Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip-Plasty in Asians

Background: The objective of this study was to illustrate a novel technique for lifting of the aging upper lip with nasal tip-plasty in Asians. With this procedure, a shortening of the philtrum, an increase of the vermilion, and a natural and nicer mouth can be obtained, with increasing the tip of the nose simultaneously. Methods: Thirty patients were subjects of this study. Incisions were made bilaterally beginning at the alar fold, entering nostrils and rising medially on the skin below the lower margin of the medial crura. Excess skin of the philtrum was eliminated in two separate pieces and the muscle was suspended to the base of the nose with interrupted stitches. Results: All patients expressed a high degree of satisfaction. The average ratio between the L1 reference line and the height of the upper lip measurement preoperatively was 0.43 ± 0.05. This ratio was improved postoperatively to an average of 0.32 ± 0.05 (p

from A via a.sfakia on Inoreader http://bit.ly/2CDhtc4

Arterial Wall Penetration Forces in Needles vs. Cannulas

Objective: If safety is defined as the diminished ability to penetrate facial arteries, the goal of this study was to investigate whether different-sized cannulas are safer than correspondingly sized needles for the application of facial soft-tissue fillers. Material and Methods: 294 penetration procedures of the facial and superficial temporal arteries were performed in four fresh frozen cephalic specimens using both needles (20G, 22G, 25G, and 27G) and cannulas (22G, 25G, and 27G). Continuously increasing force was applied and measured until intra-arterial penetration occurred. Results: No statistically significant differences were detected when comparing forces required to penetrate the facial arterial vasculature between different genders, arteries or side of the face (all p > 0.05). Forces needed to penetrate significantly (p

from A via a.sfakia on Inoreader http://bit.ly/2LAaWlv

Enhanced Recovery After Surgery Pathway for Microsurgical Breast Reconstruction: a Systematic Review and Meta-Analysis

Background: Enhanced Recovery After Surgery pathway (ERAS) was introduced in 1997 as a multimodal approach to reduce preventable postoperative harm and shorten hospital length of stay (LOS). However, there is yet no widely accepted ERAS protocol for microsurgical breast reconstruction (mBR). This study aims to conduct a systematic review and a meta-analysis of the current literature on ERAS for mBR in regards to postoperative LOS and morbidity. Methods: We searched PubMed, Embase, Cochrane, Scopus and Web of Science for all studies published prior to June 2016 that contain original data investigating ERAS in mBR in relation to postoperative LOS and morbidity. Studies found were screened using eligibility criteria previously agreed upon. Meta-analysis, odds ratio and 95% confidence interval were used to pool acquired data. Results: The initial search identified 86 studies. Two independent screeners identified four original articles, with a pooled population of 676 patients. Length of stay in days was significantly shorter for patients on ERAS pathway (Mean Difference=-1.23, 95% CI -1.50, -0.96, p

from A via a.sfakia on Inoreader http://bit.ly/2s0IKPr

A National Snapshot of Patient Reported Outcomes Comparing Types of Abdominal Flaps for Breast Reconstruction

Background: The purpose of this study was to identify differences in patient reported abdominal well-being, satisfaction, and quality of life in women with muscle-preserving free abdominal versus pedicle TRAM flap for breast reconstruction. Background: The purpose of this study was to identify differences in patient reported abdominal well-being, satisfaction, and quality of life in women with muscle-preserving free abdominal versus pedicle TRAM flap for breast reconstruction. Methods: Women with a history of breast cancer surgery were recruited from the Army of Women foundation to take the BREAST-Q© and a background questionnaire. Descriptive statistics and regression analyses were used to compare abdominal physical well-being, breast satisfaction, chest physical, psychosocial and sexual well-being in women undergoing free versus pedicle TRAM flaps. Results: Of 657 women; 273 (41%) had free flaps, 384 (58%) underwent pedicle TRAM flaps. Compared to unilateral pedicle TRAM, those with unilateral free flaps scored an average of 9.5 points higher (p

from A via a.sfakia on Inoreader http://bit.ly/2LAarrD

Combining abdominal flaps and implants in the breast reconstruction patient: a systematic and retrospective review of complications and outcomes

Background: Implants offer a method for augmenting abdominal flaps in the setting of deficient volume in breast reconstruction. They may be placed immediately at the time of reconstruction or on a delayed basis. We seek to compare outcomes from a single surgeon and previously published studies. Methods: A systematic review was performed, querying multiple databases. A retrospective review was conducted for patients who underwent abdominal based flap breast reconstruction and implant placement between July 2005 and August 2015 by the senior author(MYN). Results: A systematic review of the literature yielded four articles, for a total of 96 patients(142 breasts) included for systematic review. 87 breasts(61%) were reconstructed with immediate implant at the time of flap reconstruction and 55 breasts(39%) had a staged approach to implant placement. Complications were noted in 28 breasts(32%) following immediate placement and in 10 breasts(18%) following staged placement. A total of 53 patients(79 breasts) were retrospectively reviewed, all of which were reconstructed in a staged manner. Twelve breasts(15%) were found to have a flap or implant related complication. 97.5% of implants/flap reconstructions were successful, with a 54% revision rate. When pooling systematic and retrospective data, there was a significant difference in complication rates between the staged and immediate reconstruction cohorts(p

from A via a.sfakia on Inoreader http://bit.ly/2rZoeio

Introducing BREAST-Q Computerized Adaptive Testing – short and individualized patient-reported outcome assessment following reconstructive breast surgery

BACKGROUND: BREAST-Q is a widely used patient-reported outcome (PRO) instrument measuring health-related quality-of-life and patient satisfaction in breast surgery. Shorter assessment potentially increases patients' willingness to complete scales, but simply offering a short-form version leads to unacceptable loss in measurement precision. We aimed to develop a computerized adaptive test (CAT) to shorten BREAST-Q's Satisfaction with Breasts scale whilst maintaining reliability of measurement. METHODS: We created a CAT, which repetitively administered questions from the pool of 16 questions, until pre-specified levels of reliability were reached (i.e., standard errors (SE) of 0.32-0.55). In a simulation study, we tested the CAT's feasibility for all potential Satisfaction scores. In a second study using actual patient data, 5000 breast reconstruction patients who had previously completed the full scale were randomly selected from a large database. Their full-scale Satisfaction scores were compared with their CAT-derived scores. RESULTS: In both studies, by applying CAT, the Satisfaction with Breasts scale could be reduced to an average of 10 questions when using the minimum level of measurement precision for individual-patient measurement (SE 0.32), compared to 4 questions when using the minimum precision level for group-based research (SE 0.55). Score estimates were highly correlated between CAT assessment and the full scale (0.91-0.98 in simulation study, 0.89-0.98 in patient data study). CONCLUSIONS: Applying CAT to BREAST-Q's Satisfaction with Breasts scale facilitates reliable assessment with 38% to 75% fewer question than the full version. The novel BREAST-Q CAT version may decrease response burden and help overcome barriers to implementation in routine care. Meetings: Preliminary data was presented at the 23rd Annual Conference of the International Society for Quality of Life (ISOQOL) Research meeting in Denmark in 2016, the Patient Reported Outcome Measures UK conference in the United Kingdom in 2016, and at the bi-annual meeting of the Dutch Society for Plastic Surgery (NVPC) in the Netherlands in 2016. Disclosures: Andrea Pusic, Anne Klassen and Stefan Cano are co-developers of the BREAST-Q, which is owned by Memorial Sloan-Kettering Cancer Center and the University of British Columbia. They receive a portion of licensing fees (royalty payments) when the BREAST-Q is used in industry sponsored clinical trials. Stefan Cano is co-founder of Modus Outcomes, an outcomes research and consulting firm that provides services to pharmaceutical, medical device, and biotechnology companies. The remaining authors have no financial disclosures. Acknowledgements: Andrea Pusic, Anne Klassen and Stefan Cano are co-developers of the BREAST-Q, which is owned by Memorial Sloan-Kettering Cancer Center and the University of British Columbia. They receive a portion of licensing fees (royalty payments) when the BREAST-Q is used in industry sponsored clinical trials. Stefan Cano is co-founder of Modus Outcomes, an outcomes research and consulting firm that provides services to pharmaceutical, medical device, and biotechnology companies. The remaining authors have no financial disclosures. Corresponding author: Christopher Gibbons, Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital , 75 Francis Street, Boston, MA 02115, Fax 617-732-6387, E-mail: cgibbons2@bwh.harvard.edu ©2018American Society of Plastic Surgeons

from A via a.sfakia on Inoreader http://bit.ly/2LEHI4P

De Novo Testicular Extranodal NK/T-Cell Lymphoma: A Clinicopathologic Study of 21 Cases With Review of Additional 18 Cases in the Literature

