ABSTRACT
Introduction: Self-immolation is an uncommon way of attempting and committing a suicide, with a fatality rate of 80%. The risk factors in self-immolation victims vary depending on demographic characteristics, socio-economic and cultural factors as well as religious beliefs. Whether the COVID-19 pandemic was a potentially important stressor for self-immolation is still unknown, with insufficient studies examining this issue. Therefore, in this study, we aimed to examine the trend of self-immolation in a 13-year timeline, and the potential association of COVID-19 pandemic with the increase in the incidence and severity of self-immolation injuries in Serbia in 2021. Materials and methods: The study included hospitalized patients due to intentional burns caused by self-immolation in the period from January 1, 2008 to December 31, 2021. Joinpoint regression analysis was used for the analysis of continuous linear trends of self-immolation cases with change points. Results: While a rising trend was observed in the 2008-2013 time segment, followed by a decline in the upcoming 2013-2016 time segment, a significant increase reached its maximum during COVID-19 pandemic (2021), with annual percent change of 37.1% (p = 0.001). A significant increase in the median number of cases per year was observed during 2021 compared to the previous periods (7.5 vs. 2). Frequency of patients with a psychiatric diagnosis vs. those without a psychiatric diagnosis was significantly higher during than before the COVID-19 period (66.7 vs. 36.1%, p = 0.046). Conclusion: In our study, a significant increase in the frequency of suicide attempts by self-immolation during COVID-19 pandemic was noticed. There was also an increased frequency of pre-existing psychiatric illness among patients during the pandemic period. With limited high-quality data available, the study adds to a rising body of evidence for assessment of outcomes of the pandemic on mental health and recognition of stressors for self-immolation.
Subject(s)
COVID-19 , Mental Disorders , Humans , COVID-19/epidemiology , Pandemics , Data Accuracy , Mental HealthABSTRACT
INTRODUCTION: The radial forearm free flap has an important role in reconstruction of the oncologic defects in the region of head and neck. OBJECTIVE: The aim was to present and evaluate clinical experience and results in the radial forearm free transfer for intraoral reconstructions after resections due to malignancies. METHODS: This article illustrates the versatility and reliability of forearm single donor site in 21 patients with a variety of intraoral oncologic defects who underwent immediate (19 patients, 90.5%) or delayed (2 patients, 9.5%) reconstruction using free flaps from the radial forearm. Fascio-cutaneous flaps were used in patients with floor of the mouth (6 cases), buccal mucosa (5 cases), lip (1 case) and a retromolar triangle (2 cases) defects, or after hemiglossectomy (7 cases). In addition, the palmaris longus tendon was included with the flap in 2 patients that required oral sphincter reconstruction. RESULTS: An overall success rate was 90.5%. Flap failures were detected in two (9.5%) patients, in one patient due to late ischemic necrosis, which appeared one week after the surgery, and in another patient due to venous congestion, which could not be salvaged after immediate re-exploration. Two patients required re-exploration due to vein thrombosis.The donor site healed uneventfully in all patients, except one, who had partial loss of skin graft. CONCLUSION: The radial forearm free flap is, due to multiple advantages, an acceptable method for reconstructions after resection of intraoral malignancies.
Subject(s)
Forearm/surgery , Free Tissue Flaps , Head and Neck Neoplasms/surgery , Plastic Surgery Procedures/methods , Skin Transplantation/methods , Adult , Aged , Carcinoma, Squamous Cell/surgery , Female , Humans , Male , Maxilla/surgery , Middle Aged , Mouth Mucosa/surgery , Mouth Neoplasms/surgery , Postoperative Complications/pathology , Skin Neoplasms/surgery , Tongue Neoplasms/surgeryABSTRACT
Madelung disease is rare, and characterised by accumulation of fatty non-encapsulated tissue in the head, neck, shoulders, and upper extremities. The aetiology is not completely known, but the association with alcohol intake is clear. We present a neglected case that was associated with bilateral asymmetrical gynaecomastia. To the best of our knowledge, this is a pattern of involvement not previously reported. The treatment of choice is lipectomy for severe cases and liposuction for less extensive accumulations of fat.
Subject(s)
Genital Diseases, Male/diagnosis , Gynecomastia/diagnosis , Lipomatosis, Multiple Symmetrical/diagnosis , Scrotum/physiopathology , Alcoholism/complications , Alcoholism/diagnosis , Follow-Up Studies , Genital Diseases, Male/complications , Gynecomastia/complications , Gynecomastia/surgery , Humans , Lipectomy/methods , Lipomatosis, Multiple Symmetrical/complications , Lipomatosis, Multiple Symmetrical/surgery , Male , Mastectomy/methods , Middle Aged , Rare Diseases , Risk Assessment , Severity of Illness Index , Smoking/adverse effects , Treatment OutcomeABSTRACT
PURPOSE: This case report describes a rare and aggressive ameloblastic carcinoma that infiltrated the mandible in a "honeycomb" pattern. METHODS: A total mandibulectomy with bilateral modified neck dissection was followed by primary reconstruction with a single free vascularised fibula flap. RESULTS: The postoperative course was uneventful. The one year follow-up revealed no signs of recurrent tumour or metastases. Nine months later distant metastases occurred in the lung. CONCLUSION: Ameloblastic carcinoma is a highly malignant lesion, which requires aggressive therapy. Prognosis is poor. Further reporting of ameloblastic carcinoma is encouraged.