A Systematic Review of Pressure Injuries Associated with Urethrocutaneous Fistula

OBJECTIVE

To review the literature about combined urologic and reconstructive management of pressure injuries (PIs) with urethral fistulas.

DATA SOURCES

Authors searched the PubMed, MEDLINE, EMBASE, and Cochrane databases using the following keywords: "Perineum" or "Perineal" and "Pressure Ulcers" or '' Pressure Injury'' and "Urethral Fistula."

STUDY SELECTION

The search yielded a total of 95 articles. Study selection followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement, and the study was designed according to the PICOS (Population, Intervention, Comparison, Outcomes, Study) guidelines. Congress abstracts, letters to the editor, and editorial comments were excluded. After screening, a total of 9 studies (30 patients) were included in the review.

DATA EXTRACTION

Included patients received treatment for a perineal or ischial PI associated with a urinary fistula. The outcomes were recovery, complications, treatment failure, recurrence, and illness-related death.

DATA SYNTHESIS

Pressure injuries were mainly ischiatic (50%) and perineal (43%). Forty-six percent of patients had spinal cord injuries, and at least 40% reported voiding dysfunction. Sixteen percent had previous ischiectomy. Flaps such as posterior thigh flap, biceps femoris flap, and inferiorly based transverse rectus abdominal muscle flap had 88% to 100% success rates when used with urinary diversion techniques. Suprapubic cystostomy, the simplest method of urinary diversion, was successful in 47% of cases when performed alone and in 100% when combined with a pedicled omental flap or a transverse rectus abdominal muscle flap.

CONCLUSIONS

Prevention and wound care are essential for PI management, but when combined with a urinary fistula, surgical management is unavoidable. Urinary diversion is essential before undergoing any type of ulcer reconstruction. Urethral reconstruction showed favorable results, further strengthened when combined with a musculocutaneous flap.

Clinical and pathological features associated with high-risk, multiple, and recurrent basal cell carcinomas: a retrospective cohort analysis from the Levantine coast of the Mediterranean Sea

Basal cell carcinoma (BCC) data coming from the Levantine coast of the Mediterranean Sea are limited. The study aimed to primarily analyze the demographic, clinical, pathological, and prognostic characteristics of BCC in this region of the world and secondarily identify features associated with high-risk, recurrent, or multiple BCCs. Patients with at least one diagnosis of BCC registered in the pathology department between January 2015 and December 2019 were included in this analytical retrospective single-center cohort study. Patients with basal cell nevus syndrome were excluded. Patients' characteristics and pathological features were collected through file check for a first analysis. Risk factors and evolution were sought through a phone call interview for the second analysis. The first analysis included 506 BCCs corresponding to 365 patients with a mean age of 65 ± 15 years, twenty-two (6%) were less than 40 years old, 180 (49.3%) were women, and 85 (23.3%) had two or more BCCs. The second analysis included 279 BCCs corresponding to 205 patients. Periorificial and infiltrative BCCs were more frequent in men. Periorificial tumors were more frequently nodular or infiltrative and were associated with recurrence. Tumors with perineural involvement were histologically never nodular nor superficial. Recurrence was more frequent in BCCs having periorificial location, a size larger than 2 cm, or an infiltrative subtype. Multiple BCCs were more frequent in patients with light skin type or familial history of skin cancer. High-risk BCCs were more common in patients with low sun exposure.

Breast Implant-associated Double Capsules: What Do We Know So Far? A Systematic Review of the Literature

INTRODUCTION

A double capsule is a recently described rare occurrence following breast implant placement in which an inner capsule envelope totally or partially adheres to the implant surface while a distinct outer capsule adheres to surrounding tissues, with an intercapsular space developing between the two. The objective of this study is to review all available literature related to formation of double capsules and propose a treatment algorithm.

METHODS AND MATERIALS

A systematic review of the literature was conducted using Embase, Medline, and Cochrane databases. Articles reporting management of breast implant-associated double capsules were included in this review.

RESULTS

A total of 9 studies (68 implants) were included in the review. 94.1% of double capsules occurred with textured Biocell shaped and round implants independently from implant pocket (p value=0.64). In all cases, double capsules were diagnosed fortuitously intra-operatively for another surgical indication. Capsular contracture was present in 50% of double capsules patients and was the most common indication for secondary breast surgery, 81.5% of which being clinically evident (p value<0.001). Treatment consisted in 84.4% in an inner capsulectomy with smooth implants exchange, and management of the outer capsule as per the capsular contracture algorithm.

CONCLUSION

Double capsule formation is caused by delamination of a tight adhering capsule to a textured implant surface into two layers and continuous micro-shearing forces, and the probable contribution of bacterial biofilm. The only treatment reported so far includes inner with or without outer capsulectomy with smooth implant exchange.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Auricular pseudocysts: a systematic review of the literature

BACKGROUND

Auricular pseudocysts are benign fluid accumulations of the ear of uncertain etiology. Little is known about the optimal modality to successfully treat these lesions. No systematic review addressing auricular pseudocysts have been published to date.

OBJECTIVES

The aim of this study is to summarize all the published data regarding diagnostic and therapeutic challenges of auricular pseudocysts.

METHODS

On May 28, 2020, a systematic search of Medline, Embase, and Cochrane databases was conducted. All the studies describing treatment of auricular pseudocysts, procedure description, outcome, and follow-up period were included in this review.

