Feasibility and safety of orbital atherectomy for the treatment of in-stent restenosis secondary to stent under-expansion.

BACKGROUND: Debulking and ablative techniques are sometimes used for the treatment of in-stent restenosis (ISR) secondary to resistant stent under-expansion (SU). The safety and effectiveness of orbital atherectomy (OA) in this cohort of patients has not been reported. METHODS: We retrospectively evaluated consecutive patients treated with OA for ISR secondary to balloon undilatable SU at two academic tertiary care centers between October 2016 and June 2019. Angiographic or intravascular imaging identified SU. Technical success was defined as residual 0% stenosis with TIMI III flow. RESULTS: A total of 41 patients were included in the study. Patients had an average age of 65 ± 12 years; 73% male, 61% diabetic, 41% with prior coronary artery bypass grafting, 61% with a prior incident of ISR, 51% presented with stable angina, 17% unstable angina, and 32% non-ST elevation myocardial infarction (MI). Implantation of the under-expanded stents occurred between 2 months and 22 years prior to the index procedure. A total of 27% of patients had multiple layers of stents in the target lesion and 32% of patients had in-stent chronic total occlusion. Technical success was achieved in 40 (98%) patients. There were 2 (5%) major adverse cardiovascular events; both of them were periprocedural MI from the no-reflow phenomenon. There were 2 (5%) Ellis type II coronary perforations that required no intervention. CONCLUSIONS: OA can be effectively performed as an adjunctive tool in the treatment of ISR with balloon undilatable SU. The use of OA for SU is not approved by the U.S. Food and Drug Administration and is "off label" and caution must be used to limit any device/stent interaction.

Inappropriate Prescribing in Elderly Inpatients at a University Hospital in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Elderly populations usually use more medications than any other age group and are therefore more susceptible to potentially inappropriate prescribing (PIP), drug-drug interactions, and the related health consequences. In this study, we aimed to determine PIP prevalence and explore the most common potentially inappropriate medications (PIMs) prescribed. METHODS: This was a retrospective study involving elderly patients admitted at King Abdulaziz Medical City-Jeddah (KAMC-JD), between November 2014 and January 2015. We included all elderly patients aged 60 years and above admitted to KAMC-JD through the emergency department (ED), clinic, and direct admissions during the study period. Patients admitted to the intensive care unit, oncology department, and/or those who passed way in the ED before admission were excluded from the study. Prescriptions were assessed for PIP using the 2012 Beers Criteria, which categorizes PIMs to three classes: first class are medications to avoid in older adults regardless of their conditions; second class are medications to avoid with certain diseases or syndromes; and third class are medications that should be used with caution. RESULTS: Our study included 135 patients, of which 49.6% were males. The mean age was 71.26 ± 8.1 years. According to the 2012 Beers Criteria, 80% of patients were using at least one listed PIM. For the Criteria's first, second, and third classes, PIM prescription rates were 72.6%, 59.2%, and 37.7%, respectively. Regarding the most prescribed PIM in each class, insulin (sliding scale) was the most reported PIM in the first class, NSAIDs in the second class, and, lastly, vasodilators in the third class. CONCLUSION: PIP is a serious health issue threatening elderly patients. There is a need to develop evidence-based, context-sensitive, and user-friendly tools to assess PIP, as well as supportive training programs.

Circulating Prolidase Activity in Patients with Myocardial Infarction.

BACKGROUND: Collagen is a major determinant of atherosclerotic plaque stability. Thus, identification of differences in enzymes that regulate collagen integrity could be useful for predicting susceptibility to atherothrombosis or for diagnosing plaque rupture. In this study, we sought to determine whether prolidase, the rate-limiting enzyme of collagen turnover, differs in human subjects with acute myocardial infarction (MI) versus those with stable coronary artery disease (CAD). METHODS: We measured serum prolidase activity in 15 patients with stable CAD and 49 patients with acute MI, of which a subset had clearly defined thrombotic MI (n = 22) or non-thrombotic MI (n = 12). Prolidase activity was compared across study time points (at cardiac catheterization, T0; 6 h after presentation, T6; and at a quiescent follow-up, Tf/u) in acute MI and stable CAD subjects. We performed subgroup analyses to evaluate prolidase activity in subjects presenting with acute thrombotic versus non-thrombotic MI. RESULTS: Although prolidase activity was lower at T0 and T6 versus the quiescent phase in acute MI and stable CAD subjects (p < 0.0001), it was not significantly different between acute MI and stable CAD subjects at any time point (T0, T6, and Tf/u) or between thrombotic and non-thrombotic MI groups. Preliminary data from stratified analyses of a small number of diabetic subjects (n = 8) suggested lower prolidase activity in diabetic acute MI subjects compared with non-diabetic acute MI subjects (p = 0.02). CONCLUSION: Circulating prolidase is not significantly different between patients with acute MI and stable CAD or between patients with thrombotic and non-thrombotic MI. Further studies are required to determine if diabetes significantly affects prolidase activity and how this might relate to the risk of MI.

