Tobacco Smoking, Secondhand Smoke Exposure and Cessation Perceptions by Dental Students in Al Madinah, a Conservative Saudi Society

Objective: To explore the prevalence of tobacco use and secondhand smoke (SHS) exposure in dental students and to investigate their perceptions on the role of dentists in tobacco cessation activities. Material and Methods:  A questionnaire-based study was conducted in a public university in Al Madinah, Saudi Arabia. The questionnaire investigated demographic factors, tobacco use practices, SHS exposure, and student perceptions of tobacco cessation activities. Descriptive statistics and statistical significance of differences between demographic groups were calculated. Results: A total of 228 students participated with 43.0% (n=98) males and 57.0% (n=130) females. A proportion of 30.7% (n=70) of the participants smoked tobacco, and these constituted 51 males (73%) and 19 females (27%). Only 39 students (15 females and 24 males) indicated their method of tobacco use, which was mainly cigarettes and waterpipes. One in two students was exposed to SHS. Non-smokers had better awareness of the health hazards of SHS (p<0.001), and were more likely to adopt tobacco cessation activities recommended by dentists (p<0.05). Conclusion:  A substantial proportion of dental students in a very conservative religious area smoke tobacco and are exposed to SHS. Their perceptions of the harms of SHS and attitudes on cessation need improvement. The influence of culture and religion in shaping health risk behaviors in conservative communities needs to be verified

Inflammatory Myofibroblastic Tumor of the Right Atrium

Cardiac inflammatory myofibroblastic tumor (IMT) is a rare entity and is associated with distinct clinical, pathological and molecular features. The clinical behavior, natural history, biological potential, management and prognosis of such tumors are unclear. We present herewith an adolescent girl who presented with similar entity involving the junction of the right atrium and the inferior vena cava (IVC) in association with thrombocytosis and IVC thrombosis leading to obstruction of blood flow. Diagnostic tools included imaging and immuno-histopathology studies. Surgical management included resection of the tumor and thrombo-embolectomy of the IVC under cardiopulmonary bypass. This case is unique due to association of complete obstruction of IVC caused by the strategic location of the tumor, thrombosis of vena cava and association of thrombocytosis. These features have not been reported yet in relation to the cardiac IMT. This report will help in better understanding and management of similar cases in terms of planning cannulation of femoral veins or application of total hypothermic circulatory arrest during cardiopulmonary bypass and prompt us to look for recurrence or metastasis during follow up using echocardiography and laboratory investigations. The possibility of IMT should be kept in the differential diagnosis of cardiac tumors especially in children and adolescents

Impostor phenomenon among urologists in Saudi Arabia

Impostor phenomenon (IP) is the persistent inability to believe that one’s success is deserved or has been legitimately achieved due to one’s efforts or skills. It is associated with burnout, anxiety and depression and can negatively impact the lives of the affected individuals. This study aimed to determine the prevalence of IP among urologists in Saudi Arabia. A cross-sectional study was conducted among practicing urologists and urologists-in-training in Saudi Arabia between November and December 2022. A self-administered questionnaire comprising questions on the sociodemographic characteristics and the Clance impostor phenomenon scale (CIPS) was distributed through email to all registered urologists in the Saudi Commission for Health Specialties database. A total of 155 urologists (143 men and 12 women) were enrolled in this study. The majority of the urologists (44.5%) were consultants, and the prevalence of the impostor phenomenon in this study was 27.7%. Nearly half of the urologists (49.7%) presented moderate levels of the phenomenon, 23.9% of the urologists demonstrated high levels, and 20.6% presented low levels. Only 5.8% of the urologists showed intense levels of the phenomenon. The phenomenon was significantly more prevalent among those in training (p = 0.010) and less prevalent among those with a subspecialty in endourology (p = 0.016). The prevalence of the impostor phenomenon among urologists was 27.7%. It was more commonly seen in resident urologists, and those with a subspecialty in endourology were less likely to be affected by this phenomenon

Papillary fibroelastoma of the aortic valve - a case report and literature review

The prevalence of primary cardiac tumour ranges from 0.0017-0.28% and papillary fibroelastoma is rare but not uncommon benign cardiac neoplasm. Currently, with the advent of higher-resolution imaging technology especially transoesophageal echocardiography such cases being recognized frequently. The clinical presentation of these tumours varies from asymptomatic to severe ischaemic or embolic complications. We herein, present a 50-year-old female patient with a papillary fibroelastoma of the aortic valve arising from the endocardium of the right coronary cusp very close to the commissure between the right and non-coronary cusps. The patient presented with angina-like chest pain and was investigated using echocardiography and CT angiographic modalities in addition to the usual investigations. The differential diagnosis considered was a thrombus, myxoma, Lambl's excrescence and infective vegetation. The surgical management included a prompt resection of the tumour on cardiopulmonary bypass avoiding injury to the aortic valve. The patient recovered well. A review of the literature suggests that the cardiac papillary fibroelastoma is a rare but potentially treatable cause of embolic stroke and other fatal complications, therefore, a strong suspicion; appropriate use of imaging modality, preoperative anticoagulation and urgent surgical resection is warranted. Also, possibility of this diagnosis should be kept in mind while managing cardiac or valvular tumours

