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Abdulelah M Aldhahir,1 Heba M Bintalib,2,3 Rayan A Siraj,4 Jaber S Alqahtani,5 Omar A Alqarni,6 Abdullah A Alqarni,7 Hanin S Alghamdi,8 Mohammed M Alyami,9 Abdallah Y Naser,10 Alaa I Fatani,11 Hassan Alwafi11 1Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Department of Respiratory Care, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 3King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia; 4Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia; 5Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 6Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 7Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Respiratory Therapy, King Fahad General Hospital, Jeddah, Saudi Arabia; 9Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia; 10Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan; 11Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi ArabiaCorrespondence: Abdulelah M Aldhahir, Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Saudi Arabia, Tel +966557775561, Email Aldhahir.abdulelah@hotmail.comBackground: Nomophobia has been highly prevalent among health discipline students. However, there is no available data on the prevalence of nomophobia among respiratory therapy (RT) students in Saudi Arabia.Methods: A cross-sectional survey using the nomophobia questionnaire (NMP-Q) was conducted and distributed using a convenience sample of RT students through an online platform (Survey Monkey) between September and November 2022.Results: Overall, 1428 RT students, with males accounting for 773 (54%), responded to the online survey. The prevalence of nomophobia among RT students was 97.3% (1390). The mean (±SD) of the total NMP-Q items scores was 62 (± 22), indicating a moderate level of nomophobia among the RT students. Female RT students had significantly higher nomophobia scores than male RT students (63 (47– 80) vs 59 (43– 75); p < 0.001)). Single RT students had significantly higher nomophobia scores than married RT students (62 (46– 78) vs 46 (37– 64); p < 0.001)). RT students who were living outside the family home had significantly higher nomophobia scores than RT students who were living with their family (66 (54– 78) vs 60 (44– 77); p = 0.001)). RT students with a GPA of 4.50 to 5.00 had the highest nomophobia score (63 (46– 79); p = 0.005)). RT students who were in their third year had the highest nomophobia score (66 (48– 80); p < 0.001)). RT students who reported no academic warnings had the highest nomophobia score (63 (48– 80); p < 0.001)). RT students who spent ≥ five hours studying per week had the highest nomophobia score (64 (51– 80); p < 0.001)).Conclusion: Nomophobia is common among RT students, with the majority experiencing a moderate level. Being female, single, living outside the family home, and having a higher academic performance were risk factors associated with higher nomophobia levels.Keywords: nomophobia, respiratory therapy, NMP-Q

Jaber S Alqahtani,1 Abdulelah M Aldhahir,2 Zaid Alanazi,3 Emad Zahi Alsulami,4 Mujahid A Alsulaimani,5 Abdullah A Alqarni,6 Abdullah S Alqahtani,1 Ayadh Yahya AlAyadi,1 Musallam Alnasser,1 Ibrahim A AlDraiwiesh,1 Saeed M Alghamdi,7 Hussam M Almarkhan,1 Abdullah S Alsulayyim,2,8 Saad M AlRabeeah,1 Mohammed D AlAhmari1 1Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia; 2Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia; 3Family Medicine Department, Northern Area Armed Forces Hospital (NAAFH), Hafar Al Batin, Saudi Arabia; 4Family Medicine Department, Armed Forces Hospital in King Abdulaziz Airbase, Dhahran, Saudi Arabia; 5Basic Medical Unit, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia; 6Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 7Respiratory Care Program, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, 24382, Saudi Arabia; 8National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UKCorrespondence: Jaber S Alqahtani, Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia, Email Alqahtani-Jaber@hotmail.comBackground: Smoking behavior has been associated with poor academic performance among adult students worldwide. However, the detrimental effect of nicotine dependence on several students’ academic achievement indicators is still unclear. This study aims to assess the impact of smoking status and nicotine dependence on grade point average (GPA), absenteeism rate and academic warnings among undergraduate health sciences students in Saudi Arabia.Methods: A validated cross-sectional survey was conducted, in which, participants responded to questions evaluated cigarette consumption, urge to consume and dependency, learning performance, days of absentees, and academic warnings.Results: A total of 501 students from different health specialties have completed the survey. Of whom, 66% were male, 95% ranging between the age of 18– 30 years old, and 81% reported no health issues or chronic diseases. Current smokers estimated to be 30% of the respondents, of which 36% revealed smoking history of 2– 3 years. The prevalence of nicotine dependency (high to extremely high) was 50%. Overall, smokers had significantly lower GPA, higher absenteeism rate, and higher number of academic warnings when compared to nonsmokers (p< 0.001). Heavy smokers demonstrated significantly less GPA (p=0.036), higher days of absences (p=0.017), and more academic warnings (p=0.021) compared to light smokers. The linear regression model indicated a significant association between smoking history (increased pack-per-year) and poor GPA (p=0.01) and increased number of academic warning last semester (p=0.01), while increased cigarette consumption was substantially linked with higher academic warnings (p=0.002), lower GPA (p=0.01), and higher absenteeism rate for last semester (p=0.01).Conclusion: Smoking status and nicotine dependence were predictive of worsening academic performance, including lower GPA, higher absenteeism rate and academic warnings. In addition, there is a substantial and unfavorable dose–response association between smoking history and cigarette consumption with impaired academic performance indicators.Keywords: smoking, nicotine dependence, academic performance, health sciences, student