Although the testis is not uncommonly involved during the course of disease in both nasal and non-nasal extranodal NK/T-cell lymphoma (ENKTCL), only a few cases presenting initially with a testicular mass have been previously reported. These have been documented as case reports, rather than as study series. Because of its rarity, the clinicopathologic features and the prognosis of de novo testicular ENKTCL have not been well characterized. Clinicopathologic features of 21 cases of de novo testicular ENKTCL from 3 institutions in China were retrospectively analyzed with review of an additional 18 cases from the literature. De novo testicular ENKTCL accounted for 0.72% (21/2906) of all ENKTCL during the study period. The median age of patients with de novo testicular ENKTCL was 45 years (range, 21 to 79 y). Most (90.9%) cases occurred in Asians. All patients initially presented with testicular swelling and most (91.9%) had unilateral testicular masses. The majority (73.0%) of patients presented at Ann Arbor stage I/II. Expression of CD56 was found in 92.1% (35/38) of the available cases. Interestingly, aberrant expression of CD20 was found in the tumor cells in 10.3% (4/39) of cases. The majority of patients with follow-up data (24/30, 80%) had extratesticular involvement during the follow-up period (median follow-up, 6 months; range, 0.5 to 87 mo). Preferential sites of extratesticular involvement included lymph nodes, skin, contralateral testis, bone marrow, spleen, adrenal gland, and central nervous system. Of the 30 patients with survival data, 70% (22/30) of patients died of the disease. The 2-year overall survival of patients with de novo testicular ENKTCL was 23%, and the median survival was 9.5 months. Patients that presented with B symptoms showed a trend toward inferior overall survival (P=0.095). No statistical significance was found between patients with stage I/II and stage III/IV (P=0.783). De novo testicular ENKTCL tends to disseminate early, shows extremely poor outcome, and should be recognized as a highly aggressive form of ENKTCL. A portion of cases show aberrant expression of CD20, and accurate diagnosis as well as timely and optimal treatment are very important. Conflicts of Interest and Source of Funding: Supported by National Key R&D Program of China (2017YFC1309000); Medical Science and Technology Foundation of Guangdong Province (No. 2017116204155117); Natural Science Foundation of Guangdong Province (No. 2018A030313663); National Natural Science Foundation of China (No. 81572405, 81572406, 81502079, 81602135); and Science and Technology Program of Guangzhou (201707020038). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Jingping Yun, MD, PhD, Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, China (e-mail: yun_lab@hotmail.com). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2RiB7Cw

Reporting Adverse Events in Plastic Surgery: A Systematic Review of Randomized Controlled Trials

Background: Accurate knowledge of adverse events is critical for evaluation of the safety of interventions. Historically, adverse events in surgical trials have been poorly reported. The objective of this study was to systematically evaluate the reporting of adverse events in randomized controlled trials in the plastic surgery literature. Methods: Two independent reviewers conducted a systematic search using MEDLINE, Embase, and Scopus of the top seven plastic surgery journals with the highest impact factors. Randomized controlled trials describing a potentially invasive treatment, published between January of 2012 and December of 2016, were included. Results: One hundred forty-five randomized controlled trials involving 10,266 patients were included, of which 30 percent were registered. Anticipated adverse events were clearly defined in 15 percent of trials, and in 70 percent it was not clear who would be documenting adverse events. Furthermore, 72 percent of randomized controlled trials reported the occurrence of adverse events, of which 61 percent failed to report events occurring in the intrainterventional period. Binary logistic regression revealed that funded randomized controlled trials were 4.04 times more likely to report adverse events compared with nonfunded randomized controlled trials (95 percent CI, 1.41 to 10.83; p = 0.009). Conclusions: The authors' findings suggest the need for reporting standards for adverse events in the plastic surgery literature, as such reporting remains heterogeneous and is lacking rigor. Improved quality and transparency are needed to strengthen evidence-based practice and permit a balanced intervention assessment. This study provides a set of recommendations aimed at improving adverse event reporting.

from A via a.sfakia on Inoreader http://bit.ly/2rYGt7t

ASPS/PSF Sponsored Symposia and Workshops

No abstract available

from A via a.sfakia on Inoreader http://bit.ly/2LAUIbN

Discussion: Total Muscle Coverage versus AlloDerm Human Dermal Matrix for Implant-Based Breast Reconstruction

No abstract available

from A via a.sfakia on Inoreader http://bit.ly/2rZgGfn

Reply: Motiva Ergonomix Round SilkSurface Silicone Breast Implants: The Tale of Goldilocks: Never Be Afraid of Exploring Unknown Territory

No abstract available

from A via a.sfakia on Inoreader http://bit.ly/2LAJX9e

Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction: A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes

Background: Breast reconstruction is rapidly evolving, because of the changing face of cancer surgery and the growing acceptance of acellular dermal matrices and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long-term outcomes. Methods: Between January of 2012 and March of 2015, 179 patients undergoing mastectomy were enrolled at the authors' institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop). The BREAST-Q questionnaire was administered before surgery and after 2 years. Capsular contracture was evaluated using the Baker scale. Oncologic, surgical, and aesthetic outcomes and changes in BREAST-Q score were analyzed over time. Results: Average follow-up was 38.5 months. A total of 250 mastectomies were performed. The locoregional recurrence rate was 2.1 percent. Complications requiring reoperation were recorded in six patients (2.4 percent) and implant removal was necessary in three cases (1.2 percent), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in five breasts (2 percent), whereas 212 breasts were evaluated as grade I (84.8 percent), 28 breasts as grade II (11.2 percent), and five breasts as grade III (2 percent). Patients reported significant high rates in the BREAST-Q overall Satisfaction with Outcome (73.8), overall Satisfaction with Breasts (72.5), Psychosocial Well-being (77.7), and Sexual Well-being (57.9), scoring a significant increase in these domains from the preoperative period to the postoperative period (p

from A via a.sfakia on Inoreader http://bit.ly/2rYGsAr

Is Reconstruction Preserving the First Ray or First Two Rays Better Than Full Transmetatarsal Amputation in Diabetic Foot?

Background: The benefits of total transmetatarsal amputation over higher level amputation are well known. However, there are no studies evaluating the effects of first ray– or first two ray–sparing transmetatarsal amputation with flap coverage. The authors evaluated this approach with regard to functional outcome and to identify long-term complications. Methods: Retrospective data of 59 patients were evaluated according to their surgical method. Complete transmetatarsal amputation with free flap reconstruction was designated as the transmetatarsal amputation group with 27 patients and first ray– or first two ray–preserving transmetatarsal amputation with free flap reconstruction was designated as the ray group, with 32 patients. Demographics, flap outcomes, additional procedures after initial healing, and functional outcomes were measured and evaluated. Results: There was no statistically significant difference in demographic distribution and flap outcomes in either group, except for poor blood glucose control in the ray group. Additional procedures after initial healing showed no statistical difference, but the tendency of minor procedures was higher in the ray group. The maximum achieved ambulatory function was significantly better in the ray group, with an ambulatory function score of 4.4 compared with 3.7 in the transmetatarsal amputation group (p = 0.012). Conclusions: The preservation of the first ray or first two rays with free flap reconstruction may functionally benefit the patients despite the higher tendency toward minor procedures after initial healing. Furthermore, the progressive deformity of the preserved first and second toes will inevitably occur, requiring patients to undergo further surgery. Further studies are warranted to evaluate this approach. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

from A via a.sfakia on Inoreader http://bit.ly/2LJ625P

Prepectoral Breast Reconstruction in the Setting of Postmastectomy Radiation Therapy: An Assessment of Clinical Outcomes and Benefits

Background: Prepectoral breast reconstruction following mastectomy has become a more widely performed technique in recent years because of its numerous benefits for women. These include full pectoralis muscle preservation, reduced loss of strength, reduced pain, and elimination of animation deformity. As with any breast reconstruction technique, widespread adoption is dependent on a low morbidity profile in the setting of postmastectomy radiation therapy, as this adjuvant therapy is routine in breast cancer treatment. The authors assess the clinical outcomes of patients undergoing postmastectomy radiation therapy following prepectoral breast reconstruction, and compare these to outcomes of patients undergoing postmastectomy radiation therapy with submuscular reconstruction. Methods: A single surgeon's experience with immediate prepectoral breast reconstruction, followed by postmastectomy radiation therapy, from 2015 to 2017 was reviewed. Patient demographics and incidence of complications during the tissue expander stage were assessed. In addition, the morbidity profile of these patients was compared to that of patients undergoing submuscular/dual-plane reconstruction and postmastectomy radiation therapy over the same period. Results: Over 3 years, 175 breasts underwent immediate prepectoral reconstruction, and 236 breasts underwent immediate submuscular/dual-plane reconstruction. Overall rates of adjuvant radiation therapy (postmastectomy radiation therapy) were similar between prepectoral [26 breasts (14.9 percent)] and submuscular [31 breasts (13.1 percent)] (p = 0.6180) reconstruction. There were no significant differences in complication rates between the two reconstructive cohorts, in the setting of postmastectomy radiation therapy, including rates of explantation (15.4 percent versus 19.3 percent; p = 0.695). Conclusions: Prepectoral breast reconstruction is a safe and effective option in the setting of postmastectomy radiation therapy. The morbidity profile is similar to that encountered with submuscular reconstruction in this setting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

from A via a.sfakia on Inoreader http://bit.ly/2rXKfhl

Leaders in Plastic Surgery: The Dingman-Grabb Era 1946–1986

No abstract available

from A via a.sfakia on Inoreader http://bit.ly/2LA9DTD

Discussion: Prepectoral Breast Reconstruction in the Setting of Postmastectomy Radiation Therapy: An Assessment of Clinical Outcomes and Benefits

No abstract available

from A via a.sfakia on Inoreader http://bit.ly/2rWlLoX

Reply: The Lateral Thigh Perforator Flap for Autologous Breast Reconstruction: A Prospective Analysis of 138 Flaps

No abstract available

from A via a.sfakia on Inoreader http://bit.ly/2LH82LO

Tissue Expander Complications Do Not Preclude a Second Successful Implant-Based Breast Reconstruction

Background: Implant-based breast reconstruction is the most common method of breast reconstruction in the United States, but the outcomes of subsequent implant-based reconstruction after a tissue expander complication are rarely studied. The purpose of this study was to determine the long-term incidence of implant loss in patents with a previous tissue expander complication. Methods: This is a retrospective review of the long-term outcomes of all patients with tissue expander complications at a large academic medical center from 2003 to 2013. Patients with subsequent tissue expander or implant complications were compared to those with no further complications to assess risk factors for additional complications or reconstructive failure. Results: One hundred sixty-two women were included in this study. The mean follow-up period was 8.3 ± 3.1 years. Forty-eight women (30 percent) went on to undergo a second tissue expander or implant placement. They did not differ from women who went on to autologous reconstruction or no further reconstruction. Of these, 34 women (71 percent) had no further complications and 38 women (79 percent) had a successful implant-based reconstruction at final follow-up. There were no patient or surgical factors significantly associated with a second complication or implant loss. Conclusions: Following tissue expander complications, it is reasonable to offer women a second attempt at tissue expansion and implant placement. This study demonstrates that long-term success rates are high, and there are no definitive patient or surgical factors that preclude a second attempt at implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

from A via a.sfakia on Inoreader http://bit.ly/2rZrgDg

Assessing Quality of Life and Patient-Reported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study

