Hemorrhage is a detrimental event present in traumatic injury, surgery, and disorders of bleeding that can become life-threatening if not properly managed. Moreover, uncontrolled bleeding can ...complicate surgical interventions, altering the outcome of surgical procedures. Therefore, to reduce the risk of complications and decrease the risk of morbidity and mortality associated with hemorrhage, it is necessary to use an effective hemostatic agent that ensures the immediate control of bleeding. In recent years, there have been increasingly rapid advances in developing a novel generation of biomaterials with hemostatic properties. Nowadays, a wide array of topical hemostatic agents is available, including chitosan-based biomaterials that have shown outstanding properties such as antibacterial, antifungal, hemostatic, and analgesic activity in addition to their biocompatibility, biodegradability, and wound-healing effects. This review provides an analysis of chitosan-based hemostatic biomaterials and discusses the progress made in their performance, mechanism of action, efficacy, cost, and safety in recent years.
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Background
Self-harm typically is without lethal intent. Death can occur rarely, with suicide taking on an atypical form that raises the suspicion of hetero-aggression. Our study aimed to identify ...the link between self-harm and suicide intent and also to outline the positive diagnosis of an atypical suicide case which has raised the suspicion of hetero-aggression. For this purpose, the psychological autopsy method should be used regularly in suicide investigation because it not only allows a positive diagnosis of suicide but can also provide a detailed picture of mental degradation and associated suicide risk factors.
Case presentation
The case of a 26-year-old man from a rural area, found dead in the basement, at home, naked, barricaded inside, is described.
Methods
The on-site investigation and a complete forensic autopsy were performed. In addition, we apply the psychological autopsy method which gathered enough information to outline the positive diagnosis of suicide. We also made a brief literature review on the suicide risk factors and the behavioral changes that occurred during the COVID-19 pandemic in schizophrenic patients.
Results
The forensic autopsy revealed that he presented a complex craniofacial trauma as the cause of death (with scalp lacerations, frontal fracture, subarachnoid hemorrhage, and frontal cerebral contusions) associated with torso trauma (with self-inflicted stabbed wounds) with bruises and abrasions on the limbs. The injuries that caused death were self-inflicted and ensued repeatedly hitting his head against blunt objects. Using the psychological autopsy method, we found out that he presented multiple psychiatric hospitalizations for schizophrenia for almost 10 years, recently with reduced compliance to treatment. We also documented two previous suicide attempts and a gradual deterioration of his mental health.
Conclusions
We highlighted the role of the psychological autopsy (in addition to the judicial investigation and the forensic autopsy) for the diagnosis of committed suicide, for making a rigorous differential diagnosis between accident, hetero-aggression, and suicide, and also in pin-pointing the suicide risk factors.
The present study explored whether, given the association of temporal alpha with fear circuitry (learning and conditioning), exposure to complex childhood trauma (CCT) is reflected in the ...temporal–posterior alpha power in resting-state electroencephalography (EEG) in complex trauma-exposed adolescents in a sample of 25 adolescents and similar controls aged 12–17 years. Both trauma and psychopathology were screened or assessed, and resting-state EEG was recorded following a preregistered protocol for data collection. Temporal–posterior alpha power, corresponding to the T5 and T6 electrode locations (international 10–20 system), was extracted from resting-state EEG in both eyes-open and eyes-closed conditions. We found that in the eyes-open condition, temporal–posterior alpha was significantly lower in adolescents exposed to CCT relative to healthy controls, suggesting that childhood trauma exposure may have a measurable impact on alpha oscillatory patterns. Our study highlights the importance of considering potential neural markers, such as temporal–posterior alpha power, to understanding the long-term consequences of CCT exposure in developmental samples, with possible important clinical implications in guiding neuroregulation interventions.
