Search

Abstract Background This study aimed to assess the knowledge and current practice of using the airway pressure release ventilation (APRV) mode with acute respiratory distress syndrome (ARDS) patients and identify barriers to not using this mode of ventilation among nurses who work in critical areas in Saudi Arabia. Methods Between December 2022 and April 2023, a cross-sectional online survey was disseminated to nurses working in critical care areas in Saudi Arabia. The characteristics of the respondents were analyzed using descriptive statistics. Percentages and frequencies were used to report categorical variables. Results Overall, 1,002 nurses responded to the online survey, of whom 592 (59.1%) were female. Only 248 (24.7%) nurses had ever used APRV mode, whereas only 229 (22.8%) received training on APRV mode. Moreover, 602 (60.0%) nurses did not know whether APRV was utilized in their hospital. Additionally, 658 (65.6%) nurses did not know whether APRV mode was managed using a standard protocol. Prone positioning was the highest recommended intervention by 444 (43.8%) when a conventional MV failed to improve oxygenation in patients with ARDS. 323 (32.2%) respondents stated that the P-high should be set equal to the plateau pressure on a conventional ventilator, while 400 (39.9%) said that the P-low should match PEEP from a conventional ventilator. Almost half of the respondents (446, 44.5%) stated that the T-high should be set between 4 and 6 s, while 415 (41.4%) said that the T-low should be set at 0.4 to 0.8 s. Over half of the nurses (540, 53.9%) thought that the maximum allowed tidal volume during the release phase should be 4–6 ml/kg. Moreover, 475 (47.4%) believed that the maximum allowed P-high setting should be 35 cm H2O. One-third of the responders (329, 32.8%) stated that when weaning patients with ARDS while in APRV mode, the P-high should be reduced gradually to reach a target of 10 cm H2O. However, 444 (44.3%) thought that the T-high should be gradually increased to reach a target of 10 s. Half of the responders (556, 55.5%) felt that the criteria to switch the patient to continuous positive airway pressure (CPAP) were for the patient to have an FiO2 ≤ 0.4, P-high ≤ 10 cm H2O, and T-high ≥ 10 s. Lack of training was the most common barrier to not using APRV by 615 (61.4%). Conclusion The majority of nurses who work in critical care units have not received sufficient training in APRV mode. A significant discrepancy was observed regarding the clinical application and management of APRV parameters. Inadequate training was the most frequently reported barrier to the use of APRV in patients with ARDS.

IntroductionThe aging process is intricately linked to alterations in cellular and tissue structures, with the respiratory system being particularly susceptible to age-related changes. Therefore, this study aimed to profile the activity of proteases using activity-based probes in lung tissues of old and young rats, focusing on the expression levels of different, in particular cathepsins G and X and matrix Metalloproteinases (MMPs). Additionally, the impact on extracellular matrix (ECM) components, particularly fibronectin, in relation to age-related histological and ultrastructural changes in lung tissues was investigated.Materials and methodsLung tissues from old and young rats were subjected to activity-based probe profiling to assess the activity of different proteases. Expression levels of cathepsins G and X were quantified, and zymography was performed to evaluate matrix metalloproteinases activity. Furthermore, ECM components, specifically fibronectin, were examined for signs of degradation in the old lung tissues compared to the young ones. Moreover, histological, immunohistochemical and ultrastructural assessments of old and young lung tissue were also conducted.ResultsOur results showed that the expression levels of cathepsins G and X were notably higher in old rat lung tissues in contrast to those in young rat lung tissues. Zymography analysis revealed elevated MMP activity in the old lung tissues compared to the young ones. Particularly, significant degradation of fibronectin, an essential ECM component, was observed in the old lung tissues. Numerous histological and ultrastructural alterations were observed in old lung tissues compared to young lung tissues.Discussion and conclusionThe findings indicate an age-related upregulation of cathepsins G and X along with heightened MMP activity in old rat lung tissues, potentially contributing to the degradation of fibronectin within the ECM. These alterations highlight potential mechanisms underlying age-associated changes in lung tissue integrity and provide insights into protease-mediated ECM remodeling in the context of aging lungs.