Background: Masculinizing top surgery (bilateral mastectomy with chest wall reconstruction) is an important gender-affirming procedure sought by many transmasculine and nonbinary individuals. Current literature is focused primarily on details of surgical technique and complication rates, with limited data available on how top surgery affects subjective quality-of-life measures. Methods: An anonymous online survey was distributed to 81 of the senior author's former top-surgery patients. The survey response rate was 72 percent (58 respondents). Responses were analyzed to investigate quality of life, sexual confidence, mental health, satisfaction with top surgery, and patient attitudes toward top surgery's role in gender affirmation. Results: Following top surgery, measures of quality of life and sexual confidence improved significantly (p

from A via a.sfakia on Inoreader http://bit.ly/2LAuqWW

Discussion: Tissue Expander Complications Do Not Preclude a Second Successful Implant-Based Breast Reconstruction

No abstract available

from A via a.sfakia on Inoreader http://bit.ly/2rZnud6

Current Best Peripheral Nerve Transfers for Spinal Cord Injury

Learning Objectives: After reviewing this article, the participant should be able to: 1. Understand the anatomy and pathophysiology of spinal cord injury and the resulting upper and lower motor neuron syndromes. 2. Recognize who may benefit from nerve transfers. 3. Understand the role of history, examination, imaging, and electrodiagnostics in the determination of time-sensitive lower motor neuron injury versus non–time-sensitive upper motor neuron injury. 4. Outline the surgical options and perioperative care for those undergoing nerve transfer and the expected outcomes in restoring shoulder, elbow, wrist, and hand function. Summary: This article outlines how to localize and differentiate upper motor neuron from combined upper and lower motor neuron injury patterns in spinal cord injury by means of detailed history, physical examination, imaging, and electrodiagnostic studies to formulate appropriate surgical plans to restore function in this complex population.

from A via a.sfakia on Inoreader http://bit.ly/2LCyje9

Porcine Acellular Peritoneal Matrix in Immediate Breast Reconstruction: A Multicenter, Prospective, Single-Arm Trial

Background: Use of biological implants such as acellular dermal matrices in tissue expander breast reconstruction is a common adjunct to submuscular implant placement. There is a paucity of published prospective studies involving acellular matrices. The authors sought to evaluate a porcine-derived acellular peritoneal matrix product for immediate breast reconstruction. Methods: A prospective, single-arm trial was designed to analyze safety and outcomes of immediate tissue expander–based breast reconstruction with a novel porcine-derived acellular peritoneal matrix surgical mesh implant. Twenty-five patients were enrolled in this industry-sponsored trial. Patient demographics, surgical information, complications, histologic characteristics, and satisfaction (assessed by means of the BREAST-Q questionnaire) were evaluated. Results: Twenty-five patients (44 breasts) underwent mastectomy with immediate breast reconstruction using tissue expanders with acellular peritoneal matrix. Sixteen reconstructed breasts experienced at least one complication (36 percent). Seroma and hematoma occurred in one of 44 (2.3 percent) and two of 44 breasts (4.6 percent), respectively. Wound dehiscence occurred in four of 44 breasts (9.1 percent). Three subjects experienced reconstruction failure resulting in expander and/or acellular peritoneal matrix removal (6.8 percent); all failures were preceded by wound dehiscence. Histologic analysis showed cellular infiltration and product resorption. Results of the BREAST-Q demonstrated a level of postoperative patient satisfaction consistent with results in the available literature. Conclusions: Prepared porcine-derived acellular peritoneal matrix is a safe adjunct in immediate two-stage tissue expander-based breast reconstruction. Further studies are required to determine efficacy compared to current commercially available acellular matrices. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

from A via a.sfakia on Inoreader http://bit.ly/2s0G3xz

Ethical Issues in Aesthetic and Reconstructive Surgical Innovation: Perspectives of Plastic Surgeons

Summary: Innovative surgery is defined as a novel procedure, a significant modification of a standard technique, or a new application of an established technique. Although innovation is a crucial part of improving patient care in plastic surgery, there are various ethical considerations and dilemmas in performing unvalidated techniques and procedures, especially for non–life-threatening indications. The aim of this study was to gain a better understanding regarding the motivations and ethical considerations of plastic surgeons in their decision to perform innovative operations. An anonymous, institutional review board–approved, online survey was sent to members of the American Society of Plastic Surgeons and other international plastic surgeons worldwide. The survey asked respondents to rank various factors that influence their decisions to perform innovative plastic surgery, both reconstructive and aesthetic, on a five-point Likert scale. Seven hundred thirty-three of 26,028 plastic surgeons (response rate, 2.9 percent) responded to the survey. Although similar factors were considered to be important for both reconstructive and aesthetic operations, only approximately 50 percent of respondents considered institutional review board approval to be an important factor when considering innovation in both reconstructive (50 percent) and aesthetic surgery (51 percent), suggesting that respondents do not consider innovation a form of research that ought be subject to standard research protections. Overall, the authors' survey suggests that more effort must be extended to ethical training in plastic surgery to create a stronger professional atmosphere regarding innovation and, possibly, to the creation of a more formal group charged with oversight of innovation.

from A via a.sfakia on Inoreader http://bit.ly/2LCim7E

Function and Strength after Free Abdominally Based Breast Reconstruction: A 10-Year Follow-Up

Background: The long-term impact of abdominally based free flap breast reconstruction is incompletely understood. The aim of this study is to provide long-term, subjective and objective health data on abdominally based free flap breast reconstruction patients, with specific attention to the effects of laterality, flap type, and obesity. Methods: Patients were enrolled in this prospective study between 2005 and 2010 and completed preoperative, early (

from A via a.sfakia on Inoreader http://bit.ly/2rYaXXt

Reply: Intraoperative Nerve Blocks Fail to Improve Quality of Recovery after Tissue Expander Breast Reconstruction: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Clinical Trial

No abstract available

from A via a.sfakia on Inoreader http://bit.ly/2LCycPL

The Use of Tumescent Technique in Mastectomy and Related Complications: A Meta-Analysis

Background: Postoperative skin necrosis in surgical patients is costly to hospitals and health care providers. Tumescent dissection technique is commonly used in mastectomy and immediate breast reconstruction, as it helps reduce blood loss; however, it may increase the risk of mastectomy skin flap necrosis. In this context, the authors have conducted a systematic review of the literature to perform a meta-analysis of the relationship between tumescent technique in mastectomy with or without breast reconstruction and complication rates. Methods: The authors screened the PubMed (1966 to 2016), Scopus (2004 to 2016), Embase (1966 to 2016), and Web of Science (1964 to 2016) databases for relevant articles through March 30, 2017. The authors included studies on the use of tumescent technique in the context of mastectomy with or without immediate breast reconstruction. The primary outcome the authors evaluated was the rate of skin flap necrosis; the secondary outcomes were the rates of breast hematomas and infections. Because of the heterogeneity of the studies, the authors performed a meta-analysis using the random effects model. Results: After screening, the authors evaluated five studies including 3982 mastectomies. Mastectomies performed under the preoperative application of tumescent solution had statistically higher rates of skin flap necrosis overall (p = 0.03) and major (p

from A via a.sfakia on Inoreader http://bit.ly/2rWkRIZ

Reply: The Smile Index: Part 1. A Large-Scale Study of Phenotypic Norms for Preoperative and Postoperative Unilateral Cleft Lip

No abstract available

from A via a.sfakia on Inoreader http://bit.ly/2LJ61yN

Glioma

http://www.jglioma.com/currentissue.asp?sabs=n

Nanoparticles drug-delivery systems and antiangiogenic approaches in the treatment of gliomas Maria Caffo, Salvatore Massimo Cardali, Elena Fazzari, Valeria Barresi, Gerardo Caruso Glioma 2018 1(6):183-188 The prognosis of patients with cerebral gliomas remains noticeably poor. Total surgical resection is almost unachievable due to considerable infiltrative ability of glial cells. Furthermore, adjuvant treatments are burdened by considerable limitations. Angiogenesis is the mechanism by which new blood vessels are formed from preexisting ones, thus supporting neoplasm progression. Gliomas are characterized by extensive microvascular proliferation. The extent of neovascularization in brain tumor correlates directly with the biological aggressiveness, degree of malignancy, and clinical recurrence of the tumor. Although a plethora of molecules can act as inducers of angiogenesis, the major growth factors include members of the vascular endothelium growth factor family. The new therapeutic approaches envisage the identification of specific biomarkers involved in this process and try to inhibit them, thus slowing down the neoplastic progression. Nanoparticles (NPs) show the ability to pass the blood–brain barrier, and moreover, when suitably modified, they can bind to specific overexpressed receptors in the glial cells. As carriers, they are able to protect the therapeutic agent and allow their sustained release. In this review, we describe some NP delivery systems which target specific biomarkers to intervene in the process of angiogenesis.

