AIM:To evaluate clinical and radiological outcome in surgically treated Koos 4 vestibular schwannomas. MATERIAL AND METHODS:Volumetric analysis of the tumour volumes before surgery, after surgery (before radiation), and at follow-up time-points after radiation was performed. Clinical data on facial nerve function and complications were collected. Approximately 6 months after surgery, all patients were treated with a single fraction of stereotactic radiosurgery using the gamma knife radiosurgery with a mean marginal dose of 12.9 Gy to the residual tumour volume. RESULTS:Mean tumour volume was 11.64 cm3 which was reduced to a mean volume of 4.17 cm3 after partial resection. After a mean follow-up of 100 months, residual tumour showed a decrease in volume in 20 patients, stable disease in one patient and two patients showed progressive tumour volume requiring a second operation in one patient. Facial nerve function was preserved in all patients. One patient suffered from a trigeminal neuralgia after radiation. CONCLUSION:Planned partial resection followed by radiation for patients with Koos 4 vestibular schwannoma is an effective strategy to preserve facial nerve function and achieve tumour control. Residual tumours after planned partial resection showed a mean decrease in volume of 50% at the last follow-up time point.

BackgroundArtificial intelligence (AI) is reforming healthcare, particularly in respiratory medicine and critical care, by utilizing big and synthetic data to improve diagnostic accuracy and therapeutic benefits. This survey aimed to evaluate the knowledge, perceptions, and practices of respiratory therapists (RTs) regarding AI to effectively incorporate these technologies into the clinical practice.MethodsThe study approved by the institutional review board, aimed at the RTs working in the Kingdom of Saudi Arabia. The validated questionnaire collected reflective insights from 448 RTs in Saudi Arabia. Descriptive statistics, thematic analysis, Fisher’s exact test, and chi-square test were used to evaluate the significance of the data.ResultsThe survey revealed a nearly equal distribution of genders (51% female, 49% male). Most respondents were in the 20–25 age group (54%), held bachelor’s degrees (69%), and had 0–5 years of experience (73%). While 28% had some knowledge of AI, only 8.5% had practical experience. Significant gender disparities in AI knowledge were noted (p < 0.001). Key findings included 59% advocating for basics of AI in the curriculum, 51% believing AI would play a vital role in respiratory care, and 41% calling for specialized AI personnel. Major challenges identified included knowledge deficiencies (23%), skill enhancement (23%), and limited access to training (17%).ConclusionIn conclusion, this study highlights differences in the levels of knowledge and perceptions regarding AI among respiratory care professionals, underlining its recognized significance and futuristic awareness in the field. Tailored education and strategic planning are crucial for enhancing the quality of respiratory care, with the integration of AI. Addressing these gaps is essential for utilizing the full potential of AI in advancing respiratory care practices.

Background : Smoking is a leading cause of heart and lung diseases worldwide. Though there is a decline in tobacco smoking the use of e-cigarettes is growing in popularity. Objective: To assess the long-term effects of smoking, vaping, and dual use on cardiopulmonary function capacity and quality of life. Methods: The study participants were classified into five groups: Control, Individuals who use cigarettes only, Individuals who only use e-cigarettes, Individuals who previously smoked and currently use only e-cigarettes and Individuals who use both cigarettes and e-cigarettes. Participants performed PFT, 6MWT and completed HRQoL questionnaire. Results: A total of 175(85.7% male) participants with an average age of mean(±SD)27.38(±5.75) enrolled in the study. PFT results showed significant difference in FEV 1 (L/Sec) [F (4,170) = 7.73, p≤ 0.001] η²=0.15; FEV 1 (%predicted) [F (4,170) =24.63, p≤0.001] η²=0.36; and FEV 1 /FVC (%) [F (4,170) =16.85, p≤0.001] η² = 0.28 values across the five groups. On further analysis, FEV 1 and FEV 1 (%predicted) significantly decreased in all user groups. Similarly, in FEV 1 /FVC (%) significant difference was observed with user groups except those who only use e-cigarettes. 6MWT showed a significant difference in walking distance [F (4,170) = 19.93, p≤0.001] η² =0.31. HRQoL reported a significant difference in physical function [H (4) =20.55, p≤0.001], emotional well-being [H (4) =19.21, p=0.001], and social function [H (4) =29.63, p≤0.001] domains. Individuals who use both cigarettes and e-cigarettes reported a significant decline in lung function [(FEV 1 2.96±0.41, FEV 1 (% predicted) 72.6±6.07 and FEV 1 /FVC (%) 73.65±11], 6MWT walking distance(m) (mean ±SD) 416.26±53.49. Conclusion: We observed a significant long-term impairment in lung function, cardiopulmonary capacity, and quality of life among individuals who use cigarettes and e-cigarettes compared to those who never smoked or vaped. Also, individuals who use both cigarettes and e-cigarettes showed the worst health outcomes.

