scholarly journals Deliberate Self-Harm and the Elderly: A Volatile Combination—An Overview from the Plastic Surgery Perspective

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
J. Packer ◽  
M. A. Hussain ◽  
S. H. A. Shah ◽  
J. R. Srinivasan
Keyword(s):  
Plastic Surgery ◽  
Protective Factor ◽  
Previous History ◽  
Later Life ◽  
The Elderly ◽  
Elderly Group ◽  
History Of ◽  
Group A ◽  
Almost All ◽  
Surgery Department

Aims. To study the factors associated with the DSH in the elderly group of 60 years and above and to recommend changes to be implemented in order to improve the management in this specific group. Materials and Methods. Five-year retrospective study was undertaken from July 2005 to July 2010 in the Plastic Surgery Department of the Royal Preston Hospital, NHS Trust. A Performa was designed to collect data about the inpatient admission and included certain areas of key information. The case notes for all patients were extensively analysed in order to gather adequate information for the devised Performa. Results. DSH is getting more common in the elderly group, and males are more affected than females. 60% of the patients had a previous history of DSH. A large number (80%) of patients had a previous history of mental illness. 60% of those DSH patients were living with family. Almost all patients (90%) were reviewed by the Psychiatry Liaison Team. The timing of patients being assessed was highly variable. Conclusions. Marriage is not a protective factor in the prevention of the DSH in the elderly group. A mental health team referral in the early phases of the management would be of huge benefit and a likely step to prevent possible future admissions. The Department would benefit from the creation of a protocol for the management of these patients. There should be a joint effort of the professionals in the management of DSH in the elderly, and GPs play a very important role in the prevention of DSH in the later life.

scholarly journals An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

2021 ◽  
Vol 11 (3) ◽  
pp. 178
Author(s):  
Noah R. Delapaz ◽  
William K. Hor ◽  
Michael Gilbert ◽  
Andrew D. La ◽  
Feiran Liang ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Previous History ◽  
Current Treatment ◽  
Careful Consideration ◽  
P Value ◽  
Post Traumatic Stress ◽  
Increased Risk ◽  
History Of ◽  
Almost All

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.

Child Abuse and Attempted Suicide

1980 ◽  
Vol 137 (4) ◽  
pp. 319-323 ◽  
Author(s):  
Jacquie Roberts ◽  
Keith Hawton
Keyword(s):  
Child Abuse ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Previous History ◽  
Psychiatric Disturbance ◽  
At Risk Children ◽  
History Of ◽  
Group A ◽  
Marital Breakdown ◽  
The Relationship

SummaryOf a sample of families containing abused and at risk children, in 29 per cent one or both parents had attempted suicide. The rate at which the suicide attempts were repeated within a year was higher than that expected for other attempters of the same age group. A previous history of psychiatric disturbance and marital breakdown was strongly associated with the combination of child abuse and suicidal behaviour. The relationship between child abuse and attempted suicide did not appear in most cases to have been a direct one; often both forms of behaviour seemed to reflect marital difficulties.

scholarly journals Predictive factors for developing acute cholangitis and cholecystitis in patients undergoing delayed cholecystectomy: a retrospective study

2019 ◽  
Author(s):  
Takashi Miyata ◽  
Daisuke Matsui ◽  
Yuta Fujiwara ◽  
Hiroto Saito ◽  
Yoshinao Ohbatake ◽  
...  
Keyword(s):  
Risk Factor ◽  
Surgical Outcomes ◽  
Intraoperative Complications ◽  
Acute Cholangitis ◽  
Previous History ◽  
Cell Counts ◽  
Number Of Patients ◽  
History Of ◽  
Group A ◽  
Group B