Intraoperative fluorescence-guided resection of high-grade glioma: A systematic review Lin Yang, Yan Xiang, Guo-Hao Huang, Hong-Yao Lyu, Ke-Jie Mou, Sheng-Qing Lv Glioma 2018 1(6):189-195 High-grade glioma (HGG) is a devastating disease with very poor prognosis. Maximal resection of HGG improves survival and maximal visualization of the tumor, if reliable, improves the resection. Fluorescence is widely used as guidance mechanism and has demonstrated potential in maximizing the extent of HGG resection. Our goal is to summarize the current techniques using fluorescence during the resection of HGG and demonstrate how its use increases gross total resection rates, overall survival (OS), and progression-free survival (PFS). However, further prospective, multicenter, randomized controlled trials are still in need to prove the advantage of fluorescence-guided surgery on patients' OS/PFS.

Histologic characterization of the immune infiltrate in isocitrate dehydrogenase wild-type and mutant World Health Organization Grade II and III gliomas Josine A. E. M. Jansen, Wim G. M. Spliet, Wendy de Leng, Pierre Alain Robe Glioma 2018 1(6):196-200 Aim: This study aims to describe the immune infiltrations in low-grade glioma (LGG) with respect to their histological classification, isocitrate dehydrogenase 1 and 2 (IDH1/2) mutation status and survival. Materials and Methods: The IDH1/2 status (mutant or wild-type) of 66 World Health Organization Grade II and III gliomas were defined using next-generation sequencing or multiplex ligation-dependent probe amplification. The immune infiltrates of these tumors (46 mutant IDH, 20 wild-type IDH) were assessed immunohistochemically using a panel of antibodies (CD3, CD4, CD8, FOXP3, CD20, CD68, and CD163). Confirmatory analyses were performed on a cohort of lower grade gliomas from the Cancer Genome Atlas (TCGA). Statistical analyses were performed with Mann–Whitney U-tests and Kaplan–Meier survival estimates. Results: There was no relation between the amount of CD3+, CD4+, CD8+, or CD20+ lymphocyte infiltration and IDH mutation status in the tumors. FOXP3+ T regulatory cell infiltrates were rare, but more frequent in IDH1/2 wild-type tumors (P = 0.046). While the presence of these cells did not correlate with overall survival, FOXP3 messenger RNA expression was associated with survival in a distinct cohort of LGG from the TCGA (P < 0.05). CD4+ lymphocyte infiltrates, on the other hand, tended to prevail in astrocytic tumors as compared to oligodendrogliomas (P = 0.056). While CD68 (M1) microglial/monocytic cells were equally abundant in IDH mutant and wild-type tumors, the presence of round, activated M1 CD68+ microglia significantly associated with a mutant IDH status (P = 0.015). Conclusion: FOXP3+ expression and activated CD68+ M1 cells associated with IDH status in LGG, and might contribute to their differential evolution.

Assessment of microvascular patterns and density in glioblastoma and their correlation with matrix metalloproteinase-9, p53, glial fibrillary acidic protein, and Ki-67 Karuna Jha, Ishita Pant, Ritika Singh, Ajay Kumar Bansal, Sujata Chaturvedi Glioma 2018 1(6):201-207 Background and Aim: Microvascular patterns (MVPs) and microvessel density (MVD) can influence the progression of glioblastomas. This study aims to study MVP and MVD using immunohistochemistry, and examine any correlation with the expression of matrix metalloproteinase-9 (MMP-9), p53, glial fibrillary acidic protein (GFAP), and Ki-67 labeling index (Ki-67 LI) in 24 cases of glioblastoma multiforme. Materials and Methods: MVPs and MVD were studied by a dual staining method using periodic acid–Schiff stain with CD34 (MVDCD34), CD31 (MVDCD31), von Willebrand factor (MVDvWF), and factor VIII (MVDFVIII). The expression of MMP-9, p53, GFAP, and Ki-67 LI was analyzed using immunohistochemistry. The Pearson coefficient of correlation and intraclass correlation were obtained using SPSS software. Results: Five distinct categories of MVP were found: Microvascular sprouting (MS)/simple vessels, vascular clusters (VCs), vascular garlands, glomeruloid tufts, and vasculogenic mimicry. Of the MVPs, MS was the most common pattern and was present in all cases. On calculating the Pearson's correlation coefficient, different MVPs gave varying results regarding their correlation with MMP-9, p53, GFAP, and Ki-67 LI. MSCD34, CD31, vWF showed significant correlation with MMP-9 and Ki-67 LI, while MSFVIII did not show any correlation with Ki-67 LI. Only VCCD34 had a correlation with Ki-67 LI. No correlation between any of the MVPs and GFAP and p53 was appreciated. MVD ranged from: CD34 (9.2–41.9/hpf), FVIII (6.05–40.5/hpf), CD31 (5.1–40.7/hpf), and vWF (8.7–35.5/hpf). MVDCD34 and MVDCD31 correlated with MMP-9 and Ki-67, whereas, MVDvWF and MVD FVIII correlated with MMP-9. Interobserver agreement was seen only in the assessment of MVD and the MS type of MVP. Conclusion: MVD and MVPs had correlation with MMP-9, p53, GFAP, and Ki-67. These results could impact the development of strategies using antiangiogenic therapies.

O-6-methylguanine-DNA methyltransferase promoter methylation can change in glioblastoma recurrence due to intratumor heterogeneity Valeria Barresi, Maria Caffo, Giuseppa De Luca, Giuseppe Giuffrè Glioma 2018 1(6):208-213 Background and Aim: The standard-of-care for patients with glioblastoma (GBM) is surgery followed by concurrent chemotherapy with temozolomide and radiotherapy. O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation is commonly assessed in GBM as a predictive marker of response to temozolomide. Although MGMT methylation status has been shown to change between primary and recurrent GBM, no indication exists on retesting MGMT in recurrent GBM. In addition, what causes the change in MGMT methylation has yet to be identified. In this study, we aimed to investigate whether MGMT promoter methylation in recurrent GBM was influenced by intratumor heterogeneity in the initial GBM tumor. Materials and Methods: We investigated the status of MGMT promoter methylation in different samples taken from concentric layers of 24 GBMs and in 11-paired surgically resected recurrences. The neoplastic nature of samples submitted for methylation analysis was preliminary verified through histological examination; the fragments were accurately chosen to have adequate cellularity and minimal amount of nontumor contaminants. Results: About 27% (3 out of 11) of the recurrences had changed MGMT methylation status compared to the initial tumor. Initial tumor heterogeneity might play a role in this change, as all three cases had intratumor heterogeneity (with the central part of the tumor methylated and the peripheral part unmethylated) in the primary GBM. Conclusion: This study suggests that MGMT methylation variation in recurrent GBM may depend on intratumor heterogeneity in the initial tumor. Intratumor heterogeneity and possible changes in the recurrence should be taken into account when testing MGMT promoter methylation status as a predictive factor orienting therapeutic decisions in patients with GBM.

Pediatric Nephrology

http://www.ajpn-online.org/currentissue.asp?sabs=n

Challenge of congenital abnormalities of the kidney and urinary tract RN Srivastava Asian Journal of Pediatric Nephrology 2018 1(2):49-51

Epidemiology of acute kidney injury in critically ill children living in the Kingdom of Saudi Arabia Jameela Abdulaziz Kari Asian Journal of Pediatric Nephrology 2018 1(2):52-55 Acute kidney injury (AKI) is very common in children admitted to pediatric intensive care and affected children are at increased risk of morbidity and mortality. The epidemiologic characteristics of children with AKI have not been well described in children living in the Kingdom of Saudi Arabia (KSA). This review of the epidemiology of AKI in critically ill children in KSA shows that AKI is common in this population and is chiefly attributed to sepsis, other infections and postcardiac surgery. The occurrence of AKI is linked to increased mortality and length of hospital stay. The severity of AKI correlates with increased inhospital mortality as well as risk of mortality after discharge. A considerable proportion of survivors develop evidence of chronic kidney disease. Cystatin C and urinary neutrophil gelatinase-associated lipocalin are useful in enabling early diagnosis of AKI in critically ill children.

Therapies for steroid-sensitive nephrotic syndrome RS Thalgahagoda, A H. H M. Jayaweera, UI Karunadasa, AS Abeyagunawardena Asian Journal of Pediatric Nephrology 2018 1(2):56-61 Nephrotic syndrome (NS), a common childhood kidney disease, is associated with significant morbidity and mortality due to disease complications. Most patients who respond to corticosteroids show a relapsing course that requires repeated courses of therapy, and frequent relapses or steroid dependence are common. Most children with steroid-sensitive relapses show minimal change disease upon biopsy. Focal segmental glomerulosclerosis is the predominant histology in patients with steroid-resistant NS where renal biopsy is recommended, and a complicated disease course is anticipated. Patients with frequent relapses are at risk of severe infections, thrombosis, and hypovolemia and receive repeated and prolonged courses of prednisolone that often result in corticosteroid toxicity. These challenges have led to the use of numerous corticosteroid-sparing agents or regimens to reduce the risk of relapses as well as cumulative corticosteroid burden. This review discusses therapy-related aspects of steroid-sensitive NS and compares different regimens of corticosteroid and other immunosuppressive medications that are used in managing this condition.

Nationwide pediatric renal biopsy audit by the Indian Society of Pediatric Nephrology Rajiv Sinha, Nimisha Arora, Manpreet Kaur, Arpana Iyengar, Pankaj Hari, Abhijeet Saha Asian Journal of Pediatric Nephrology 2018 1(2):62-66 Objective: The survey was conducted to identify current renal biopsy practices in India and compare them with the British Association of Pediatric Nephrology (BAPN, 2015) standards. Methods: A 53-question survey questionnaire was sent to 48 centers across the country by electronic mail. Questions included were related to the number of biopsies performed, indications, prerequisites and procedure of biopsy, monitoring, and complications. The results were compared against the BAPN 2015 standards. Results: Thirty (62.5%) out of 48 centers responded to the questionnaire. Real-time ultrasound was the favored method at 24 (80%) centers. Most (80%) of the biopsies were performed by nephrologists alone. The biopsy was usually (80%) an inpatient procedure with overnight hospitalization; 20% of the centers performed it as a day-care procedure. The 18-gauge needle was preferred by 60% of the centers. Biopsy was achieved with three or fewer passes in 93% of the centers. Almost half (47%) of the centers considered 10 or more glomeruli on light microscopy as adequate to reach a diagnosis. The rates of gross hematuria were <5% in 80% of the centers surveyed. Death following biopsy was reported by two centers. Conclusion: Majority of the centers surveyed across India achieve BAPN standards in most parameters. Such audit of practices against the standards for kidney biopsy enables comparison between units as well as for monitoring of individual center's performance over time.