RESULTS

After full-text article review, 74 articles were included, representing a total of 1,011 lesions. The commonly used treatments for auricular pseudocysts were deroofing (493 lesions), aspiration (284 lesions), incision and drainage (171 lesions), intralesional steroids (53 lesions), and observation (10 lesions). The highest cure rate was found with the deroofing procedure (97.2%) followed by incision and drainage (95.9%). The mean follow-up period was 6.7 months.

CONCLUSION

Surgical procedures (anterior deroofing or incision and drainage) showed the highest cure rates and should be considered as first-line treatment for auricular pseudocysts. Future adequately designed randomized controlled trials are warranted to compare the efficacy of the techniques described.

An unusual tell sign of botulinum toxin injection in patients with facial flushing: incorporating a new questionnaire in the evaluation of botulinum toxin patients

Lately it has been established that intra-dermal botulinum toxin is also effective in treating many dermatological conditions including refractory erythematous-telangiectatic rosacea, post - menopausal facial flushing and other similar conditions.However, the desired effect of treating the reddening in patients suffering from facial flushing can become an undesirable and embarrassing side effect when these same patients present to the clinic for esthetic concerns such as upper face rhytids. In this case, intramuscular botulinum toxin injections used for wrinkles treatment will also secondarily treat the facial reddening in their localized skin diffusion zones and result in embarrassing white patches all over the face. The patchy appearance following botulinum toxin injections for esthetic purposes could be bothersome for some patients and could be a tell-tale sign of botulinum toxin injections.

Acquired ungual fibrokeratoma: a systematic review of the literature

BACKGROUND

Acquired ungual fibrokeratomas (AUFKs) are benign recurrent fibrokeratotic tumors of the nail unit of uncertain etiology. Little is known about the optimal modality to successfully treat these lesions. No systematic review addressing ungual fibrokeratomas has been published to date.

OBJECTIVES

The aim of this study is to summarize all the published data regarding diagnostic and therapeutic challenges of AUFKs.

METHODS

On August 9, 2019, a systematic search of Medline and Cochrane databases was conducted. All the studies describing the treatment of ungual fibrokeratomas, procedure description, pathological findings, outcome, and follow-up period were included in this review.

RESULTS

After full-text article review, 103 articles were included, representing a total of 78 lesions. The commonly used treatments for fibrokeratomas were complete tumor resection (90.5%), shave excision (8.3%), and cryotherapy (1.2%). Complete surgical excision yielded the highest cure rate among all treatment modalities (90.8%) compared to partial surgical excision (28.6%) and cryotherapy (0%). The mean follow-up period was 12.1 months (1-144).

CONCLUSION

Complete surgical removal preserving the matrix showed the highest cure rates and should be considered as first-line treatment for AUFKs. Future adequately designed randomized control trials are warranted to compare different treatment modalities.

Quilting Sutures in Rhytidectomy: A Systematic Review of the Literature

BACKGROUND

Different technical variations exist for the utilization of quilting sutures (QS) in rhytidectomy. No systematic review or meta-analysis of the studies describing the use of QS in facelifts has been published to date to the authors' knowledge.

OBJECTIVES

The objective of this study was to summarize all the published data regarding the utilization of QS in rhytidectomy, compare QS techniques, and evaluate their effect on postoperative complications.

METHODS

On April 1, 2019, a systematic search of the Medline, Embase, and Cochrane databases was conducted. All the studies describing the usage of QS in facelifts were included in this review. Studies reporting hematoma rate in a QS group and a control group were included in the meta-analysis part of this study.

RESULTS

The initial search of the databases yielded 93 results. Four trials were included in the systematic review and 2 were included in the meta-analysis. The total number of included patients with QS was 527. Two studies employed internal QS and the remaining studies utilized external QS. The meta-analysis found a lower rate of hematoma in the QS group (relative risk, 0.02; 95% confidence interval = 0.00-0.13; P < 0.0001).

CONCLUSIONS

QS can be applied either internally or externally and are very effective in reducing hematomas after facelifts. QS could be a great asset in facelifts but should be utilized with caution because additional work is needed to confirm their safety and efficacy.

LEVEL OF EVIDENCE: 2

FRI0185 DIAGNOSTIC SIGNIFICANCES OF BOTH MICRORNA-146A AND KALLIKREIN-1 IN PATIENTS WITH LUPUS NEPHRITIS

Background:

Lupus nephritis (LN) is one of the most critical complications of systemic lupus erythematosus (SLE). Approximately 30–50% of SLE patients develop LN with 5-year survival rate of about 70-80%. Thus, finding reliable non-invasive biomarkers at the early stages of SLE is of great interest (1). Many studies focused on the association between microRNAs and the risk of LN. miRNA-146a (miR-146a) was one of the most promising circulating markers which was suggested recently for early diagnosis of SLE but its diagnostic relevancies regarding LN have not been extensively investigated.

Objectives:

This study aims to test the expression of miR-146a in patients with LN in relation to Kallikrein-1 as another widely investigated diagnostic marker for LN along with other conventional measures.

Methods:

One hundred and thirty subjects were enrolled in this study. They were divided into forty six patients with LN, forty four patients with SLE but without nephritis and forty healthy controls. The expression levels of miR-146a in peripheral blood mononuclear cells (PBMCs) were detected via RT-qPCR analysis. Besides, serum Kallikrein-1 levels were determined by ELISA. The diagnostic role of miR-146a and Kallikrein-1 in LN was evaluated by Receiver operating curve (ROC). The impact of miR-146a and Kallikrein-1 on renal disease was compared to albumin creatinine ratio, renal biopsy findings as well as renal SLEDAI.

