Cryoballoon ablation for atrial fibrillation in patients with heart failure and reduced left ventricular ejection fraction: A systematic review and meta-analysis.

The coexistence of atrial fibrillation (AF) with heart failure (HF) is prevalent, leading to severe complications. This review aimed to investigate the success rate and efficacy of cryoballoon ablation (CBA) by measuring the improvement in the New York Heart Association (NYHA) classification and the effect on the left ventricular systolic function in patients with AF accompanied by heart failure with reduced ejection fraction (HFrEF). Electronic databases search included PubMed, Web of Science, and Scopus in January 2023. Outcomes addressed the following: left ventricular ejection fraction (LVEF) improvement, AF recurrence, NYHA classification improvement, and mortality. STATA 17.0 software was used for data analysis. The effect size for the studies was a standard mean difference (SMD) with a 95% confidence interval (CI) for outcomes. Proportion analysis with 95% CI was used for freedom from early AF and AF after 2 years and all-cause death. We included six studies, including 1699 HF patients with 365 HFrEF patients. The SMD of postoperative LVEF compared to preoperative LVEF in HFrEF was 0.99 ([95% CI: 0.60, 1.39], p = .00), and for NYHA was -1.12 ([95% CI: -1.36, -0.87], p = .00). The analysis results in HFrEF patients for freedom from AF after 1 year was 65% ([95% CI: 0.55, 0.75], and after 2 years was 39% ([95% CI: 0.10, 0.67]). Proportional analysis was conducted for all-cause death, resulting in 3% mortality ([95% CI: -0.01, 0.07]). Cryoablation of AF accompanied by HFrEF appeared safe as it reduced AF recurrence and enhanced clinical outcomes.

Knowledge Is (Still) Key: Awareness to Shape Trends in Telemedicine Use during the Pandemic Based on Management Perceptions and Implementation Systems.

Objectives: The digital revolution has brought rapid developments to the health sector. People were taking advantage of telemedicine technology during the COVID-19 pandemic. Telemedicine is highly recommended during a pandemic because it will reduce the transmission rate of viruses, and it is considered adequate and low-cost. However, a fundamental challenge still occurs; most people need to be used to telemedicine technology. Presumably, inadequate education and lack of experience regarding the use of telemedicine are obstacles for society in utilizing telemedicine. Methods: This study is aimed at determining the factors that influence the use of telemedicine. It focused on variables such as data confidentiality, administration, and knowledge to measure potential factors that pushed people to utilize telemedicine. We used a quantitative approach, using multivariate analysis, namely, simple linear regression. Most of our respondents are people aged 18-30 years young. Results: All respondents stated that administration factors in the implementation of telemedicine were good. Through the Chi-square test, the data safety factor has no effect (p value =0.090 or >0.05) on telemedicine implementation, while the knowledge factor has a significant effect on telemedicine implementation with a p value =0.043 (<0.005). The multivariate analysis explained that the knowledge variable influenced telemedicine use with a p value =0.033 (<0.05), meaning it contributed 1.624 times to telemedicine. Conclusion: This study discusses the factors that influence the use of telemedicine. The study's results explain that the knowledge variable is the most significant factor influencing telemedicine use. Knowledge is an intellectual property that everyone must have to capitalize on with telemedicine. A lack of knowledge will become an information gap and a barrier for someone to reach new tools/technologies.

Morphea Involving the Lips and Gingiva: A Rare Case Report.

Morphea is a subtype of scleroderma that does not involve Raynaud's phenomenon or internal organ involvement. It is a connective tissue disease that features the excessive deposition of collagen in the dermis and subcutaneous tissue, leading to a thickening of the dermis and subcutaneous tissue, eventually forming a scar-like lesion. We represent a 19-year-old male Saudi patient displaying a white patch on the marginal gingiva of tooth #21 and multiple yellowish papules on the outer surface of the lip. Both teeth #21 and #22 have experienced recession and bone loss. The patient's clinical history and histopathology revealed characteristic features of localized scleroderma. A treatment was proposed involving immunosuppressants, methotrexate, and pimecrolimus cream along with topical corticosteroids and excimer laser therapy (308 nm). The patient followed the treatment plan for a full month and the white patch quickly improved for the patient. Afterward, the patient has been taking only methotrexate with a significant but gradual improvement. In this paper, we discuss the differential diagnosis to be considered and present an unusual occurrence of localized scleroderma in the oral cavity.

