Magnet and receiver-stimulator displacement after cochlear implantation: Clinical characters and management approaches

Objectives:To systematically review the occurrence of magnet or receiver/stimulator displacement following cochlear implant (CI) placement complication and evaluate the existing literature on this topic.Methods:A systematic literature search was conducted using PubMed, Scopus, Web of Science, Virtual Health Library (VHL), and Cochrane Library. Original studies reporting cases of magnet or receiver-stimulator migration occurring as a complication after CI placement were included. The quality of the included studies was evaluated using the National Institutes of Health Quality Assessment Tool for observational studies and CARE checklist for case studies.Results:A total of 36 studies, including 6469 patients, were included. Magnet migration was reported in 82 (1.3%) patients, while receiver/stimulator was reported in 4 (0.1%) cases. The cause of magnet migration was identified in 78 cases; MRI-induced movement was the most frequently reported cause (n=43, 55.1%), followed by head trauma (n=25, 32.1%). A total of 20 studies involving 35 patients with magnet migration performed skull radiography to diagnose magnet migration. Revision/exploratory surgery with surgical repositioning or replacement was the most frequent management procedure (n=46).Conclusions:Further research on magnet pocket design and standard protocols for MRI in CI users is needed. Early diagnosis of magnet migration and instant referral to specialized CI centers is necessary for proper management and prevention of major complications. PROSPERO REG. NO. CRD: 42020204514     

N-nitrosodimethylamine (NDMA) contamination of ranitidine products: A review of recent findings

Ranitidine is a medication that has been used to alleviate heartburn and other disorders for over 40 years. Following reports of N-nitrosodimethylamine (NDMA) contamination in ranitidine products, there have been many recalls and registration suspensions. Here, we revise the literature information confirming ranitidine association with NDMA. Then, we highlight the documented mechanisms for NDMA release from ranitidine. In addition, the stability issue for this medicine is discussed. After that, we review and discuss the results of the United States Food and Drug Administration and the Australian Therapeutic Goods Administration laboratory testing of ranitidine products and the detected NDMA levels. Finally, the case of NDMA generation in Angiotensin II Receptor Blockers (ARBs) and ranitidine were compared in an attempt to address the circumstances leading to the current contamination.     

Effective ureteral access sheath insertion during flexible ureteroscopy: Influence of the ureteral orifice configuration

IntroductionWe sought to determine the possible predictors for effective insertion of the ureteral access sheath (UAS) during flexible ureteroscopy (fURS) in virgin ureters and their impact on postoperative ureteral wall injury and the procedural outcome.MethodsA retrospective review of prospectively collected data was performed for all consecutive patients scheduled for fURS of virgin ureters at two tertiary care centers between 2018 and 2020. Demographics, stone characteristics, and perioperative data, including the configuration of the ureteral orifice (UO) over introductory guidewire insertion, were collected. Multivariate logistic regression was used to detect possible predictors of successful UAS insertion.ResultsIn total, 128 patients who underwent primary fURS were included, with a mean age of 43.3±12.3 years and a stone burden of 12.3±6.9 mm. One hundred and ten patients (85.9%) achieved successful ureteral access insertion, including 81 (63.3%) without ureteral dilatation and 35 with dilation, of which 29 (22.7%) had a successful UAS afterward, while six failed. Total patients who underwent ureteral orifice dilatation were 35. 29 had a successful UAS afterward, while 6 failed. Patients who underwent successful UAS placement into virgin ureters were significantly older and had a lower body mass index (BMI). A tent-shaped UO over the guidewire led to successful UAS insertion. In multivariate regression analysis, cases with BMI <30 kg/m² (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.28–7.03) and those with a tent-shaped UO over the introductory guidewire (OR 6.60, 95% CI 3.8–7.2) maintained their significance to predict successful UAS insertion into virgin ureters. Nine patients (8.2%) had ureteral mucosal injuries, and the overall stone-free rate was 78.2%.ConclusionsPatients with normal BMIs and tent-shaped UOs over the introductory guidewires are more likely to achieve primary UAS insertion without the need for ureteral dilation.     

