Contemporary reconstruction of a severe neuropathic foot burn injury.

The neuropathic foot in diabetic patients constitutes a special clinical entity that needs particular care and ministration. A burn on such a foot requires special care and attention in order to avoid amputation, especially when the burn is a deep partial or a full-thickness burn. The indication for early excision and coverage of a diabetic foot is taken under consideration in clinical practice. An 80-year-old male diabetic patient with deep partial and full-thickness burns on both his feet after a long hot footbath is presented. Even though feet appearance indicated the need for amputation of both feet, we performed gradual surgical debridement and primary coverage with human skin allografts. Both feet were finally covered with partial thickness skin grafts. Considering age, general condition and severity of the burn injuries, the final results were very satisfactory. We believe that the gamma-radiated allograft is another useful adjunct to the reconstructive armamentarium of the surgeon.

Les pieds du patient souffrant de neuropathie diabétique nécessitent des soins spécifiques. Le traitement d'une brûlure profonde de tels pieds a pour but d'en éviter l'amputation, l'indication d'excisiongreffe précoce étant systématiquement à évoquer. Nous présentant la cas d'une patiente diabétique de 80 ans ayant subi des brûlures profondes des 2 pieds du fait d'un bain trop chaud. Alors même que l'aspect des brûlures laissait craindre la nécessité d'une amputation, nous avons choisi des excisions réitérées avec couverture par allogreffe avant autogreffe dont les résultats, compte tenu de l'âge, de la comorbidité et de la profondeur de la brûlure, sont considérés comme satisfaisants. Les allogreffes irradiées représentent un élément utile dans l'arsenal thérapeutique du chirurgien brûlologue.

Anxiety and depression in primary care patients suffering of rheumatoid diseases.

Rheumatic diseases are chronic debilitating conditions with a known association with anxiety and depression. Individuals with rheumatic diseases experience more psychological distress as these conditions mostly follows a painful, progressively disabling course. The aim of this study was to assess the levels and explore factors associated with anxiety and depression experienced by Greek patients with rheumatic diseases. The sample consisted of 108 patients with rheumatic diseases who visited a rheumatology outpatient clinic. Data collection was conducted using a questionnaire which included patients' characteristics and the Zung Self-Rating Depression Scale (SDS) and Anxiety Scale (SAS). Of the 108 patients in the current study, 44.6% and 41.5% were assessed with depression and anxiety, respectively. Among patients exhibiting depression, 13% had severe depression, with the rest having moderate (12%) and mild (19.6%) severity of depression. Among patients exhibiting anxiety, the majority (20.2%) exhibited mild anxiety, whereas 17% of patients exhibited moderate and 4.3% severe anxiety. Higher levels of depression were experienced by those who experienced severe pain (p=0.001), those who were relapsed (p=0.008), those who had quitted their job due to health limitations (p=0.021), those who had the experience of a miscarriage (p=0.021) and those who used antidepressant or antianxiety medication (p<0.001). Higher levels of anxiety were experienced by female (p=0.011), the unemployed (p=0.047), those who experienced severe pain (p<0.001), those who were relapsed (p=0.015) and those who used antidepressant or antianxiety medication (p<0.001). Individuals with rheumatic diseases should be monitored for accompanying anxiety or depression during follow-up. Given their high prevalence, their profound impact on quality of life, and the range of effective treatments available, health care providers should be encouraged to screen all patients for both anxiety and depression. It is important to assess patients' characteristics when implementing strategies to confront with psychiatric disorders in this vulnerable population group.

Management of anxiety and depression in haemodialysis patients: the role of non-pharmacological methods.

Anxiety and depression in patients undergoing haemodialysis can be reduced by a variety of treatment methods, including pharmacological therapy, cognitive-behavioural therapy, regular exercise and relaxation techniques, such as Benson's relaxation method and acupressure treatment. Additionally, intradialytic exercise training programmes have a positive effect on patients' physical and psychological functioning. Moreover, social support from family and social environment, spirituality and religiosity, tele- nursing programmes and participation in network support groups frequently lead to a reduction of anxiety and depressive symptoms in these people. Finally, the provision of education and information to dialysis patients by renal professionals and a systematic psychiatric evaluation of these individuals can lead to early diagnosis and treatment of depressive symptoms.

The role of socio-demographic factors in depression and anxiety of patients on hemodialysis: an observational cross-sectional study.

PURPOSE: Depression and anxiety have high prevalence in patients on hemodialysis and are strongly associated with socio-economic factors. The aim of this study was to evaluate the prevalence of depression and anxiety in hemodialyzed patients in Greece and its association with socio-demographic factors. METHODS: Four hundred and fourteen (414) patients on hemodialysis (262 males and 152 females) from 24 dialysis centers in Greece participated in this observational cross-sectional study. Mean age was 63.54 (54.06-72.41), and mean time of dialysis treatment was 36 (16-72) months. Depression and anxiety were assessed by the state-trait anxiety inventory (STAI), the beck depression inventory (BDI) and the hospital anxiety and depression scale (HADS). Multinomial logistic regression was performed to estimate the factors being independently associated with anxiety and depression levels (HADS scale). Multiple linear regression was performed to estimate the factors being independently associated with BDI and STAI. RESULTS: From a total of 414 participants, (29.4%, n = 122) had depression and 35.9% (n = 149) had anxiety. Depression and anxiety were significantly associated with females, low level of education, increased patients' age, retirement, poor financial situation, marital status and co-morbidities. CONCLUSION: The overall study findings indicated a significant correlation between the levels of anxiety and depression in patients on hemodialysis. Patients with high levels of anxiety had higher levels of depression and those with high depression scores had higher anxiety scores.