Jaber S Alqahtani,1 Mohammed D AlAhmari,1,2 Hajed M Al-Otaibi,3 Saad M AlRabeeah,1 Noor A Al Khathlan,4 Abdulelah M Aldhahir,5 Abdullah S Alqahtani,1 Khalid S Alwadeai,6 Saleh S Algarni,7,8 Rayan A Siraj,9 Abdullah A Alqarni,3 Mohammed A Almeshari,6 Saeed M Alghamdi,10 Mohammed AlTaweel,11 Musallam Alnasser,1 Jithin K Sreedharan,1 Abdullah A Almojaibel,4 Mushabbab Alahmari,12 Yousef S Aldabayan,9 Bodor H Bin Sheeha,13 Fahad H Alahmadi,14 Abdullah S Alsulayyim,5,15 Eidan M Alzahrani16 1Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia; 2Dammam Medical Complex, Dammam Health Network – Eastern Health Cluster, Dammam, 32245, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 4Respiratory Care Department, Imam Abdulrahman bin Faisal University, Dammam, 34212, Saudi Arabia; 5Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia; 6Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 11451, Saudi Arabia; 7Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia; 8King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 9Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, 31982, Saudi Arabia; 10Respiratory Care Program, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, 24382, Saudi Arabia; 11Respiratory Care Department, AlMaarefa University, Riyadh, 13713, Saudi Arabia; 12Department of Respiratory Therapy, Faculty of Applied Medical Sciences, University of Bisha, Bisha, 67714, Saudi Arabia; 13Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11564, Saudi Arabia; 14Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Madinah, 42353, Saudi Arabia; 15National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UK; 16Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi ArabiaCorrespondence: Jaber S Alqahtani, Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia, Email Alqahtani-Jaber@hotmail.comBackground: Despite recent advancements in the respiratory care (RC) profession, no single institution in the Kingdom of Saudi Arabia (KSA) offers a master’s degree program in RC.Methods: A nationwide and validated survey was used to explore the current needs and interests in establishing RC master’s degree programs in the KSA. The process included representatives from the healthcare industry, universities, and professional societies.Results: A total of 1250 stakeholders across the KSA completed the survey. The sample includes 722 (58%) males, 504 (40%) respiratory therapists, 547 (44%) students, 138 (11%) leaders, and 61 (5%) were academic respondents. Most respondents were from Central 491 (39%) and Eastern 307 (25%) regions, with 1003 (80%) of the total sample worked or studied in governmental sectors. A total of 574 (82%) of the leaders and RTs had Bachelor degree and 430 (61%) of them had 1– 5 years working experience. According to 80% of the employers and employees, only 0– 5% of the RTs in their organization had a master’s degree. The calculated mean % of the agreement (agree/strongly agree) on the needs was 83% in all needs’ assessment items, which shows a great support for establishing a master’s in RC to meet the personal, professional and society needs. The mean % of the agreement for the level of interests among all participants was 86%, indicating a great level of interests in establishing a master degree in RC. The agreement % on the needs assessment and level of interests in establishing a master degree in RC in KSA were ≥ 80% in each stakeholder group.Conclusion: There are obvious needs and interests in establishing master’s degree programs in RC in the KSA. A master’s degree in RC should be established to address the growing needs for advanced RC services throughout the nation and enhance RC research.Keywords: respiratory care, master degree, education, Saudi Arabia, NCAAA, accreditation

