Patient satisfaction and adverse effects following the use of topical hair fiber fillers

Introduction:

Alopecia (hair loss) commonly affects patients and can severely affect one's confidence and self-esteem. In addition to medical therapy, hair filler fibers can improve the gross appearance of thinning hair in a targeted manner by making hair appear fuller and thicker. The objective of this study is to assess patient use, satisfaction, and adverse effects following the application of a commercially available hair fiber filler product.

Materials and Methods:

This cross-sectional study was conducted at an academic tertiary dermatology center. Alopecia patients were supplied a keratin hair fiber filler, which best matched their natural hair color. Following 90 days of application, patients were asked to complete questionnaires to assess patient satisfaction and record patient-reported adverse events.

Results:

Twenty women and 20 men with hair loss participated. Patients reported improved hair volume and increased perceptions of confidence and attractiveness after applying fiber. Most subjects (92.5%) reported a high level of satisfaction with the fiber's ability to match hair color and provide sufficient coverage. No serious adverse effects were reported.

Conclusion:

Alopecia has a negative impact on quality of life and several psychological domains. Topical hair filler fiber can serve as an effective and safe camouflage for patients with alopecia with high user satisfaction.

The Effects of Smoking on Hair Health: A Systematic Review

Smoking is not only a preventable cause of significant systemic disease but also affects the follicular growth cycle and fiber pigmentation. Ambient tobacco smoke exposure results in nicotine accumulation in hair follicles and the hair shaft. This review summarizes the evidence on the association between smoking and hair health, as denoted by alopecia and premature hair graying (PHG). In July 2020, a review of the literature using PubMed/MEDLINE and CINAHL databases identified 32 studies investigating the relationship between smoking, PHG, and alopecia (androgenetic alopecia and frontal fibrosing alopecia). The prevalence of hair loss and PHG is more prevalent in smokers than nonsmokers. Smoking is associated with negative effects on hair health as evidenced in PHG and alopecia. Smoking status should be assessed in patients who are presenting to their dermatologist for evaluation of alopecia and PHG.

The Effect of a Screen Protector on Blue Light Intensity Emitted from Different Hand-held Devices

PURPOSE:

In response to growing concern about the effect of blue light on ocular tissue, companies have created mobile device screen protectors to block blue light. This project evaluates one of these screen protectors' ability to reduce blue light intensity.

METHODS:

The intensity of light at 450 nm from an iPhone 8, iPhone X, and iPad was measured in a dark room. The averages of three measurements were taken with and without the screen protector at different distances, settings of brightness, and Apple's night shift (NS) mode. Results were analyzed using paired t-tests.

RESULTS:

At 33 cm, 100% brightness, and 0% NS, the screen protector decreased intensity by 43.9%, 32.3%, and 34.9% for the iPhone 8, iPhone X, and iPad, respectively. At 33 cm and 100% brightness, increasing NS mode from 0% to 100% decreased intensity by 81.2%, 84.2%, and 86.5%. At 33 cm without NS, decreasing the brightness from 100% to 0% decreased intensity by 99.5%, 99.8%, and 97.8%.

CONCLUSIONS:

The screen protector decreased the intensity at 450 nm for every setting other than those at 0% brightness. Decreasing brightness and applying NS mode were more effective in reducing blue light. More research is needed to determine the benefits of decreasing blue light exposure from electronic devices.

Iatrogenic delirium on symptom-triggered alcohol withdrawal protocol

Purpose

The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative treatment modalities. In the management of alcohol withdrawal syndrome, symptom-triggered therapy directs nursing staff to regularly assess patients using standardized instruments, such as the Clinical Institute for Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), and administer benzodiazepines at symptom severity thresholds. Symptom-triggered therapy has been shown to lower total benzodiazepine dosage and treatment duration relative to fixed dosage tapers (Daeppen et al., 2002). However, CIWA-Ar has important limitations. Because of its reliance on patient reporting, it is inappropriate for nonverbal patients, non-English speakers (in the absence of readily available translators) and patients in confusional states including delirium and psychosis. Importantly, it also relies on the appropriate selection of patients and considering alternate etiologies for signs and symptoms also associated with alcohol withdrawal.

Design/methodology/approach

The authors report a case of a 47-year-old male admitted for cardiac arrest because of benzodiazepine and alcohol overdose who developed worsening delirium on CIWA-Ar protocol.

Findings

While symptom-triggered therapy through instruments such as the CIWA-Ar protocol has shown to lower total benzodiazepine dosage and treatment duration in patients in alcohol withdrawal, over-reliance on such tools may also lead providers to overlook other causes of delirium.

Originality/value

This case illustrates the necessity for providers to consider using other available assessment and treatment options including objective alcohol withdrawal scales, fixed benzodiazepine dosage tapers and even antiepileptic medications in select patients.

Case of significantly delayed divalproex-induced thrombocytopaenia

We describe a 48-year-old male patient on long-term divalproex treatment for bipolar disorder who developed grade II thrombocytopaenia after approximately 18 years of therapy. Abrupt cessation of divalproex led to immediate platelet level reconstitution.