Use of social media in education among medical students in Saudi Arabia.

PURPOSE: Social media (SM), a virtual place where people can share, exchange, and communicate their ideas and knowledge, has become the new trend in communication and learning. This study aims to explore Saudi Arabian medical students' usage of SM and to discover the most common resources used in medical education. Furthermore, it aims to illustrate students' belief about the influence of SM on their learning. METHODS: This cross-sectional study administered validated questionnaires to medical students from different universities in Saudi Arabia, via emails, Twitter, Facebook, and short message service. A non-probability sampling technique was utilized and a sample size of 381 students was arrived at, using 95% confidence interval and 5% margin of error, since the total number of medical students in Saudi Arabia is approximately 36,000. The total respondents were 657 students from 23 different Saudi Arabian medical schools (females: 60.5%, n=397; males: 39.5%, n=260). RESULTS: The questionnaires of 21% of the students (n=139) were excluded from the analysis since they were incomplete. The most common website used by both genders was YouTube (42.3%, n=185); however, males preferred using Twitter and Wikis (p=0.001). With regard to utilizing SM for learning, 95.8% (n=419) of the students believed that it is beneficial. Females stated that SM helps them link basic and clinical science (p=0.003). CONCLUSION: Medical schools need to improve the utilization of SM by their faculty and students by developing activities and encouraging the usage of SM in education.

Variations in Clinical Presentation, Risk Factors, Treatment, and Prognosis of Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection (SCAD) has been considered a rare cause of acute coronary syndrome (ACS) in younger patients without known cardiovascular risk factors. However, recent studies have reported a higher incidence of SCAD in patients presenting with ACS with use of advanced invasive imaging modalities. In light of increasing awareness, the diagnosis of SCAD has increased significantly. We conducted a single-center retrospective analysis of cases with reported SCAD during a 10-year period between 2003 and 2013. Ten cases of SCAD were identified after review of coronary angiograms and clinical records. Basic demographic details, comorbidities, initial presentation, length of dissection, specific vessels involved in dissection, initial management, subsequent outcome, and incidence of recurrence were documented. All patients were female, with mean age of 42 years. One-third of cases occurred in the peripartum period. All patients presented with acute coronary syndromes. The left anterior descending artery was the predominant vessel involved in 80% of the patients on initial presentation. Out of 10 patients, 6 were managed conservatively, 2 had emergent coronary artery bypass graft, and 2 had percutaneous coronary intervention with placement of stents. Three of the 6 patients undergoing medical management after the initial presentation had recurrence within the same hospitalization.

Use of social media in education among medical students in Saudi Arabia / 한국의학교육

PURPOSE: Social media (SM), a virtual place where people can share, exchange, and communicate their ideas and knowledge, has become the new trend in communication and learning. This study aims to explore Saudi Arabian medical students' usage of SM and to discover the most common resources used in medical education. Furthermore, it aims to illustrate students' belief about the influence of SM on their learning. METHODS: This cross-sectional study administered validated questionnaires to medical students from different universities in Saudi Arabia, via emails, Twitter, Facebook, and short message service. A non-probability sampling technique was utilized and a sample size of 381 students was arrived at, using 95% confidence interval and 5% margin of error, since the total number of medical students in Saudi Arabia is approximately 36,000. The total respondents were 657 students from 23 different Saudi Arabian medical schools (females: 60.5%, n=397; males: 39.5%, n=260). RESULTS: The questionnaires of 21% of the students (n=139) were excluded from the analysis since they were incomplete. The most common website used by both genders was YouTube (42.3%, n=185); however, males preferred using Twitter and Wikis (p=0.001). With regard to utilizing SM for learning, 95.8% (n=419) of the students believed that it is beneficial. Females stated that SM helps them link basic and clinical science (p=0.003). CONCLUSION: Medical schools need to improve the utilization of SM by their faculty and students by developing activities and encouraging the usage of SM in education.