This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV).NIV is used increasingly in acute respiratory failure (ARF). Sedation and analgesia are potentially beneficial in NIV, but they can have a deleterious impact. Proper guidelines to specifically address this issue and the recommendations for or against it are scarce in the literature. In the most recent guidelines published in 2017 by the European Respiratory Society/American Thoracic Society (ERS/ATS) relating to NIV use in patients having ARF, the well-defined recommendation on the selective use of sedation and analgesia is missing. Nevertheless, some national guidelines suggested using sedation for agitation.Electronic databases (PubMed/Medline, Google Scholar, and Cochrane library) from January 1999 to December 2019 were searched systematically for research articles related to sedation and analgosedation in NIV. A brief review of the existing literature related to sedation and analgesia was also done.Sixteen articles (five randomized trials) were analyzed. Other trials, guidelines, and reviews published over the last two decades were also discussed. The present review analysis suggests dexmedetomidine as the emerging sedative agent of choice based on the most recent trials because of better efficacy with an improved and predictable cardiorespiratory profile.Current evidence suggests that sedation has a potentially beneficial role in patients at risk of NIV failure due to interface intolerance, anxiety, and pain. However, more randomized controlled trials are needed to comment on this issue and formulate strong evidence-based recommendations.Karim HMR, Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, et al. Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations. Indian J Crit Care Med 2022;26(8):938-948.

Mohammed A Almeshari,1,2 Ziyad Alshehri,3 Jaber S Alqahtani,4 Ali M Alasmari,3 Ahmed A Alzahrani,3 Fahad H Alahmadi,3 Abdullah S Alsulayyim,5 Faraj K Alenezi,6 Khalid S Alwadeai1 1Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; 3Department of Respiratory Therapy, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia; 4Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 5Department of Respiratory Care, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 6College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCorrespondence: Mohammed A Almeshari, Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia, Tel +966 11 469 3593, Email malmeshari@ksu.edu.saBackground: Respiratory Care Practitioner (RCP) is a vital healthcare professional in Saudi Arabia (SA). Many factors regarding the education of RCPs in SA are unknown, including the number of active institutions, levels of education and barriers to promoting the profession.Methods: A cross sectional-based survey was conducted between June 1st, 2020 and September 20th, 2020 in SA to explore the status of RCPs education. Institutions that offered RCP programs were identified through the Ministry of Education and Ministry of Defense academic programs websites. The RCP program directors were invited to participate in an electronic survey.Results: Among the 74 institutions searched, 23 indicated that they offered RC programs. Only 13 (56.52%) responded to the survey. Among all programs, four (17.39%) were inactive, 17 (73.91%) were governmental institutions, and only one (4.35%) obtained a national accreditation. From the 13 respondents, there were 1297 students enrolled and 123 full-time faculty members. None of the institutions reported offering postgraduate RC degrees. The respondents reported many barriers; however, shortage of staff (76.92%), lack of postgraduate programs (69.23%), lack of research activity (69.23%), and ineffective communications between institutions (61.54%) were the most reported barriers.Conclusion: The RC education in SA is developing but not well distributed throughout the country. The shortage of staff and the limited number of postgraduate degree holders potentially contributed to the delay in establishing postgraduate RC degrees, obtaining accreditation, and implementing subspecialties to advance the profession in terms of research and quality of care.Keywords: respiratory care, education, respiratory therapy, Saudi Arabia