Risk of General Anesthesia in Pediatric Skin Procedures with Projection on Tumescent Anesthesia.

BACKGROUND: Uses of general anaesthesia in outpatient invasive procedures have increased, especially in dermatology. Being uncooperative, children often require general anaesthesia, since surgical skin operations are mostly painful. AIM: The purpose of this study is to evaluate the safety, significant adverse events, and the complication rates related to general anaesthesia, when used among pediatric population undergoing skin procedures. METHODS: We conducted a first retrospective cohort study of patient chart review during the period from September 1, 2017 through September 2019. All patients admitted for pediatric skin procedures during this period have participated in our study. We reviewed selected charts to document any unexpected admissions, adverse events, or complications. Surgical outcomes and anaesthesia complications were reviewed by three anesthesiologists. We assessed inter-rater reliability. RESULTS: A total of 211 procedures were reported for 211 patients with 19 diagnoses. No adverse events related to anaesthesia were recognized, apart from minor complications noticed in twelve patients. The kappa value range is between 0.78 and 1.00 (95% C.I., 0.46809 to 1.00). CONCLUSION: Dermatologist and pediatricians can safely do necessary procedures under general anaesthesia with the supervision of pediatric-trained anesthesiologists while considering other safety and risk precautions and the pediatric age group.

Prevalence and determinants of physical activity in a mixed sample of psychiatric patients in Saudi Arabia.

OBJECTIVES: To estimate prevalence of physical activity and its associations with various psychiatric disorders and the use of psychotropic medications. METHODS: A cross-sectional observational study was carried out between July 2012 and June 2014. Patients were enrolled from a number of hospitals located in 5 regions of the Kingdom of Saudi Arabia. RESULTS: A total of 1185 patients were included in current analysis: 796 were outpatients, and 389 were inpatients. Out of 1,185 patients, 153 (12.9%) were physically active. Much higher rates of physical activity were reported among males than females (15.9% versus 9.6%, p less than 0.001). According to the univariate analysis, higher rates of physical activity were positively correlated with primary bipolar disorders, the use of antianxiety medications and, to a lesser extent, use of antipsychotic medications, but they were negatively correlated with primary anxiety disorders, use of antidepressant medications, and use of multiple psychotropic medications. The associations between physical activity and primary bipolar disorders (odds ratio [OR]=2.47, p=0.002), use of antianxiety medications (OR=3.58, p=0.003), and use of multiple psychotropic medications (OR=0.33, p less than 0.001) remained significant after adjusting for demographic and clinical characteristics. CONCLUSION: We report a variable but generally low prevalence of physical activity among a large, mixed sample of psychiatric patients in Saudi Arabia. These findings may highlight the importance of assessing physical activity status of psychiatric patients and the critical need for physical activity promotion programs among this group of disadvantaged patients.

Ultrasound-guided bilateral superficial cervical plexus block is more effective than landmark technique for reducing pain from thyroidectomy.