Telepsychiatry: knowledge,effectiveness, and willingness; assessments of psychiatrists in Saudi Arabia

Objectives:To assess psychiatrists’ knowledge and perception regarding telepsychiatry and evaluate their willingness to adopt telepsychiatry clinical practice in Saudi Arabia.Methods:A cross-sectional study was conducted among psychiatrists working in Saudi Arabia from November 2020 through May 2021. A self-administered questionnaire comprising socio-demographic data, factors related to knowledge, perception, willingness, barriers, and the effectiveness of telepsychiatry, was distributed via. online platform. Data were tabulated and cleaned in MS Excel, and all statistical analyses were performed using SPSS v26.Results:There were 328 psychiatrists enrolled in the group with an average age of 25–35 years (48.8%). The group comprised mainly Saudis (83.5%); male participants outnumbered females (70.4% to 29.6%). Overall, the psychiatrists’ telepsychiatry knowledge level was poor (51.8%), while (48.2%) of the respondents showed good knowledge. However, nearly all respondents exhibited good perception (80.8%), with only 19.2% classified as poor. In addition, older individuals, consultants, clinicians with 11–15 years of experience, clinicians interacting with patients via email, and those who frequently received patient questions regarding online communication indicated increased knowledge.Conclusion:Although perception was positive regarding telepsychiatry, psychiatrists’ knowledge on the subject was deemed insufficient. Psychiatrists’ knowledge depended on their age, position, years of experience, frequent interaction with patients through an online platform, and clients that provided their online contact details.