BackgroundChronic obstructive pulmonary disease (COPD) is associated with disruption in autonomic nervous control of the heart rhythm. We present here quantitative evidence of the reduction in HRV measures as well as the challenges to clinical application of HRV in COPD clinics.MethodFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we search in June 2022 Medline and Embase databases for studies reporting HRV in COPD patients using relevant medical subject headings (MeSH) terms. The quality of included studies was assessed using the modified version of the Newcastle–Ottawa Scale (NOS). Descriptive data were extracted, while standardized mean difference was computed for changes in HRV due to COPD. Leave-one-out sensitivity test was performed to assess exaggerated effect size and funnel plots to assess publication bias.ResultsThe databases search yielded 512 studies, of which we included 27 that met the inclusion criteria. The majority of the studies (73%) had a low risk of bias and included a total of 839 COPD patients. Although there were high between-studies heterogeneity, HRV time and frequency domains were significantly reduced in COPD patients compared with controls. Sensitivity test showed no exaggerated effect sizes and the funnel plot showed general low publication bias.ConclusionCOPD is associated with autonomic nervous dysfunction as measured by HRV. Both sympathetic and parasympathetic cardiac modulation were decreased, but there is still a predominance of sympathetic activity. There is high variability in the HRV measurement methodology, which affects clinical applicability.

Objective To investigate the trends in hospital admissions and medication prescriptions related to asthma and chronic obstructive pulmonary disease (COPD) in England and Wales. Methods An ecological study was conducted between April 1999 and April 2020 using data extracted from the hospital episode statistics database in England and the patient episode database for Wales. The Office of National Statistics mid-year population estimates for 1999 through 2020 were collected, and medication prescription data for 2004–2020 were extracted from the prescription cost analysis database. Results The total annual number of COPD and asthma hospital admissions for various causes increased by 82.2%, from 210,525 in 1999 to 383,652 in 2020, representing a 59.1% increase in hospital admission rate (from 403.77 in 1999 to 642.42 per 100,000 persons in 2020, p Conclusions Throughout the study period, hospital admissions due to chronic obstructive pulmonary disease and asthma, as well as medication prescriptions, increased dramatically among all age groups. Hospitalization rates were higher for women. Further observational and epidemiological research is required to identify the factors contributing to increased hospitalization rates.

Background Acute exacerbations (AEs) and disease progression in interstitial lung disease (ILD) pose important challenges to clinicians and patients. AEs of ILD are variable in presentation but may result in rapid progression of ILD, respiratory failure and death. However, in many cases AEs of ILD may go unrecognised so that their true impact and response to therapy is unknown. The potential for home monitoring to facilitate early, and accurate, identification of AE and/or ILD progression has gained interest. With increasing evidence available, there is a need for a systematic review on home monitoring of patients with ILD to summarise the existing data. The aim of this review was to systematically evaluate the evidence for use of home monitoring for early detection of exacerbations and/or progression of ILD. Method We searched Ovid-EMBASE, MEDLINE and CINAHL using Medical Subject Headings (MeSH) terms in accordance with the PRISMA guidelines (PROSPERO registration number CRD42020215166). Results 13 studies involving 968 patients have demonstrated that home monitoring is feasible and of potential benefit in patients with ILD. Nine studies reported that mean adherence to home monitoring was >75%, and where spirometry was performed there was a significant correlation (r=0.72–0.98, p, First systematic review that provides supportive evidence for the feasibility and utility of home monitoring in ILD; further studies are necessary to evaluate approaches to detect exacerbation and/or progression https://bit.ly/2Y8OCJL

BackgroundThe COVID-19 pandemic and associated preventative measures introduced a shock to the teaching paradigm in Saudi Arabia and the world. While many studies have documented the challenges and perceptions of students during the COVID-19 pandemic, less attention has been given to higher education staff. The aim of the present investigation is to evaluate the staff’s perception and experiences of online teaching during the COVID-19 pandemic.Materials and methodsA validated survey was conducted between December 2021 and June 2022 in Saudi Arabian Universities to assess the status of online teaching during the COVID-19 pandemic among faculty members. The collected responses were exploratively and statistically analyzed.ResultsA total of 1117 response was received. About 66% of the respondents were male and 90% of them hold postgraduate degree. Although rarely or occasionally teach online pre-COVID-19, only 33% of the respondents think the transition was difficult and 55% of them support the move. Most respondents received adequate training (68%) and tools (80%) and 88% of the respondents mentioned that they did not accrue additional workload in online study design. While the perception of online teaching was mostly positive (62%) with high satisfaction (71%). However, 25% of the respondents reported that a poor internet bandwidth was an obstacle and 20% was unable to track students’ engagement. Respondents with more years of experience, previous training, support, or perceived online transition as easy were also more likely to be satisfied with the process. Also, older respondents, those who support the transition and those with previous training were less likely to report barriers (allp< 0.001).ConclusionThe perception and experience of transition to online teaching during the COVID-19 pandemic in Saudi Arabia were positive. Low internet bandwidth and inability to track students’ limited effective online teaching. Work experience, previous training, and positive perception are the main factors that influence staff online teaching satisfaction.