Results:

Levels of miR-146a were significantly lower in the plasma of LN patients than both patients of SLE without LN and normal controls (p < 0.05). However, serum levels of Kallikrein-1 were significantly higher in LN patients when compared to SLE patients and normal population (p < 0.05). ROCs were conducted to assess the diagnostic values of both miR-146a and kallikrein-1. They revealed good diagnostic values with AUC of 0.888 and 0.913 respectively. Also, plasma miR-146a was observed to be negatively associated with serum creatinine, proteinuria as well as SLEDAI score (p < 0.01) while serum Kallikrein-1 was positively correlated with them (p < 0.05) and inversely correlated with miR-146a (p < 0.01).

Conclusion:

The expression levels of miR-146a are reduced in SLE patients with more reduction with LN. Therefore, miR-146a could be considered as potential biomarker for detecting LN either alone or in combination with Kallikrein-1. However, more studies are required.

References:

[1]Soliman S. And Mohan C. Lupus nephritis Biomarkers.Clin Immunol.2017 Dec; 185: 10-20.

Disclosure of Interests:

None declared

[Not Available]

Massive influx of burns (thermal, chemical or electrical) is a potential crisis situation in the world in peacetime. In fact, burn is one of the most frequently encountered injuries following natural or human disasters. The management of a massive influx of burn victims is considered to be a real challenge, not only from a medical point of view but also from a logistical and organizational point of view. It is an exceptional event requiring exceptional organization and planning in advance, including systematically training medical and paramedical personnel, without forgetting ambulance and fire workers as they will be the first to arrive at the scene. Planning must necessarily include equipment for fast and effective support. We will present our experience in managing a massive influx of burns from a juvenile detention centre. We share it in order to help establish a better plan to deal with these rare but challenging situations.

Integrating obstetrical simulation into the medical curriculum: one more gap in women's health for low-income countries

Low-income countries do not have well-established simulation centers; introduction of simulation-based learning in obstetrics faces many cost-associated difficulties. Simulation-based learning yield many benefits that are reported in many studies such as improved maternal and neonatal outcomes, social stature of medical teachers, and better management of difficult situations. Though low-income countries do not have established surgical simulations, centralization, and cooperation amongst the educational institutions and local and regional hospitals for maintenance of medical educational practices and financial supplementation through both established and newly created entities will provide the potential for improved patient outcomes and maintenance of quality of education, that is, comparable to the medical education found in higher income countries.

Consecutive aquatic jump-gliding with water-reactive fuel

Robotic vehicles that are capable of autonomously transitioning between various terrains and fluids have received notable attention in the past decade due to their potential to navigate previously unexplored and/or unpredictable environments. Specifically, aerial-aquatic mobility will enable robots to operate in cluttered aquatic environments and carry out a variety of sensing tasks. One of the principal challenges in the development of such vehicles is that the transition from water to flight is a power-intensive process. At a small scale, this is made more difficult by the limitations of electromechanical actuation and the unfavorable scaling of the physics involved. This paper investigates the use of solid reactants as a combustion gas source for consecutive aquatic jump-gliding sequences. We present an untethered robot that is capable of multiple launches from the water surface and of transitioning from jetting to a glide. The power required for aquatic jump-gliding is obtained by reacting calcium carbide powder with the available environmental water to produce combustible acetylene gas, allowing the robot to rapidly reach flight speed from water. The 160-gram robot could achieve a flight distance of 26 meters using 0.2 gram of calcium carbide. Here, the combustion process, jetting phase, and glide were modeled numerically and compared with experimental results. Combustion pressure and inertial measurements were collected on board during flight, and the vehicle trajectory and speed were analyzed using external tracking data. The proposed propulsion approach offers a promising solution for future high-power density aerial-aquatic propulsion in robotics.

"The Evolution of Eyebrow Morphology: The Westmore Model Revisited"

BACKGROUND

The most widely recognized eyebrow model was described by Westmore in 1974. With the rapidly changing concept of beauty, an accurate up-to-date model is needed.

METHODS

The Westmore model was tested on fashion models that were randomly selected from the covers of the 1965-1975 (group 1) and 2006-2016 (group 2) Vogue magazine. The eyebrows of fashion models, which represent the beauty ideals of these decades, were objectively measured and compared. We proposed a modified eyebrow model more adapted to the modern standards of beauty, applied it to group 2, and objectively compared it to the Westmore model. This new model was validated on a group of randomly selected Caucasian women.

RESULTS

Thirty women were included in each group. The medial edge of the eyebrow was better defined by the Westmore model in group 1 compared to group 2. The lateral edge of the eyebrow was better defined by the Westmore model in group 2. The peak of the eyebrow was not well defined by the Westmore model in both groups. The new model was more adapted than the Westmore model for both the medial edge and the peak of the eyebrow in group 2. It was also accurate in non-model Caucasian women.

CONCLUSION

Eyebrow morphology has evolved since the description of the Westmore model. Our model represents a simple way to accurately predict the eyebrow landmarks according to the modern ideals of beauty.

High photodegradation and antibacterial activity of BN–Ag/TiO2 composite nanofibers under visible light

To develop material with good photocatalytic properties for organic compound degradation and bacterial removal, we produced Ag/TiO₂ and BN–Ag/TiO₂ composite nanofibers that included controlled amounts of boron nitride (BN) nanosheets and silver (Ag).

Botulinum Toxin for Eyebrow Shaping: A Systematic Review

BACKGROUND

Currently, there is no standardized approach for eyebrow shaping with botulinum toxin, and controversies still exist regarding this subject.