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Neonatal brain injury or neonatal encephalopathy (NE) is a significant morbidity and mortality factor in preterm and full-term newborns. NE has an incidence in the range of 2.5 to 3.5 per 1000 live ...births carrying a considerable burden for neurological outcomes such as epilepsy, cerebral palsy, cognitive impairments, and hydrocephaly. Many scoring systems based on different risk factor combinations in regression models have been proposed to predict abnormal outcomes. Birthweight, gestational age, Apgar scores, pH, ultrasound and MRI biomarkers, seizures onset, EEG pattern, and seizure duration were the most referred predictors in the literature. Our study proposes a decision-tree approach based on clinical risk factors for abnormal outcomes in newborns with the neurological syndrome to assist in neonatal encephalopathy prognosis as a complementary tool to the acknowledged scoring systems. We retrospectively studied 188 newborns with associated encephalopathy and seizures in the perinatal period. Etiology and abnormal outcomes were assessed through correlations with the risk factors. We computed mean, median, odds ratios values for birth weight, gestational age, 1-min Apgar Score, 5-min Apgar score, seizures onset, and seizures duration monitoring, applying standard statistical methods first. Subsequently, CART (classification and regression trees) and cluster analysis were employed, further adjusting the medians. Out of 188 cases, 84 were associated to abnormal outcomes. The hierarchy on etiology frequencies was dominated by cerebrovascular impairments, metabolic anomalies, and infections. Both preterms and full-terms at risk were bundled in specific categories defined as high-risk 75-100%, intermediate risk 52.9%, and low risk 0-25% after CART algorithm implementation. Cluster analysis illustrated the median values, profiling at a glance the preterm model in high-risk groups and a full-term model in the inter-mediate-risk category. Our study illustrates that, in addition to standard statistics methodologies, decision-tree approaches could provide a first-step tool for the prognosis of the abnormal outcome in newborns with encephalopathy.
The COVID-19 pandemic is associated with suicide, as some data suggests. Our study aims to investigate the emergence of eleven completed suicide cases suspected to be linked to the COVID-19 pandemic ...during the restrictive measures imposed by the Romanian government, and to identify the consequences of mental health, suicidal motivation, and behavioral changes. To this end, we analyzed the deceased's medical records and applied the psychological autopsy method to the relatives/caregivers of the deceased for a suicidal investigation history, within conducted free-flow discussions. To highlight behavioral changes that occurred in the distant antecedents as well as immediately before the suicidal act, we used two sets of closed questions comprised of fifteen alarm signs, including depressive and/or anxiety symptoms. Our results showed that a deterioration of the mental status, especially concerning depressive and anxiety symptoms, was evident in people without or with pre-existing psychiatric pathology. The suicidal motivation proved to be complex including, in addition to the SARS-CoV-2 infection, social and economic consequences of the COVID-19 pandemic. We noted an intensification of the investigated alarm signs and even the emergence of new warning signs in the recent antecedents. Based on our findings, we reaffirmed the important role of the psychological autopsy method in suicide investigation, proving that it can detect the specific impact of the COVID-19 pandemic on people prone to suicide. This impact can be psycho-emotional, social, and/or economical, and thus we can state that the COVID-19 pandemic and its consequences can be, at least, a triggering factor that enhances completed suicide risk. Further studies are needed in this particular area because correlations between the COVID-19 pandemic and completed suicide do not appear to be accidental.
The search for biomarkers has been central to efforts of improving clinical diagnosis and prognosis in psychopathology in the last decades. The main approach has been to validate biomarkers that ...could accurately discriminate between clinical diagnoses of very prevalent forms of psychopathology. One of the most popular electrophysiological markers proposed for discrimination in depressive disorders is the electroencephalography (EEG)-derived frontal alpha asymmetry. However, the validity, reliability and predictive value of this biomarker have been questioned in recent years, mainly due to conceptual and methodological heterogeneity.
In the current non-experimental, correlational study we investigated relationship of resting-state EEG alpha asymmetry from multiple sites (frontal, frontolateral, and parietal) with different forms of depressive disorders (varying in type or severity), in a clinical sample.
Results showed that alpha asymmetry in the parietal (P3-P4) was significantly higher than in the frontal (F3-F4) and frontolateral sites (F7-F8). However, we did not find significant relations between alpha asymmetry indices and our depressive disorder measures, except for a moderate positive association between frontolateral alpha asymmetry (eyes-closed only) and depressive disorder severity (determined through clinical structured interview). We also found no significant differences in alpha asymmetry between participants, depending on their depression type.
Based on results, we propose the parietal and frontolateral asymmetry indices to form hypotheses that should not be abandoned in the depression markers research, but worth for further experimental research. Methodological and clinical implications of the current findings are discussed.
