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Byline: Esam. Alhamad, Joseph. Cal, Nuha. Alrajhi, Muthurajan. Paramasivam, Waleed. Alharbi, Mohammed. AlEssa, Mohammed. Omair, Ammar. AlRikabi, Ahmad. AlBoukai BACKGROUND: Diagnosing primary Sjogren's syndrome (pSS)-associated interstitial lung disease (ILD) is [...]

Byline: Esam. Alhamad, Joseph. Cal, Nuha. Alrajhi, Ahmad. AlBoukai BACKGROUND: Information regarding acute exacerbation (AE) in patients with interstitial lung disease (ILD) is limited. OBJECTIVES: The objective of the study [...]

Byline: Esam. Alhamad, Joseph. Cal BACKGROUND: There is a paucity of information regarding prognostic factors associated with reduced survival in interstitial lung disease (ILD) patients without pulmonary hypertension (PH). AIMS: [...]

Byline: Esam. Alhamad, Joseph. Cal, Nuha. Alrajhi, Waleed. Aharbi, Ammar. AlRikabi, Ahmad. AlBoukai BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a common subtype of interstitial lung disease (ILD). Information about the [...]

Byline: Nuha. Alrajhi, Muthurajan. Paramasivam, Ahmad. Alboukai, Ammar. Alrikabi, Esam. Alhamad Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNEC) is an abnormal proliferation of pulmonary neuroendocrine cells that occur without underlying [...]

Background : Pulmonary hypertension (PH) occurs in many patients with interstitial lung disease, including sarcoidosis. We explored the frequency, clinical characteristics and outcomes of PH in Arab patients diagnosed with pulmonary sarcoidosis. Methods : A retrospective study in three tertiary hospitals was performed on 96 patients who underwent Doppler echocardiography. Demographic and clinical characteristics, physiological studies and computed tomography (CT) results were collected, and compared between patients with and without PH. Results : Twenty (20.8%) patients were found to have PH. Patients with PH were more likely to be symptomatic (cough, P = 0.008; dyspnea, P = 0.04), to have an advanced radiographic stage (P = 0.001), and to be receiving systemic therapy (P = 0.001), compared to those without PH. Physiological data including pulmonary function test parameters, arterial blood gas levels and oxygen saturation at rest and after exercise were all significantly lower in patients with PH compared to those without PH. Comparison of CT patterns between patients with and without PH showed significant differences in the frequencies of ground-glass opacity (61.5 vs. 28.8%, P = 0.032) and fibrosis (76.9 vs. 44.2%, P = 0.035). In total, four patients died during the study period, including three with evidence of PH. Conclusions : The frequency of PH in the present study was 20.8%. Clinical, physiologic and radiographic characteristics appeared to differentiate patients with PH from those without PH. The presence of PH contributed to poor outcomes in patients with pulmonary sarcoidosis.

Background and Objective : Sarcoidosis is prevalent worldwide with significant heterogeneity across different ethnic groups. We aimed To describe the clinical characteristics and computed tomography findings among Arab patients with pulmonary sarcoidosis. Methods : A retrospective study of patient demographics, symptoms, co-morbid illness, sarcoidosis stage, treatment, pulmonary function and CT results. Results : Of 104 patients, most (77%) were 40 years of age or older at diagnosis, and females in this category (΃40 years ) significantly outnumbered male patients (69/104 (66.3%) vs. 35/104 (33.7%), P=.003). The most common complaints were dyspnea (76%), cough (72.1%) and weight loss (32.7%). The majority of patients displayed impairment in lung function parameters at presentation. However, significant impairment in forced vital capacity, percentage predicted (FVC%) (< 50%) was present in only 17% of patients. The most frequent CT finding was mediastinal lymph node enlargement in 49 patients (73.1%). Parenchymal abnormalities indicating lung fibrosis were noted in 31 patients (46.3%), and traction bronchiectasis was the most common (35.8%) fibrotic pattern detected on CT scans. Conclusion : At presentation, clinical manifestations of sarcoidosis among this sample of Arab patients were similar to reports from other nations. Further studies are needed to explore the effects of race and ethnicity on disease severity in the Middle East.