Abstract Background We evaluated the risk of acute cholangitis and cholecystitis while waiting for cholecystectomy for gallstones. Methods We retrospectively enrolled 168 patients who underwent cholecystectomy for gallstones after a waiting period and conservative therapy between April 2014 and March 2018 at our hospital. We compared the clinical data from 20 patients who developed acute cholangitis and cholecystitis while waiting for cholecystectomy (group A) with data from 148 patients who did not develop cholangitis and cholecystitis (group B). The risk factors for developing acute cholangitis and cholecystitis and all patients' surgical outcomes were investigated. Results Preoperatively, significant differences in age (68.6 years vs 60.7 years; p= 0.004) and the number of patients with a previous history of acute grade II or III cholecystitis (55.0% vs 10.8%; p< 0.001) and biliary drainage (20.0% vs 2.0%; p= 0.004) were observed between group A and group B, respectively. Preoperative white blood cell counts (13500/µL vs 8155/µL; p< 0.001) and serum C-reactive protein levels (12.6 mg/dL vs 5.1 mg/dL; p< 0.001) were significantly increased, and serum albumin levels (3.2 g/dL vs 4.0 g/dL; p< 0.001) were significantly decreased in group A vs group B, respectively. Gallbladder wall thickening (≥ 5 mm) (45.0% vs 18.9%; p= 0.018), incarcerated gallbladder neck stones (55.0% vs 22.3%; p= 0.005), and abscess around the gallbladder (20.0% vs 1.4%; p= 0.002) were seen significantly more frequently during imaging in group A vs group B, respectively. Furthermore, investigating patients' surgical outcomes revealed a higher conversion rate to open surgery (20.0% vs 2.0%; p= 0.004), longer operation time (137 min vs 102 min; p< 0.001), and a higher incidence of intraoperative complications (10.0% vs 0%; p= 0.014) in group A vs group B, respectively. Conclusions Our results suggest that a history of severe cholecystitis is a risk factor for developing acute cholangitis and cholecystitis in patients waiting for surgery, and a risk factor for increased surgical difficulty.

scholarly journals Impact of COVID-19 on Neurological Manifestations: An Overview of Stroke Presentation in Pandemic.

2020 ◽  
Author(s):  
Nida Fatima ◽  
Maher Saqqur ◽  
Ashfaq Shauib
Keyword(s):  
Risk Factors ◽  
Virus Disease ◽  
Previous History ◽  
Neurological Manifestation ◽  
Cochrane Library ◽  
Mesh Terms ◽  
History Of ◽  
The Mean ◽  
Almost All ◽  
Underlying Risk

Abstract Introduction: Corona virus disease 2019 (COVID-19) pandemic has become a globally challenging issue after its emergence in December 2019 from Wuhan, China. Despite its common presentation as respiratory distress, patients with COVID-19 have also shown neurological manifestation especially stroke. Therefore, the authors sought to determine the etiology, underlying risk factors, and outcomes among patients with COVID-19 presenting with stroke. Methods: We conducted a systematic review of the electronic database (PubMed, Google Scholar, Scopus, Medline, EMBASE, and Cochrane library) using different MeSH terms from January 2000 to June 2020. Results: A total of 39 patients with stroke from 6 studies were included. The mean age of our included patients was 61.4±14.2 years. Majority of the patients (92.3%) with COVID-19 had ischemic stroke, 5.1% had hemorrhagic stroke, and 2.6% had cerebral venous thrombosis at the time of initial clinical presentation. Almost all of the patients presented had underlying risk factors predisposing to stroke which included, diabetes mellitus, hyperlipidemia, hypertension, and previous history of cerebrovascular disease. 51.2% of the included patients infected with COVID-19 with stroke died, while remaining patients were either discharged home or transferred to a rehabilitation unit. Conclusion: Exploring the neurological manifestation in terms of stroke among patients with COVID-19 is a step towards better understanding of the virus, preventing further spread, and treating the patients affected by this pandemic.

scholarly journals The Significance of Detective Arrhythmia by Using the Long- Term Ecg Monitoring in the Elderly “so Called” Healthy People: A Screening Study