Determining the optimal dose of cholecalciferol supplementation in children with chronic kidney disease (C3 Trial): Design of an open-label multicenter randomized controlled trial Arpana Aprameya Iyengar, Nivedita Kamath, V Hamsa, Susan Uthup, Jyoti Sharma, Jyoti Singhal, Sudha Ekambaram, Rukshana Shroff Asian Journal of Pediatric Nephrology 2018 1(2):67-73 Introduction: 25-hydroxyvitamin D (25OHD) deficiency is common in children with chronic kidney disease (CKD) and can affect bone mineralization and cardiovascular morbidity. It is important to treat 25OHD deficiency appropriately in a manner that ensures not only replenishing stores but also sustaining adequate 25OHD levels without causing toxicity. The present study was planned to determine the appropriate dosing regimen for oral cholecalciferol that achieves and maintains normal 25OHD levels in children with CKD stage 2–4 and to assess the effect of various dosing regimens on bone biomarkers, secondary hyperparathyroidism, and vitamin D toxicity. Methods: We present the design of an open-label, multicenter randomized controlled trial conducted across four pediatric nephrology centers in India. Children in CKD stages 2–4 with 25OHD levels <30 ng/ml will be randomized to one of three therapy regimens for oral cholecalciferol (3000 IU daily, 25,000 IU weekly, or 100,000 IU monthly) given for 3 months, allowing an equivalent cumulative cholecalciferol dose in all arms over this intensive replacement therapy phase. After 3 months, patients with 25OHD levels ≥30 ng/ml will continue on maintenance therapy, administered at 1000 IU cholecalciferol orally daily for 9 months. Outcomes include the median change in the level of 25OHD from baseline to the end of intensive phase; proportions of children in each limb that attain and maintain normal 25OHD levels after intensive replacement and maintenance treatment; the change in levels of bone biomarkers and the incidence of adverse effects with each therapy regimes. Conclusion: The study design of a multicenter randomized controlled trial in children with CKD is described. Trial Registration: Clinical Trials Registry of India; www.ctri.nic.in; CTRI/2015/11/010180.

Long-term outcome of childhood steroid-sensitive nephrotic syndrome Nada Kalakattawi, Halimah Alghamdi, Najlaa Alotaibi, Khalid A Alhasan, Jameela A Kari Asian Journal of Pediatric Nephrology 2018 1(2):74-77 Background: The long-term outcome of childhood steroid-sensitive nephrotic syndrome (SSNS) needs further evaluation. In this study, In this study, we report the long-term outcome of childhood SSNS at our center. Patients and Methods: This is a retrospective review of cohort of children with SSNS followed by cross-sectional follow-up evaluation. We included all children aged ≥16 years with a history of childhood SSNS. Of 45 children diagnosed with SSNS and contacted for follow-up, only 9 children were available for evaluation of long-term outcome. Demographic, socioeconomic, and disease history data were collected through a questionnaire. All the patients were examined and had their urine and blood samples collected for investigations. The data were analyzed using SPSS. Results: The mean age at onset for the 45 children was 7.3 ± 3.9 years. Follow-up revealed that 65.1% had frequent relapsing or steroid-dependent nephrotic syndrome and 34.9% had infrequent relapses. Of nine patients were included in the follow-up study for a median (range) duration of 11 (5–18) years, 2 of the patients were relapsing at the time of the study and two had one or more relapses during the previous year. Estimated glomerular filtration rate (eGFR) declined in two children and the mean eGFR for the whole group was lower at the time of last follow-up than at baseline (P = 0.032). Conclusion: Children with SSNS need careful long-term monitoring of disease activity and kidney function. A larger prospective study is required.

Eculizumab as treatment in dense deposit disease in children Saeed M Alzabli, Abdulkarim Al Anazi, Hassan Y Faqeehi, Muhammad Amin Ur Rahman, Mohamed E Suliman, Khawla A Rahim Asian Journal of Pediatric Nephrology 2018 1(2):78-83 Background: Dense deposit disease (DDD), a subtype of C3 glomerulopathy, is a rare disease that occurs secondary to hyperactivity of the alternative complement pathway. Renal biopsy typically reveals electron-dense deposits in the glomerular basement membrane. However, treatment options are limited. Till date, to the best of our knowledge, no evidence exists for specific treatment influencing the disease course. Eculizumab, a monoclonal antibody, has been reported to prevent membrane attack complex formation by binding to C5 and leads to improvement in clinical findings. However, the number of reported cases in which eculizumab was administered, particularly in children, is limited. Subjects and Methods: In this report, we present our experience with three pediatric cases of DDD receiving eculizumab treatment. All three patients were diagnosed with DDD on kidney biopsy. All patients showed acute kidney injury, high blood pressure, proteinuria >1 g/day, and decreased C3 levels. Immunosuppressive therapy, which included high-dose methylprednisolone, prednisolone, mycophenolate mofetil, or plasma exchange (in the third patient), as well as antihypertensive drugs, was administered to all the patients. Eculizumab treatment was initiated early in two patients but was initiated later in the third patient, who underwent dialysis initially. Results: The two patients with early initiation of eculizumab treatment showed significant improvement of proteinuria and renal function within weeks of treatment. C3 levels were normalized in one patient but remained decreased in the other. The third patient showed no response. She ultimately progressed to end-stage renal disease and eventually needed maintenance dialysis. Conclusions: Early initiation of eculizumab was associated with decreased proteinuria and improved renal function in two patients. These findings were in agreement with previous reports on the beneficial effects of eculizumab in DDD patients.

Nephrogenic systemic fibrosis: A rare complication following exposure to gadolinium-based contrast media Habib Qaiser, Vina Tresa, Sabeeta Khatri, Irshad Bajeer Ali, Ali Lanewala, Seema Hashmi Asian Journal of Pediatric Nephrology 2018 1(2):84-86 Nephrogenic systemic fibrosis (NSF) is a rare complication following exposure to gadolinium-based contrast media. Gadolinium-based contrast agents (GBCAs) are widely used for imaging throughout the world. NSF, formerly known as nephrogenic fibrosing dermopathy, is a rare progressive fibrosing disorder associated with administration of GBCA in patients with severely compromised renal functions. The condition is well reported in adults, but pediatric cases are rarely reported. Out of 1280 cases in the literature of NSF associated with GBCA, only 12 were found in the pediatric age group. We are reporting a pediatric case of a 7-year-old child with chronic kidney disease Stage VD, who developed NSF following magnetic resonance imaging.

Metanephric adenofibroma in a child with impaired renal function Juliana Mancera, Daniella Chacón, Juan Pablo Luengas Asian Journal of Pediatric Nephrology 2018 1(2):87-89 A 5-year-old girl presented with a history of bilateral reflux nephropathy and a left kidney mass, suspicious of Wilms tumor on imaging studies. She underwent radical nephrectomy according to the National Wilms Tumor Study protocol. The pathology report was consistent with metanephric adenofibroma (MAF), for which radical nephrectomy was considered curative. MAF is a benign, uncommon tumor, which is frequently confused with Wilms tumor on diagnostic imaging; histopathologic studies reveal the diagnosis. The diagnostic and management approach to MAF is discussed.

Hypertension with metabolic alkalosis Aakanksha Sharma, Priyanka Khandelwal, Aditi Sinha, Sanjeev Kumar, Pankaj Hari, Arvind Bagga Asian Journal of Pediatric Nephrology 2018 1(2):90-92 Severe hypertension in children is chiefly renal parenchymal or renovascular in origin. Renovascular hypertension is usually symptomatic and rarely presents with renal tubular dysfunction. We describe a 2-year-old child with polyuria, failure to thrive, hyponatremia, hypokalemia, metabolic alkalosis, hypercalciuria, low molecular weight proteinuria, and medullary nephrocalcinosis. Evaluation revealed severe hypertension and discrepant renal sizes. Doppler ultrasonography and digital subtraction angiography showed right main renal artery stenosis. Hypertension and electrolyte abnormalities abated following percutaneous angioplasty. Unilateral renal artery stenosis may manifest with symptoms of renal tubular dysfunction alone. Hypokalemia and metabolic alkalosis must prompt consideration of renovascular hypertension and monogenic causes. Angiography is essential for confirmation of renovascular hypertension and enables angioplasty, the mainstay of management.

BLDE University Journal of Health Sciences,BLDE (Deemed to be University), formerly BLDE university, is a Single Faculty (Medical Science) institution with Shri B. M. Patil Medical College, Hospital & Research Centre as its constituent college (Est. 1986). The Government of India conferred deemed to be university status onto the institute u/s3 of UGC Act 1956 vide MHRD notification no. F.9-37/2007-U3(A) dated 29-02-2008.

http://www.bldeujournalhs.in/currentissue.asp?sabs=n

Moving toward competency-based medical education Tejaswini Vallabha BLDE University Journal of Health Sciences 2018 3(2):67-68

Health analytics and disease modeling for better understanding of healthcare-associated infections Martin Lopez-Garcia, Meghana Aruru, Saumyadipta Pyne BLDE University Journal of Health Sciences 2018 3(2):69-74 Healthcare-associated infections (HAIs) are a growing challenge and a major cause of health concern worldwide. It is difficult to understand precisely the dynamics of spread of hospital-acquired infections owing to the usual involvement of different populations, risk factors, environments, and pathogens. Mathematical and computational models have proved to be useful tools in providing realistic representations of HAI dynamics and the means of evaluating interventions to minimize the risk of HAIs.