OBJECTIVE

The objective of this systematic review is to summarize and compare all the published data regarding eyebrow shaping with botulinum toxin.

METHODS

On March 10, 2017, an online search of published articles in the Medline, Embase, and Cochrane databases were conducted. All articles that used objective measurements to quantify the eyebrow changes after botulinum toxin injection were included in this review.

RESULTS

Eleven studies were selected for inclusion with a total of 585 patients. All the included studies used onabotulinumtoxin A. Seven studies injected both the lateral and the medial eyebrow depressors, 2 studies injected the lateral depressors alone, and 2 studies injected the medial depressors alone. The highest elevation was observed in the lateral brow (0.4-4.8 mm). Bruising and headache were the most frequently reported complications, and only 5 cases of eyelid ptosis were noted.

CONCLUSION

Botulinum toxin injection for eyebrow shaping is a noninvasive, safe, and reproducible procedure. Eyebrow reshaping can be achieved by targeting different muscle groups. However, further randomized controlled trials are warranted.

Labia Majora Augmentation: A Systematic Review of the Literature

BACKGROUND

Currently, there is no standardized approach for labia majora augmentation and controversies still exist regarding this subject.

OBJECTIVES

This systematic review aimed to assess the evidence in the literature regarding labia majora augmentation.

METHODS

On November 20, 2016, we conducted an online search of published articles in the Medline, Embase, and Cochrane databases. All articles describing labia majora augmentation were included in this review.

RESULTS

Nine studies were selected for inclusion in the systematic review. Only 2 studies were prospective trials. The most commonly used technique was fat grafting with a total of 4 articles and 183 patients. The mean total injected fat volume ranged from 18 mL to 120 mL per session. Two articles described hyaluronic acid injection techniques. The total injected volume of hyaluronic acid ranged from 2 to 6 mL per session. Three articles used surgical techniques for labia majora augmentation. All included articles did not report any major or life-threatening complications. All techniques demonstrated high satisfaction rates.

CONCLUSIONS

Labia majora augmentation appears to be a safe, efficient technique with a high satisfaction rate and no reported major complications. However, further randomized controlled trials are warranted.

LEVEL OF EVIDENCE

4.

Intraperitoneal rupture of hydatid cysts

PURPOSE

Hydatid cyst rupture into abdominal cavity is a rare but a serious complication. The rupture can occur after a trauma, or spontaneously as a result of increased intracystic pressure. It is a surgical emergency with high morbidity and mortality rates. Early diagnosis and appropriate surgical management of this complication can be life saving. The objective of the current paper is to evaluate the clinical, and radiographic findings and surgical treatment of this complication.

METHODS

A retrospective study on 12 patients operated in our department for intraperitoneal rupture of hydatid cyst between January 1990 and May 2015. We reviewed age, gender, imaging findings, surgical treatment procedures, mortality, morbidity and recurrence.

RESULTS

Our study includes 12 cases of intraperitoneal rupture of hydatid cysts; eight of the patients were men, and four were women. Four patients had a history of abdominal trauma and the other ruptures occurred spontaneously. All the patients had peritoneal irritation signs at presentation. All them underwent ultrasonography and CT scan. Imaging showed intraabdominal free fluid in all of cases. In 11 cases the cyst was unique and only in one case an associated mesenteric hydatid cyst was noted. Ruptured cysts were located in the right lobe of the liver in nine cases, in the left lobe in the other three cases. All the patients underwent emergency surgery after imaging. The procedure applied was conservative associated with drainage in all the cases. Some associated procedures were performed during the same operation. In only one case total pericystectomy for intraperitoneal cyst was performed. There were no post operative deaths. A total of five morbidities developed in three patients (one case of evisceration, three cases of biliary fistula and a case of pulmonary infection).

CONCLUSIONS

Hydatid cyst rupture in peritoneal cavity is a rare complication. Imaging assessment has an important role in diagnosis but clinical signs are mandatory. A quick diagnosis and emergency surgery can decrease postoperative death. Surgery and postoperative care constitute the basis of treatment.

The acting out in patients with Schizophrenia examined in a forensic psychiatric assessment

Introduction

Many studies have shown that schizophrenic patients are responsible for the highest rates of violence among all the mentally ill patients.

Aims of the study

Describe the socio-demographic and clinical characteristics of patients with schizophrenia examined in a forensic psychiatric assessment and identify the risk factors of violence in these patients.

Methodology

A retrospective study carried out in the psychiatric department of university hospital of Mahdia during fifteen years involving 40 patients with schizophrenia examined in a forensic psychiatric assessment following a forensic act. These patients were compared to a population of 40 patients followed in the same establishment for the same disease and without criminal record.

Results

Age average of 36.08 years, male (95%), rural origin (65%), primary level education (47.5%), single (65%), unemployed (65%) and average socio-economic level (65%). Personal psychiatric history (87.5%), personality disorder (12.5%), judiciary history (12.5%) and substance abuse (57.5%). Subtypes of schizophrenia: undifferentiated (52.5%) and paranoid (30%). They have committed serious physical assaults (55%) and aggression against property (27.5%). The victim was mostly a family member (40%), under the influence of toxic (22%), driven by delusions of persecution (61%), with hallucinatory mechanism (55%). The psychiatric expert has concluded an abolition of discernment in 77.5% of cases. Risk factors of acting out were: rural origin, alcohol and psychoactive substances use, productive forms of schizophrenia, poor adherence and irregular monitoring.