PURPOSE: Thyroidectomy causes postoperative pain and patient discomfort. Bilateral superficial cervical plexus block is a regional anesthesia technique that can provide analgesia during and after surgery. This study aims to compare the effectiveness of ultrasound (US)-guided versus landmark (LM) technique for bilateral superficial cervical plexus block in thyroidectomy. PATIENTS AND METHODS: Thirty-six patients undergoing thyroidectomy were divided into two groups randomly (n=18); either US-guided (US group) or LM technique (LM group) for bilateral superficial cervical plexus block. Patient-controlled analgesia was used to control postoperative pain. Intraoperative opioid rescue, postoperative visual analog scale (VAS) score and opioid consumption were measured. RESULTS: The number of patients who required intraoperative opioid rescue was significantly lower in the US group (p≤0.05). There was no significant difference in postoperative VAS score at 3 hours (p>0.05), but postoperative VAS score at 6 and 24 hours was significantly lower in the US group (p≤0.05). Twenty-four hour postoperative opioid consumption was significantly lower in the US group (p≤0.05). CONCLUSION: Ultrasound-guided bilateral superficial cervical plexus block is more effective in reducing pain both intra- and postoperatively compared with landmark technique in patients undergoing thyroidectomy.

Effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia.

PURPOSE: Cesarean section is a surgical procedure. Surgical procedures will induce stress responses, which may have negative impact on postoperative recovery. Ketamine plays a role in the homeostatic regulation of inflammatory response in order to attenuate stress response. We tried to determine the effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia. PATIENTS AND METHODS: Thirty-six pregnant women undergoing emergency cesarean section with spinal anesthesia were randomly divided into two groups (n=18). Ketamine 0.3 mg/kg (KET group) or NaCl 0.9% (NS group) was administered intravenously before the administration of spinal anesthesia. C-reactive protein (CRP) and neutrophil levels were measured preoperatively and postoperatively. RESULTS: Elevation of CRP stress response was lower in the KET group and significantly different (P≤0.05) from that in the NS group. Neutrophil level was elevated in both the groups and hence not significantly different from each other (P>0.05). Postoperative visual analog scale pain score was not significantly different between the two groups (P>0.05), but there was a statistically significant (P≤0.05) positive and weak correlation between visual analog scale and CRP level postoperatively. CONCLUSION: Low-dose intravenous ketamine effectively attenuates the CRP stress response in patients undergoing emergency cesarean section with spinal anesthesia.

Attitudes and beliefs on organ donation among students in a university in Central Saudi Arabia.

OBJECTIVES: Thousands of people with end-stage organ disease and organ failures die waiting for donations. Although, Saudi Arabia has an active center for organ transplantation, the number of donors is still low. The study focus was the attitudes, beliefs, and knowledge of university students toward organ donation, because the youth are agents of change in their communities and could help to promote organ donation.   METHODS: This study had a cross-sectional design and included randomly selected 195 students (97 males and 98 females) between the ages of 19-25 in Qassim University between January and March 2013. A 23-question self-administrated questionnaire in both Arabic and English was completed. The questionnaire was pre-tested on 10 students for validity and reliability. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 13.  RESULTS: The primary source of students' knowledge on organ donation was television (61.5%). Most students (85.1%) believed that there is low public awareness regarding the subject. However, 37.4% of the students agreed to donate in the future and 68.2% would donate for a relative. One-third of students knew about organ donation cards, but none have signed them. The main reason for refusal was fear of side effects (51.8%). Half of the students (48.7%) think there are misconceptions of the Islamic perspective, as a result there are fewer donors. Medical students showed significantly higher knowledge about organ donation cards and the effectiveness of transplantation as a treatment compared to non-medical students.   CONCLUSIONS: College students have little knowledge on the benefits of organ donations. Further, religious misconceptions and accessibility of donor cards are barriers to donations. Public health promotion campaigns could address religious beliefs while a systematic intervention should be put in place to make donor registration more available. A nationwide study with a larger sample size addressing the same objectives needs to be conducted.

Experimental and theoretical study of the vibrational spectra of 12-thiacrown-4 and 18-thiacrown-6, evaluation of the performance of the different anharmonic force fields compared to the scaled quantum mechanical force fields.