The earliest telemedicine trials were in the 1950s when Norfolk State Hospital and Nebraska Psychiatric Institute used closed-circuit television to provide patient consultations. Telemedicine has various branches; it includes telepsychiatry, which offers psychiatric care through any form of telecommunication, such as video conferencing. ¹ Telecommunication provided for both psychiatrists and their patients a convenient, easy, and fast tool to connect both parties for accessible psychiatric evaluations, various forms of therapy such as individual, group, family therapy, medication management, and essential information on their diseases; most importantly it saved both time and effort for both psychiatrists and their patients. ^2,3 It can also be utilized for non-clinical applications, such as organizational learning, in addition to infinite services. ⁴ Telepsychiatry can be applied in situations where patients stay in rural areas or move from distant areas become difficult; also, in follow-ups or medication refills. ⁵ Many patients reported their satisfaction with telecommunications. ³ Telepsychiatry, similar to any technology, faces barriers or limitations in its use; therefore, considerable research has been conducted to identify these barriers. ^2-13 Barriers such as technical, interpersonal challenges hindering their use of Telepsychiatry, lack of cost-effectiveness, the opposing view among psychiatrists; as many psychiatrists find it challenging to accept Telepsychiatry, and they are reluctant to accept the effectiveness of this service delivery and think that system workflow integration should be improved. In addition, psychiatrists dislike their inability to take physical steps to ensure patients’ comfort. ^2-7 Furthermore, Telepsychiatry is the most active telemedicine application functioning as a feasible alternative for current mental health services, improved care services, and early treatment. Regardless of the benefits mentioned previously; psychiatrists are less satisfied with it because the quality of audio-visual technology impacts the reliability of teleconsultation. in addition, there were a few limitations when addressing satisfaction, such as the lack of return to clinics (RTCs), small sample sizes, and no apparent difference in satisfaction between Telepsychiatry and face-to-face consultation. For that reason, substantial research has been conducted to identify this satisfaction limitation as it is still unknown whether opposing is due to the program or technology. User acceptance or Patients and cultural factors presented a primary barrier or challenges in implementation, as many Saudi psychiatrists are skeptical of Telepsychiatry’s outcomes, and clinicians are unsatisfied with the service, affecting their willingness to utilize telemedicine. The second barrier is consumer acceptance, impacting patients’ willingness to be treated by telemedicine. Other obstacles are the lack of qualified experts to implement the technology, essential Information and Communications Technology (ICT) infrastructure, and acceptable strategies and plans for implementing telemedicine in Saudi Arabia. In addition, some health providers lack ICT skills and cannot apply the innovation. ^6-13 Thus, there are scattered current data investigating psychiatrists’ satisfaction with Telepsychiatry in Saudi Arabia. Therefore, this study aims to fill the research gap in this area.The earliest telemedicine trials were in the 1950s when Norfolk State Hospital and Nebraska Psychiatric Institute used closed-circuit television to provide patient consultations. Telemedicine has various branches; it includes Telepsychiatry, which offers psychiatric care through any form of telecommunication, such as video conferencing. ¹ Telecommunication provided for both psychiatrists and their patients a convenient, easy, and fast tool to connect both parties for accessible psychiatric evaluations, various forms of therapy such as individual, group, family therapy, medication management, and essential information on their diseases; most importantly it saved both time and effort for both psychiatrists and their patients. ^2,3 It can also be utilized for non-clinical applications, such as organizational learning, in addition to infinite services. ⁴ Telepsychiatry can be applied in situations where patients stay in rural areas or move from distant areas become difficult; also, in follow-ups or medication refills. ⁵ Many patients reported their satisfaction with telecommunications. ³ Telepsychiatry, similar to any technology, faces barriers or limitations in its use; therefore, considerable research has been conducted to identify these barriers. ^2-13 Barriers such as technical, interpersonal challenges hindering their use of Telepsychiatry, lack of cost-effectiveness, the opposing view among psychiatrists; as many psychiatrists find it challenging to accept Telepsychiatry, and they are reluctant to accept the effectiveness of this service delivery and think that system workflow integration should be improved. In addition, psychiatrists dislike their inability to take physical steps to ensure patients’ comfort. ^2-7 Furthermore, Telepsychiatry is the most active telemedicine application functioning as a feasible alternative for current mental health services, improved care services, and early treatment. Regardless of the benefits mentioned previously; psychiatrists are less satisfied with it because the quality of audio-visual technology impacts the reliability of teleconsultation. in addition, there were a few limitations when addressing satisfaction, such as the lack of return to clinics (RTCs), small sample sizes, and no apparent difference in satisfaction between Telepsychiatry and face-to-face consultation. For that reason, substantial research has been conducted to identify this satisfaction limitation as it is still unknown whether opposing is due to the program or technology. User acceptance or patients and cultural factors presented a primary barrier or challenges in implementation, as many Saudi psychiatrists are skeptical of Telepsychiatry’s outcomes, and clinicians are unsatisfied with the service, affecting their willingness to utilize telemedicine. The second barrier is consumer acceptance, impacting patients’ willingness to be treated by telemedicine. Other obstacles are the lack of qualified experts to implement the technology, essential Information and Communications Technology (ICT) infrastructure, and acceptable strategies and plans for implementing telemedicine in Saudi Arabia. In addition, some health providers lack ICT skills and cannot apply the innovation. ^6-13 Thus, there are scattered current data investigating psychiatrists’ satisfaction with Telepsychiatry in Saudi Arabia. Therefore, this study aims to fill the research gap in this area.Table 1- The psychiatrists’ socio-demographic characteristics. n=328

Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve–Guided Revascularization Strategy

ObjectivesThis study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)– and fractional flow reserve (FFR)–guided revascularization strategies.BackgroundAn iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes.MethodsThis is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization.ResultsAmong the entire population, women had a lower number of functionally significant lesions per patient (0.31 ± 0.51 vs. 0.43 ± 0.59; p < 0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p < 0.001). There was no difference in mean iFR value according to sex (0.91 ± 0.09 vs. 0.91 ± 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 ± 0.09 vs. 0.85 ± 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919).ConclusionsAn FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex. (Functional Lesion Assessment of Intermediate Stenosis to guide Revascularization [DEFINE-FLAIR]; NCT02053038)     

Factors associated with recovery delay in a sample of patients diagnosed by MERS‐CoV rRT‐PCR: A Saudi Arabian multicenter retrospective study

Background

Research evidence exists that poor prognosis is common in Middle East respiratory syndrome coronavirus (MERS‐CoV) patients.