An evidence-based review on quackery in dentistry Shail Kumari, Sunil Kumar Mishra, Pankaj Mishra BLDE University Journal of Health Sciences 2018 3(2):75-78 BACKGROUND: Uncustomary medicine has been known since ancient period and is very commonly practiced by many individuals. Due to traditions and religious beliefs, these different unconventional practices were followed in the form of quackery. PURPOSE: This review is done to focus the quack practices done in dentistry affecting the oral health of the individuals and what measures to be taken to totally eradicate it from the society. MATERIALS AND METHODS: In April 2018, an electronic data search was done to find the published literature in PubMed, Medline, and EBSCOhost database. The search was focused on reports on quack practices in dentistry, reason behind such practices and their effects on oral health of the individuals. The titles and abstracts obtained in relation to focused questions were screened. Handsearching of other printed articles was also performed. The articles published in only English language were considered for the study. RESULTS: The initial search resulted in 102 papers. The abstracts of the articles related to the focus question were independently screened by the reviewers. Eighty-seven articles were excluded for not being related to topic or not in English or whose abstract is not available. Handsearching of literature resulted in one additional paper. A total of 16 articles were included in the review, of which five articles reported dental treatment of subjects poorly treated with quacks and one article is on patient's perception toward dental quacks. CONCLUSION: Quackery in dental field is growing fast in cities and villages and it is going to be a major challenge to populations due to unsterilized instruments being used. This gives unethical practices, giving invitation to certain major health hazards in the form of AIDS and hepatitis to individuals. It is the major responsibility of the government organizations and dental councils to interfere in the current scenario, so that quack practices in dental field can be eliminated from its roots, and to provide good oral treatment and education to the population who are in real need of it.

Clinical and laboratory profile of diabetic ketoacidosis in elderly with type 2 diabetes mellitus B Anupama, P Chandrasekhara, MS Krishnamurthy, Mohsin Aslam BLDE University Journal of Health Sciences 2018 3(2):79-84 INTRODUCTION: Diabetic ketoacidosis (DKA) in elderly is rare and poses a special problem because of high degree of mortality, comorbidity, age-related impairment of functional ability, and increased chances of hypoglycemia. OBJECTIVES: The main objective is to study the precipitating factors, clinical and laboratory profile of DKA in elderly. MATERIALS AND METHODS: A total of 100 type 2 diabetes mellitus (T2DM) patients, ≥60 years, admitted in a rural tertiary medical center were included in this study. RESULTS: Most of them had prolonged diabetes with mean duration of 7.3 ± 4.6 years. 24 patients were newly detected diabetes mellitus. Systemic infections seen in 67 patients (respiratory –32.8%, sepsis – 28.4%, acute gastroenteritis – 22.4%, and urinary tract infections– 16.4%), were the main precipitating factors, followed by noncompliance to drugs (34). Osmotic symptoms were reported by most (62) followed by pain abdomen (56). Dehydration was seen in 72 patients, whereas altered sensorium in 48. Blood glucose at presentation (493.12 ± 72.38 mg/dl) and HbA1c levels (9.63 ± 0.94%) were found to be elevated with lowered arterial pH (7.14 ± 0.07) and bicarbonate (13.7 ± 4.2 mEq/L). 22 had severe acidosis and 10 had mild acidosis. There was no mortality in the present series. CONCLUSION: DKA is more common in T2DM than anticipated. The most common precipitating factor is infection followed by noncompliance even in elderly. Majority had poor glycemic control. All elderly diabetic patients with high serum glucose level must be investigated for ketosis as the symptoms of DKA are minimal and morbidity and mortality are high in these patients.

Effects of static stretching in comparison with Kaltenborn mobilization technique in nonspecific neck pain Faria Riaz, Rizwan Haider, Muhammad Mustafa Qamar, Ayesha Basharat, Anum Manzoor, Akhtar Rasul, Azhar Ayyoub, Waqas Ahmad BLDE University Journal of Health Sciences 2018 3(2):85-88 BACKGROUND: Neck pain is a common medical problem resulting from any diseases or biomechanical disturbances. In mechanical/nonspecific neck pain, muscles become tighten, leading to restricted neck mobility. The study purposed to determine the efficacy of Kaltenborn mobilization technique and static stretching in pain and regain of a normal cervical range of motion (ROM) in patients with nonspecific/mechanical neck pain. MATERIALS AND METHODS: Forty-four patients suffering from non specific neck pain were randomly divided into two groups. Group A, in which participants received static stretching (n = 22) and Group B, in which participants received Kaltenborn mobilization technique (n = 22). Pain intensity was measured by numeric rating pain scale and active ROM (AROM) by neck disability index at baseline and poststudy. RESULTS: At baseline, there was no difference in pain intensity and ROM in both groups. At poststudy, a significant improvement was found in both groups in improving ROM and pain. However, no intervention was superior. CONCLUSION: Both the Kaltenborn mobilization technique and static stretching are effective in reducing nonspecific neck pain and increasing cervical AROM.

Medical ethics in a resource-constrained context: A cross-sectional study of awareness, attitude, practice, violations of its principles, and ethical dilemmas experienced by medical professionals in Abia State, Nigeria Gabriel Uche Pascal Iloh, Prince Ezenwa Ndubueze Onyemachi, Miracle Erinma Chukwuonye, Chukwuneke Valentine Ifedigbo BLDE University Journal of Health Sciences 2018 3(2):89-96 BACKGROUND: Ethics of medical care are global health concerns. It is universally acknowledged that medical practice should be guided by ethical principles which serve as yardsticks for regulation of professional conduct and discipline. AIM: The study was aimed at describing the awareness, attitude, practice, violations of ethical principles, and ethical dilemmas experienced by medical professionals in Abia State, Nigeria. MATERIALS AND METHODS: A descriptive study was carried out on a cross-section of 210 medical practitioners in Abia State, Nigeria. Data were collected using pretested, self-administered questionnaire that elicited information on awareness, attitude, practice, violations of ethical principles, and ethical dilemmas. Attitude and practice of principles of medical ethic (ME) were assessed in the previous 1 year. Violations and ethical dilemmas were assessed over lifetime practice as a medical doctor. RESULTS: The age of the participants ranged from 26 to 77 years. There were 173 (82.4%) males and 37 (17.6%) females. The participants were most commonly aware of principles of autonomy (100%) and nonmaleficence (100%), while the least was justice (91.9%). The positive attitude to principles of ME was predominantly oriented toward autonomy (92.4%) and the least was justice (76.2%). The most adequately practiced principle was autonomy (78.1%) and the least was justice (71.4%). The most violated ethical principle was autonomy while the most common ethical dilemma was issues related to rights of patients. The attitude (P = 0.042) and practice (P = 0.034) of principle of autonomy were significantly associated with >10 years of medical practice. CONCLUSION: Awareness of principles of ME was very high but did not translate to appropriate positive attitude and adequate practice orientations. The most violated principle was patients' autonomy and most common ethical dilemma was issues related to the rights of the patients.

Space travel in a high-altitude environment: One more step in human BioSpaceForming Gustavo Rafael Zubieta-Calleja, Natalia Mariela Zubieta-DeUrioste BLDE University Journal of Health Sciences 2018 3(2):97-103 BACKGROUND: Currently, space programs use sea-level pressures (760 mmHg) and normoxia (21% oxygen fraction) in space capsules. When astronauts need to go for a spacewalk, the pressure has to be reduced to 1/3 that of sea level (240 mmHg). This implies that in order to avoid decompression sickness (DCS) and acute mountain sickness (AMS), complex and time-consuming procedures need to be carried out. Furthermore, space suits have to sustain such pressure and protect them from radiation. A cooling vest is also used in order to keep the body temperature within normal values. This makes the space suits very voluminous and hence with rigid structures in order to sustain the pressure in space. Astronauts suffer, among many other complex microgravity alterations, anemia, that upon return to sea level, has to be correspondingly normalized to preflight levels. The reason that anemia presents is in part due to a lower requirement of oxygen by orthostatic muscles in microgravity. Exercise in space, reduces bone and muscle wasting. Over 200 million high-altitude residents live above 2000 m (6560 ft) of altitude and have adapted perfectly to life in the mountains. They live their life as if they were at sea level. They reproduce and practice sports, all this with a higher hematocrit. They even have proved extended longevity. METHODS: The knowledge acquired during 47 years of medical practice at high altitude, is applied to a proposal for a most efficient capsule environment for the human exploration of space. RESULTS: A cabin pressure similar to the city of La Paz, Bolivia (495 mmHg), that is, 2/3 that of sea level (760 mmHg) would not only maintain the hematocrit for reentry, but furthermore, could significantly accelerate the preparation for extravehicular activity that currently takes up several hours. High-altitude residents can tolerate lower levels of oxygen (hypoxia) providing them with an advantage of survival in oxygen poor environments. We likewise propose that a lower pressure (149 mmHg) be used in space suits, making them more flexible and thereby reducing the risks of DCS and AMS. This implies only 346 mmHg in pressure difference, from space capsule to space suit, as compared to 520 mmHg in the current methodology. CONCLUSIONS: The laws of physics in relation to pressure changes cannot be broken. However, human biology with adaptation to lower pressures and lower levels of oxygen and carbon dioxide, which is the case of high-altitude residents, can reduce the pressure gap significantly. Thereby, biology breaks the limitations of the laws of physics. Space travel will always have hypoxia as a fundamental threat, hence a hypobaric, normoxic space capsule environment results beneficial, practical, and one more step in “BioSpaceFormin” of human beings.