Conclusion

The knowledge of risk factors improves the management and allows us better prevention of violence among our patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acute psychotic disorders: Factors related to schizophrenia evolution

Introduction

Acute psychotic disorders are described as a clinical syndrome characterized by Acuteness of the installation, the intensity and the polymorphism of delirium.

Aim

Describe the demographic characteristics of a population of patients with an acute psychotic disorder and identify factors correlated with evolution to schizophrenia.

Methods

This is a retrospective, descriptive and analytic study conducted on hospitalized patients in psychiatric department EPS Mahdia for acute psychotic disorder according to DSM-VI-TR criteria. A study of the recurrence time was performed by Kaplan–Meier and Cox test was used to identify factors correlated with evolution to schizophrenia.

Results

One hundred and eleven patients were collected. The average age of the study population was 27 years, a male predominance was noted (59.5%), 39.6% of patients had family history of psychiatric disorders, including schizophrenic disorders and bipolar disorder were the most common with rates of 63.6 and 18.4% of cases. For our patients, 38.7% progressed to schizophrenia. Four risk factors were significantly predictive of progression to schizophrenia: male gender (P = 0.026), subacute or progressive onset disorders (P = 0.003), partial remission of the disorder (P = 0.023) and the prolonged duration of untreated psychosis (P = 0.027).

Conclusion

The evolution of an acute psychotic disorder remains unpredictable. In fact, the severity is related to the risk of developing schizophrenia or mood disorder. Attention is paid in recent years to recognize and seek most precociously as possible factors associated with this evolution.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Socio-demographic, clinical and therapeutic features of patients treated for schizoaffective disorder using cannabis

Introduction

Psychotic disorders were formerly associated with cannabis use. It could accelerate the course of the illness and thus, constitutes a severity factor in terms of prognosis.

Objectives

To define the socio-demographic, clinical and therapeutic profiles of patients suffering from schizoaffective disorder (ASD) and who are consuming cannabis.

Methods

A retrospective study of 16 patients diagnosed with ASD, who were hospitalized at the psychiatric department of Tahar Sfar Mahdia's hospital, and whose toxicology test results during the hospitalization came back positive for tetrahydrocannabinol.

Results

Sixteen patients were gathered, all male, the average age was 26 years. The average age of first hospitalization was 25 years, 41.9% were unemployed; 76.3% of our sample were single. Three quarters of patients were hospitalized without consent. The average hospital stay was 30.33 days. Our patients had required during their stay an average dosage of antipsychotic, equivalent to chlorpromazine, of 752.42 ± 342.79 mg. The average scores of psychometric scales were: BPRS = 55.72 ± 14.11, SAPS = 41.5 ± 14.80 and 42.11 ± 18.88.

Conclusion

Currently, it is recognized that prolonged use of cannabis is an exogenous risk factor. The association between cannabis and schizoaffective disorder may amend the treatment modalities. It requires, thereby, an integrated and simultaneous treatment of schizophrenia and addictive behavior.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Depression in people with multiple sclerosis

Introduction

Depression is the most common syndrome associated with Multiple Sclerosis (MS) with a high prevalence during a lifetime.

Objectives

To assess the prevalence of depression in patients treated in neurology for MS.

Methods

We performed a retrospective study on 17 patients diagnosed with MS and confirmed with the criteria of Mac Donalds 2010 with a follow-up in the neurology department of the EPS Mahdia for a period of nine years (2006–2014), then addressed to a psychiatric consultation for depression.

Results

In total 17 patients were hospitalised in the neurology department during the study. Ages ranged from 20 to 39 years with an average of 33 years. The average course of the disorder is 5 years. We objectified a female predominance with 82%, a professional activity was found in 76% of patients. The comorbidities found are mainly hypertension, diabetes and asthma, respectively in 11%, 5% and 5%. Depression was clinically confirmed in 9 patients, that to say, 52% of our sample addressed in the psychiatric consultation, whose 6 received an antidepressant (fluoxetine) and 3 received paroxetine. An anxiolytic was given to the half of these patients.

Conclusion

The association between MS and depression would, therefore, be neither fortuitous nor only related to non-specific factors of any chronic disease. Specifying the relative share of these explanatory factors is probably one of the challenges for future researches in this area.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acute psychotic disorder: Which future?

Introduction

At present, in absence of reliable clinical and evolutionary data, it is difficult to determine what the consequences of an acute psychotic disorder, specifically if it is a mode of entry into schizophrenia, a mood disorder or a short-lived episode.

Aim

The objective of this study was to describe the sociodemographic characteristics and evolutionary modalities of a population of patients with a first psychotic episode.

Methods

This is a retrospective descriptive study, which involved patients admitted to psychiatric ward EPS Mahdia for acute psychotic disorder according to DSM-VI-TR criteria. Data collection was conducted from archived observations and through a predetermined sheet.

Results

One hundred and eleven patients were collected. The average age of the study population was 27 years, a male predominance was noted (59.5%), 52.3% were from urban, 73% of patients were single, 33.3% were from a consanguineous marriage. Among those patients with a first acute psychotic episode, 43 patients (38.7%) progressed to schizophrenia, 15.3% to bipolar disorder, 23, 4% to recovery while 22.5% were lost view.

