The use of cardiac implantable electronic devices (CIEDs) has continued to rise along with indications for their removal. When confronted with challenging clinical scenarios such as device infection, malfunction or vessel occlusion, patients often require the prompt removal of CIED hardware, including associated leads. Recent advancements in percutaneous methods have enabled physicians to face a myriad of complex lead extractions with efficiency and safety. Looking ahead, emerging technologies hold great promise in making extractions safer and more accessible for patients worldwide. This review will provide the most up-to-date indications and procedural approaches for lead extractions and insight on the future trends in this novel field.

Objective To examine sociodemographic and audiometric factors associated with hearing aid (HA) uptake in adults with hearing loss (HL), and to investigate the role of self‐perceived hearing status on pursuit of hearing treatment. The relationship between self‐perceived hearing status and HA adoption has not been reported in a nationally representative sample of United States (US) adults. Study Design Cross‐sectional analysis of nationwide household health survey. Methods Audiometric and questionnaire data from the 2005 to 2012 National Health and Nutrition Examination Survey cycles were used to examine trends in untreated HL and HA adoption in US adults. Adjusted odds ratios for HA adoption were calculated for individuals with measured HL. Results Of 5230 respondents, 26.1% had measurable HL, of which only 16.0% correctly self‐identified their hearing status, and only 17.7% used an HA. Age, higher education, severe hearing impairments, and recent hearing evaluations, were positively associated with HA adoption. Conclusion Hearing loss is a global public health concern placing significant economic burden on both the individual and society. Self‐reported hearing status is not a reliable indicator for HL, and measured HL is not correlated with increased rates of treatment. Recent hearing evaluation is positively associated with increased rates of treatment. Routine hearing assessment will help to better identify those with HL and improve access to hearing treatment. Level of Evidence III Laryngoscope, 131:E289–E295, 2021

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Background: Superior vena cava (SVC) tears are one of the most lethal complications in transvenous lead extraction. An endovascular balloon can occlude the SVC in the event of a laceration, preventing blood loss and offering a more controlled surgical field for repair. An early study demonstrated that proper use of this device is associated with reduced mortality. Thereafter, high-volume extractors at the Eleventh Annual Lead Management Symposium developed a best practice protocol for the endovascular balloon. Methods: We collected data on adverse events in lead extraction from July 1, 2016, to July 31, 2018. Data were prospectively collected from both a US Food and Drug Administration–maintained database and physician reports of adverse events as they occurred. We gathered case details directly from extracting physicians. Confirmed SVC tears were analyzed for patient demographics, case details, and index hospitalization mortality. Results: From July 1, 2016, to July 31, 2018, 116 confirmed SVC events were identified, of which 44.0% involved proper balloon use and 56.0% involved no use or improper use. When an endovascular balloon was properly used, 45 of 51 patients (88.2%) survived in comparison to 37 of 65 patients (56.9%) when a balloon was not used or improperly used ( P =0.0002). Furthermore, multivariate regression modeling found that proper balloon deployment was an independent, negative predictor of in-hospital mortality for patients who experienced an SVC laceration (odds ratio, 0.13; 95% CI, 0.04–0.40; P <0.001). Conclusions: From July 1, 2016, through July 31, 2018, patients undergoing lead extraction were more likely to survive SVC tears when treatment included an endovascular balloon.

Introduction Patch testing is the gold standard for evaluating allergic contact dermatitis (ACD), yet current interpretation methods are limited by their subjectivity and possible variability between observers. Optical coherence tomography (OCT) imaging enables noninvasive in vivo skin visualization and holds promise as an objective method of patch test interpretation. Objective To evaluate the micromorphological changes of patch test reactions and identify objective, quantitative OCT markers that correlate with clinically graded patch test reactions. Results A total of 25 patch test reactions (7 grade‐0, 4 grade‐1+, 14 grade‐2+) from 7 patients underwent OCT evaluation. Increased epidermal thickness and density was qualitatively observed in grade 1+ and grade 2+ allergic reactions while well‐demarcated, signal‐free cavities were observed in all grade 2+ reactions. Attenuation coefficients significantly increased across the three reaction grades (2.58 ± 0.092, 2.96 ± 0.121, 3.05 ± 0.065; P < 0.01). Cutaneous blood flow at 0.35 mm monotonically increased with reaction grade severity and blood measurements significantly differed across the three reaction grades (0.053 ± 0.011 mm/s, 0.078 ± 0.015 mm/s, and 0.121 ± 0.008 mm/s; P < 0.01). Conclusions and Relevance Attenuation coefficient and cutaneous blood flow at 0.35 mm correlate with clinically graded patch test reactions and hold promise as objective, quantitative markers. OCT may help dermatologists differentiate clinical scoring of allergic reactions in patch test and thereby improve their diagnostic accuracy and interpretation of patch test reactions.

Introduction: Dermoscopy is a noninvasive, in vivo imaging technique that allows for the visualization of subsurface skin structures. In recent years, several education interventions have incorporated dermoscopy in the primary care setting to improve skin cancer detection. We aim to describe the perspectives, attitudes, and interest of primary care physicians (PCPs) regarding dermoscopy. Methods: PCPs associated with academic institutions completed an anonymous survey emailed to faculty and resident listservs. The survey consisted of 23 questions related to dermoscopy. Results: A total of 156 PCPs completed the questionnaire. Few PCPs reported having access to a dermatoscope (16%), using it regularly (9%), or having received training (15%). The most common reasons for not using a dermatoscope were the lack of access to the device (85%), followed by the lack of training (76%). However, the majority view dermoscopy as a valuable tool in primary care and are interested in receiving training (87%), particularly with a hands-on approach. Conclusion: Our sample of PCPs in the United States showed that although few use dermoscopy, most perceive it as a useful tool, particularly family medicine physicians. The main reported barriers preventing its use included the lack of training and poor access to dermatoscopes. The vast majority of PCPs in our sample want to be trained in dermoscopy, thereby providing an opportunity for educational initiatives that take into account the barriers and preferred learning strategies.

A woman in her late 30s recently diagnosed with viral myopericarditis presented with 1 month of worsening fatigue, diffuse myalgias and chest pain radiating to her back. While undergoing work-up for chest wall myositis, she rapidly decompensated, developing heart failure and acute hypoxaemic respiratory failure. Her clinical course was complicated by cardiac arrest and severe cardiogenic shock requiring intra-aortic balloon pump support.

ImportanceAsylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers.ObjectiveTo examine HI prevalence and association with neuropsychiatric comorbidities in asylum seekers.MethodsA retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, PTSD, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics.ResultsOne hundred and thirty-nine medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1, 56.8% identified as female, 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio: 4.2; 95% CI [2.0–8.7]) and depression (odds ratio: 2.5; 95% CI [1.1–5.7]).ConclusionsWe observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.