Accurate classification of brain tumor subtypes is important for prognosis and treatment. Researchers are developing tools based on static and dynamic feature extraction and applying machine learning and deep learning. However, static feature requires further analysis to compute the relevance, strength, and types of association. Recently Bayesian inference approach gains attraction for deeper analysis of static (hand-crafted) features to unfold hidden dynamics and relationships among features. We computed the gray level co-occurrence (GLCM) features from brain tumor meningioma and pituitary MRIs and then ranked based on entropy methods. The highly ranked Energy feature was chosen as our target variable for further empirical analysis of dynamic profiling and optimization to unfold the nonlinear intrinsic dynamics of GLCM features extracted from brain MRIs. The proposed method further unfolds the dynamics and to detailed analysis of computed features based on GLCM features for better understanding of the hidden dynamics for proper diagnosis and prognosis of tumor types leading to brain stroke.

The coronavirus disease 2019 (COVID-19) pandemic presents a significant global public health challenge. One in five individuals with COVID-19 presents with symptoms that last for weeks after hospital discharge, a condition termed "long COVID". Thus, efficient follow-up of patients is needed to assess the resolution of lung pathologies and systemic involvement. Thoracic imaging is multimodal and involves using different forms of waves to produce images of the organs within the thorax. In general, it includes chest X-ray, computed tomography, lung ultrasound and magnetic resonance imaging techniques. Such modalities have been useful in the diagnosis and prognosis of COVID-19. These tools have also allowed for the follow-up and assessment of long COVID. This review provides insights on the effectiveness of thoracic imaging techniques in the follow-up of COVID-19 survivors who had long COVID.

α-Fe2O3 coated hydroxy magnesium silicate (HMS) was prepared by the coprecipitation method and was used for the sorption of Cr(VI) from the aquatic environment. FT-IR, XRD, and SEM characterised th...

Background: Poor sleep quality, depression, and anxiety are common comorbidities among individuals with chronic respiratory diseases (CRDs). However, there has been no work to estimate their prevalence and assess their associations among the CRDs population in Saudi Arabia. Methods: A cross-sectional study was conducted in primary healthcare centers and included a total of 390 patients. Structured self-administered questionnaires were completed that included the Sleep Quality Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Score (HADS). Multiple linear regression analyses were performed to assess the associations between patients’ characteristics and sleep disturbance, anxiety and depression. Results: Poor sleep quality, depression, and anxiety affect 75%, 49.2%, and 36.4% of the study participants, respectively. The PSQI was significantly correlated with anxiety (r = 0.30) and depression (r = 0.16). Furthermore, a significant correlation was found between anxiety and depression (r = 0.44). The predictors of poor sleep quality were age, gender, and family history of CRDs, education level and anxiety and these variables accounted for 0.19% of the variance in PSQI. Variables that independently predicted an increased level of depression were age, gender, marital status, family history of CRDs, diagnosis, previous hospital admission, the presence of comorbidities, dyspnea last month and anxiety. On the other hand, the variables that independently predicted an increased level of anxiety were age, BMI, family history of CRDs, previous hospital admission, the presence of comorbidities, dyspnea last month and depression. Conclusion: Healthcare providers managing patients with CRDs should be alert to the high prevalence of poor sleep quality, depression, and anxiety. Appropriate interventions to reduce the prevalence should be developed and timely applied.