Conclusion

The long-term evolution of an acute psychotic disorder remains unpredictable. In fact, the severity is related primarily to the risk of developing a schizophrenic disorder or a mood disorder. In this context, attention is paid in recent years to recognize and seek the earliest possible factors associated with this development.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Does the Addition of Progressive Tension Sutures to Drains Reduce Seroma Incidence After Abdominoplasty? A Systematic Review and Meta-Analysis

BACKGROUND

Progressive tension sutures (PTS) are commonly utilized to reduce postoperative seroma in abdominoplasty. However, current evidence regarding PTS in abdominoplasty is limited to small series and the findings of single institutions.

OBJECTIVES

The authors reviewed the available literature concerning the effects of PTS and drains on seroma formation following abdominoplasty, and summarized the different techniques that have been described to date.

METHODS

We conducted a systematic review of the Medline, Embase, and Cochrane databases. We identified randomized controlled trials (RCTs) and observational studies in which the numbers of patients who had postoperative seroma were indicated. We applied the Cochrane Collaboration's tool for assessing the risk of bias.

RESULTS

Seven studies were included (three RCTs and four retrospective studies). Patients who had PTS and drains following abdominoplasty had a significantly lower rate of postoperative seroma than those who had drains only. The mean surgical time difference between the two groups was 23 minutes. There was no difference in postoperative seroma rate in patients who had PTS and drains placed following abdominoplasty compared to those who had PTS only.

CONCLUSIONS

Addition of PTS to drains reduces the risk of postoperative seroma in standard abdominoplasty. More RCTs with larger sample sizes and better comparability are warranted to confirm with more confidence the impact of PTS in abdominoplasty.

LEVEL OF EVIDENCE 2

Psychoaffectives Repercussions of Autism on Parents

Introduction

Caring for a child with autism is a stressful experience for parents. The daily stress of this handicap has a major impact and triggers in the parents a series of adverse psychological reactions.

Aim

To reveal sociodemographic characteristics of parents of autistic children and to estimate the prevalence of anxiety and depressive symptoms among these parents.

Methods

A cross-sectional study conducted among parents of autistic children supported by four of autistic children rehabilitation centers under the Tunisian Association for the Promotion of Mental Health. Data were collected through a questionnaire to explore the sociodemographic data of parents of autistic children. Depressive symptoms were assessed by the Beck scale and anxiety symptoms by the Hamilton scale.

Results

Fifty-two parents were collected. The middle age was 35.73 years. They lived in an urban area in 96% of cases. The majority had an average socioeconomic level (88.4%). The respective rates of depressed or anxious parents as Beck scales and Hamilton were 48% and 23%. The association between depressive and anxious symptoms was found in 19%. In addition, depression was more common in mothers (P < 10−4) and anxiety was also more evident among mothers (P = 0.01).

Conclusion

The presence of an autistic child causes profound changes in families and can be a source of tension and stress. The anxious and depressive impact on parents is important and frequent. The intervention that designs the psychiatrist to help children with autism should necessarily include an action for parents.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Schizoaffective disorder and life quality

Introduction

schizoaffective disorder is a nosographic entity characterized by a combination of symptoms of schizophrenia with mood episodes. The fact that its diagnosis is difficult, and often oscillates between schizophrenia and bipolar disorder raises the problem of its care and the outcome of patients who suffers from it.

Objective

To evaluate the quality of life of treated patients with schizoaffective disorder.

Materials and methods

This is a cross-sectional study realized at the psychiatric consultation of Mahdia hospital during a 6month period. Data were collected from patients and from their medical records using a predefined questionnaire.

Results

A total of 52 patients were included, the average age was 38 years. The majority of patients (63.5%) were unemployed. The use of psychoactive substances was noted in 63.5% of patients. Multiple linear regression analysis allowed us to find that 12 factors were more significantly associated with impaired quality of life which were, in descending order of importance: the EAS score > 39, the EGF score ≤ 70, the null or partial adherence, the presence of side effects seriously affecting daily activity, the depressive subtype, the lack of employment, the socio-economic level, the lack of stable budgetary resources, an age > 60years, the widowed and divorced marital status, the PANSS score (≥ 45) and negative symptomatology (PANSS).

Conclusion

The diagnosis of schizoaffective disorder has a triple relevance: clinical, prognostic and therapeutic. Identifying a schizoaffective disorder and the risk factors that may affect the quality of life provides a significant practical impact for the patient's benefit.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Schizoaffective disorder and life events

Introduction

The schizoaffective disorder is multifactorial. Several factors almost unquestioned, even indisputable, participate in the episodes’ decompensation and affect various fields: biological, pharmacological or neurobiochemical.

Objectives

Draw up the sociodemographic and clinical profile of patients treated for schizoaffective disorder and determine the role of life events in the onset of the disorder.

Methods

This is a retrospective study of 52 patients hospitalized in the psychiatric department of Mahdia diagnosed with schizoaffective disorder according to DSM-IV-TR during the period from January 2014 until June 2014. The information was collected using a preset sheet with 35 items.

Results

A total of 52 records was gathered. The average age was 38 years. The sample was predominantly male, of rural origin in 61.5% of cases. The level of education was low in 59.6% of cases. More than half were without profession and single in 46.2% of cases. The mean age at onset of the disorder was 25.2 years. The presence of life events preceding the onset of the disorder was noted in 22 patients, that to say, 42.3% of the sample. Family and emotional events were most frequently encountered with respective rates of 48.2 and 24.7%, followed by the professional events (20%) and social ones (6%).

Conclusion

Life events are due to chance but also to the environment. The complexity of the “event” concept was again underlined in a new perspective, breaking social rhythms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Major Depressive Disorder: Recurrence Risk Factors

Introduction

In spite of the frequency and the gravity of the depressive episodes, the major depressive disorder (MDD) is diagnosed and treated today insufficiently and the risk factors of its recurrence are little approached.

