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The last 2 decades have seen a growing trend towards the use of noninvasive ventilation (NIV) therapy in the management of many conditions that cause acute respiratory failure. However, there is a serious side effect that results in using these devices; the development of facial skin pressure damage, specifically pressure ulcers. This skin damage has a considerable effect on patients’ quality of life, treatment adherence and patients’ comfort in addition to the therapy challenges of wound care. The aim of this clinical review is to discuss the different characteristics of NIV interfaces and to provide evidence based recommendations to facilitate the selection and application of such interfaces to reduce NIV interfaces related pressure ulcers.

The respiratory care (RC) profession in Saudi Arabia is over 40-year-old. Although there have been major advancements in the profession, no history and enough information are available about its development and evolvement at current. This paper describes the history and development of the field of RC and future prospects for the profession in Saudi Arabia. A comprehensive review and assessment were conducted through direct contact, interviews, and a review of existing documents in the Medical Services Division of the Ministry of Defense, the Ministry of Health, The Ministry of Civil Services, representative hospitals, academic institutions, and other relevant texts. The data obtained were evaluated for its relevance and grouped on a thematic basis. This is currently the first paper about the history and development of the RC profession in Saudi Arabia over the last 45 years.

BACKGROUND:We conducted this national survey to quantitatively assess sleep medicine services in the Kingdom of Saudi Arabia (KSA) and to identify obstacles that specialists and hospitals face, precluding the establishment of this service.MATERIALS AND METHODS:A self-administered questionnaire was designed to collect the following: General information regarding each hospital, information regarding sleep medicine facilities (SFs), the number of beds, the number of sleep studies performed and obstacles to the establishment of SFs. The questionnaire and a cover letter explaining the study objectives were mailed and distributed by respiratory care practitioners to 32 governmental hospitals and 18 private hospitals and medical centers in the KSA.RESULTS:The survey identified 18 SFs in the KSA. The estimated per capita number of beds/year/100,000 people was 0.11 and the per capita polysomnography (PSG) rate was 18.0 PSG/year/100,000 people. The most important obstacles to the progress of sleep medicine in the KSA were a lack of trained sleep technologists and a lack of sleep medicine specialists.CONCLUSION:The sleep medicine services provided in the KSA have improved since the 2005 survey; however, these services are still below the level of service provided in developed countries. Organized efforts are needed to overcome the identified obstacles and challenges to the progress of sleep medicine in the KSA.

Obstructive sleep apnoea is a common condition associated with cardiovascular risk. Continuous positive airway pressure (CPAP) is an effective treatment but is associated with nasal side-effects, which hinder compliance and may result from inflammation.We investigated whether CPAP was pro-inflammatory to human subjects in vivo, and to cultured bronchial epithelial cells in vitro. In vivo, we further investigated whether induction of nasal inflammation was associated with the development of systemic inflammation, nasal symptoms and changes in nasal mucociliary clearance.In vitro, CPAP resulted in cytokine release from cultured BEAS-2B cells in a time-and dose (pressure)-dependent manner. In vivo, CPAP resulted in dose-dependent upregulation of nasal inflammatory markers associated with the development of nasal symptoms, and reduced mucociliary clearance. CPAP also upregulated selected markers of systemic inflammation.CPAP results in dose-dependent release of inflammatory cytokines from human epithelial cells in vitro and in vivo. In vivo responses were associated with systemic inflammation, reductions in nasal mucociliary function and the development of nasal symptoms. This emphasises the need for novel strategies to reduce nasal inflammation and therefore aid compliance.

Objectives: In August 2019, Saudi Arabia started implementing plain packaging for cigarettes. Three months later, an opposing campaign on twitter using an Arabic hashtag “the new smoke” gained momentum amongst smokers. The purpose of this study is to document this opposing campaign’s timeline and describe consumers, government, and tobacco industry rhetoric. Methods: We created a timeline of the campaign events then performed online social listening of Arabic twitter hashtags related to the campaign. Results: Campaigners mainly complained of an unfavorable new taste in cigarette packs with plain packaging. The messaging developed to accusations to government entities and neighboring countries, and then after threats to boycott tobacco companies. The campaign received a significant amount of media coverage and elicited an official response from a number of Saudi government bodies, such as the Saudi Food and Drug Authority and Ministry of Commerce and Investment. Conclusion: This case points at a need for risk communication training, possible tobacco industry manipulation, and a need to gain consumer trust with evidence-based messaging techniques. The case of cigarette plain packaging adoption in Saudi Arabia serves as an example to other countries of potential consumer interaction, tobacco industry interference, and state official counter-reactions.

BackgroundClinical and research utility of non-cardiac ultrasound (US) in chronic obstructive pulmonary disease (COPD) has been widely investigated. However, there is no systematic review assessing the clinical values of non-cardiac US techniques in COPD.MethodsWe systematically searched electronic databases from inception to 24 June 2020. Two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines extracted data. A narrative synthesis of the results was conducted considering non-cardiac US techniques that looked for diaphragm, muscles and bones in patients with COPD.ResultsIn total, 2573 abstracts were screened, and 94 full-text papers were reviewed. A total of 54 studies met the inclusion criteria. Thirty-five studies assessed the diaphragm, while 19 studies evaluated different muscles, including limb muscles and pulmonary lesions in COPD using US. Of the 54 included studies, 30% (16/54) evaluated the changes in either limb muscles or diaphragmatic features before and after physical interventions; 67% (36/54) assessed the correlations between sonographic features and COPD severity. Indeed, 14/15 and 9/13 studies reported a significant reduction in diaphragm excursion and thickness in COPD compared with healthy subjects, respectively; this was correlated significantly with the severity and prognosis of COPD. Three studies reported links between diaphragm length and COPD, where lower diaphragm length correlated with poorer prognosis and outcomes. Quadriceps (rectus femoris), ankle dorsiflexor (tibialis anterior) and vastus lateralis were the most common muscles in COPD assessed by US. More than 70% (12/17) of the studies reported a significant reduction in the cross-sectional area (CSA) of the rectus femoris, rectus femoris and vastus lateralis thickness in COPD compared with healthy subjects. Quadriceps CSA and thickness correlated positively with COPD prognosis, in which patients with reduced quadriceps CSA and thickness have higher risk of exacerbation, readmission and death.ConclusionUS measurements of diaphragm excursion and thickness, as well as lower limb muscles strength, size and thickness, may provide a safe, portable and effective alternative to radiation-based techniques in diagnosis and prognosis as well as tracking improvement postintervention in patients with COPD.

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