Background: Over the past ten years, significant transformations have occurred in the healthcare landscape, presenting respiratory therapists (RTs) with a mix of challenges and opportunities. Hence, their perceptions about career progression and job satisfaction will be critical factor in determining the recruitment and retention of RTs. However, there are no studies in the literature that comprehensively assessed these aspects using a reliable and valid measure specific to RTs. Our objective was to develop and psychometrically test a Standardized Questionnaire (SQ) for evaluating RT's overall job satisfaction. Methods: Following consultations with experts and interviews conducted with RTs, a preliminary questionnaire was devised for the purpose of exploratory factor analysis (EFA). The 49 items of the Structured Questionnaire (SQ) were used for verification of the theorized factor structure and content validity using a confirmatory factor analysis (CFA). Principal Component Analysis (PCA), Structural Equation Modeling (SEM), and Confirmatory Factor Analysis (CFA) for the global fit were done. Cronbach's alpha was performed to estimate the internal consistency. The samples of RTs were collected from India between August 2021 and January 2022. Results: A convenience sample comprising 409 respiratory therapists (RTs) employed in India participated in the survey conducted from June 2021 to January 2022. The exploratory factor analysis revealed three factors that explained 61.2 % of the total variance. The confirmatory factor analysis yielded a 3-factor structure (X2/df = 4.4, p < 0.02, standardized root-mean-square residual = 0.05, goodness of fit index = 0.94, comparative fit index = 0.98). The Cronbach's alpha was 0.94 for the total scale. Conclusions: Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) are becoming more prevalent, especially in the development and psychometric evaluation of instruments. This Structured Questionnaire is a reliable and valid tool that has utility for assessing perceptions, satisfaction, and attitude among Respiratory Therapists and for making comparisons of similar psychometric measures.

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.

The result of the movement restrictions during the COVID-19 pandemic was an impromptu and abrupt switch from in-person to online teaching. Most focus has been on the perception and experience of students during the process. The aim of this international survey is to assess staffs' perspectives and challenges of online teaching during the COVID-19 lockdown. Cross-sectional research using a validated online survey was carried out in seven countries (Brazil, Saudi Arabia, Jordan, Indonesia, India, the United Kingdom, and Egypt) between the months of December 2021 and August 2022, to explore the status of online teaching among faculty members during the COVID-19 pandemic. Variables and response are presented as percentages while logistic regression was used to assess the factors that predict levels of satisfaction and the challenges associated with online instruction. A total of 721 response were received from mainly male (53%) staffs. Most respondents are from Brazil (59%), hold a Doctorate degree (70%) and have over 10 years of working experience (62%). Although, 67% and 79% have relevant tools and received training for online teaching respectively, 44% report that online teaching required more preparation time than face-to-face. Although 41% of respondents were uncertain about the outcome of online teaching, 49% were satisfied with the process. Also, poor internet bandwidth (51%), inability to track students' engagement (18%) and Lack of technical skills (11.5%) were the three main observed limitations. Having little or no prior experience of online teaching before the COVID-19 pandemic [OR, 1.58 (95% CI, 1.35-1.85)], and not supporting the move to online teaching mode [OR, 0.56 (95% CI,0.48-0.64)] were two main factors independently linked with dissatisfaction with online teaching. While staffs who support the move to online teaching were twice likely to report no barriers [OR, 2.15 (95% CI, 1.61-2.86)]. Although, relevant tools and training were provided to support the move to online teaching during COVID-19 lockdown, barriers such as poor internet bandwidth, inability to track students' engagement and lack of technical skills were main limitations observed internationally by teaching staffs. Addressing these barriers should be the focus of higher education institution in preparation for future disruptions to traditional teaching modes.