Aims of the study

Describe the socio–demographic, clinical and therapeutic characteristics of patients with MDD and identify the factors involved in the recurrence risk.

Methodology

This is a retrospective study carried out in the university hospital of Mahdia, Tunisia during two years. We have included patients with a follow up for at least two years and diagnosed with MDD, isolated episode or MDD, recurrent episode according to the DSM-IV-TR criteria. Data collection was performed using two pre-established questionnaires respectively with 51 and 92 items. We have estimated the time to recurrence with the Kaplan-Meier estimator.

Results

We have collected 150 patients. The time to recurrence was 109 months. Five factors were associated with recurrence: early age at onset of the disorder, family history of mood disorders, severity of the index major depressive episode, persistent residual symptoms and ceasing treatment.

Conclusion

Depression is a very common mental illness that is highly recurrent in individuals. There is great interest in the development of strategies that might reduce the recurrence of depression.

Major depressive disorder: Recurrence risk factors

Introduction

Despite the frequency and the severity of depressive episodes, the major depressive disorder (MDD) is today inadequately diagnosed and treated, and the risk factors for its recurrence are not well elaborated. The objectives of this study were to describe the sociodemographic, clinical evolutionary and therapeutic features of this disorder and to identify the factors involved in the risk of its recurrence.

Methods

This is a retrospective, descriptive and analytical study, involving 150 patients with MDD, isolated episode or recurrent major depressive disorder (RMDD) with a follow-up for at least two years. Data collection was performed using two pre-established questionnaires for the MDD isolated episode and for the RMDD respectively with 51 and 92 items. A study of the recurrence period was performed by Kaplan–Meier method. The Cox-test was used to determine the survival curves and to look for the risk factors significantly associated with MDD recurrence.

Results

A total of 150 patients was gathered, predominantly female, married and from urban origin. The average age at the beginning of the disorder was 35 years. The recurrence period was 109 months and the factors associated with recurrence were the early age of onset of the disorder, family history of mood disorders, the severity of MDE index, residual symptoms and discontinuation of treatment.

Conclusion

The study of factors involved in MDD recurrence is of a particular importance since it allows not only to know the group of patients at risk but also to improve their therapeutic care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Therapy initiation during a first acute episode psychosis in the psychiatric department of Mahdia

Introduction

The quality of the therapeutic care during a first episode psychosis (FEP) determines the middle- and long-term prognosis.

Objectives

The aim of our study is to describe the therapeutic attitudes in front of a FEP and discuss them according to current international recommendations.

Methods

This is a retrospective descriptive study. All patients with a FEP, hospitalized in the psychiatric department of the university hospital, Mahdia during the period from 15 May 2000 to 31 December 2013 have been included.

Results

We recruited 111 patients. The average age was 27 years, a male predominance was noted. Initially, the majority of patients were treated in monotherapy (55.9%) and mostly with typical antipsychotic drugs (80.2%), by injection. Among those under association, 63.4% received corrective treatment and 26.8% a benzodiazepine. The prescription of a mood stabilizer and an antidepressant was noted in respectively 5.6 and 2.8% of cases. The majority of patients received typical antipsychotic drugs (53.1%) while 39.6% were under atypical antipsychotic. The follow-up period, after which a reduction of the antipsychotic dose was decided, ranged from 1 to 66 months with an average of 8.26.

Conclusion

The progression to a chronic psychosis, still has a severe connotation. The Early and adequate therapeutic care in accordance with the international recommendations, determines the prognosis and constitute a decisive moment in the evolutionary trajectory of the disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Hyperinsulinism as evidence of munchausen syndrome by proxy: A case report

Introduction

Hyperinsulinism is one of the most important causes of hypoglycemia. Rarely, drug toxicity can be a reason. In the context of Munchausen syndrome by proxy (MSBP), toxicity usually occurs in children due to drug administration by a parent or caregiver.

Methods

we report a case of a 2-year-old girl with hyperinsulinaemic hypoglycaemia due to insulin injections by her mother.

Case report

Mrs. W. is a 28-year-old mother of three children. In her medical history, she was diagnosed with gestational diabetes and treated briefly with insulin. She was hospitalized several times for hypoglycemia and she was diagnosed with factitious disorder. Lately, her youngest daughter aged 2 years old was hospitalized in the pediatric department for repeated unexplained loss of consciousness. The hospitalization lasted 2 months with recurrence of severe hypoglycemia. A full metabolic screen revealed no abnormalities. The mood of the mother appeared quite discordant with the situation. Strict monitoring of maternal behavior showed that the mother gives insulin injections to her daughter. She denied deliberately injecting insulin, and then she accused the health workers. She was referred to our psychiatric department and we diagnosed the MSBP.

Conclusion

MSBP should be considered particularly in patients who have been evaluated by more than one hospital and have discordant test results.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Mentally ill Patients Who Committed Sexual and Physical Assaults: A Study About 37 Cases of Expertise Reports

Introduction

Several studies suggest the existence of a relationship between major mental disorders and crime. However, it is important to emphasize that violent behaviors do not affect all patients and that issues of criminality among mentally ill persons only represents a small proportion.

Aims

The objective of this study is to establish the general and clinical profile of perpetrators of sexual and physical assaults.

Methods

This is a retrospective study of the records of forensic psychiatric expertise, conducted in the psychiatry department of the University Hospital of Mahdia during the period from May 1st 2000 to May 31st 2013.

