Incidence and Factors Associated with Uncontrolled Hypertension at 12 months after Kidney Transplantation in Saudi Arabia.

INTRODUCTION: Uncontrolled blood pressure (uBP) after kidney transplantation (KTx) is very common and is associated with significant morbidity. However, studies that assess its incidence and risk factors are limited and outdated in the Middle East. METHODS: This is a single-center retrospective study of KTx recipients (KTRs) in our center between January 2017 and May 2020 with a 12-month follow-up period. The target of hypertension treatment during the time of this study was <140/90 mm Hg, according to the published guidelines. We divided patients according to their blood pressure (BP) control at 1 year into two groups: controlled BP (cBP) (<140/90) and uBP (≥140/90). We studied the association between uBP and patients' demographics, baseline cardiovascular risk factors, and changes in their metabolic and cardiovascular profile during the first 12 months post-KTx. RESULTS: A total of 254 KTRs were included. 79.2% developed post-KTx hypertension, 74% were ≥30 years, 58% were men, and 80% were living donor KTRs. The renal replacement modality among our patients pre-KTx was hemodialysis in 78.4%, peritoneal dialysis in 11.5%, and 10.1% underwent preemptive transplantation. At 1 year, 76 (29.9%) KTRs did not attain the target BP goal. Systolic BP (SBP) decreased from baseline to 12 months by 13 ± 24 mm Hg in the cBP group and increased by 8.7 ± 21 mm Hg in the uBP group (p < 0.001). Additionally, diastolic BP (DBP) decreased by 8.5 ± 16.9 mm Hg in the cBP group and increased by 2.3 ± 18.8 mm Hg in the uBP group (p < 0.001). Factors associated with uBP included age (47 vs. 41 years, p = 0.008) and diabetes mellitus (p = 0.012). Contrarily, gender, dialysis vintage, preemptive transplantation, type of dialysis (hemodialysis vs. peritoneal dialysis), type of transplant (living donor KTx vs. deceased donor KTx), and smoking were not different among the two groups. There were no significant differences between the two groups in regard to changes in creatinine, weight, A1c, low-density lipoprotein, and parathyroid hormone levels. Additionally, rate of rejection, new onset diabetes post-transplant, and persistent hyperthyroidism were not different between the groups. However, higher body mass index at 12 months was associated with a higher incidence of uBP (27.2 ± 5.9 vs. 29.2 ± 5.4, p = 0.013). Using multivariate analysis, we found that serum creatinine at 12 months was the only predictor of uBP (OR = 1.005 [1-1.011], p = 0.036). CONCLUSION: At 1-year post-renal transplantation, about one-third of KTRs had uBP despite multiple antihypertensive medications. SBP and DBP significantly trended upward after transplantation in uBP patients, whereas SBP and DBP significantly trended downward after transplantation in cBP patients. Serum creatinine at 12 months was the only factor independently associated with uBP.

The use of computer-assisted surgery as an educational tool for the training of orthopedic surgery residents in pedicle screw placement: a pilot study and survey among orthopedic residents.

BACKGROUND: The training of orthopedic residents in adequate pedicle screw placement is very important. We sought to investigate orthopedic residents' perspectives on the use of computer-assisted surgery (CAS) in a training trial. METHODS: Orthopedic residents were randomly assigned to independently place a screw using the free-hand technique and the CAS technique on 1 of 3 cadavers (Cobb angles 5º, 15º and 67º) at randomly selected thoracolumbar vertebral levels. All residents were blinded to their colleagues' pedicle screw placements and were asked to complete a short questionnaire at the end of the session to evaluate their experience with CAS. We obtained CT images for each cadaver to assess pedicle screw placement accuracy and classified placement as A) screw completely in pedicle, B) screw < 2 mm outside pedicle, C) screw 2-4 mm outside pedicle, or D) screw > 4 mm outside pedicle. RESULTS: Twenty-four orthopedic residents participated in this trial study. In total, 65% preferred using the free-hand technique in an educational setting even though most (60%) said that CAS is safer. The main reason for free-hand technique preference was the difficult technical aspects encountered with CAS. In addition, accuracy of pedicle screw placement in this trial showed that 5 screws were classified as A or B (safe zone) and 19 as grade C or D (unsafe zone) using the free-hand technique compared with 15 and 9, respectively, using CAS (p = 0.008). CONCLUSION: Orthopedic residents perceived CAS as safe and demonstrated improved accuracy in pedicle screw placement in a single setting. However, the residents preferred the free-hand technique in an educational stetting owing to the difficult technical aspects of CAS.