Objectives

This study estimates recovery delay intervals and identifies associated factors in a sample of Saudi Arabian patients admitted for suspected MERS‐CoV and diagnosed by rRT‐PCR assay.

Methods

A multicenter retrospective study was conducted on 829 patients admitted between September 2012 and June 2016 and diagnosed by rRT‐PCR procedures to have MERS‐CoV and non‐MERS‐CoV infection in which 396 achieved recovery. Detailed medical charts were reviewed for each patient who achieved recovery. Time intervals in days were calculated from presentation to the initial rRT‐PCR diagnosis (diagnosis delay) and from the initial rRT‐PCR diagnosis to recovery (recovery delay).

Results

The median recovery delay in our sample was 5 days. According to the multivariate negative binomial model, elderly (age ≥ 65), MERS‐CoV infection, ICU admission, and abnormal radiology findings were associated with longer recovery delay (adjusted relative risk (aRR): 1.741, 2.138, 2.048, and 1.473, respectively). Camel contact and the presence of respiratory symptoms at presentation were associated with a shorter recovery delay (expedited recovery) (aRR: 0.267 and 0.537, respectively). Diagnosis delay is a positive predictor for recovery delay (r = .421; P = .001).

Conclusions

The study evidence supports that longer recovery delay was seen in patients of older age, MERS‐CoV infection, ICU admission, and abnormal radiology findings. Shorter recovery delay was found in patients who had camel contact and respiratory symptoms at presentation. These findings may help us understand clinical decision making on directing hospital resources toward prompt screening, monitoring, and implementing clinical recovery and treatment strategies.     

Public awareness of central nervous system tumors in the Kingdom of Saudi Arabia

Objectives:To investigate individuals’ knowledge about central nervous system tumors (CNST) signs and symptoms and risk factors, as well as their readiness to seek medical advice. The signs and symptoms associated with CNSTs are often vague, and failure to recognize them could lead to delays in seeking help and possibly fatal results.Methods:This was a cross-sectional survey that utilized 2 delivery methods. A total of 1,500 personally delivered and 1,500 online self-administered questionnaires were completed in parallel between June 2015 and June 2016 for the occupants of the Kingdom of Saudi Arabia.Results:Significant differences were observed for the sociodemographic characteristics of participants recruited via the 2 methods. The most recognized symptom was “Headaches” (45.2%), and the most recognized risk factor was “Radioactive location/occupation” (84.1%). Overall knowledge scores were low, significantly predicted by employment and cancer contact (p<0.05), while the scores significantly higher for participants who were willing to see their doctors within a week (p<0.005). The most recognized barrier to seeking help was “Worry about what the doctor might find” (74.0%).Conclusion:The level of awareness of CNSTs was low. Using a questionnaire delivered in 2 different ways enabled the recruitment of sample pools with different sociodemographic characteristics.

