. Screening and quality assessment were conducted using Endnote X9 software. Quality scores were assigned using the Newcastle-Ottawa Scale and the AHRQ assessment tool. Basic information, sample size, and adherence-related factors were extracted, and heterogeneity and publication bias were assessed.

Results: A total of 321 articles were initially identified, with 8 English articles involving 325 patients included after screening. Quality assessment yielded five high-quality articles (score > 8), two medium-quality articles (score = 7), and one low-quality article (score = 6). Meta-analysis results showed a COPD patient HFNC adherence rate of 32.7%. Negative factors included the number of acute exacerbations (odds ratio [OR] =2.17), adverse reactions (OR = 4.13), regular follow-up (OR = 9.45), educational level (OR = 5.38), and concurrent medications (OR = 4.71). Positive factors included age < 70 years (OR = 0.45), duration of use (OR = 0.30), inhalation technique (OR = 0.31), treatment satisfaction (OR = 0.35), and adverse reactions (OR = 0.15). Funnel plot and Egger's test results indicated minimal publication bias.

Conclusion: Adherence to HFNC in elderly COPD patients is relatively low, influenced by negative factors such as the number of acute exacerbations, adverse reactions, regular follow-up, educational level, and concurrent medications. Positive factors include age < 70 years, duration of use, inhalation technique, treatment satisfaction, and adverse reactions.

Background: This study aimed to examine the impact of the COVID-19 lockdown on adherence to continuous positive airway pressure (CPAP) therapy among Saudi patients with obstructive sleep apnea (OSA). It also sought to assess the influence of demographic variables and comorbidities on CPAP adherence.

Methods: A prospective cohort study was conducted at the University Sleep Disorders Center at King Saud University Medical City. The study included 67 OSA patients who exclusively used CPAP for treatment across three distinct intervals: prelockdown, during lockdown, and postlockdown. Adherence to CPAP therapy was objectively measured using "mask-on on-time monitoring" data from the CPAP machines.

Results: The study found a significant decrease in the number of days with CPAP usage during the lockdown period, which persisted postlockdown. Approximately half of the patients adhered to CPAP treatment throughout the three study intervals. The decrease in CPAP usage days during lockdown was particularly noticeable among patients younger than 50 and older than 65 years of age. The presence of comorbidities, body mass index, and sex did not significantly influence CPAP treatment adherence.

Conclusion: The COVID-19 lockdown significantly impacted CPAP treatment adherence among OSA patients, with a decrease in adherence persisting postlockdown. This highlights the need for interventions to support CPAP adherence during challenging times such as a pandemic. Further research is needed to understand the long-term effects of the pandemic on CPAP therapy adherence.

Introduction: The choice of treatment strategy in patients with idiopathic pulmonary arterial hypertension (IPAH)/HPAH/DPAH (Hereditary pulmonary arterial hypertension/ Drug-induced pulmonary arterial hypertension) II-III functional class (FC) (WHO) based on an acute vasoreactive testing result (VRT). Positive VRT (VRT+) is an indication for calcium channel blockers therapy. Long-term vasoresponders demonstrate sustained low-risk status and the highest survival among all PH subtypes.

The study aimed: To characterize VRT performance in IPAH patients and differences in presentation between patients with positive, negative VRT, and patients with not done VRT due to physicians' decision.

Methods: One hundred and sixty-six adult IPAH patients (44.2 ± 15.3 years, 34 males) comprised into prospective single-center study between 2008 and 2023 years. Inhaled iloprost was used for VRT. Positive VRT was defined with established Sitbon criteria. Standard baseline pulmonary arterial hypertension (PAH) evaluation including cardiopulmonary exercise test (CPET) was performed. Risk status was evaluated using ESC/ERS (European Society of Cardiology/European Respiratory Society) risk scale 2015. Survival was assessed with the Kaplan-Mayer method.

Results: Eighty-five (51.2%) patients underwent VRT. VRT not done (ND VRT) due to the physicians' decision in 26.7% patients, due to the technical inability in 15.4% and IV FC (WHO) in 16.2% patients. Positive VRT registered in 26 (15.6%) patients. Patients with negative VRT demonstrated worse hemodynamics and exercise tolerance, higher N-terminal pro-brain-type natriuretic peptide (NT-proBNP) level, and right heart dilatation compared with VRT+. Patients with ND VRT due to the physicians decision were often older than 60 years, had higher body mass index, symptoms of right heart failure, hemoptysis, arrhythmias, high NT-proBNP, and hemodynamic criteria of high risk in comparison with patients with done VRT. Some CPET parameters were similar between VRT + group and patients ND VRT group. Loss of vasoreactivity and PAH worsening were detected in 50% of VRT + patients in a 1.76 year of follow-up. Patients with vasoreactivity loss exhibited the criteria of intermediate risk at a baseline. Five-year survival was 97% in VRT + group in comparison with 61% in VRT - and 53% in ND VRT group.