Background: The 6-min walk test (6MWT) is a useful tool to assess prognosis and functional impairment in various pulmonary diseases. Aims: To evaluate functional capacity during various stages of pulmonary sarcoidosis and develop a scoring system clinical radiological physiological score (CRP) that can potentially be used to assess the functional status among patients with sarcoidosis. Materials and Methods: We performed a retrospective study on 26 patients diagnosed with pulmonary sarcoidosis from 2001 to 2007. All patients completed the 6MWT. The parameters assessed during the test included spirometry, arterial blood gas, 6-min walk distance (6MWD), Borg dyspnea score, and initial and end oxygen saturation. Results: Females covered a significantly shorter distance than males (343 m (223-389) vs. 416.5 m (352-500); P < 0.0001). In addition, females had a significantly lower SpO 2 at the end of the 6MWT than males (90.5 (61-99) vs. 96 (75-98); P < 0.03). The 6MWD was inversely correlated with the final Borg score (r = −0.603, P = 0.004) and the CRP score (r = -0.364, P = 0.047) and positively correlated with forced expiratory volume in 1 s (FEV 1 ) % (r = 0.524, P = 0.006) and forced vital capacity (FVC) % (r = 0.407, P = 0.039). Conclusions: Female gender, FEV 1 %, final Borg score, FVC%, CRP score, and SpO 2 at the end of the 6MWT are associated with reduced 6MWD. It appears that Saudi patients diagnosed with sarcoidosis have a markedly reduced walking distance compared with other races. The effect of race and ethnicity and the utility of the CRP score as a potential marker to assess functional status require further exploration.

Background: Because little has been reported about the outcome of severe asthma outside the US and western Europe, we performed a retrospective case analysis of patients treated in the medical intensive care unit (MICU) of a university hospital in Riyadh, Saudi Arabia, to de-termine the management, complications and outcome of severe asthma requiring ICU admission. Methods: The records of patients with severe asthma admitted to the MICU between the periods of January 1996 to December 2003 were re-viewed. Sixty-one episodes from 54 patients were studied, of which 27 (44%) were male. Results: All patients were hypercapnic; 23 (38%) were ventilated. The Acute Physiological and Health Evaluation (APACHE) score II was significantly higher in the ventilated group (P< 0.0001). The pH was sig-nificantly lower and PaCO 2 was significantly higher in the ventilated group (P< 0.0001). All patients survived. Only 42% of patients our series received inhaled corticosteroids before admission. Conclusion: Our results suggestthat severe asthma requiring ICU ad-mission is now safely managed in ICUs. Our results are comparable to recently published data on the treatment of severe asthma in the ICU.

Byline: Mona. Fouda, Esam. Alhamad, Mohammed. Al-Hajjaj, Shaffi. Shaik, Ahmad. Alboukai, Feisal. Al-Kassimi Background: Osteoporosis, the most common extra-pulmonary complication of chronic obstructive pulmonary disease (COPD), may be related to [...]

Byline: Esam. Alhamad, Zahid. Shakoor, Feisal. Al-Kassimi, Adel. Almogren, Mohamed. Gad ElRab, Shyam. Maharaj, Martin. Kolb Background: Current protocols for detection of circulating fibrocytes (CFs) in peripheral blood described in [...]

Byline: Esam. Alhamad Background: Recent trials involving pirfenidone suggest a beneficial effect in the treatment of idiopathic pulmonary fibrosis (IPF). Objective: To report on the efficacy and safety of pirfenidone [...]