For many health-related issues, awareness is considered an important factor associated with behavior.1 Several studies have linked high knowledge to the ability to address modifiable associated causes, for instance, improving diet and increasing exercise to prevent cancer, as well as taking appropriate actions in response to detecting associated symptoms.2 Assessing the level of public awareness of health-related issues is important for identifying deficient areas and increasing awareness in areas where needed.3 The occurrence of a central nervous system tumor (CNST) in any individual, with its associated consequences, is a devastating event.4 In 2012, the World Health Organization (WHO) Global Cancer report (GLOBOCAN) stated that more than 250,000 individuals worldwide were diagnosed with a CNST, and approximately 190,000 died, ranking CNSTs in the top 10 mortalities caused by cancer.5,6,7 More than 120 CNST entities have been classified by the World Health Organization (WHO) based on their clinicopathological characteristics and histological patterns.8 The signs and symptoms for CNSTs depend on the tumor location, and they are not exclusively indicative of the presence of these tumors.3,9,10 Causes associated with the development of CNSTs vary, and many are still under investigation.11-20 Many studies that assess health public awareness rely on random sampling through telephone directories, a system that is not necessarily available in many developing countries. Questionnaires provided online have frequently been used, including in marketing research and psychological studies. Due to their attractive ability to access larger cohorts and improve validation checks, and thus data quality, these Web-based questionnaires represent an important tool for many epidemiological studies on public health.21,22 Awareness of the symptoms and risk factors for CNSTs is especially critical, since the disease signs tend to be vague and easily overlooked, resulting in a delayed response to take appropriate action. Unfortunately, there is a lack of CNST awareness studies that assess the level of public understanding in many regions of the world. In this study, we aimed to investigate the knowledge concerning CNST signs and symptoms and risk factors, as well as readiness to seek medical advice, among citizens of the Kingdom of Saudi Arabia (KSA) using 2 questionnaire delivery methods.     

Endodontic mishaps during root canal treatment performed by undergraduate dental students: An observational study

Endodontic mishaps during root canal treatment (RCT) are considered to be one of the most commonly encountered errors, which affect the quality of treatment and may have dangerous health implications for patients.The present study was conducted to assess the frequency and types of endodontic mishaps in root canal-treated teeth performed by undergraduate dental students.A total 404 endodontically treated teeth were performed by undergraduate dental students of King Khalid University College of Dentistry, Abha, Kingdom of Saudi Arabia. The radiographs of the endodontically treated teeth were studied for a period of 6 months, and the related demographic data were collected from patient files.The most commonly identified mishaps were related to obturation, where the maximum number of cases (68.1%) had under-obturated root canals. More endodontic mishaps were performed by students in level 9 education. The upper left 2nd molar teeth had a higher frequency of mishaps, and molars were found to have more access-related mishaps. Lastly, access-related and instrument-related mishaps had a low frequency of occurrence.The majority of endodontic mishaps found in the study sample were related to root canal obturation. The undergraduate students at level 9 were less proficient in conducting RCTs with many endodontic mishaps when compared to the cases performed by students at higher levels. The study suggests relevant guidance for dental students while performing RCTs, especially during obturation of the root canals.     

β-Cell Knockout of SENP1 Reduces Responses to Incretins and Worsens Oral Glucose Tolerance in High-Fat Diet–Fed Mice

SUMOylation reduces oxidative stress and preserves islet mass at the expense of robust insulin secretion. To investigate a role for the deSUMOylating enzyme sentrin-specific protease 1 (SENP1) following metabolic stress, we put pancreas/gut-specific SENP1 knockout (pSENP1-KO) mice on a high-fat diet (HFD). Male pSENP1-KO mice were more glucose intolerant following HFD than littermate controls but only in response to oral glucose. A similar phenotype was observed in females. Plasma glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) responses were identical in pSENP1-KO and wild-type littermates, including the HFD-induced upregulation of GIP responses. Islet mass was not different, but insulin secretion and β-cell exocytotic responses to the GLP-1 receptor agonist exendin-4 (Ex4) and GIP were impaired in islets lacking SENP1. Glucagon secretion from pSENP1-KO islets was also reduced, so we generated β-cell–specific SENP1 KO mice. These phenocopied the pSENP1-KO mice with selective impairment in oral glucose tolerance following HFD, preserved islet mass expansion, and impaired β-cell exocytosis and insulin secretion to Ex4 and GIP without changes in cAMP or Ca²⁺ levels. Thus, β-cell SENP1 limits oral glucose intolerance following HFD by ensuring robust insulin secretion at a point downstream of incretin signaling.