Awareness and utilization of postpartum intrauterine contraceptive device among postnatal women in Vijayapur Anita Nath, Archana Kulkarni, Shubhashree Venkatesh, Mohan Kumar BLDE University Journal of Health Sciences 2018 3(2):104-107 BACKGROUND: A fair proportion of women face an unmet need for family planning during the 1st year following childbirth. The postpartum period is an optimal time for effective contraception as the new mother is more receptive to accept family planning. OBJECTIVE: The objective of this study is to determine the awareness and utilization of postpartum intrauterine contraceptive device (PPIUCD) among postnatal women belonging to Vijayapur district in Northern Karnataka. MATERIALS AND METHODS: This was a cross-sectional study conducted over the duration of 1 month among postnatal women admitted at Vijayapur district hospital. RESULTS: Only 20% of the women were aware, 6% had accepted, and 17% were willing to accept. Most of the acceptors were younger in age, better educated, and primipara and had delivered male baby, although there was no statistical significance. A significant number of acceptors were from urban areas and had undergone cesarean section. CONCLUSION: Awareness and acceptance of PPIUCD are extremely low. Concerted effort is needed to be boost the utilization rates of this effective and safe contraceptive during the postpartum period.

A quasi-experimental study to assess the effectiveness of music therapy on pain level among cancer patients admitted to regional cancer hospital Indira Gandhi Medical College, Shimla, Himachal Pradesh Navjeet Kaur, Jansi Kesava BLDE University Journal of Health Sciences 2018 3(2):108-110 INTRODUCTION: Cancer is an uncontrolled growth and spread of abnormal cells. About 53% of patients suffer pain in various stages of their illness. There are different nonpharmacological measures that are used widely for reducing pain. Music is believed to reduce pain and also the intake of analgesic. AIM: This study aims to find the effect of music therapy in reducing pain among cancer patients. SETTINGS AND DESIGN: A nonrandomized control group design study was conducted in Regional Cancer Hospital Indira Gandhi Medical College, Shimla, Himachal Pradesh. MATERIALS AND METHODS: A total of 50 individuals were selected based on inclusion criteria through nonprobability purposive sampling technique. They were divided into experimental and control groups nonrandomly. Background information was collected using structured interview schedule. The pain level was assessed by using a numerical pain rating scale. Indian classical instrumental music was administered for 20 min in the morning and evening for 3 consecutive days. RESULTS: Majority of the individuals (52%) were in the age group of 41–50 years, and higher proportions (84%) of individuals were females out of which 64% had cancer of cervix in experimental as well as control group. In the experimental group during the posttest, pain level was less than the pretest pain level which was statistically significant (F = 47.21, P < 0.001). However, in the control group, there was no change in pre- and post-test pain level (P = 0.177). CONCLUSIONS: The findings of the study showed that the pain level in the experimental group during the posttest was less than that in the pretest as compared to the control group which showed that music therapy was effective in reducing the pain level among cancer patients.

"Graph's disease" and students' anxieties in understanding physiology Hwee-Ming Cheng, See-Ziau Hoe BLDE University Journal of Health Sciences 2018 3(2):111-115 Graphs are visual summaries that explain the phenomenon in different disciplines. Students who approach physiology in rote-learning mode usually have more difficulty and anxieties to understand the graphical information. Graphs can be used in many ways to conceptualize much of physiology. The relationship between the X-axis and Y-axis variables can indicate a cause and effect scenario as in the hemoglobin-oxygen association/dissociation. Temporal, sequential events are illustrated with the X-axis as the time parameter and several changing parameters can be followed along the Y-axis in a dynamic way as in the Wigger's cardiac cycle diagram. Graphs can also provide a different perspective on the fluctuations between two parameters that is produced by a third physiologic event as seen in the ventricular volume-pressure loop. Hopefully, this article on physiological graphs will help students to relax and enjoy looking and thinking through the different line profiles in graphs they face in their “Physbook.”

Geriatric Mental Health

http://www.jgmh.org/currentissue.asp?sabs=y

Mobile phone use in the elderly: Boon or bane? Alka A Subramanyam, Shipra Singh, Nitin B Raut Journal of Geriatric Mental Health 2018 5(2):81-83

Insomnia in elderly: A neglected epidemic Shiva Shanker Reddy Mukku, Vijaykumar Harbishettar, Palanimuthu T Sivakumar Journal of Geriatric Mental Health 2018 5(2):84-93 Sleep is an important vital function. Sleep promotes many functions such as restoration of body, repair of tissues, immune regulation, and consolidation of memory. Insomnia is one of the most common complaints in patients with mental health problems. The prevalence of insomnia is higher in elderly than in general population. The reasons could be due to physiological changes in sleep architecture with aging, high medical morbidity, multiple medication, loneliness, and environmental factors causing sleep disturbances. Although insomnia is a common troubling problem in the elderly, only minority seek professional help. Some elderly self-medicate with over-the-counter medications for their sleep problems. These practices lead to serious adverse effects over the long term. There are many myths related to insomnia in elderly. Thus, insomnia in elderly is often under-recognized and under-treated problem. In this article, we review the literature on sleep problems in the elderly and discuss the systematic evaluation of insomnia in the elderly.

The role of epigenetics in Alzheimer's disease Purushothaman Sujeetha, Jeenu Cheerian, Preethi Basavaraju, Puthamohan Vinayaga Moorthi, Arumugam Vijaya Anand Journal of Geriatric Mental Health 2018 5(2):94-98 Neurodegenerative diseases are debilitating and incurable condition resulting in the progressive degeneration of nerve cells which causes problems with movement or mental functioning. Alzheimer's disease is the most common form of dementia and an irreversible neurodegenerative disorder. The mechanism of Alzheimer's disease is still unknown. The changes in the primary DNA sequence due to heritable alterations in the gene are known as epigenetics. The most studied epigenetic mechanisms are DNA methylation, histone modifications, and noncoding RNAs. Therefore, this change triggers the alterations in the transcriptional level of genes which are involved in the pathogenesis of Alzheimer's disease. Over the past decade, it is progressively clear that the epigenetic mechanisms play an important role in the pathogenesis of Alzheimer's disease. The literature search was performed on reviews addressing the topics in the databases PubMed and Google Scholar. This review focuses on the three major epigenetic mechanisms and their role in the pathogenesis of Alzheimer's disease.

Relationship of loneliness and social connectedness with depression in elderly: A multicentric study under the aegis of Indian Association for Geriatric Mental Health Sandeep Grover, Ajit Avasthi, Swapnajeet Sahoo, Bhavesh Lakdawala, Amitava Dan, Naresh Nebhinani, Alakananda Dutt, Sarvada C Tiwari, Ab Majid Gania, Alka A Subramanyam, Jahnavi Kedare, Navratan Suthar Journal of Geriatric Mental Health 2018 5(2):99-106 Aim of the Study: This study aimed to evaluate the prevalence of loneliness and its relationship with social connectedness and depression in elderly. Additional aims were to evaluate the demographic and clinical factors associated with loneliness and social connectedness in elderly patients with depression. Methodology: The study sample comprised 488 elderly patients (age ≥60 years) with depression recruited across 8 centers. These patients were evaluated on Geriatric Depression Scale (GDS-30), Generalized Anxiety Disorder-7 Scale (GAD-7), Patient Health Questionnaire-15 (PHQ-15) Scale, Columbia Suicide Severity Rating Scale, UCLA Loneliness Scale (LS), and Revised Social Connectedness Scale. Results: About three-fourth (77.3%) of the entire sample reported the presence of loneliness. With respect to specific loneliness symptom, 62.5% reported lack of companionship, 58.7% reported being left out in life, and 56.5% of the individuals reported felt isolated from others. No gender differences were noted in the prevalence of any loneliness symptom. Higher loneliness scores had significant positive correlation with severity of depression, anxiety, and somatic symptoms as assessed by GDS-30, PHQ-15, and GAD-7, respectively, in individuals of both the genders. Higher social connectedness was associated with higher level of anxiety and lower loneliness in females only. Being currently single, older age, longer duration of illness, presence of family history of mental illness, presence of comorbid physical illness, and absence of substance abuse were associated with higher loneliness. With regard to suicidality, higher loneliness was associated with nonspecific active suicidal thoughts, active suicidal ideations with and without intent, nonsuicidal behavior, and higher intensity of suicidal ideations. Conclusions: About three-fourth of the elderly patients with depression also have associated loneliness. Loneliness is associated with higher severity of depression, anxiety, and somatic symptoms. Severity of depression is associated with loneliness but not with social connectedness. Lower social connectedness among elderly females with depression is associated with higher loneliness, but this is not true for elderly males with depression.