BACKGROUND:There is a concerning lack of representative data on chronic obstructive pulmonary disease (COPD) awareness in Saudi Arabia, and a significant proportion of the population is vulnerable to developing a smoking habit, which is a major risk factor for the disease.METHODS:Population-Based Survey of 15,000 people was conducted to assess the public knowledge and awareness of COPD across Saudi Arabia from October 2022 to March 2023.RESULTS:A total of 15002 responders completed the survey, with a completion rate of 82%. The majority 10314 (69%) were 18-30 year and 6112 (41%) had high school education. The most common comorbidities among the responders were depression (7.67%); hypertension (6%); diabetes (5.77%) and Chronic Lung Disease (4.12%). The most common symptoms were dyspnea (17.80%); chest tightness (14.09%) and sputum (11.19%). Among those who complains of any symptoms, only 16.44% had consulted their doctor. Around 14.16% were diagnosed with a respiratory disease and only 15.56% had performed pulmonary function test (PFT). The prevalence of smoking history was 15.16%, in which current smokers were 9.09%. About 48% of smokers used cigarette, 25% used waterpipe and around 27% were E-cigarette users. About 77% of the total sample have never heard about COPD. Majority of current smokers (73.5%; 1002), ex-smokers (68%; 619), and non-smokers (77.9%; 9911) are unaware of COPD, p value <0.001. Seventy five percent (1028) of the current smokers and 70% (633) of the ex-smokers have never performed PFT, p value <0.001. Male, younger age (18-30 years), higher education, family history of respiratory diseases, previous diagnosis of respiratory disease, previous PFT, and being an ex-smokers increases the odds of COPD awareness, p-value <0.05.CONCLUSION:There is a significantly low awareness about COPD in Saudi Arabia, especially among smokers. A nationwide approach must include targeted public awareness campaigns, continued healthcare professional education, community-based activities encouraging diagnosis and early detection, advice on smoking cessation and lifestyle changes, as well as coordinated national COPD screening programs.

Background Few studies have looked at how SARS-CoV-2 affects pulmonary function, exercise capacity, and health-related quality of life over time. The purpose of this study was to evaluate these characteristics in post COVID-19 subjects 1 year after recovery. Methods The study included two groups. The case group included post COVID-19 subjects who had recovered after a year, and the control group included healthy participants who had never tested positive for COVID-19. Results The study screened 90 participants, 42 of whom met the eligibility criteria. The findings revealed that the majority of post COVID-19 subjects had relatively normal lung function 1-year post-recovery. A significant reduction in DLCO (B/P%) was observed in the case group vs. control. The exercise capacity test revealed a clinically significant difference in distance walked and a significant difference in the dyspnea post-walk test in the case group compared to the control group. The case group’s health-related quality of life domain scores were significantly affected in terms of energy/fatigue, general health, and physical function. Conclusions The post COVID-19 subjects were shown to have well-preserved lung function after 1 year. However, some degree of impairment in diffusion capacity, exercise capacity, and health-related quality of life remained.

Background: 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.

BACKGROUND:Chordoma are rare tumors of the axial skeleton. The treatment gold standard is surgery, followed by particle radiotherapy. Total resection is usually not achievable in skull base chordoma (SBC) and high recurrence rates are reported. Ectopic recurrence as a first sign of treatment failure is considered rare. Favorable sites of these ectopic recurrences remain unknown.METHODS:Five out of 16 SBC patients treated with proton therapy and surgical resection developed ectopic recurrence as a first sign of treatment failure were critically analyzed regarding prior surgery, radiotherapy, and recurrences at follow-up imaging.RESULTS:Eighteen recurrences were defined in five patients. A total of 31 surgeries were performed for primary tumors and recurrences. Seventeen out of eighteen (94%) ectopic recurrences could be related to prior surgical tracts, outside the therapeutic radiation dose. Follow-up imaging showed that tumor recurrence was difficult to distinguish from radiation necrosis and anatomical changes due to surgery.CONCLUSIONS:In our cohort, we found uncommon ectopic recurrences in the surgical tract. Our theory is that these recurrences are due to microscopic tumor spill during surgery. These cells did not receive a therapeutic radiation dose. Advances in surgical possibilities and adjusted radiotherapy target volumes might improve local control and survival.