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Influence of some environmental conditions on stability and activity of Bacillus thuringiensis formulations against the cotton leaf worm, Spodoptera littoralis (Boisd.) (Lepidoptera: Noctuidae)

Abstract The entomopathogenic bacterium Bacillus thuringiensis (Bt) has been used in crop protection for the last 70 years; however, many environmental conditions affect its activity. The present study was directed to evaluate the influence of certain environmental conditions on stability and activity of Bt samples of the two commercial formulations (Dipel 2 × 6.4% WP and Protecto 9.4% WP), when stored under accelerated hot storage, shelf, and outdoor storage. Photo degradation of the two formulations was studied in aqueous solution. The results revealed that the loss percentage of Protecto formulation was above the permissible limits of WHO specifications after 2 years of storage at ambient conditions and the thermal stability of the Bt was affected negatively depending on the storage periods. In accordance with this trend, the bioassay tests versus neonate and second instar larvae of the cotton leaf worm, Spodoptera littoralis (Boisd.) (Lepidoptera: Noctuidae), showed a decrease in toxicity of the formulations to (60%) after storage at 35 ± 2 °C for 12 weeks and about (70%) after storage under sunlight for 2 days. Photolysis of aqueous solutions reduced the half-life of formulations by about 1–2 days. The stability of Bt should be evaluated prior to submission for registration as these products have showed less stability under storage at ambient conditions. The stakeholders and decision-makers can utilize these results and examine such products case by case

Modeling of a symmetric five-bar displacement amplification compliant mechanism for energy harvesting

This paper presents an analytical model to determine a closed form mathematical represen-tation for the output displacement of a displacement amplification compliant mechanism used for energy harvesting. A symmetric five-bar compliant mechanism with right-circular and corner-filleted flexure hinges was mathematically modeled and its displacement was determined using the Cas-tigliano energy theorem. The stresses within the flexure joints, the weakest points in the mechanism body, were calculated. The mathematical model expresses both the displacement amplification and the stresses as functions of the design parameters and the load caused by the harvester. The developed model can be used to optimize the mechanism dimensions for maximum harvested power, while minimizing its structural stresses. The mechanism was also modeled numerically using finite element methods; both the analytical and numerical models were verified experimentally. The mathematical model of the mechanism was integrated with a model representing a piezoelectric energy harvester to calculate the open-circuit voltage. As a proof of concept, experiments were performed using an unimorph piezoelectric cantilever at low-frequency (less than 1 Hz) harmonic excitation inputs. The measured open-circuit voltage was found to be in agreement with that calculated using the proposed model, when integrated with the model representing the piezoelectric beam. The power generated by the piezoelectric harvester, equipped with the proposed displacement amplification mechanism, was more than a hundred times that without amplification

Incidence and Determinants of Complications of Percutaneous Kidney Biopsy in a Large Cohort of Native Kidney and Kidney Transplant Recipients

Objectives: Percutaneous kidney biopsy is a useful diagnostic procedure. Hemorrhagic complications may occur following the procedure. Methods: We retrospectively analyzed the records of 1198 patients who had percutaneous renal biopsy between March 2013 and March 2018. The cohort included both native kidney and transplant biopsies. We have included only the first biopsy for each patient; repeat biopsies for 132 patients were excluded from the analysis. Results: 1198 patients ( 332 transplant recipients and 886 native kidney patients) were included in the study. Major complications occurred in 18(1.5%) of patients (1.4% in native kidney biopsies Vs 1.6% in kidney transplant recipients. Adequate renal tissue (core of > 6 glomeruli ) was obtained in 91 % of patients. Our analysis revealed that the incidence of major complications, in the native kidney biopsy are increased with age>65 years (odds ratio2.4, 95 % CI (1.5-5.6), eGFR<30 ml/min/m2 (odds ratio 9.7, 95 % CI (3.4-18.2)  ) and anemia(9-11 mg/dl)(odds ratio3.2 (1.7-5.2), 95 % CI(1.7-5.2). In transplant recipients kidney biopsy the incidence of complications was increased with age>65 years (odds ratio 2.8(1.7-7.3), 95 % CI (1.7-7.3), eGFR<30 ml/min/m2 (odds ratio 11.3, 95 % CI  (3.5-16.8 ) and anemia (9-11mg/dl )(odds ratio 2.4, 95 %(1.7-4.7). Conclusion: The incidence of major complications following kidney biopsy was 1,5%(for  a cohort of native kidney biopsy and kidney transplant  biopsies . Age> 65 years, lower eGFR < <30 ml/min/m2 and anemia were independent risk predictors for the occurrence of major complications in both native and transplant kidney biopsy. Keywords: Biopsy; biopsy, needle; renal, complications, safety, adequacy