Prevalence of physical comorbidity and prescription patterns in elderly patients with depression: A multicentric study under the aegis of IAGMH Sandeep Grover, Ajit Avasthi, Swapnajeet Sahoo, Bhavesh Lakdawala, Amitava Dan, Naresh Nebhinani, Alakananda Dutt, Sarvada C Tiwari, Ab Majid Gania, Alka A Subramanyam, Jahnavi Kedare Journal of Geriatric Mental Health 2018 5(2):107-114 Aim of the Study: This study aims to evaluate the prevalence of physical comorbidities and prescription patterns in elderly patients with depression. Materials and Methods: This study included 488 elderly patients (aged ≥60 years) with depression recruited across eight centers. A self-designed physical comorbidity checklist was used to assess for the presence of various physical comorbidities and prescription of psychotropic medications was recorded. Results: More than three-fourth of the study sample (n = 384; 78.7%) had at least one physical comorbidities and one-third (36.7%) of the samples had at least three physical illnesses. About half of the study samples had hypertension (47.3%) and slightly more than one-fourth had diabetes mellitus (29%). The most common physical illness involved the cardiovascular system (51.5%), followed by endocrinological system (39.3%), orthopedic and joint-related diseases (35%), and ophthalmological problems (22.3%). Those with physical comorbidity had higher severity of depression, anxiety, and somatic symptom. Sertraline was the most preferred antidepressant followed by escitalopram and mirtazapine. Only 12.7% of the sample was prescribed antipsychotics of which quetiapine and olanzapine were the most commonly used agents. Benzodiazepines were prescribed to more than half of the study samples (56.55%), with clonazepam being the most preferred benzodiazepine followed by lorazepam. Compared to those without hypertension, those with hypertension were more commonly prescribed sertraline and escitalopram and less commonly prescribed fluoxetine. Similarly, compared to those without diabetes mellitus, those with diabetes mellitus were more commonly prescribed sertraline and less commonly prescribed fluoxetine. Conclusion: Comorbid physical illnesses are highly prevalent in elderly participants with depression with hypertension being the most common physical comorbidity followed by diabetes mellitus and osteoarthritis. The presence of physical comorbidity is associated with more frequent prescription of sertraline and escitalopram.

Antidepressant-associated hyponatremia among the elderly: A retrospective study Sandeep Grover, Anish Shouan, Aseem Mehra, Subho Chakrabarti, Ajit Avasthi Journal of Geriatric Mental Health 2018 5(2):115-120 Background: The use of antidepressants among elderly is associated with dreaded side effect of hyponatremia. However, there is limited information about specific risk factors associated with developing hyponatremia in elderly. Aim of the Study: The aim of this study was to evaluate the clinical risk factors for the development of hyponatremia among elderly patients started on antidepressant medications. Methodology: Using retrospective study design, patients who developed hyponatremia (n = 35) and those who did not develop hyponatremia (n = 43) with use of antidepressants, were matched on sociodemographic parameters and were compared for various parameters such as physical illness, other medications, and dose and type of antidepressant drug. Results: Higher proportion of those who developed hyponatremia had history of comorbid hypertension, were receiving antihypertensive agents, and were receiving 2 antihypoglycemic agents concomitantly. Majority of the patients who developed hyponatremia were receiving mirtazapine, followed by sertraline and venlafaxine. There was no association of hyponatremia with concomitant use of psychotropics, presence of other physical illnesses, comorbid dementia, and comorbid substance use. Conclusion: Antidepressant-associated hyponatremia is more commonly seen in patients with comorbid hypertension, those receiving any antihypertensive agent and those on more than one hypoglycemic agent.

Dropout rates and reasons for dropout from treatment among elderly patients with depression Sandeep Grover, Aseem Mehra, Subho Chakrabarti, Ajit Avasthi Journal of Geriatric Mental Health 2018 5(2):121-127 Background: Adherence to medical treatment is a major challenge. A significant proportion of patient's dropout of treatment after the initial visit. Little is known about the reasons for such high dropouts. Aim: This study aimed to evaluate the dropout rates and reasons for dropout from treatment among elderly patients with depression attending a tertiary care psychiatry outpatient facility. Methodology: One hundred and forty consecutive new patients aged 60 years or more, attending the psychiatry walk-in clinic, diagnosed with depressive disorders were assessed at baseline and then contacted at 6 months and 1 year to evaluate the follow-up status and reasons for dropout of treatment. Results: Out of the 140 participants, 132 could be contacted after initial registration with the clinic. About two-fifths (n = 58; 41.4%) never return back to the clinic after the first visit. By 6 months and 1 year, 105 (75%) and 126 (90%) patients had dropped out of treatment. When the reason for dropout of those who dropped out “very early (i.e., never returned back)” were evaluated, the most common reason for dropout was “no relief” of symptoms, and this was closely followed by complete relief of symptoms. Among those who followed up at least once, but had dropped out at 6 months, the most common reason for dropout was complete relief of symptoms, and this was closely followed by “no relief” and “worsening of illness” being the other common reasons of dropout. Among those who dropped out after 6 months, the most common reason for dropout was complete relief of symptoms. None of the demographic variable emerged as a predictor of dropout at any time point. Few clinical variables were associated with dropout of treatment. Conclusion: Very high proportion of elderly patients with depression dropout of treatment prematurely. Providing proper information to the patients at each visit can help in reducing the treatment dropout rates.

Elder abuse and its association with depression and social support: A community-based study from Tezpur, Assam Ananya Bordoloi, Arif Ali, Sabana Nasrin Islam Journal of Geriatric Mental Health 2018 5(2):128-133 Background: Abuse among older adults is a sensitive issue that needs an elaborative research study in the Indian context, specifically in rural areas. A drastic change in the sociocultural aspects of looking at this vulnerable group of people is not only limited to urban areas but also touches the simple rural life. Thus, the present study aimed to know about the prevalence of abuse and its associations with depression and social support among the rural older adults. Materials and Methods: A cross-sectional rural community-based study was conducted. The universe of the study comprised older adults residing under Mazgaon Panchayat, Tezpur, Sonitpur district of Assam. Two polling stations were randomly selected, using simple random sampling (lottery method) for the present study. Based on the two electorate lists, 141 older adults aged 60 years and above were listed out. From that list, 102 participants fulfilled the inclusion criteria and completed the interview. A semi-structured sociodemographic data sheet, Mini–Mental Status Examination, Vulnerability to Abuse Screening Scale, Geriatric Depression Scale (GDS), and the Multidimensional Scale of Perceived Social Support were administered to the respondents. Results: The prevalence of vulnerability was 28.4%, dependence was 13.7%, dejection was 45%, and coercion was 2% among the rural older adults. In the GDS, 29.4% of the respondents reported mild depression and 7.8% of respondents reported severe depression. In perceived social support, result shows that the mean score is high in the domain of family (24.62 ± 4.6) followed by significant others (24.52 ± 4.2) and friends (20.94 ± 6.05). Significant positive correlation was found between abuse and depression (r = 0.619, P = 0.01) among the older adults. Vulnerability to abuse has a significant negative correlation with perceived social support (r = −0.443, P = 0.01). Perceived social support and depression contributed significantly to the prediction of vulnerability to abuse among older adults (F(5,96) =18.684, P = 0.000) accounting for 4.93% variance. Conclusions: The older adults in the rural community are prone to vulnerability with a high risk of dejection. Depression strongly contributed to the variance on the overall vulnerability to abuse among older adults. The results of this study may guide in planning and implementing programs regarding prevention and management of abuse among older adults.

Evaluation of emotional abuse perceived by the elderly living in nursing homes Saliha Bozdogan Yesilot, Ayse Inel Manav, Ebru Gozuyesil Journal of Geriatric Mental Health 2018 5(2):134-138 Introduction: In recent years, a significant increase in elderly population, modernization, industrial improvements, and greater involvement of women in the workforce have led to an increase in elder abuse. Elder abuse and frequent emotional abuse of the elderly have significant negative effects on their health and well-being. This study was conducted to evaluate the level of emotional abuse perceived by the elderly living in nursing homes. Materials and Methods: This cross-sectional and descriptive study was carried out between June 15 and July 15, 2017, at the Nursing Home Elderly Care and Rehabilitation Center in Adana, Turkey. The study sample consisted of a total of 118 elderly individuals who were selected using a simple random sampling method. Research data were collected using a personal information form and the perceived emotional abuse scale for adults (PEASA). The study results were evaluated using the IBM SPSS Statistics 22 (IBM SPSS, Turkey) program. The statistical significance level was set at P <0.05 for all analyses. Results: The mean age of the participants was 74.63 ± 6.76 years; of these, 50.2% were male, 70.3% were married, 29.7% were primary school graduates, and 83.1% had children. Their mean PEASA score was determined as 133.86 ± 35.23. The mean PEASA score of the elderly individuals without children was found to be statistically significantly higher than that of the elderly individuals with children (P = 0.044; P < 0.05). No statistically significant difference was found between the mean PEASA scores in terms of other descriptive characteristics of the participants (P > 0.05). Conclusion: The study results showed that the mean PEASA score of elderly individuals living in nursing homes was slightly above the scale mean score in general, and these individual perceived moderate emotional abuse.

Inpatient treatment outcomes of aged substance-using patients admitted to a tertiary care center Preethy Kathiresan, Siddharth Sarkar, Yatan Pal Singh Balhara Journal of Geriatric Mental Health 2018 5(2):139-142 Background and Aims: Studies on aged substance users are few from the Indian subcontinent, though they are likely to represent a subgroup of patients with distinct clinical needs. This study aimed to present the inpatient treatment outcomes of such aged substance-using patients admitted to a tertiary care treatment facility in India. Methodology: This descriptive, retrospective chart-based study presents data of aged patients (age 50 years and above) admitted between January and December 2014 at the National Drug Dependence Treatment Centre, Ghaziabad. Results: A total of 72 aged patients were admitted during this period out of total 953 admissions (7.6% of the sample). All of them were male. Forty patients (55.6%) had a diagnosis of alcohol dependence and 32 (44.4%) had a diagnosis of opioid dependence. The mean duration of stay was 12.9 (±9.6) days. Of these 72 patients, treatment could be completed for 57 patients (79.2%), while seven patients left against medical advice, four were discharged on disciplinary grounds, three were shifted to another facility (two due to medical reasons), and one absconded. Treatment completion rate was least among aged patients with only opioid dependence (25.65%). Conclusion: Medical issues may be a consideration of premature discharge among aged patients admitted for the treatment of substance use disorders. Furthermore, treatment noncompletion is more among aged patients with opioid use disorder than among alcohol use disorder. Further studies are needed with prospective methodology for the assessment of various factors associated with treatment completion, which can help to address the treatment needs of aged patients with substance use disorders, which in turn can lead to better treatment outcomes for them.