Nigella sativa Supplementation Improves Asthma Control and Biomarkers: A Randomized, Double-Blind, Placebo-Controlled Trial.

Poor compliance with conventional asthma medications remains a major problem in achieving asthma control. Nigella sativa oil (NSO) is used traditionally for many inflammatory conditions such as asthma. We aimed to investigate the benefits of NSO supplementation on clinical and inflammatory parameters of asthma. NSO capsules 500 mg twice daily for 4 weeks were used as a supplementary treatment in a randomized, double-blind, placebo-controlled trial in asthmatics (clinicaltrials.gov: NCT02407262). The primary outcome was Asthma Control Test score. The secondary outcomes were pulmonary function test, blood eosinophils and total serum Immunoglobulin E. Between 1 June and 30 December 2015, 80 asthmatics were enrolled, with 40 patients in each treatment and placebo groups. After 4 weeks, ten patients had withdrawn from each group. Compared with placebo, NSO group showed a significant improvement in mean Asthma Control Test score 21.1 (standard deviation = 2.6) versus 19.6 (standard deviation = 3.7) (p = 0.044) and a significant reduction in blood eosinophils by -50 (-155 to -1) versus 15 (-60 to 87) cells/µL (p = 0.013). NSO improved forced expiratory volume in 1 second as percentage of predicted value by 4 (-1.25 to 8.75) versus 1 (-2 to 5) but non-significant (p = 0.170). This randomized, double-blind, placebo-controlled trial demonstrated that NSO supplementation improves asthma control with a trend in pulmonary function improvement. This was associated with a remarkable normalization of blood eosinophlia. Future studies should follow asthmatics for longer periods in a multicentre trial. Copyright © 2017 John Wiley & Sons, Ltd.

Pulmonary manifestations in systemic lupus erythematosus: association with disease activity.

BACKGROUND AND OBJECTIVE: Although systemic lupus erythematosus (SLE) is the most common connective tissue disease affecting the lung, few studies have assessed risk factors that predict pulmonary manifestations. The objectives of the present study were to determine the prevalence of lung manifestations in SLE patients from Western Saudi Arabia by analysing results from high-resolution computed tomography (HRCT) scans and to identify independent risk factors for lung involvement. METHODS: This was a 10-year retrospective study involving 184 SLE patients. We examined all HRCT lung abnormalities and determined whether findings were associated with the presence of lupus nephritis (LN), SLE disease activity (as defined by SLE Disease Activity Index 2000 item scores ≥ 4 for any and all items) or levels of complement and anti-double-stranded DNA (anti-dsDNA). RESULTS: We identified 61 patients (33%) with pulmonary involvement, and 52 (85%) of these subjects showed HRCT abnormalities. The most common HRCT findings were pleural effusion, consolidation and atelectasis (58%, 42% and 42%, respectively). There was a significant association between abnormal HRCT results and hypocomplementemia, high levels of anti-dsDNA and disease activity (P < 0.05), particularly with regard to pleuropericardial effusion and consolidation. Pulmonary abnormalities were significantly higher within the first five years after SLE diagnosis (P < 0.001). However, neither disease duration nor LN was associated with increased risk. CONCLUSIONS: Lung manifestations were frequent in SLE patients from Saudi Arabia, with pleural effusion, consolidation and atelectasis being the most common. Low complement levels, high anti-dsDNA levels and disease activity were significantly associated with abnormal HRCT findings (all P < 0.001).

Golden Standard and Golden Proportion of Maxillary Anterior Teeth Among Saudi Population in Makkah.