Biomechanical effects of position and angle of insertion for all-suture anchors in arthroscopic Bankart repair

BACKGROUND

The biomechanical properties of all-suture anchor for labral repair depending on the insertion angle and location are lacking. The purpose of this study was to quantify the biomechanical fixation characteristics of the anchor position and insertion angle of all-suture anchors for arthroscopic Bankart repair.

METHODS

Twenty-four fresh frozen cadaveric glenoid were used. All-suture anchors with 1.5-mm diameter were randomly inserted at 2:30, 4:00, and 5:30 o'clock positions on the glenoid edge, with either 30°, 45° or 60° insertion angles to the mediolateral axis of the glenoid. Anchors were preloaded to 5 N and cyclically loaded from 5 N to 20 N for 10 cycles, followed by a load to failure test at 60 mm/min. Permanent, non-recoverable displacement was quantified at the end of the cyclic loading test to yield load.

FINDINGS

All-suture anchors implanted at the 2:30 o'clock position of the glenoid provided greater stiffness, yield load, and ultimate load than those inserted at the 4:00 and 5:30 o'clock positions, regardless of the insertion angle. Displacement at yield and ultimate load were similar among the positions and insertion angles (yield load, vs. 4:00, p = 0.01; vs. 5:30, p = 0.045; ultimate load, vs. 4:00, p < 0.01; vs. 5:30, p < 0.01). The insertion angles of 30°, 45° and 60° did not influence mechanical stability between the 4:00 and 5:30 o'clock positions.

INTERPRETATION

The insertion angle of all-suture anchors does not significantly affect the stability at antero-inferior quadrant of the glenoid.

Outcomes following laparoscopic transhiatal esophagectomy for esophageal cancer

BACKGROUND

Most published minimally invasive esophagectomy techniques involve a multiple field approach, including laparoscopic and thoracoscopic esophageal mobilization. Laparoscopic transhiatal esophagectomy (LTE) should potentially reduce the complications associated with thoracotomy. This study aims to compare outcomes of LTE with open transhiatal esophagectomy (OTE) and en-bloc esophagectomy (EBE).

METHODS

Retrospective chart review was performed on all patients who had an LTE for cancer between July 2008 and July 2012 at our institution. Data was compared with an historic cohort of patients who underwent OTE and EBE at the same institution from July 2002 to July 2008.

RESULTS

There were 33 patients with LTE, compared with 60 patients with OTE and 139 with EBE. The presence of minor operative complications was similar (p = 0.36), but major complications were significantly less common in the LTE group (12, 23 and 33 %, respectively; p = 0.04). The median number of blood transfusions during hospitalization was significantly lower in the LTE group (0, 2.5 and 3, respectively; p = 0.005). Median tumor size was significantly smaller (1.5, 2.2, and 3 cm, respectively; p = 0.03), but the LTE group had a significantly higher percentage of patients with neoadjuvant treatment (39, 14 and 29 %, respectively; p = 0.008). Median lymph node yield for LTE was lower (24, 36 and 48, respectively; p < 0.0001), but the percentage of patients with positive nodes was similar (33, 33 and 39 %, respectively; p = 0.69). Mortality was equivalent among the groups (0, 2 and 4 %, respectively; p = 0.38). The median LOS for the LTE group was significantly lower (10, 13 and 15 days, respectively; p < 0.0001). Overall survival was not different between the three groups (p = 0.65), with median survival at 24 months of 70, 65 and 65 %, respectively.

CONCLUSION

LTE can be performed safely with less major complications and shorter hospital stay than open esophagectomy. The reduced lymph-node harvest did not impact overall survival.

Focal renal infarction: an unusual cause of haematuria in a patient with sickle cell trait

A 29-year-old woman with sickle cell trait developed persistent haematuria. Intravenous urography, ultrasound, cystoscopy and selective renal angiography revealed focal renal infarction, but in the absence of papillary necrosis. There are no prior reports of focal renal infarction as a cause of haematuria in patients with sickle cell trait.

Hospital admission after day-case gynaecological laparoscopy

We have examined aspects of the anaesthetic technique that may influence the likelihood of unplanned overnight hospital admission after ambulatory gynaecological laparoscopy and have determined if any anaesthetically controllable factors were involved. The retrospective audit involved 300 patients. All patients attended the day-case unit at the Liverpool Women's Hospital between September 1996 and May 1997. One hundred ASA I-II patients who had unplanned overnight admissions during this time were evaluated. For every admitted patient, two similar patients who did not require admission were studied. Variables such as patient age and anaesthetic technique were evaluated by logistic regression. Our results indicated that postoperative emesis was the commonest cause for admission. Significant factors increasing the likelihood of unplanned admission included returning from the recovery unit after 15:00, use of a laryngeal mask airway and undergoing diagnostic laparoscopy. Significant factors reducing the likelihood of admission were the use of fentanyl and rectally administered diclofenac.

A cystic biliary tumour responding to regional fluorinated pyrimidine infusion

We describe a patient with an intrahepatic biliary hamartoma associated with transformation to undifferentiated carcinoma which responded to intrahepatic arterial floxuridine chemotherapy.