Results

The general profile of the population the study was characterized by a mean age of 39 years, a sex ratio of 8.25, unemployment in 73% of cases and by the presence of a psychiatric personal history 54% of cases. Sexual and physical assaults accounted for 54.5% of cases. It was essentially in descending order: assault and battery (65%), rape (16.2%) and incest (5.4%). As for the clinical profile, schizophrenia and epilepsy were recorded each in 13.5% of cases, major depressive disorder in 8.1% of cases, bipolar disorder in 5.4% and substance abuse in 5.4% of cases. A personality disorder was observed in 48.6% cases, essentially antisocial personality (55%). Comorbidity with addictive behavior was observed in 56.7% of cases.

Conclusion

It is necessary to characterize a subgroup of patients with mental disorders, likely to commit violent crimes, in order to prevent acting out behaviors and adapt their management.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Clinical predictors of clozapine response

Introduction

Schizophrenia is a chronic, severe, and disabling mental disorder. An evaluation of clinical predictors to clozapine was described.

Object

Identify clinical predicting factors to clozapine.

Methods

This is a cross-sectional study including patients diagnosed with schizophrenia or schizoaffective disorder according to the DSM 5 criteria and treated with clozapine.

Results

Of the 33 patients, 78.8% were males and 69.7% of them were single. The mean age was 36 years old. The mean age at the onset of the disorder was 24 years old. The mean number of hospitalizations was 6. The beginning of the mental disorder was acute in 21.2% of the cases. The mean duration of the disease course before starting clozapine treatment was 11 years. The mean duration of treatment was 19 months. The diagnosis according to DSM 5 criteria was schizophrenia in 87.9 and schizoaffective disorder in 12.1% of cases. The outcome was assessed by PANSS and BPRS scales with a symptomatic remission in 63.63% of cases. The analytical study revealed a significant correlation between favorable evolution and the latest onset of the disorder (P = 0.04), the number of previous hospitalizations (P = 0.009), disorder's duration (P = 0.032), male sex (P = 0.0004) and secondary resistance (P < 10−3).

Conclusion

The evaluation of clinical factors is important in our practice in order to improve the response to clozapine. Otherwise, adherence to treatment and quality of insight are determining factors of the treatment response.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acute Psychotic Disorder and Forensic Acts: About 25 Cases

Background

The aim of this study was to identify the socio-demographic status and clinical features of patients with acute psychotic disorder and who committed a medicolegal act, seek acute psychosis implicated and raise the characteristics of this medicolegal acts.

Methods

We performed a retrospective study of 25 male patients with acute psychotic disorder. They were involuntary hospitalized in the medicolegal department of Razi, according to Article 29 of Law after committing a medicolegal act because of dementia within the meaning of article 38 of the Tunisian Penal Code.

Results

It was about a young person, average age of 27.32 years, family cohesion was often present (80%), with forensic history (20%), violence history (20%) and substance abuse (40%), having a personality disorder (25%), having a precipitating factor (32%), having an acute psychotic episode (72%), repetitive acute psychotic episode (16%), a first manic episode (8%) and drug-related psychotic disorder (4%). They had committed by order of frequency serious physical assault (43.5%), attempted murder, assault and injury followed by attacks against property (40%). The victim was mostly a family member (40%), without determination, under the influence of toxic substances (16%) and motivated by delusions of persecution (51%). The acting out was recognized (68%). The majority was indifferent (92%) and does nothing (68%).

Conclusion

The first-episode psychosis have a high-risk of acting out, early treatment may prevent some medicolegal acts. Preventing of acting out in the psychotic involves the identification of risk factors and an early treatment of mental disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Risque de récidive de violence chez le patient schizophrène

Introduction

La violence fait partie intégrante de la psychiatrie, que ce soit à travers des actes auto-agressif ou hétéroagressifs. Évaluer le risque de récidive chez les patients schizophrènes semblerait, alors, primordial.

Objectif

Évaluer le risque de récidive d’un groupe de patients suivis pour schizophrénie.

Méthodologie

C’est une étude transversale réalisée auprès de 51 schizophrènes hospitalisés au service de psychiatrie de Tahar Sfar à Mahdia. Un questionnaire préétabli a permis d’explorer les données générales et cliniques de l’échantillon. Le risque de récidive de violence a été exploré à l’aide d’une échelle actuarielle VRAG.

Résultats

Les caractéristiques générales de l’échantillon étaient : une prédominance masculine (84,3 %), un âge moyen de 37 ans et un statut de célibataire (76,5 %). Dix patients avaient des antécédents judiciaires et 6 ont été examinés dans le cadre d’une expertise pénale. Environ 80,4 % des patients ont été hospitalisés selon le mode d’office. Le diagnostic de schizophrénie indifférenciée (35,3 %) était le plus fréquent, suivi de la forme paranoïde (25,5 %) et désorganisée (21,6 %). Une personnalité antisociale a été retenue chez seulement 2 patients. L’âge moyen au début des troubles était de 26 ans. Le score moyen à l’échelle VRAG était de –4,96 ± 6,83 attestant d’un risque faible de récidive. L’étude analytique a retrouvé des liens significatifs entre un score VRAG plus élevé et : le sexe masculin (p = 0,042) ; l’âge jeune (p = 0,002) ; le célibat (p = 0,006) et l’âge précoce au début des troubles (p = 0,021).

Conclusion

L’évaluation de la dangerosité implique un regard longitudinal et qualitatif sur le risque de violence. Identifier les facteurs de risque de violence est nécessaire pour prévenir les récidives.