BACKGROUND: Maxillary anterior teeth are important in achieving optimum aesthetics, Different methods are used to calculate their dimension: as golden standard (GS) to measure Width/Height (W/H) of anterior teeth and Golden Proportion (GP) to measure their perceived widths. Researchers had reported on GS and GP in different populations. OBJECTIVES: The aim of the present study is to evaluate the occurrence of GS and GP of maxillary anterior teeth among the Saudi population in Makkah. MATERIALS AND METHODS: A total of 384 participants (2304 teeth) were included in this study; photographs were taken by using a digital camera at a fixed distance and saved on a personal computer; the perceived mesio-distal widths and occluso-gingival heights of the maxillary anterior teeth were measured; GS was calculated from W/H of upper central incisors (W11/H11 and W21/H21); and GP was calculated from width of canines/laterals (W13/W12 and W23/W22) and laterals/centrals (W12/W11 and W22/W21). The normal range of GS was considered between 75% and 85%, whereas the normal range of GP was considered between 55% and 65%. Data were analyzed by using suitable statistical tests, and p-value ≤ 0.05 was considered statistically significant. Both GS and GP were compared in relation to gender, race, and shape of the face. RESULTS: There were 43% of GS ratios, 14% of GP of canines/laterals, and 34% of GP ratios of laterals/centrals that were within the normal range. There were no significant differences between GS of males and females (p=0.512) as well as among different races (0.137), whereas there were significant differences among different face shapes (p=0.001). For GP of canines/laterals, there were significant differences between males and females (p=0.000), different races (p=0.000), and different face shapes (p=0.001). For GP of laterals/centrals; there were no significant differences between males and females (p=0.216) whereas there were significant differences among different races (p=0.000) and different face shapes (p=0.007). CONCLUSION: The GS was 85% among the Saudi population in Makkah and it was more prevalent than other golden measures. The GP was 77.5 for canines/laterals and 65.8 for laterals/centrals, and their frequencies were very low. Personal characteristics and dento-facial specifications should be considered to obtain maximum aesthetics.

Pleuropulmonary manifestation in patients with rheumatoid arthritis in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Pleuropulmonary (PP) involvement in rheumatoid arthritis (RA) is associated with high morbidity and mortality. Nevertheless, limited data are available regarding lung complications in the Middle East, especially in Saudi Arabia. The objectives of the current study were to determine the prevalence of PP manifestations and to identify the associated risk factors. METHODS: This was a retrospective study involving 419 patients diagnosed at a tertiary center over a 12.5-year period. The frequency of pulmonary manifestations was recorded based on combined results from chest X-rays, pulmonary function tests, and high-resolution computed tomography scan of the chest. RESULTS: The overall frequency of lung involvement was 25.8%. Pneumonia, bronchiectasis, and interstitial lung disease were the most common abnormalities (36%, 35%, and 23%, respectively). The presence of comorbid illness (odds ratio [OR]: 3.19; 95% confidence interval [CI]: 2.02-5.1), male gender (OR: 2.4; 95% CI: 1.3-4.24), and the presence of extra-articular manifestations of RA (ExRA) (OR: 2.35; 95% CI: 0.4-4.01) were predictive of lung involvement. CONCLUSIONS: Pneumonia, bronchiectasis, and interstitial lung disease were the most common abnormalities seen in RA patients. The presence of comorbidity, male gender, and ExRA was significantly associated with lung involvement.

Long-term pulmonary complications after laparoscopic adjustable gastric banding.

Early pulmonary complications following laparoscopic adjustable gastric banding (LAGB) have been rare, while long-term pulmonary complications have not been reported. Herein, we report two patients who presented 2 and 3 years after LAGB with unexpected pulmonary complications. The first patient had aspiration pneumonia secondary to stomal obstruction and esophageal reflux. The second patient had left lobar pneumonia, in which the connecting catheter appeared as a linear structure within the consolidation. This may be due to migration of the connecting catheter through the diaphragm, piercing lung parenchyma. Both complications presented as asthma-like symptoms. Diagnosis could have been missed if not evaluated properly. A high index of suspicion and long-term follow-up are important for diagnosing such complications after LAGB.

Prevalence and risk factors of asymptomatic bronchiectasis in patients with rheumatoid arthritis at a tertiary care center in Saudi Arabia.

