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Background: Pneumonia is a common and serious infectious disease that can cause high mortality. Lung ultrasonography is being increasingly utilized in emergency and critical settings. The role of Lung Ultrasound (LUS) in the diagnosis and follow-up of pneumonia is becoming more and more important. Aim of the Work: To compare the diagnostic accuracy of LUS against a referent Chest X-Ray (CXR), chest contrastenhanced Computerized Tomography (CT) scan and/or clinical criteria for diagnosis and follow-up of pneumonia in critically ill adult patients. Patients and Methods: We enrolled 32 (11M, 21F) multimorbid patients aged 61.31 ± 12.13 years from March 2016 to October 2016. Each participant underwent CXR and bedside LUS within 6 hours from Intensive Care Unit (ICU) admission. LUS was performed by skilled clinicians, blinded to CXR results and clinical history. The final diagnosis (pneumonia vs. no-pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT. Diagnostic parameters of CXR and LUS were compared. Results: 28 patients (87.5%) out of 32 patients with positive LUS had a final diagnosis of pneumonia. LUS was falsely positive in two cases (6.2%) and false negative in two patients (6.2%). The sensitivity and the specificity of LUS were 87.5% (95% CI 78.9-92.7%) and 89.3% (95% CI78.3-91.9%) respectively. Conclusion: The study supports that LUS when conducted by highly-skilled sonographers, performs well for the diagnosis of pneumonia. Intensivist and Emergency Medicine physicians should be encouraged to learn LUS since it appears to be an established diagnostic tool in the hands of experienced physicians.

Article informationBackground: Bronchial asthma increasing all over the world and the need of a gold-standard biomarkers for prediction of asthma and follow up of treatment is mandatory. However, it is still not existing. Aim of the work:To measure the serum level of plasma myeloperoxidase [MPO], and its correlation with respiratory function as well as its predictive power of asthma and its severity. Patients and Methods:The study recruited 130 patients with asthma, with age and sex-matched other 130 healthy controls. Patients were clinically evaluated; respiratory functions were performed and blood samples were drawn to estimate the serum levels of MPO. In addition, sputum was assessed for cellular content. Asthma severity was determined according to available guidelines and both mild and moderate forms were considered as [non-severe form of asthma]. Receiver operation characteristic [ROC] curve was built to assess the predictive power of MPO.Results: There was female-sex predominance in the study and control groups [65.4% and 70.0%, respectively]. 15.4% had mild, 35.4% had moderate and 49.2% had severe asthma. MPO levels were significantly higher in the study than the control groups [3310.35±373.39 vs. 1900.32±333.57 pg/ml, respectively]. The serum levels of MPO were positively correlated with asthma severity, all cellular content in BAL and body mass index. However, it was inversely correlated with respiratory function. MPO were significantly higher in severe than nonsevere forms [3666.59±736.37 vs. 2964.91±554.47 pg/ml, respectively]. MPO had a good predictive power of asthma and its severe form [the AUC was 0.950 and 0.819 respectively]. Conclusion:Serum levels of MPO can used as a good biomarker for diagnosis of asthma and its severity. But results must be treated with caution, and MPO should be used with a panel of biomarkers till more evidence originated to confirm its role from future studies.

Background The COVID-19 pandemic extended to reach most countries in the world during a few months. The preparedness of health care institutions and health care workers (HCWs) is crucial for applying effective prevention and control measures. Objective This study aims to assess HCWs’ and institutional preparedness in facing the new emerging COVID-19 infection at the early phase of the pandemic and to explore HCWs’ risk perception, concerns, and risk acceptance. Methods A cross-sectional survey was conducted among hospital HCWs in King Khalid and New Najran hospitals, Saudi Arabia, at the early phase of the pandemic, during March and April 2020. Results Overall, 563 completed questionnaires were received (n=382, 67.9% from King Khalid and n=181, 32.1% from New Najran). The majority were female participants (78.6%); nurses constituted 74.7% of the sample. The age range of the participants was 20-63 years, with the mean age of physicians and nurses being 36.5 (SD 9.15) years and 31.8 (SD 7.48) years, respectively. Among participants, 65.8% attended training programs for COVID-19 infection, of whom 69.9% were satisfied with this training. Almost all (97.4%) of the participants reported reading the official circulars assigned for guidelines, case definition, and infection control measures regarding COVID-19 infection; 97.1% received basic infection control training; 98.9% checked for the best-fitted size of an N95 mask; and 89.4% were influenza vaccinated. Of the participants, 82.6% reported that they have sufficient knowledge about the COVID-19 pandemic, 82.0% reported being confident that they can protect themselves and their patients when dealing with COVID-19 cases, 92.9% reported that they understand the risk of COVID-19 infection for patients and health care staff, and 83.2% reported agreement of accepting the risk of getting the infection being a part of their job. The study participants attained a mean 20.26 (SD 2.60) knowledge score on a scale of 26 maximum points (77.9%); of them, 74.5% attained 20 points or more (>75%), indicating good working knowledge about the COVID-19 pandemic. Exploring the participants’ perception about the preparedness of their institutions toward the COVID-19 pandemic, 70.8% agreed that institutional precautionary measures to COVID-19 in the workplace are sufficient, 71.6% agreed that all personal protective equipment is provided and always available in the workplace, and 90.6% mentioned that the staff in their institutions have had adequate training. Exploring risk perception and the affective aspect of the pandemic on HCWs, 79.0%, 35.2%, and 64.2% of the participants felt that they, their families, and the Najran community are at high risk of getting an infection of COVID-19, respectively, and 54.7% and 55.1% were concerned about their personal and family health, respectively. Conclusions The findings revealed good knowledge about the COVID-19 pandemic among HCWs in Najran hospitals, Saudi Arabia. Concerns and worries were expressed regarding working with the highly infectious patients with COVID-19. Participants appreciated important aspects of institutional preparedness. Experience gained from the previous Middle East respiratory syndrome–related coronavirus outbreak may explain good knowledge, risk acceptance, self-efficacy, and good and rapid institutional preparedness at the early stage of the pandemic.