ObjectivesThis study aimed to evaluate and compare the prevalence of Forward Head Posture (FHP) in car and bike drivers, and its potential correlation with neck and cardiopulmonary parameters.MethodsThis cross-sectional study involved 400 participants from urban and suburban areas around Lucknow, Uttar Pradesh, India, including 200 car drivers and 200 bike drivers aged 18-65 years with a minimum five-year driving history. Neck health was assessed using measurements such as cervical range of motion and Neck Disability Index (NDI), cardiopulmonary parameters were evaluated through resting heart rate, blood pressure, and pulmonary function tests using the spirometry test, and FHP was assessed using Surgimap application. Statistical analysis was performed using IBM SPSS Statistics software (version 26.0) and included descriptive statistics, hypothesis testing, Chi-square or Fisher's exact test for binary data, and correlation analyses.ResultsThe result show that difference in the mean FHP between car and bike drivers was statistically significant (p = 0.0001), indicating a higher prevalence of FHP among car drivers than among bike drivers. Correlation analyses revealed significant associations between FHP and neck health metrics, especially cervical flexion (r = 0.71, pConclusionWe observed a higher incidence of FHP in car drivers, indicating that a prolonged static posture may lead to greater postural deviation than dynamic movement during biking. This association suggests that FHP could have wide-reaching implications for systemic health, beyond musculoskeletal issues. These findings have the potential to influence preventative strategies and interventions aimed at improving the overall health outcomes for drivers.

Introduction: There is evidence showing that central nervous system TB (CNS-TB) causes meningitis, pachymeningitis, tuberculomas, and granulomas. However, the impact of pulmonary or spine TB on brain morphology and thickness is yet to be documented. TB is associated with increased levels of inflammatory biomarkers in specific brain regions. Objectives: The primary aim of this study was to compare cortical-brain volume and thickness between patients with pulmonary or spine TB and non-TB individuals and investigate the association between inflammatory biomarkers and brain volume or thickness among patients with pulmonary or spine TB. Methods: Participants ranging in age from 18 to 65 years (23 TB patients and 50 healthy controls), who were scanned using 1.5-T MRI at Jazan Hospital, were compared in terms of brain volumes and thicknesses. Brain volume and thickness were measured using FreeSurfer. Results: There were significant differences in the volumes of the bilateral and total amygdala and accumbens areas, right hippocampus and cerebellum, and CSF, and in the thickness of the right pericalcarine area between patients with pulmonary or spine TB and healthy controls. We also found significant associations between inflammatory biomarkers (CRP, WBC, and platelets) and brain volume but not thickness in patients with TB, p

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still a global concern with high morbidity and mortality rates. The role of endothelial cells in the progress of COVID-19 is well established. Therefore, the current study aimed to measure the endothelial markers and their correlation with the hematological parameters in intensive care unit-admitted COVID-19 patients. This study involved 111 adult participants, including 55 ICU-admitted patients with COVID-19 and 56 healthy controls. Levels of E-selectin, ICAM-1, and VCAM-1 in the plasma of the study participants were measured and correlated with hematological parameters. The study demonstrates that COVID-19 patients admitted to the ICU have higher levels of E-selectin, ICAM-1, and VCAM-1 compared to healthy controls ( p < .05). These elevated levels can serve as reliable indicators of endothelial dysfunction and early markers for the detection and prediction of endothelial cell involvement in COVID-19 complications. The findings of this study suggest that increased levels of E-selectin, VCAM-1, and ICAM-1 in patients with COVID-19 are indicative of the participation of endothelial cells in the pathogenesis of COVID-19 complications. Consequently, these endothelial markers are proposed as potential early indicators for predicting the severity of COVID-19.

Allied Healthcare encompasses various professions involved in diagnosing, evaluating, and preventing diseases and disorders. Allied Healthcare Institutes (AHIs) provide education and training in these professions. However, there is currently a lack of explicit guidelines for ensuring quality excellence in AHIs. This narrative review aims to address this gap by examining existing literature on quality assurance in AHIs and proposing a conceptual framework that outlines essential components for establishing a high-quality AHI. A comprehensive search of PubMed and Google Scholar electronic databases yielded 86 relevant articles, which were analyzed and grouped into Nine themes related to the study's objectives. These themes include leadership in AHIs, student selection and support, teaching quality, curriculum development, research opportunities, stakeholder involvement, quality improvement initiatives, the impact of accreditation/certification, and physical facilities. Based on the review, the study presents 33 carefully formulated recommendations. By implementing these guidelines, policymakers and those interested in establishing AHIs can create institutions that promote the acquisition of new knowledge and skills, foster research and development, and provide excellent educational resources.