INTRODUCTION AND OBJECTIVES: Bronchiectasis is a pulmonary manifestation that often occurs in individuals with rheumatoid arthritis (RA). Nevertheless, the prevalence of bronchiectasis in RA patients and predictors of its development/progression remain ill-defined. Our objective was to investigate the prevalence of bronchiectasis in a group of RA patients and examine possible clinical or biochemical risk factors that might contribute to its development. METHODS: This was an observational study analyzing 100 RA patients with no pulmonary symptoms selected from King Abdulaziz University Hospital in the Western region of Saudi Arabia from October 2013 to 2014. Demographic, clinical and laboratory information were collected for all patients. Diagnosis was based on the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification system, and disease activity was assessed using the 28-Joint Disease Activity Score Index with C-reactive protein; high-resolution computed tomography chest scans were performed. The prevalence of bronchiectasis was recorded and its association with different risk factors was examined using standard statistical methods. RESULTS: All 100 patients fulfilled the ACR and EULAR classification criteria for RA diagnosis. Their mean age was 51.05 ± 13.5 years, disease duration was 6.19 ± 6.4 years and disease activity index was 4 ± 1.3 (moderate activity). A total of 35 (35%) patients developed bronchiectasis. Notably, we observed significant positive associations of bronchiectasis with age, disease duration and male gender (P < 0.001, P = 0.006, P = 0.028, respectively). CONCLUSIONS: Asymptomatic bronchiectasis represents a common complication in moderately active RA patients within the Western Region of Saudi Arabia. Furthermore, several predictors of bronchiectasis development were identified, which can contribute to effective risk stratification in RA patients. Further prospective studies are needed to detect the prognosis of asymptomatic bronchiectasis in RA patients.

Pitfalls of inhalation technique in chronic asthmatics. Effect of education program and correlation with peak expiratory flow.

OBJECTIVE: To determine the pattern of pitfalls of inhalation technique in chronic asthmatics; to assess whether an educational program can reduce the pitfalls of inhalation technique; and to evaluate whether reduction of the pitfalls could have a positive correlation with peak expiratory flow (PEF) measurements. METHODS: The pitfalls of inhalation technique in 106 chronic asthmatics using either metered dose inhaler (MDI) (65%) or turbuhaler (35%) were studied prospectively. The pitfalls of inhalation technique and PEF measurement were recorded before and after an educational program at first and second visit. It was performed in the outpatients asthma clinic of the King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from October 2001 until March 2002. RESULTS: Among the MDI group; failure to breath hold for 5-10 seconds (52.2%) and failure to breath in slowly and deeply after inhaler activation (46.4%) were the most common pitfalls that have been reduced after education (20.3%, 21.7%). While in the turbuhaler group; failure to breath hold for 5-10 seconds (23.1%) and failure to twist the grip forward and backward before use (21.1%) were the most common pitfalls that have been reduced after education (0%, 0%). In both groups, the education program has been significantly contributed in reducing the mean number of pitfalls among MDI and turbuhaler users with p<0.001 and p=0.002. Moreover, the mean PEF has been improved significantly from 312.4 +/- 109.9 l/minute to 331+/- 105.8 l/minute (p=0.003). CONCLUSION: An educational program used in the outpatients asthma clinic has been significantly reduced the pitfalls of inhalation technique. The reduction of the pitfalls correlated positively with an increase in the PEF measurement. Therefore, we recommend such an education to be used in patients using such inhalers.

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

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is rare and can be challenging to diagnose. Limited data is available from the Middle Eastern region, especially Saudi Arabia. METHODS: 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. RESULTS: 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), FEV1 56 ± 15 percent of predicted, FVC 53 ± 13 percent of predicted, FEV1/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 SpO292 ± 7%, presentation 6-min walk distance 338 ± 64 m and lowest SpO2 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. CONCLUSIONS: 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.

OBJECTIVE: To assess the prevalence of epidemiologically defined chronic obstructive pulmonary disease (COPD) in Saudi Arabia. METHODS: 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. RESULTS: 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%]). CONCLUSION: 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.

Quality of life of patients with chronic obstructive pulmonary disease in the Gulf Cooperation Council countries.