Post-Traumatic Stress Disorder (PTSD) is often considered challenging to treat due to factors that contribute to its complexity. In the last decade, more attention has been paid to ...non-pharmacological or non-psychological therapies for PTSD, including neurofeedback (NFB). NFB is a promising non-invasive technique targeting specific brainwave patterns associated with psychiatric symptomatology. By learning to regulate brain activity in a closed-loop paradigm, individuals can improve their functionality while reducing symptom severity. However, owing to its lax regulation and heterogeneous legal status across different countries, the degree to which it has scientific support as a psychiatric treatment remains controversial. In this state-of-the-art review, we searched PubMed, Cochrane Central, Web of Science, Scopus, and MEDLINE and identified meta-analyses and systematic reviews exploring the efficacy of NFB for PTSD. We included seven systematic reviews, out of which three included meta-analyses (32 studies and 669 participants) that targeted NFB as an intervention while addressing a single condition—PTSD. We used the MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 and the criteria described by Cristea and Naudet (Behav Res Therapy 123:103479, 2019,
https://doi.org/10.1016/j.brat.2019.103479
) to identify sources of research waste and increasing value in biomedical research. The seven assessed reviews had an overall extremely poor quality score (5 critically low, one low, one moderate, and none high) and multiple sources of waste while opening opportunities for increasing value in the NFB literature. Our research shows that it remains unclear whether NFB training is significantly beneficial in treating PTSD. The quality of the investigated literature is low and maintains a persistent uncertainty over numerous points, which are highly important for deciding whether an intervention has clinical efficacy. Just as importantly, none of the reviews we appraised explored the statistical power, referred to open data of the included studies, or adjusted their pooled effect sizes for publication bias and risk of bias. Based on the obtained results, we identified some recurrent sources of waste (such as a lack of research decisions based on sound questions or using an appropriate methodology in a fully transparent, unbiased, and useable manner) and proposed some directions for increasing value (homogeneity and consensus) in designing and reporting research on NFB interventions in PTSD.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
With the covid-19 pandemic and the related restrictions to reduce the spread of the virus, the interaction between doctor and patient has changed, especially in the outpatients department. Thus, the ...need for remote consultations also appeared in the Romanian health system, especially in the psychiatric one. Although in other countries psychiatrists were familiar with this form of consultation, for Romanian psychiatrists, who were not trained either in residency or during medical school, it was a great challenge. If until March 2020 the patient’s consultation had to be performed only in the physical presence of a doctor, once the COVID-19 pandemic appeared, the Romanian government and the president, through the legislative acts issued, provided a legal framework for conducting this remote consultations. With the advent of telepsychiatry, discussions arose in the psychiatric community about the advantages and disadvantages of this type of consultation.
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It is crucial to inform the public about the procedures in psychiatric practice, meant to ensure complex and adequate medical care for the mentally ill patient, in respect of the dignity and rights ...of the patient, but also according to legal regulations. The occurrence of twisted considerations about psychiatry and patients with mental illness is due to the lack of information about mental illness, the beneficial effects of drug therapy, the need for hospitalization and patient protection in a psychiatric hospital, as part of treatment. When a psychiatric patient is brought in the guard room of a psychiatric hospital by the public services (EMT, police, public guardians, etc.), by his family or when the patient voluntarily asks to be hospitalized (the ideal model), they will receive complex medical care in full respect for his rights. Some situations occur when the patient refuses to express his consent regarding the consultation, diagnosis, treatment or even hospitalization (surveillance and monitoring) in the psychiatric hospital, considering unjustified any approach in this regard and that this violates his fundamental rights. The form of hospitalization, without the patient’s consent, is called involuntary hospitalization (sectioned). This raises an issue between “respecting the patient’s rights” if he is acting to endanger himself or others or “restricting” them by involuntary hospitalization, which would increase the quality of care and patient safety.
The patients with psychiatric pathology, during the hospitalization in the “Dr.Gh.Preda” Psychiatric Hospital of Sibiu attend to the activities carried out in the ergotherapy department. The ...complementary therapies are designed to help the patient to integrate socially and professionally easier. To make this possible, the quality of the services provided to the patients is important. We conducted this study in order to evaluate the quality of these services and to find solutions for possible problems. Occupational therapy has had an important place in the history of our hospital, being a department with tradition in which the quality of the services offered has always been emphasized.
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