Objectives To assess the attitude of healthcare providers (HCPs) towards the delivering of pulmonary rehabilitation (PR) to patients with chronic obstructive pulmonary disease (COPD) and identify factors and barriers that might influence referral.Design A cross-sectional online survey consisting of nine multiple-choice questions.Settings Saudi Arabia.Participants 980 HCPs including nurses, respiratory therapists (RT) and physiotherapists.Primary outcome measures HCPs attitudes towards and expectations of the delivery of PR to COPD patients and the identification of factors and barriers that might influence referral in Saudi Arabia.Results Overall, 980 HCPs, 53.1% of whom were men, completed the survey. Nurses accounted for 40.1% of the total sample size, and RTs and physiotherapists accounted for 32.1% and 16.5%, respectively. The majority of HCPs strongly agreed that PR would improve exercise capacity 589 (60.1%), health-related quality of life 571 (58.3%), and disease self-management in patients with COPD 589 (60.1%). Moreover, the in-hospital supervised PR programme was the preferred method of delivering PR, according to 374 (38.16%) HCPs. Around 85% of HCPs perceived information about COPD, followed by smoking cessation 787 (80.3%) as essential components of PR besides the exercise component. The most common patient-related factor that strongly influenced referral decisions was ‘mobility affected by breathlessness’ (64%), while the ‘availability of PR centres’ (61%), the ‘lack of trained HCPs’ (52%) and the ‘lack of authority to refer patients’ (44%) were the most common barriers to referral.Conclusion PR is perceived as an effective management strategy for patients with COPD. A supervised hospital-based programme is the preferred method of delivering PR, with information about COPD and smoking cessation considered essential components of PR besides the exercise component. A lack of PR centres, well-trained staff and the authority to refer patients were major barriers to referring patients with COPD. Further research is needed to confirm HCP perceptions of patient-related barriers.

Abstract Background Pneumocystis pneumonia (PCP) is a fatal infectious disease caused by Pneumocystis jirovecii (PJP). The major factor relevant to morbidity and mortality seems to be the host inflammatory reaction. The objective of this study was to evaluate the role of IL-2, IL-4, IL-10, and IL-13 cytokine mRNA expression among suspected P. jirovecii infection. Methods This was a cross-sectional analytical study undertaken in Aseer region, Saudi Arabia. One hundred suspected PCP cases and 100 healthy controls were included in the study. Basic clinical manifestations, radiological findings, microbiological and immunological findings were extracted from the hospital records from January 2019 to August 2019, Pneumocystis detection was done by immune-fluorescent staining (IFAT, Gomorimethanamine silver staining (GMSS), Giemsa staining, Toluidine blue O (TBO), and Pneumocystis RT-PCR. Results Increased more than 5 fold, 3 fold, 4 fold, and 7 fold of IL-2, IL-4, IL-10, and IL-13 mRNA expression were observed in PCP cases compared to controls. Higher expression of IL-2 mRNA was connected with crept, wheezing and chest X-ray findings like central perihilar infiltrate, patchy infiltrate, consolidation, hilar lymphadenopathy, pneumothorax, pleural effusion which showed higher expression compared to counterpart (p