Background: Severe COVID-19 is associated with hypoxemia and acute respiratory distress syndrome (ARDS), which may predispose multiorgan failure and death. Inhaled nitric oxide (iNO) is a clinical vasodilator used in the management of acute respiratory distress syndrome (ARDS). This study evaluated the response rate to iNO in patients with COVID-19-ARDS. Method: We searched Medline and Embase databases in May 2022, and data on the use of iNO in the treatment of ARDS in COVID-19 patients were synthesized from studies that satisfied predefined inclusion criteria. A systematic synthesis of data was performed followed by meta-analysis. We performed the funnel plot and leave-one-out sensitivity test on the included studies to assess publication bias and possible exaggerated effect size. We compared the effect size of the studies from the Unites States with those from other countries and performed meta-regression to assess the effect of age, year of publication, and concomitant vasodilator use on the effect size. Results: A total of 17 studies (including 712 COVID-19 patients) were included in this systematic review of which 8 studies (involving 265 COVID-19 patients) were subjected to meta-analysis. The overall response rate was 66% (95% CI, 47–84%) with significantly high between-studies heterogeneity (I2 = 94%, p < 0.001). The funnel plot showed publication bias, although the sensitivity test using leave-one-out analysis showed that removing any of the study does not remove the significance of the result. The response rate was higher in the Unites States, and meta-regression showed that age, year of publication, and use of concomitant vasodilators did not influence the response rate to iNO. Conclusion: iNO therapy is valuable in the treatment of hypoxemia in COVID-19 patients and may improve systemic oxygenation in patients with COVID-19-ARDS. Future studies should investigate the mechanism of the activity of iNO in COVID-19 patients to provide insight into the unexplored potential of iNO in general ARDS.

Background Multiple vaccines have been tested in clinical trials for their efficacy and safety. In Saudi Arabia, Pfizer–BioNTech or Moderna were approved for children, however, previous studies to report their safety profile are limited. This research aims to understand the side effect of children's vaccination against SARS-CoV-2 infection in Saudi Arabia. Methods This was an observational retrospective cross-sectional study was conducted using an online survey in Saudi Arabia from March to May 2022. The inclusion criteria were parents aged 18 years and above who live in Saudi Arabia and have vaccinated their children. The self-reported questionnaire was adopted from published studies to investigate the study objectives Descriptive statistics were used to describe patients’ demographic characteristics, continuous data were reported as mean ± S.D., categorical data were reported as percentages (frequencies), and logistic regression was used to identify predictors of persistent post-COVID-19 symptoms. Results This study had a total of 4,069 participants. Only 41.9% of the participants reported that their child(ren) had been infected with the coronavirus. 2.00 was the median number of children (IQR: 1.00–4.00). More than half of the study participants (64.2%) reported that a family member had been infected with the coronavirus. Both parents received COVID-19 vaccination, according to most participants (88.7%). Most participants (70.5%) stated that all children who met the vaccination criteria had received the vaccine. Most participants (83.5%) said their child or children had two doses of their vaccine, and about half (50.4%) of those who received the vaccine reported experiencing side effects. In addition, the majority (78.9%) reported that the side effects appeared within one day of receiving the vaccine, and nearly two-thirds (65.7%) reported that the side effects lasted between one and three. A total of 11,831 side effects cases were documented. Pain at the injection site, hyperthermia, and fatigue were the most reported side effects, accounting for 15.3%, 14.1%, and 13.2%, respectively. Conclusion It appears that the side effects of the COVID-19 vaccine for children are minor, tolerable, and like those described previously in clinical trials. Our data should encourage the public about the safety of receiving the COVID-19 vaccine for children.

Introduction Invasive mechanical ventilation (IMV) is associated with several complications. Placement of a long-term airway (tracheostomy) is also associated with short and long-term risks for patients. Nevertheless, tracheostomies are placed to help reduce the duration of IMV, facilitate weaning and eventually undergo successful decannulation. Methods We performed a narrative review by searching PubMed, Embase and Medline databases to identify relevant citations using the search terms (with synonyms and closely related words) “non-invasive ventilation”, “tracheostomy” and “weaning”. We identified 13 publications comprising retrospective or prospective studies in which non-invasive ventilation (NIV) was one of the strategies used during weaning from IMV and/or tracheostomy decannulation. Results In some studies, patients with tracheostomies represented a subgroup of patients on IMV. Most of the studies involved patients with underlying cardiopulmonary comorbidities and conditions, and primarily involved specialized weaning centres. Not all studies provided data on decannulation, although those which did, report high success rates for weaning and decannulation when using NIV as an adjunct to weaning patient off ventilatory support. However, a significant percentage of patients still needed home NIV after discharge. Conclusions The review supports a potential role for NIV in weaning patients with a tracheostomy either off the ventilator and/or with its decannulation. Additional research is needed to develop weaning protocols and better characterize the role of NIV during weaning.