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CONTEXT: Early use of a high-flow nasal cannula (HFNC) provides positive outcomes for preventing the risk of intubation. However, the efficiency and usage of HFNC in the case of coronavirus disease 2019 (COVID-19) among adult patients with multiple risk factors remain debatable and require more investigation. AIMS: The aim of this study was to determine the efficiency of HFNC in preventing the possible risk of intubation. SETTINGS AND DESIGN: This study was an observational cross-sectional study that was conducted at a selected hospital in Jeddah, Saudi Arabia, from July 2020 to August 2021. METHODS: The data were collected from patients’ medical records through the hospital health information system. Adult COVID-19 patients who used HFNC were included, while those who used bilevel positive airway pressure or continuous positive airway pressure without any trials of HFNC and neonatal or pediatric patients were excluded. The exposure of HFNC setting which included variables such as percentages of the fraction of inspired oxygen and the duration of using HFNC were measured to find the relation with respiratory rate oxygenation (ROX) index as a measurement of patient outcome. STATISTICAL ANALYSIS USED: The data were analyzed by using the online calculator socscistatistics. com for prevalence statistics, and correlation tests of significance. Prevalence statistics were presented in mean, median, frequencies, and percentages. Statistical tests were used to measure correlations of key variables. P < 0.05 of ANOVA and t -tests was considered statistically significant. RESULTS: A total of 159 adult COVID-19 patients using HFNC were included, and most of these patients were male. The median age was 64 years. Most of patients were reported to have hypertension and diabetes mellitus. The majority (94.34%) of patients were successfully weaned from HFNC and shows effective intervention with a mean of 7.53 of ROX score. Appropriate implementation of HFNC might be a successful intervention for preventing the risk of intubation. CONCLUSIONS: According to the success rate of HFNC, which was considered a positive outcome, there might be a promising intervention for HFNC to prevent the risk of intubation and decrease the mortality rate.

A 55 year old Indonesian male known case of DM on oral hypoglycaemic drugs presented to ER with productive cough for 3 days. He had no history of SOB, neither haemoptysis, vomiting, haematuria nor bleeding. On physical examination, he appeared disoriented agitated, pale, jaundiced and with good body built. He was not distressed without any cyanosis, clubbing or sign of dehydration. His temperature was 39.3˚C. Laboratory investigation revealed WBC count of 22 /ml, HB 7, 5 gm/dl normochromic normocytic anaemia, normal platelet and normal AB, random blood sugar 320 ml/dl, urea 140 ml/dl, creatinine 2.5 ml/dl , LDL 1500, total bilirubin 3 mainly indirect. CT brain was clear. CSF analysis showed 10 cells 100% lymphocytes, protein 100mg/dl (high) and glucose 160 mg/dl (normal). The patient was initially treated with I.V hypertonic saline, ceftriaxone, vancomycin, acyclovir and dexamethasone, insulin and diet management. Two days later. patient showed improvement in his level of conscious as his Na become 121 mg/dl, urine output 600ml/day, but patient still had high grade fever ongoing haemolysis, erythromycin was started and an obvious improvement happened, he become communicating, afebrile, LDH decrease from 2000 to 750, with increase HB level from 6,5 g/dl to 9 g/dl. Conclusively, Aseptic meningitis should be considered in patient with mycoplasma pneumonia presented with confusion despite he has hypernatremia.

Background: Asthma and rhinosinusitis share the same pathophysiological mechanism and often occur together. The root cause of chronic rhinosinusitis is still a challenge to cure, but its clinical symptoms can be improved by symptomatic treatment, which are also considered asthma symptom relievers. Objective: The primary objective of this study was to measure the prevalence of asthma with rhinosinusitis among adult and pediatric patients in Saudi Arabia as there have been limited studies that assessed this objective. Methods: This study is a retrospective cross-sectional study. The data was collected from a selected hospital from 2016 to 2019. The inclusion criteria were patients with a confirmed diagnosis of asthma and rhinosinusitis aged 18 years and older Results: The prevalence of rhinosinusitis among asthma patients was 0.30% in a total of 1,688 asthmatic patients, and 1683 patients had asthma without rhinosinusitis (99.7%). Females accounted for 67.7% of the patients, while males were accounted for 32.3%. Most of the asthma patients (56%) were 60 years old or older, and 44% were aged between 18 and 59 years old. Asthma patients with a past medical history of chronic obstructive pulmonary disease (COPD) accounted for 2.3% of the patients. Moreover, 1.9% of the asthma patients had bronchiectasis. The majority of the asthma patients (79%) had an unknown allergic status, while 21% had allergies. The smoking status variable revealed that 3.1% of the asthma patients were smokers Conclusion: The prevalence of rhinosinusitis among asthma patients was considered low.

Background: Alpha-1 antitrypsin is an important protein produced by the liver, and deficiency in this protein will cause many liver diseases. A deficiency in this protein can cause congenital emphysema, characterized by damaged and stretched air sacs of the lungs. To our knowledge, limited studies have been performed on liver disease prevalence among chronic obstructive pulmonary disease (COPD) patients in Saudi Arabia. Methods: This study was a secondary data analysis of existing clinical records and aimed at determining the prevalence and association of liver diseases among COPD patients from 2016 to 2020. A total of 1579 clinical records were collected. In this study we analyzed one hundred fifty-five records. Results: Senior patients who were aged 65 or older represented most patients (61.29%). In addition, 81% of the selected COPD patients were diagnosed with cirrhosis, while only one patient was diagnosed with fibrosis. Senior COPD patients aged 65 years or older were more likely to be diagnosed clinically with any type of liver disease (61.75%) than those from younger age groups. Conclusions: Screening and expression tests for patients showing liver and lung diseases are the procedures to determine whether symptoms are due to alpha-1 antitrypsin deficiency. However, this is challenging in patients with COPD.