Background: Medical students are expected to excel in their academics. Hence exposing them to a certain amount of strain may sometimes cause sleep disruptions. The purpose of this study was to determine the sleep quality among Saudi Applied Medical Sciences students and its potential connections with their academic performance and mental health. Methods: This online cross-sectional questionnaire-based study was conducted at Jazan University’s College of Applied Medical Sciences in Saudi Arabia. The Pittsburgh Sleep Quality Index (PSQI), a known indicator of sleep quality, a validated mental health measure; Depression Anxiety Stress Scales-21 (DASS-21), and Academic Performance Scale (APS) with 89 internal consistencies were included in the questionnaire. The cumulative grade point average (GPA) was also used as a covariate to evaluate students’ academic success. Results: 112 people responded (response rate = 93%), and 105 of them presented comprehensive information about their backgrounds, way of life, academic standing, sleep patterns, and mental health. Participants’ average GPA and APS scores were 4.23 ± 0.52 and 33.16 ± 5.63, respectively. The mean global PSQI score was 6.47 with 2.34 of standard deviation (SD). The majority of individuals (60%) had poor sleep quality particularly due to abnormal sleep latency and lesser sleep duration, as determined by their PSQI score. The prevalence rates for depression, anxiety, and stress were higher; 53%, 54% and 40%, respectively. Both depression and anxiety were substantially correlated with poor sleep quality (p-value = 0.008, p-value = 0.01, respectively). Sleep quality had no significant effect on GPA while global PSQI and depression were significantly negatively correlated with an APS score of participants (p-value = 0.007 and 0.015, respectively). Conclusions: Higher rates of poor sleep quality and psychologically negative emotions were prevalent. Unhealthy sleep patterns were linked to increased levels of anxiety and depression. Self-perceived academic performance was negatively impacted by inadequate sleep and negative emotions, despite the fact that the GPA results were unaffected.

The emergence of multi-drug-resistant Mycobacterium tuberculosis (Mtb) strains has rendered many of the currently available anti-TB drugs ineffective. Hence, there is a pressing need to discover new potential drug targets/candidates. In this study, attempts have been made to identify novel inhibitors of the ribonuclease VapC2 of Mtb H37Rv using various computational techniques. Ribonuclease VapC2 Mtb H37Rv’s protein structure was retrieved from the PDB databank, 22 currently used anti-TB drugs were retrieved from the PubChem database, and protein–ligand interactions were analyzed by docking studies. Out of the 22 drugs, rifampicin (RIF), being a first-line drug, showed the best binding energy (−8.8 Kcal/mol) with Mtb H37Rv VapC2; hence, it was selected as a parent molecule for the design of its derivatives. Based on shape score and radial plot criteria, out of 500 derivatives designed through SPARK (Cresset®, Royston, UK) program, the 10 best RIF derivatives were selected for further studies. All the selected derivatives followed the ADME criteria concerning drug-likeness. The docking of ribonuclease VapC2 with RIF derivatives revealed the best binding energy of −8.1 Kcal/mol with derivative 1 (i.e., RIF-155841). A quantitative structure–activity relationship study revealed that derivative 1’s activity assists in the inhibition of ribonuclease VapC2. The stability of the VapC2–RIF155841 complex was evaluated using molecular dynamics simulations for 50 ns and the complex was found to be stable after 10 nsec. Further, a chemical synthesis scheme was designed for the newly identified RIF derivative (RIF-155841), which verified that its chemical synthesis is possible for future in vitro/in vivo experimental validation. Overall, this study evaluated the potential of the newly designed RIF derivatives with respect to the Mtb VapC2 protein, which is predicted to be involved in some indispensable processes of the related pathogen. Future experimental studies regarding RIF-155841, including the exploration of the remaining RIF derivatives, are warranted to verify our current findings.

Background: The wide scope and spread of Coronavirus Disease 2019 (COVID-19) could lead to a true mental health disaster, especially in countries with high caseloads. Very few studies have assessed the impact on hospital staff. This study aimed to assess mental health changes in health-care workers (Northern Area Armed Forces Hospital-Kingdom of Saudi Arabia). Materials and Methods: This is a cross-sectional study. A survey questionnaire was designed and distributed among the participants, and the survey contained demographic questions and questions related to anxiety, worries, and fears, in addition to depressive symptoms and basic sleep profile. In addition, the psychological impacts, feelings, fears of developing COVID-19, and symptoms of posttraumatic stress disorder were assessed using the Impact of Events Scale-Revised (IES-R). Results: The mean age of the staff was 38.2 years. The examined staffs showed high levels of anxiety and depressive features: 19.3% had crying and depressed mood and 2.4% had loss of motivation; they depended mainly on social media as a source of COVID-19 information. Moreover, these features correlated positively with their Post-Traumatic features measured by the IES-R. Nearly 27.3% of the participants had their duty impacted by COVID-19 and 40.6% were affected financially. Conclusion: Our study identified a vulnerable group susceptible to psychological distress. Psychological support could also be included as counseling services and development of support systems among colleagues.