We report, to the best of our knowledge, for the first time the vibrational, IR and Raman, spectra of 12-thiacrown-4 (12t4) and 18-thiacrown-6 (18t6). To predict in what conformation 12t4 and 18t6 exist, for the vibrational analysis of both molecules and to assess the performance of the different computational methods for the accurate prediction of the vibrational frequencies of relatively large molecules, the computations were done using the harmonic and anharmonic force fields using the 6-31G* and 6-311G** basis sets. The computations were performed at the HF, B3LYP, CAM-B3LYP, BLYP, BP86, G96LYP, PBE1PBE, TPSSH and MP2 levels. Comparison was made between the calculated and experimental vibrational frequencies as indicated by the root-mean-square (rms) deviations, using either the unscaled and scaled harmonic vibrational frequencies and, unscaled, anharmonic vibrational frequencies. For the harmonic vibrational frequencies two scaling schemes were used. One uses one-scale-factor (1SF) scaling and the other uses 8SF scaling. In terms of the vibrational analysis of 12t4 and 18t6, the report confirms the solid state X-ray structure of D4 of 12t4 and C2 of 18t6. It is concluded that a lower rms deviation is obtained using 1SF scaled harmonic vibrational frequencies at even the HF/6-31G* level than using anharmonic vibrational frequencies at the MP2/6-311G** level. The CAM-B3LYP method showed some improvement over the traditional B3LYP method.

Evaluation of ethanolamine oleate sclerotherapy on the submandibular glands of canines as a potential therapy for sialorrhea.

BACKGROUND: Sialorrhea can have major negative effects on the physical and social well-being. Sclerotherapy may be useful in patients with sialorrhea by decreasing the amount of saliva production. The aim of this study was to test the effect of ethanolamine oleate (EO) in an experimental model as a preliminary step for its application in humans. METHODS: Histopathological and morphometric analysis of submandibular glands from thirteen dogs was preformed. A total of 25 glands were injected with 1ml of 2.5% EO (n=5), 1ml of 5% EO (n=5), 5ml of 2.5% EO (n=5) and 5ml of 5% EO (n=5). Five glands were used as control. RESULTS: EO significantly induced a dose dependent scaring of the gland ending in lobular transformation (salivary gland cirrhosis). Morphometric measurements showed that 1ml of 2.5% or 5% EO significantly induced fibrosis compared to normal glands (p=0.014 and 0.021, respectively). Fibrosis significantly increased and was more apparent when a dose of 5ml of 2.5% EO or 5% EO were injected [by semi-quantitative evaluation (p=0.016 and 0.002, respectively) and morphometric measurements (p=0.016 and 0.008, respectively)]. This scarring effect was significantly associated with reduction of area of acinar cells when a dose of 1ml-5%, 5ml-2.5% or 5ml-5% EO were applied (p=0.03. 0.012 and 0.004, respectively). Moreover, ductal injury was only significant when a dose of 5ml of 5% EO was used (p=0.034). This dose and concentration (i.e. 5ml-5% EO) had a significant synergetic effect [p=0.0119]. CONCLUSION: In this model, treatment with EO proved to permanently reduce the acinar area through induction of progressive, irreversible and dose dependant scarring (medical sialoadenectomy).

Stem cells: a tree model.

A tree model is presented in order to illustrate the hypotheses that earlier stem cells will respond differently than later progenitors to the same stimuli. Experimental data and decision analysis tools are shown to demonstrate the concept.

Game theoretic analysis of interferons effect on hematopoietic progenitors growth.

The effects of recombinant alpha, beta and gamma interferons (IFN), alone or in combinations were studied in a case of essential thrombocythemia, using the mixed colony formation assay. This assay allows growth of multipotent (CFU-Mix), and unipotent granulocytic-macrophage (CFU-GM), erythroid (BFU-E) and megakaryocytic (CFU-Meg) progenitors. The bone marrow precursors were cultured in the presence of each type of IFN at 100 U/ml and all possible combinations performed. The results were analysed using the Shapley formula, a game theoretic approach. It is concluded that IFN alpha would be the best candidate for reducing megakaryocytic progenitors while growth of other hematopoietic precursors would be stimulated. These types of analytical biological experiments controlled by using six permutations and calculation of the Shapley value for the three types of IFNs are suggested as a fair approach for a rational choice.