Abstract Background We assessed the relationship between physiologic parameters, computed tomography patterns, 6 minute walk distance (6MWD) and the distance-saturation product [DSP; defined as the product of the 6MWD and the lowest oxygen saturation during the 6 minute walk test (6MWT)]. In addition, we investigated factors affecting 6MWD in patients with pulmonary sarcoidosis. Methods We performed a retrospective study of patient demographics, treatment, pulmonary function, 6MWT, echocardiography and computed tomography results. Results Fifty nine patients were included in this study. Their mean+standard deviation age was 47.5 years + 12.5 years, and 42 (71.2%) were female. Mean pulmonary function parameters for forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and total lung capacity (TLC) results, as percentages of predicted values, were 77.6 ± 22.2, 77.1 ± 22.8 and 78.7 ± 16.1, respectively. Comparison of the DSP with distance walked revealed a significant correlation with factors underlying reduced 6MWD, including gender, pulmonary function indices, partial pressure of oxygen (PaO2), and Borg dyspnea score. Other factors were significantly associated with DSP but not distance; these included lung fibrosis (p = 0.02), pulmonary hypertension (p = 0.01) and systemic therapy (p = 0.04). Backward elimination stepwise multiple regression analysis revealed that gender, and FEV1 were independent predictors of 6MWD, but FEV1 was more strongly related when DSP applied [DSP, R2 = 0.53, p = 0.02; distance, R2 = 0.45, p < 0.0001]. Conclusion Our findings reveal that, compared to 6MWD alone, the DSP is correlated with a greater number of factors associated with reduced 6MWT performance. Therefore, the DSP may be a useful indicator of functional status in patients with sarcoidosis. Additional large-scale studies are warranted to validate our findings.

Byline: Esam. Alhamad Sir, I read with great pleasure the comments from Dr. Majdy Idrees on our recent article in Annals of Thoracic Medicine [sup][1] and am willing to respond [...]

Byline: Esam. Alhamad, Joseph. Cal, Hussam. Alfaleh, Mostafa. Alshamiri, Ahmad. AlBoukai, Suliman. AlHomida Context: Several international studies have described the epidemiology of pulmonary hypertension (PH). However, information about the incidence [...]

Byline: Esam. Alhamad Background: There are relatively few epidemiological studies on interstitial lung disease (ILD) worldwide. Objective: To report the incident cases of ILD and compare our data with reports [...]

Byline: Faisal. AI-Kassimi, Esam. Alhamad A survey of pulmonologists attending a clinical meeting of the Saudi Thoracic Society found that only 55% of responders considered that inhaled corticosteroids (ICS) had [...]

Byline: Feisal. Al-Kassimi, Esam. Alhamad, Mohammed. Al-Hajjaj, Abdullah. Abba, Emad. Raddaoui, Shaffi. Shaikh Background and Objective: Some studies show a decline of FEV [sub]1 only one month after withdrawal of [...]

ABSTRACT Background and objective Post-mortem and computed tomography ( CT) studies indicated that emphysema is a feature of COPD even in the 'blue bloater/chronic bronchitis' type. We aim to test the hypothesis that the non-emphysematous patients are distinct from the main body of COPD and are more akin to asthmatic patients. Methods We studied 54 patients with COPD. Emphysema was measured by Goddard's visual scoring of CT scan and the carbon monoxide transfer coefficient ( KCO). Bronchial biopsy was offered for thickness of basement membrane ( BM) (≥7 µm) as a marker of remodelling in irreversible asthma. Spirometry was repeated after therapy with Budesonide/Formoterol for 1 year. Results The non-emphysematous phenotype were 24 of 54 patients (44%) by CT scan and 23 of 54 patients (43%) by KCO, showing agreement in 53 out of 54 patients. The non-emphysematous patients were younger, had higher forced expiratory volume in 1 s ( FEV1 ) (median 61% vs 49.7%), greater prevalence of hypertrophy of nasal turbinates and higher serum IgE. The emphysematous phenotype had lower BMI and greater dyspnoea score. The BM was thickened in 11 of 14 and 0 of 10 patients in the non-emphysematous and emphysematous groups, respectively. Three patients without emphysema and a normal BM normalized their FEV1 upon receiving inhaled corticosteroid ( ICS)/long-acting β2 agonist ( LABA). All the non-emphysematous improved their FEV1 after ICS/ LABA (median = 215 mL). The median decline in the emphysematous was −65 mL. Conclusion The non-emphysematous phenotype of COPD displays important features of asthma: clinical picture, histology and response to ICS. CT and KCO can predict spirometric response to ICS/ LABA. [ABSTRACT FROM AUTHOR]