OBJECTIVE: To assess the health-related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD) in 4 Gulf Council Cooperation (GCC) countries. METHODS: We conducted a cross-sectional survey between December 2011 and March 2012 in the following countries: Kingdom of Saudi Arabia (Riyadh, Dammam, and Jeddah), Kuwait, Bahrain, and the United Arab Emirates. The HRQL was measured using the COPD Assessment Test (CAT) and the Chronic Respiratory Disease Questionnaire-Self-Administered Standardized questionnaire (CRQ-SAS). RESULTS: We recruited 120 patients from 6 centers in 4 countries. Their average forced expiratory volume (FEV)1 was 49.3% ( +/- 13.4) of predicted, and the ratio of FEV1 to forced vital capacity was 0.58 ( +/- 0.11). The average COPD Assessment Test (CAT) score was 20.4 +/- 7.6; CAT scores were highest for Riyadh (24.1 +/- 7.7) and lowest for Kuwait (18.5 +/- 9.2), with no significant difference between the centers. For the CRQ-SAS, the dyspnea domain score was 4.6 +/- 1.6, the fatigue domain score was 4.3 +/- 1.3, the emotional domain was 4.6 +/- 1.2, and the mastery domain was 4.8 +/- 1.4. The correlation coefficients of the association between the CAT score and the 4 domains of the CRQ-SAS for all of the centers combined was statistically significant. CONCLUSION: The CAT and CRQ-SAS revealed that the patients with COPD experienced a moderate to severe impact from the disease, and a considerably compromised quality of life in the GCC countries.

Lung cancer at a University Hospital in Saudi Arabia: A four-year prospective study of clinical, pathological, radiological, bronchoscopic, and biochemical parameters.

OBJECTIVES AND BACKGROUND: Lung cancer accounts for 4% of all newly diagnosed cancers in Saudi Arabia. The pattern of presentation is unknown. The objectives of this study were to assess the clinical, radiological, pathological, biochemical and bronchoscopic abnormalities in lung cancer patients and to compare our findings with those reported in the literature. METHODS: A total of 114 patients with proven lung cancer were selected for the study. A questionnaire concerning patients' demographic data was obtained; the abnormalities and the cell types of lung cancer were recorded prospectively in each subject. RESULTS: A total of 114 patients with lung cancer were studied. Mean age ± SD was (59.8 ± 10.8) years, and (71.1%) were smokers and 95.1% of them were male, (90.1%) smoked >20 pack/yr (96.2%) for 20 years or more. Cough (76.3%) and clubbing (40.4%) were the most common symptom and physical abnormality respectively. The right lung (64.9%) was more commonly affected than the left (37.7%). Metastases were present in (49.1%) at presentation. The right and left upper bronchi (24% vs. 16%) were the mostly affected. Hypercalcemia was more common in squamous cell, while hyponatremia was more common in adenocarcinoma, and small cell. Squamous cell carcinoma was the most common cell type (51.8%) and significantly associated with smoking (P ≤ 0.001) CONCLUSION: Squamous cell carcinoma was the most common cell type, and significantly associated with smoking. The incidence of metastasis was high at presentation. The right lung and right upper bronchus were often affected. Hypercalcemia and hyponatremia were the most common biochemical abnormalities.

Bacterial infection and risk factors in outpatients with acute exacerbation of chronic obstructive pulmonary disease: a 2-year prospective study.

BACKGROUND AND OBJECTIVES: Acute exacerbations of COPD (AECOPD) are commonly observed in community-based patients worldwide. The factors causing exacerbation are largely unknown. This study was undertaken to determine the predominant bacterial pathogens cultured from sputum in community-based patients with AECOPD, to assess the risk factors associated with exacerbations and to compare these findings with published studies. METHODS: Forty-five patients with stable COPD were prospectively followed in the outpatients' clinic of King Abdulaziz University Hospital. At the first visit, personal data, CXR and measurement of baseline PEF were obtained from each patient. In the subsequent visits, sputum culture and CXR were carried out during exacerbations. RESULTS: Over a period of 24 months, patients made a total of 139 visits for exacerbations, and 69.8% had a positive sputum culture for a single pathogen. Moraxella catarrhalis (25.2%), Pseudomonas aeruginosa (12.2%) and Haemophilus influenzae (11.5%) were the most common isolated organisms. Patients with a lower level of baseline PEF had a significantly increased frequency of exacerbations (r = 0.337, P = 0.024). However, there was a weak correlation between exacerbation frequency and duration of COPD and exposure to cigarette smoking. CONCLUSION: There was a higher incidence of Moraxella catarrhalis and Pseudomonas aeruginosa than reported in previous studies. These findings should influence antibiotic selection for exacerbations. COPD patients with a low baseline PEF are at a higher risk of having repeated exacerbations and gram-negative pathogens.