CONTEXTE: Il est très important d'apprendre aux médecins résidents en chirurgie orthopédique comment positionner adéquatement une vis pédiculaire. Notre objectif était d'obtenir l'opinion des médecins résidents sur le recours à la chirurgie assistée par ordinateur (CAO) dans un essai sur la formation. MÉTHODES: Des médecins résidents en chirurgie orthopédique répartis aléatoirement ont placé indépendamment une vis à l'aide d'une technique à main libre basée sur les repères topographiques et la palpation, et de la CAO dans 1 de 3 cadavres (angles de Cobb de 5°, 15° et 67°) dans une vertèbre dorsolombaire sélectionnée aléatoirement. Aucun des médecins résidents n'a pu observer le positionnement de la vis de ses collègues, et les participants ont rempli un court questionnaire à la fin de la séance pour évaluer leur expérience de la CAO. Nous avons obtenu un tomodensitogramme pour chaque cadavre afin d'évaluer la précision du positionnement de la vis pédiculaire, classée selon 4 catégories : A) vis entièrement dans le pédicule, B) vis < 2 mm hors du pédicule, C) vis de 2­4 mm hors du pédicule, ou D) vis > 4 mm hors du pédicule. RÉSULTATS: Vingt-quatre médecins résidents en chirurgie orthopédique ont participé à l'étude clinique. Au total, 65 % d'entre eux ont préféré utiliser la technique à main libre dans un contexte de formation, même si la plupart (60 %) considéraient que la CAO était plus sécuritaire. La principale raison justifiant cette préférence était le degré de difficulté technique associé à la CAO. De plus, une évaluation de la précision du positionnement a montré qu'avec la technique à main libre, 5 des vis posées se classaient dans les catégories A ou B (sécuritaire) et 19 dans les catégories C ou D (non sécuritaire), alors que la CAO a permis de positionner 15 vis dans les catégories A ou B et 9 dans les catégories C ou D (p = 0,008). CONCLUSION: Chez un sous-groupe de patients souffrant de traumatismes abdominaux pénétrants, le traitement conservateur est sécuritaire et se traduit par une durée de séjour inférieure de 1,9 jour. La présence de fluide détectée par tomodensitographie est un indicateur de l'échec du traitement.

Complications of Silicone Fillers in Gluteal Augmentation: An Unusual Case of Filler Migration and Granuloma Formation.

Silicone liquid (polydimethylsiloxane) is an inert material commonly used for cosmetic purposes. A combination of both systematic and local devastating complications can cause end-organ toxicity and multi-organ dysfunction. In this article, we examine the literature and present a case of a patient who presented with lower extremity filler migration and granuloma formation 11 years post gluteal silicone injection. A 31-year-old woman who had received a gluteal silicone injection 11 years ago was experiencing painful erythema, progressive fibrosis, and swelling as the result of the injection. The patient was diagnosed with postfiller autoimmune syndrome. Multiple surgical interventions were conducted to remove the permanent filler from her left knee. As a result of multiple surgical sessions, the patient has been managed successfully with no relapses. This case demonstrated complications of an unusual silicone injection technique for gluteal augmentation. Despite silicone being considered inert, complications can arise years after injection, necessitating extensive medical intervention. This case also raises questions regarding the systemic effects of silicone fillers, warranting further research. Through this report, we aimed to enhance awareness and management of similar future cases.

Emotional Intelligence and Burnout Among Otorhinolaryngology-Head and Neck Surgery Residents.

Background: Burnout syndrome is common among surgical residents, negatively affecting their mental health, physical wellbeing, and work performance. We investigated the relationship between emotional intelligence (EI) and burnout among Otorhinolaryngology-Head and Neck surgery residents. Methods: This cross-sectional study examined 51 residents across different Otorhinolaryngology-Head and Neck surgery programs at various hospitals in Saudi Arabia using a survey conducted between January 2021 and March 2021. The questionnaire had different validated measurements of burnout and included the Trait EI Questionnaire-Short Form, Maslach Burnout Inventory-Human Services survey, and questions regarding demographics and job satisfaction. Results: Of all the residents, 17.6% had a high risk of burnout, 39.2% had emotional exhaustion (EE), 29.4% had depersonalization (DP), and 43.1% had a low sense of personal accomplishment (PA). A statistically significant negative association was observed between the total EI score and EE (r = -0.577, p < 0.001) and DP (r = -0.765, p < 0.001), indicating that higher total EI scores were associated with lower EE levels. Conclusions: Positive associations existed between high levels of EI, PA, and satisfaction with both surgical skills and specialty choice. Therefore, residency programs should use EI modifiers as tools to reduce the risk of burnout.

Postoperative Assessment of Pedicle Screws and Management of Breaches: A Survey among Canadian Spine Surgeons and a New Scoring System.

STUDY DESIGN: This study was designed as a survey amongst Canadian spine surgeon to determine a scoring system to standardize pedicle screw placement assessment. PURPOSE: This study aimed to obtain and analyze the opinions of spine surgeons regarding the assessment of pedicle screw accuracy, with the goal of establishing clinical guidelines for interventions for malpositioned pedicle screws. OVERVIEW OF LITERATURE: Accurate placement of pedicle screws is challenging, and misalignment can lead to various complications. To date, there is no recognized gold standard for assessing pedicle screw placement accuracy. The literature is lacking studies attempting to standardize pedicle screw placement accuracy assessment. METHODS: A survey of the clinical methods and imaging criteria that are used for assessing pedicle screw placement accuracy was designed and sent to orthopedic and neurosurgery spine surgeons from the Canadian Spine Society for their anonymous participation. RESULTS: Thirty-five surgeons completed the questionnaire. The most commonly used modalities for assessing pedicle screw position postoperatively were plain X-rays (97%) and computed tomography (CT, 97%). In both symptomatic and asymptomatic patients, the most and least worrisome breaches were medial and anterior breaches, respectively. The majority of surgeons tended not to re-operate on asymptomatic breaches. More than 60% of surgeons would re-operate on patients with new-onset pain and a ≤4-mm medial or inferior breach in both thoracic and lumbar regions. If a patient experienced sensory loss and a breach on CT, in either the thoracic or lumbar levels, 90% and 70% of the surgeons would re-operate for a medial breach and an inferior breach, respectively. CONCLUSIONS: Postoperative clinical presentation and imaging findings are crucial for interpreting aberrant pedicle screw placement. This study presents a preliminary scoring system for standardizing the classification of pedicle screws.