2021 ◽  
Author(s):  
Rongsheng Xie ◽  
Siting Hong ◽  
Guoliang Gao ◽  
Jiaoyue Zhong ◽  
Lixin Geng ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrioventricular Block ◽  
Previous History ◽  
The Elderly ◽  
Healthy People ◽  
Ecg Monitoring ◽  
Adhesive Patch ◽  
Screening Study ◽  
History Of

Abstract BackgroundArrhythmias are potential harmful diseases to human beings, especially atrial fibrillation and ventricular arrhythmia, for causing serious consequences such as acute stroke or even sudden cardiac death. Recently the screening of asymptomatic atrial fibrillation by using the long-term ECG monitoring has been widely noticed. The study is to evaluate the significance of detective arrhythmia by using the long-term ECG monitoring in the elderly “so called” healthy people who never have the symptoms of palpitation, short breath or deny previous history of arrhythmia.MethodsWe enrolled a screening study of 1056 participants who were the elderly “so called” healthy people and ready to have a healthy examination from three different communities. They all underwent a long-term ECG monitoring（an adhesive patch）to evaluate cardiac arrhythmia. Inclusion criterias were 1) without any symptoms, 2) age ≥55, and 3) denying previous history of arrhythmia. We excluded patients with prior arrhythmias and who carried the patch for less than one day due to various factors. Then we compared the detected arrhythmia events in the first 24 hours and the total wearing time. ResultsOut of 1056 participants (69.8±12.0 years, 620 males), supraventricular tachycardia (SVT) was present in 538 subjects (44% VS 54%, 24 hours VS after 24 hours, P>0.05), atrial fibrillation (AF) was detected in 69 subjects (75% VS 25%, 24 hours VS after 24 hours, P<0.001), second degree type II atrioventricular block/third degree atrioventricular block (AVB) and sinus arrest were detected in 9 subjects(22% VS 78%, 24 hours VS after 24 hours, P<0.001),ventricular tachycardia was detected in 29 subjects (31% VS 69%, 24 hours VS after 24 hours, P<0.001). The adhesive patch monitor detected 32.10%（339/1056）arrhythmia events over the first 24 hours compared with arrhythmia events over the total wearing time of the devices, 61.08%（645/1056）(P<0.001). ConclusionsThe long-term adhesive patch monitor (APM) can improve the diagnosis of conceal arrhythmias which have high risks for life quality and lifespan in the elderly “so called ” healthy people, and the diagnostic advantage in bradycardia and ventricular arrhythmias are more obvious.

scholarly journals The history of the plastic surgery department, K.E.M. Hospital, Mumbai, India

2004 ◽  
Vol 37 (02) ◽  
pp. 136-142
Author(s):  
Kuldip Singh Goleria ◽  
Roshani E. Rana
Keyword(s):  
Plastic Surgery ◽  
Hard Work ◽  
History Of ◽  
Surgery Department

ABSTRACTThe history of the Department of Plastic Surgery, K.E.M. hospital, Mumbai, is presented from its inception in 1961, to date. The initial struggle, hard work and complete dedication have been mentioned. Fond, cherished memories of personalities, faculty and students along with their contributions are revived.

Abstract 4427: Electrocardiographic Left Ventricular Hypertrophy Predicts Long Term Fatal Outcomes in Elderly Hypertensives Despite Diuretic-Based Antihypertensive Treatment: 14-Year Follow-Up of the Systolic Hypertension in the Elderly Program (SHEP)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tudor Vagaonescu ◽  
Alan C Wilson ◽  
John B Kostis
Keyword(s):  
Antihypertensive Treatment ◽  
Ventricular Hypertrophy ◽  
Previous History ◽  
The Elderly ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
All Cause Mortality ◽  
History Of

