Introduction: Randomized trials investigating neuromuscular blocking agents in adult acute respiratory distress syndrome (ARDS) have been inconclusive about effects on mortality, which is very high in this population. Uncertainty also exists about the associated risk of ICU-acquired weakness. Methods: We conducted a systematic review and meta-analysis. We searched the Cochrane (Central) database, MEDLINE, EMBASE, ACP Journal Club, and clinical trial registries for randomized trials investigating survival effects of neuromuscular blocking agents in adults with ARDS. Two independent reviewers abstracted data and assessed methodologic quality. Primary study investigators provided additional unpublished data. Results: Three trials (431 patients; 20 centers; all from the same research group in France) met inclusion criteria for this review. All trials assessed 48-hour infusions of cisatracurium besylate. Short-term infusion of cisatracurium besylate was associated with lower hospital mortality (RR, 0.72; 95% CI, 0.58 to 0.91; P = 0.005; I² = 0). This finding was robust on sensitivity analyses. Neuromuscular blockade was also associated with lower risk of barotrauma (RR, 0.43; 95% CI, 0.20 to 0.90; P = 0.02; I² = 0), but had no effect on the duration of mechanical ventilation among survivors (MD, 0.25 days; 95% CI, 5.48 to 5.99; P = 0.93; I² = 49%), or the risk of ICU-acquired weakness (RR, 1.08; 95% CI, 0.83 to 1.41; P = 0.57; I² = 0). Primary studies lacked protracted measurements of weakness. Conclusions: Short-term infusion of cisatracurium besylate reduces hospital mortality and barotrauma and does not appear to increase ICU-acquired weakness for critically ill adults with ARDS.

Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS‐CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05). ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.

Coughing is a common symptom of several respiratory diseases. The sound and type of cough are useful features to consider when diagnosing a disease. Respiratory infections pose a significant risk to human lives worldwide as well as a significant economic downturn, particularly in countries with limited therapeutic resources. In this study we reviewed the latest proposed technologies that were used to control the impact of respiratory diseases. Artificial Intelligence (AI) is a promising technology that aids in data analysis and prediction of results, thereby ensuring people’s well-being. We conveyed that the cough symptom can be reliably used by AI algorithms to detect and diagnose different types of known diseases including pneumonia, pulmonary edema, asthma, tuberculosis (TB), COVID19, pertussis, and other respiratory diseases. We also identified different techniques that produced the best results for diagnosing respiratory disease using cough samples. This study presents the most recent challenges, solutions, and opportunities in respiratory disease detection and diagnosis, allowing practitioners and researchers to develop better techniques.

The COVID-19 epidemic has caused a large number of human losses and havoc in the economic, social, societal, and health systems around the world. Controlling such epidemic requires understanding its characteristics and behavior, which can be identified by collecting and analyzing the related big data. Big data analytics tools play a vital role in building knowledge required in making decisions and precautionary measures. However, due to the vast amount of data available on COVID-19 from various sources, there is a need to review the roles of big data analysis in controlling the spread of COVID-19, presenting the main challenges and directions of COVID-19 data analysis, as well as providing a framework on the related existing applications and studies to facilitate future research on COVID-19 analysis. Therefore, in this paper, we conduct a literature review to highlight the contributions of several studies in the domain of COVID-19-based big data analysis. The study presents as a taxonomy several applications used to manage and control the pandemic. Moreover, this study discusses several challenges encountered when analyzing COVID-19 data. The findings of this paper suggest valuable future directions to be considered for further research and applications.

Background: This study explores the most influential factors affecting Saudi medical students and interns' choice of specialty at the University of Dammam, Kingdom of Saudi Arabia. Methods: A self-administered questionnaire was distributed during the period from June 1 to June 14, 2013. Chi-square test and logistic regression were used to test the association between participants' choices and the motivational factors that led to their choice of specialty. Results: One-hundred sixty-eight (44.7%) participants chose lifestyle as their most influential factor for the choice of their specialty. Significantly more medical interns considered lifestyle as an important factor compared to medical students (P=0.020). Internal medicine was the preferred specialty for 56 participants (14.77%) followed by family medicine for 35 participants (9.2%). Thirty-four participants (8.97%) chose general surgery, and 27 participants (7.1%) chose both pediatrics and emergency medicine. Sex influences indicated that men preferred pediatrics and emergency medicine (P=0.033 and P=0.0006, respectively), while women preferred family medicine practice (P=0.034). Conclusion: Saudi medical students and interns at the University of Dammam were influenced mostly by lifestyle when they considered their future specialty. Internal medicine, family medicine, general surgery, pediatrics, and emergency medicine were the preferred specialties.

Objective: The objective was to evaluate the efficacy and safety of single‐dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC).Methods: This study was a parallel‐group, prospective, randomized, double‐blind, pragmatic trial. Participants were randomized to receive a single dose of either ketamine or morphine, infused over 30 min. Primary outcome was mean difference in the numerical pain rating scale (NPRS) score over 2 h. NPRS was recorded every 30 min for a maximum of 180 min and secondary outcomes were cumulative dose of opioids, emergency department (ED) length of stay, hospital admission, change in vital signs, and drug‐related side effects. Authors performed the analysis using intention‐to‐treat principle.Result: A total of 278 adults with SCD and who presented with acute sickle VOC participated in this trial. A total of 138 were allocated to the ketamine group. Mean (±standard deviation [SD]) NPRS scores over 2 h were 5.7 (±2.13) and 5.6 (±1.90) in the ketamine and morphine groups. The ketamine group received significantly lower cumulative doses of morphine during their ED stay (mean ± SD = 4.5 ± 4.6 mg) than of the morphine group (mean ± SD = 8.5 ± 7.55 mg). Both groups had similar rates of hospital admission: 6.3% in the ketamine group had drug‐related side effects compared to 2.2% in the morphine group.Conclusion: Early use of ketamine in adults with VOC resulted in a meaningful reduction in pain scores over a 2‐h period and reduced the cumulative morphine dose in the ED with no significant drug‐related side effects in the ketamine‐treated group.