Conclusions: Physicians' decision was the most common reason for not doing VRT in IPAH patients. Intermediate high-risk criteria presence at a baseline were associated with not done VRT due to physicians decision, negative VRT, and the vasoreactivity loss during the follow-up. CPET should be used more widely to detect the early signs of PAH progression in low risk or VRT + patients.

Background: Standards of treatment for limited-stage small-cell lung cancer (SCLC) include chemoradiotherapy. The place of the surgery in this indication is still debated. The objective of this study was to evaluate the overall survival (OS) in patients who underwent surgery for an SCLC undiagnosed before resection in the University Hospital of Nancy, France. Secondarily, the impact of surgery on recurrence-free survival (RFS) was analyzed.

Methods: All the patients who underwent lung resection in the Department of Thoracic Surgery, from 1991 to 2018, and a diagnosis of SCLC after surgery were included. OS and RFS were analyzed according to the resection type, postoperative staging, and lymph node extension.

Results: Sixty-one patients were included. The median OS was higher in patients with lobectomy than those with pneumonectomy (26 [8.4-208.7] vs. 12 [3.4-27.6] months, P < 0.001) in stage I compared to other stages (58 [8.4-208.7] vs. 17 [3.4-83.5] months, P = 0.002), and N0-1 than N2 (25 [3.6-208.7] vs. 15 [3.4-83.5] months, P = 0.01). RFS was also significantly higher after lobectomy than after pneumonectomy (17 [1.6-184.9] vs. 8 [0.5-17.6], P < 0.001), stage I than stages II-III (35 [5-184.9] vs. 11 [0.5-42.4], P < 0.001) and N0-1 compared to N2 (25 [1.6-184.9] vs. 9 [0.5-16.5] months, P = 0.006). In multivariate analysis, the only independent factor influencing the OS was the pneumonectomy (hazard ratios = 3.19; 95% confidence interval [1.46-6.98], P = 0.004).

Conclusion: Surgical resection of stage I SCLC may lead to better OS and RFS. N1 patients should not automatically be excluded from surgery. Lobectomy with regional lymph node resection is the preferable choice of surgery.

Background: Pediatric obstructive sleep apnea (OSA) poses a significant health concern, affecting the well-being and quality of life of affected children. This study focuses on the translation, adaptation, and validation of the OSA-18 questionnaire for Arabic-speaking pediatric patients, aiming to contribute to the understanding of OSA and its implications on the quality of life in this population.

Methods: A study was conducted at Jordan University Hospital, involving 186 Arabic-speaking pediatric patients with suspected OSA. The OSA-18 questionnaire was translated and culturally adapted following the World Health Organization guidelines. Overnight polysomnography was conducted to assess OSA severity. Internal consistency, construct validity, convergent validity, and predictive/discriminant validity were analyzed.

Results: The study sample (68.8% of males, median age: 10.87) showed a median Apnea-Hypopnea Index (AHI) of 7.0, OSA-18 score of 46.5, and Pediatric Sleep Questionnaire (PSQ) score of 7.0. Internal consistency of OSA-18 was acceptable, except for the "physical symptoms" domain. Exploratory and confirmatory factor analyses revealed five factors corresponding to different OSA-18 domains. Convergent validity was supported by significant correlations between OSA-18 and PSQ scores. However, no correlation was found between OSA-18 scores and AHI. OSA severity was associated with higher PSQ scores but not with AHI.

Conclusion: This study provides valuable insights into pediatric OSA in Arabic-speaking children. While the translation and validation of the OSA-18 questionnaire demonstrated acceptable reliability and convergent validity, the lack of correlation between OSA-18 scores and AHI raises questions about the survey's ability to capture the full impact of OSA objectively. Future research should focus on developing more reliable diagnostic tools, especially in resource-limited settings.

Context: Early detection of lung cancer through screening can improve outcomes; yet public knowledge, attitudes, and practices regarding lung cancer screening in Saudi Arabia are limited.

