Ventilation practices in the neonatal intensive care units in Saudi Arabia, survey of the utilization of volume-targeted ventilation among practicing neonatologists.

OBJECTIVE: To assess the current practice in using volume-targeted ventilation among neonatologists working at the Neonatal Intensive Care Units (NICU) of Saudi Arabia. METHODS: The questionnaire was provided electronically to 153 practicing Neonatologists working in 39 NICUs. The survey's results were received and statistically analyzed. RESULTS: One hundred nineteen (119) responses were received with, a 78% response rate. Volume Targeted Ventilation (VTV) was used routinely by 67.2%, whereas 21.8% still use only pressure control (PC)/pressure limited (PL) mode. During the acute phase of ventilation support, Assist Control was the most popular synchronized mode, whereas Synchronized Intermittent Mandatory Ventilation (SIMV) with pressure support (PS) or PSV were the two most common modes during the weaning phase, 31.8%, and 31% respectively. The majority of the neonatologists used a tidal volume of 4 ml/kg as the lowest and 6 ml/kg as the highest. The major reasons for not implementing VTV were the limited availability of ventilator devices that have an option of VTV, followed by lack of experience. CONCLUSION: VTV is the predominant ventilation practice approach among neonatologists working in the KSA. Limited availability and lack of experience in using are the main challenges. Efforts to equip NICUs with the most advanced ventilation technology, enhance practitioners' experience and sufficient training in its use are warranted.

The Relation between Asthma Control and Quality of Life in Children.

BACKGROUND: Asthma is a common chronic illness worldwide. Asthmatic children are forced to alter their way of living to avoid its complications or exacerbations, which negatively affects their psychological and social well-being. High prevalence of behavioral and emotional difficulties was noticed among children with asthma. METHODS: Cross-sectional study that was conducted over 8 months involving asthmatic children within the ages of 7-17 years presenting to two governmental hospitals in Jeddah, Saudi Arabia. Three questionnaires were used: asthma control test, the strengths and difficulties questionnaire, and the pediatrics asthma quality of life questionnaire. Using SPSS, Pearson's chi-square and independent sample t-tests were used to find associations. RESULTS: Among the 106 respondents, 84% of the sample had poor asthma control. Significantly poorer quality of life was observed in children with uncontrolled asthma (p = <0.001). Children with controlled and uncontrolled asthma were equally affected psychosocially with no relation between asthma control and their psychosocial well-being (p = 0.58). CONCLUSION: The majority of asthmatic children were uncontrolled with poor quality of life. This study recommends that the psychosocial well-being should be assessed during clinic visits for a better holistic approach and effective improvement of outcome. Further researches are needed to study the psychological effect of asthma.

Removal of fouling species from brackish water reverse osmosis reject stream.

Brine disposal from reverse osmosis (RO) systems remains a major challenge for the desalination industry especially in inland areas where discharge options are very limited. Solutions will entail the introduction of economic treatment processes that will alleviate the brine's negative impact on the environment and reduce its discharge volume. Such processes could act as an intermediary treatment process for the recycling of the brine through an additional RO stage which, for brackish water (BW) desalination, could lead to saving valuable water while reducing the amount of brine discharge. In this context, the study at hand attempts to evaluate the effectiveness of a one-step chemical process for the treatment of BWRO brine. This study seeks to determine optimal operating conditions relative to type, ratio, and dosage of alkalizing chemicals, pH and temperature, for substantially reducing the concentrations of scaling parameters such as calcium, magnesium, silica, and strontium. The results indicate that precipitation softening at pH = 11.5 using combined chemical dosages of NaOH and Na2CO3 in a ratio of 2:1 leads to substantial removal of calcium and magnesium (>95%) and moderately high removal of strontium and silica (>71%).

Hollow fiber vs. flat sheet MBR for the treatment of high strength stabilized landfill leachate.

The Membrane Bioreactor (MBR) technology is increasingly becoming a prominent process in the treatment of high-strength wastewater such as leachate resulting from the decomposition of waste in landfills. This study presents a performance comparative assessment of flat sheet and hollow fiber membranes in bioreactors for the treatment of relatively stable landfill leachate with the objective of defining guidelines for pilot/full scale plants. For this purpose, a laboratory scale MBR system was constructed and operated to treat a leachate with Chemical Oxygen Demand (COD) (3900-7800mg/L), Biochemical Oxygen Demand (BOD5) (∼440-1537mg/L), Total Phosphorus (TP) (∼10-59mg/L), Phosphate (PO4(3)(-)) (5-58mg/L), Total Nitrogen (TN) (1500-5200mg/L), and ammonium (NH4(+)) (1770-4410mg/L). Both membranes achieved comparable BOD (92.2% vs. 93.2%) and TP (79.4% vs. 78.5%) removals. Higher PO4(3)(-) removal efficiency or percentage (87.3% vs. 81.3%) and slightly higher, but not statistically significant, COD removal efficiency were obtained with the hollow fiber membrane (71.4% vs. 68.5%). On the other hand, the flat sheet membrane achieved significantly higher TN and NH4(+) removal efficiencies (61.2% vs. 49.4% and 63.4% vs. 47.8%, respectively), which may be attributed to the less frequent addition of NaOCl compared to the hollow fiber system.

The place of antibiotics in the prevention of post-appendicectomy sepsis: a prospective study of 400 cases.

Post-appendicectomy sepsis still causes considerable morbidity and prolongs hospital stay. A large amount of recent work has gone into attempts to reduce such problems using various topical and systemic agents in differing regimes, with wide variation in their results. The aim of our study was to examine further the effectiveness of those different lines of prophylaxis against placebo in reducing post-appendicectomy sepsis. It is a comparative study of 400 cases of uncomplicated appendicitis operated upon by three senior Surgeons. The cases were allocated randomly in equal number to four groups according to the prophylactic antibiotic regime used: (a) Placebo; (b) Metronidazole alone; (c) Metronidazole and cefazolin; (d) Metronidazole and tobramycin. Antibiotics were given preoperatively with premedication and continued postoperatively for three days. The patients were checked for signs of sepsis during hospital stay and weekly up to a minimum of four weeks after discharge. They were also compared as far as their hospital stay is concerned. The conclusion of this study is that a combination of an antibiotic aimed at aerobes (cefazolin or tobramycin) with another aiming at anaerobes (metronidazole) is the best prophylactic regime against post-appendicectomy sepsis.

Systemic plus local metronidazole and cephazolin in complicated appendicitis: a prospective controlled trial.

Appendicectomy was performed on 100 patients with complicated appendicitis through a grid-iron incision. All patients received systemic metronidazole and cephazolin sodium which started preoperatively and continued postoperatively for 5 days. At operation, patients were allocated randomly to receive either local instillation of metronidazole and cephazolin intraperitoneally and interparietally (group A) or no local antibiotic therapy (group B). All wounds were closed primarily without drainage. Postoperative wound sepsis occurred in four (8%) of the 50 patients in group A and in 17 (34%) of the 50 patients in group B. One patient in group B developed pelvic abscess in addition to wound sepsis. The mean duration of postoperative hospital stay was 6.6 days (s.d. 2.98) in group A and 8.7 days (s.d. 5.55) in group B. These differences were statistically significant. No adverse reaction was noted. The conclusion of this study is that a single peroperative instillation of metronidazole and cephazolin into the peritoneum and wound layers is a safe and valuable adjunct to the perioperative systemic administration of these drugs in significantly reducing postoperative sepsis and duration of hospital stay in complicated appendicitis.