Background: To assess if diuretic-based antihypertensive treatment improves long term fatal (cardiovascular) outcomes in the elderly with isolated systolic hypertension (ISH) and ECG documented left ventricular hypertrophy (LVH). Methods: Retrospective analysis of the SHEP database of 4,736 patients age ≥60 years and ISH and subsequent vital status ascertainment by matching to the National Death Index. Results: 348 subjects (7.35%) of SHEP participants had ECG documented LVH at baseline. Subjects with LVH had at baseline: higher SBP and pulse pressure (p<0.0001), carotid bruits (13% vs. 7%, p<0.0001) and previous history of myocardial infarction (8% vs. 4%, p=.0008) when compared with participants without LVH. There were no significant differences with regard to age, sex, heart rate, body mass index, smoking and alcohol use, previous history of stroke, diabetes, angina, and assignment to treatment or placebo group. Over 14.3 years (mean) of follow up subjects with baseline LVH experienced significantly more all cause mortality (51% vs. 40%, p<0.0001) and cardiovascular death (24% vs. 19%, p=0.002) than participants without baseline LVH. In the group of participants with LVH at baseline active treatment of hypertension did not decrease all cause mortality (51% vs. 50%, NS) or cardiovascular death (26% vs. 24%, NS). There was no statistically significant interaction between LVH and the assignment to treatment (antihypertensive medication vs. placebo). In a multivariable analysis, the adjusted Cox hazard ratio of developing any fatal outcome in the LVH group was 1.181 (95% CI 1.005–1.387, p=0.043) after adjusting for age, sex, race, history of myocardial infarction, diabetes, alcohol smoking status, education, blood pressure, and assignment to treatment or to placebo group. Conclusion: In the elderly with ISH the presence of LVH documented by ECG increased the risk for long term fatal outcomes despite treatment with diuretic-based antihypertensive therapy. Although active treatment lowered risk in the SHEP study, treated participants with LVH had a higher risk for fatal outcomes than treated subjects without LVH.

Abstract P101: Hypertension in Pregnancy and Risk of Hypertension in Later Life: The Bogalusa Heart Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Shengxu Li ◽  
Xu Xiong ◽  
Camilo Fernandez ◽  
Wei Chen ◽  
Sathanur R Srinivasan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Body Mass ◽  
Previous History ◽  
Later Life ◽  
Bogalusa Heart Study ◽  
Hypertension In Pregnancy ◽  
Heart Study ◽  
History Of ◽  
In Pregnancy

Background: Few studies have examined whether hypertension in pregnancy imposes long-term cardiovascular risk compared to a normal pregnancy. The objective of this study was to examine if previous history of hypertension in pregnancy is a risk for hypertension after pregnancy. Methods: A case-control analysis was performed using the Bogalusa Heart Study database. Cases were defined as women whose systolic blood pressure ≥140 mmHg or diastolic ≥ 90 mmHg, or having hypertension treatment. Controls were defined as women with normal blood pressure. After exclusions, 604 women (67% white and 33% black, aged 32-44 years) were included for analysis. Univariable and multivariable logistic regression were used to estimate the odds ratio (OR) and 95% confidence interval (CI). Results: The prevalence of hypertension in women was 12.1% (73/604). Hypertensive women had higher proportion of previous history of hypertension in pregnancy (25/73, 34%) than normotensive controls (83/531, 13.7%), with an OR of 2.81 (95% CI: 1.64-4.81). After adjustment for age, race, body mass index and smoking, adjusted OR (aOR) of having previous history of hypertension in pregnancy for developing hypertension later was 1.36 (1.00-3.75). In addition, age, black ethnicity and body mass index were associated with hypertension, with aORs of 1.16 (1.09-1.25), 3.73 (2.13-6.52), and 1.09 (1.05-1.13), respectively. Conclusions: Hypertension in pregnancy may be associated with an increased risk of hypertension in later life. Further studies are needed to separate the effect of pregnancy-induced hypertension and pre-exiting chronic hypertension on the subsequent risk of hypertension later in life.

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