Sleep-disordered breathing in patients with acquired retrognathia secondary to rheumatoid arthritis.

BACKGROUND: Sleep-disordered breathing (SDB) is associated with a variety of conditions that cause upper-airway narrowing. It was hypothesized that upper-airway narrowing can occur in patients with rheumatoid arthritis (RA) when retrognathia develops secondary to temporomandibular joint (TMJ) destruction. Therefore, the aim of this study was to detect the prevalence of SDB in patients with acquired retrognathia secondary to rheumatoid arthritis and to assess the efficacy of nasal continuous positive airway pressure (nasal CPAP) therapy in patients with SDB. MATERIAL/METHODS: Employed were a questionnaire, lateral cephalometry, and overnight polysomnography in seven women and three men (mean age +/-SD: 50+/-20 years, mean body mass index: 24.2+/-5.7 kg/m(2)) with acquired retrognathia secondary to RA. RESULTS: Three patients had severe obstructive sleep apnea (OSA) with apnea+hypopnea indices (AHI) >60/hour, three had mild obstructive sleep hypopnea (AHI >10/hour), and four had AHI <10/hour. The three patients with severe OSA all had excessive daytime sleepiness and evidence of retrognathia. In these three patients the mean AHI decreased from 72/hour to 3/hour with nasal CPAP therapy. CONCLUSIONS: SDB occurs quite frequently in non-obese patients with acquired retrognathia secondary to RA. The severity of SDB is related to the degree of retrognathia and the presence of daytime sleepiness. Nasal CPAP therapy is effective and well tolerated in these patients.

The efficacy of a management protocol in reducing emergency visits and hospitalizations in chronic asthmatics.

OBJECTIVES: To assess whether a simple protocol used in the outpatient's asthma clinic was effective in reducing emergency room (ER) visits and hospitalizations in chronic asthmatics during a year of follow-up, and to evaluate which type of asthmatics, according to severity of asthma, may benefit more from the protocol. METHODS: Prospective assessment of a simple protocol (consisted of combined medical and educational aspects in the form of corticosteroids inhalation as a monotherapy and correction of the pitfalls of inhalation technique) in reducing ER visits, and hospitalization in chronic asthmatics. It was performed in the outpatients asthma clinic at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia. A total of 128 chronic asthmatics were evaluated and followed up for one year between January 1999 and March 2000. RESULTS: Between January 1999 and March 2000 the total number of ER visits, and hospitalizations in 128 chronic asthmatics in the year before the protocol were 269 and 85. This was reduced to 116 ER visits and 27 hospitalizations a year after the protocol, a 55.4%, and 68.2% reduction. While only 25% never attended ER before the protocol, almost 58.6% did not attend ER after the protocol. The proportion that visited ER more frequently (at least 3 times/year) decreased from 50.8-18%, a 65% reduction. Similarly, patients who did not require hospitalization increased from 62.5% up to 85.2%. Moreover, the proportion that was hospitalized more frequently (at least 3 times/year) decreased from 10.2% to as low as 0.8%. Mean paired differences for ER visits were -1.16 1.42 with 95% confidence interval extending from -1.412 to - 0.916 with a P value <0.001. Mean paired differences for hospitalization were -0.453 0.955 with 95% confidence interval extending from -0.620 to -0.286 with a P value <0.001. CONCLUSION: A simple protocol in outpatient's asthma clinic can significantly reduce ER visits and hospitalizations in chronic asthmatics. All asthmatics, irrespective of severity benefited significantly from the protocol.