Aims: The aim is to assess knowledge, attitudes, and practices toward lung cancer risk factors and screening, and understand the impact of demographic factors on these variables.

Settings and design: An observational cross-sectional study was conducted from October 2023 to March 2024, involving 708 participants.

Methods: A validated questionnaire from a previous Malaysian study, translated into Arabic, was distributed to participants.

Statistical analysis used: Descriptive statistics, Shapiro-Wilk test, one-way analysis of variance, Tukey's test, and logistic regression were used.

Results: Most participants (95.9%) recognized smoking as a major risk factor. Common misconceptions included viewing lung cancer as infectious (84.0%) or affecting only men (14.4%). Nonetheless, 66.4% expressed willingness for future screening. Younger participants (18-40 years) and those with higher education demonstrated better knowledge scores (mean score: 11.33 ± 2.97 for ages 18-40; 11.42 ± 2.88 for those with master's or doctorate degrees), with significant differences based on age (P = 0.007) and education level (P = 0.025). No significant differences were observed based on gender, region of residence, or monthly family income.

Conclusions: There is a positive inclination toward lung cancer screening among the Saudi public, but there are significant knowledge gaps, particularly regarding nonsmoking-related risk factors and misconceptions, suggesting a need for enhanced public education and screening programs.

Background: Sleep-disordered breathing (SDB) is characterized by upper airway dysfunction and is linked to severe health issues. Individuals with SDB have distinct craniofacial morphology for which orthodontists are most suitable for the management due to their dental expertise.

Aim: This study aims to discern key differences in dental parameters between individuals with and without SDB.

Methods: The present study is a cross-sectional observational study conducted for 12 months. Out of 70 participants, 35 were placed in the SDB group as per the Berlin questionnaire (BQ) and 35 in the control aged 18-22 years. Criteria excluded individuals with preexisting illnesses, missing teeth, tonsillectomy, orthodontic or jaw surgeries, cleft lip/palate, or craniofacial anomalies. Dental assessments included interdental width, palatal vault depth and shape, molar relation, overjet, and overbite. In addition, self-perceived orthodontic treatment needs were evaluated as a secondary measure.

Results: In the SDB group, interdental distances were significantly reduced in the canine, first premolars, second premolars, and molar regions by 2, 3, 4, and 1.8 mm, respectively. A noticeable V-shaped arch was observed. Overjet and overbite increased by 42.85% and 31.42%, respectively, with Class 1 malocclusion more prevalent than Class 2. The Berlin questionnaire identified 54.3% as high-risk SDB. The Index of Orthodontic Treatment Need-Esthetic Component (IOTN-AC) revealed that 68.6% of snoring participants required orthodontic treatment.

Conclusion: Individuals with SDB exhibit a constricted maxilla and reduced interdental measurements, indicating a moderate risk. The Berlin questionnaire proves valuable in assessing SDB severity. Moreover, individuals displaying signs of SDB often present a high prevalence of orthodontic treatment needs, as indicated by the IOTN-AC.

Aims: Primary spontaneous pneumothorax (PSP) is a sudden pleural disease predominantly affecting healthy adolescents and young adults, making it a prevalent thoracic disorder within this demographic. This study evaluated the necessity of preoperative chest tube insertion for PSP patients and reassessed current clinical practices.

Methods: We conducted a retrospective analysis of medical records for individuals aged 14-30 years diagnosed with PSP who underwent video-assisted thoracoscopic surgery (VATS) at Wonju Severance Christian Hospital from January 2016 to December 2022. Patients were categorized retrospectively into two groups based on their initial treatment: Those who had a chest tube inserted and those who did not. We collected and compared clinical data, including demographics, treatment specifics, and outcomes.

Results: The study included 128 PSP cases. There was no difference in preoperative clinical data between the two groups, and there were no differences in operation time, number of wedge resections, and number of mechanical pleurodesis. However, the use of single-port surgery was significantly higher in the nonchest tube group (P = 0.001). The nonchest tube group had a significantly shorter hospital stay (P < 0.001), attributed to the absence of preoperative chest tube insertions. There were no significant differences in postoperative complications or recurrence rates between the groups.

Conclusions: In young PSP patients, proceeding directly to VATS without prior chest tube insertion in stable individuals does not lead to serious complications or negatively affect outcomes. This approach may offer an effective alternative for PSP management.