This is the first study to develop research priorities in tobacco use and substance abuse in Saudi Arabia. Health personnel and community volunteers participated in a national internet survey using the Delphi method. In Round 1, 75 experts identified 33 research priorities. In Round 2, 47 experts divided those research priorities into five primary research categories. The panelists then scored both the categories and priorities. Preventive services received the highest priority in research categories. Smoking relapse and its determinants were ranked the top research priorities. Future research should focus on cigarette smoking relapse and factors associated with long-term smoking cessation.

There exist numerous instances of natural materials with hierarchical and layered microstructures having superior mechanical and functional properties. An example of such a material is nacre, which is a tough natural composite found in the inner part of many seashells. This preliminary study aimed to obtain an understanding of the flexural strength and ductility of bio-inspired cementitious samples inspired by the techniques that nacre uses. In this work, we fabricated and tested samples that contain polymeric layers sandwiched between cementitious layers, mimicking the layering of aragonite tablets and proteins found in nacre. Results of this preliminary study show that using the layering feature found in nacre can improve the flexural strength of mortar samples. In addition, increased ductility was observed in the nacre-inspired samples compared with control samples due to crack deflection and layers sliding. Finite element analysis was performed to probe the effect of geometries and mechanical properties on the flexural behavior of nacre-inspired cementitious beams.

Background: Lung Ultrasound (LUS) had proved to be beneficial in detecting respiratory disorders at the bedside. Understanding the important role of Respiratory Therapists (RTs) in the critical care, we aimed to assess their knowledge, perceived relevance of LUS to clinical practice, current skill gaps, and barriers to practice. Methods: A cross-sectional, nationwide survey conducted among the RTs working in the Kingdom of Saudi Arabia. The validated questionnaire included 4 sections; the demographics, knowledge and perceptions, applicability and self-reported proficiency, and barriers to the use of LUS by RTs. Results: A total of 256 RTs across different regions of Saudi Arabia participated in this survey. 71.9% of them were males, and 46.1% of the participants were having <5 years of working experience. Only (18.1%) of the participants used LUS in their clinical practice, and (43%) of them had never received any training. 66% of the participants perceived LUS as an effective tool in the RT practice and immensely valuable in their daily practice (70%). A large proportion of RTs perceived LUS to be ineffective in calculating the lung score (50.4%), assessing the diaphragm (40.2%), and detecting pulmonary edema (38.3%). Calculating lung score has a lower mean score of 2.55 on both skills, and identifying its applicability to clinical practice with a mean score of 2.71 than other indications. Lack of training and curriculum (154/256; 60.2%) remains the top barrier that prevented RTs from using LUS in their clinical practice. Conclusion: While many RTs in Saudi Arabia perceived LUS as an effective tool in the RT practice, considerable competence gap exist, indicating the need for LUS training. There is a need for incorporating LUS into the curriculum of RT schools and promoting competency-based training for the current RT workforce to help improve patient care.

Background: 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.

Background: Uncertainty surrounds the use of early mobilisation (EM) for mechanically ventilated patients in Saudi ICUs. The adoption and spread of such practice may be influenced by existing practice. Methods: A validated instrument was used to evaluate the ICUs9 features, EM practices for mechanically ventilated patients, and barriers. Results: We received a 65% (133/205 ICUs) response rate, despite 64% of the total respondents had no prior training in EM, the prevalence of EM for mechanically ventilated patients was 47%. Among the included ICUs, 55% reported no protocols, 36% initiated EM between 2-5 days of severe illness, and 35% reported that EM for mechanically ventilated patients was entirely based on physician orders. There was at least one EM coordinator in 47% of the ICUs that used EM. Previous training in EM and years of experience of the ICU in-charge were shown to be significant predictors in promoting EM in ICU mechanically ventilated patients, with odds ratios of 7.6 (3.37–17.26) and 1.07 (1.01–1.14), respectively. Lack of protocols for EM, as well as insufficient personnel and poor training to assist EM, were frequent obstacles (Fig 1). Conclusion: In Saudi Arabia, although only 36% of the ICUs had prior EM training, 47% of mechanically ventilated patients received EM. To improve the use of EM for mechanically ventilated patients in Saudi ICUs, a holistic approach should be implemented to address the observed modifiable barriers.

Background Pituitary apoplexy (PA) is a rare complication of pituitary tumors that can present with a myriad of symptoms, including sudden onset cranial nerve deficits. After patient stabilization and hormone replacement, surgical decompression is often recommended. The timing of surgical decompression remains controversial. In this case series, we describe our institutional experience pertaining to the cranial nerve recovery in patients who underwent endoscopic endonasal transsphenoidal (EETS) surgery for PA while evaluating outcome based on tumor stage using the suprasellar infrasellar parasellar anterior posterior (SIPAP) classification. Design Present study is a single-institution retrospective cohort. Methods A retrospective review of all EETS cases for pituitary tumor resection between November 2009 and August 2018. Queries of the hospital database were completed by trained personnel to identify cases of PA treated using the EETS approach. Baseline characteristics, tumor type, endocrine data, and SIPAP classification based on preoperative magnetic resonance imaging (MRI) and operation characteristics were extracted from medical records. Postoperative results were extracted for the duration of the follow-up period available for each patient. Results Fifteen cases of PA were identified. Patient follow-up period was a mean of 30 months. The cranial nerve deficits present at admission were visual deficit (33%); unilateral third nerve palsy (47%) and unilateral sixth nerve palsy (27%). No fourth nerve palsies were observed. Following EETS, 60% of patients with preoperative visual deficit had normal visual fields. For those with third and sixth nerve palsies preoperatively, 43 and 75%, respectively, had return to normal function postoperatively. SIPAP tumor characteristics were not related to postoperative cranial nerve recovery. Conclusion In this series of surgically treated patients with pituitary apoplexy, all cranial nerve deficits normalized or improved following surgery. The tumor SIPAP classification was not associated with patient outcome. Though in a small series, the presented results suggest surgical treatment is beneficial for these patients.

Background: Pituitary tumor recurrence following endoscopic endonasal transsphenoidal surgery (EETS) has been reported widely. We evaluated a modified score using the SIPAP classification system, combining the suprasellar and paraseller extension scores of the pituitary tumor, to determine its impact on adenoma recurrence. Methods: A retrospective cohort study design with patient characteristics, tumor type, endocrine, operation, imaging data collected. Preoperative MRI images were reviewed and SIPAP classification applied. Postoperative data were extracted for the follow-up period available for each patient.The suprasellar score and the highest parasellar scoring from both sides were numerically summed in a bilateral suprasellar and parasellar (SaP) score and combined to make 4 grades. Results: 276 patients were identified, 56.5% of the cohort was male. The mean cohort age was 54 years old.The mean follow up period was 32 months. Patient perioperative tumor grade according to SaP classification and recurrence rate was: Grade 1: 11%: Grade 2: 10%; Grade 3: 15%; Grade 4: 22%. The results followed a pattern of logarithmic curve. Conclusions: The SaP classification was useful in determining the pituitary tumor expected recurrence following EETS. The advanced tumors had the highest recurrence rates. Use of the SaP score may allow for more accurate preoperative counselling of patients with pituitary adenoma.

The coronavirus disease-19 (COVID-19) is impacting large patient populations, resulting in respiratory compromise, necessitating artificial respiratory supports. Early treatment modalities for severe respiratory failure during the pandemic focused on early intubation and invasive ventilation, as this was considered to be more effective than noninvasive respiratory strategies. However, emerging evidence proved that noninvasive respiratory supports such as noninvasive ventilation, high flow nasal cannula along with prone positioning might have a more significant and positive role than initially thought during the pandemic. Reflective evidence also suggests the utility of noninvasive respiratory supports as appropriate bridging adjuncts in the early stages of the disease process and has the potential to prevent intubation or invasive ventilation. This narrative review focusses on various strategies that are attempted in COVID-19 patients to avoid endotracheal intubation.