PURPOSE: The purposes of this study were 1) to examine the differences in suicidal ideation and psychological variables by gender, 2) compare the contribution of demographic-behavioral variables and psychosocial variables in explaining the variance in suicidal ideation, and 3) identify the most important predictors of suicidal ideation for male adolescents and female adolescents. METHODS: The subjects consisted of 271 male adolescents and 230 female adolescents. Data were collected through self-report questionnaires, which were constructed to include SSI-C, DEP subscale of the SCL-90-R, PACI, and SWLS. The data were analyzed by the SPSS/WIN program. RESULTS: Suicidal ideation differed by gender. Depression and family communication differed by gender. The unique contribution of demographic-behavioral variables and psychosocial variables in explaining the variance in suicidal ideation differed between male adolescents and female adolescents. The significant predictors of suicidal ideation for male adolescents were life satisfaction, depression, and family communication, explaining 28% of the variance in suicidal ideation. The significant predictors of suicidal ideation for female adolescents were depression, smoking, and life satisfaction, explaining 38% of the variance in suicidal ideation. CONCLUSION: The findings of this study suggest that the approach to effective suicide prevention program for adolescents should consider gender differences.
Suicide/prevention & control/*psychology ; Socioeconomic Factors ; Sex Factors ; Risk Factors ; Regression Analysis ; Multivariate Analysis ; Male ; Korea ; Humans ; Female ; Family Relations ; Depression/psychology ; *Adolescent Psychology ; Adolescent

INTRODUCTION: Stenotrophomonas maltophilia is an aerobic gram-negative rod of low virulence. However, it is becoming an important cause of nosocomial infections usually among susceptible patients. More data in the local setting is needed to help clinicians recognize this emerging cause of infection.
OBJECTIVE: Determine the clinical profile and outcome of S. maltophilia infections among adult patients admitted at the University of Santo Tomas Hospital over a period of seven years.
METHODOLOGY: This is a retrospective descriptive study. Medical records of all patients > 18 years old admitted and assessed to have S. maltophilia infection from January 1, 2006 to December 31, 2012 were available for review.
RESULTS: Medical charts of 66 patients with S. maltophilia infection were reviewed. Seventy-two percent of these were hospital-acquired, whereas 28% were from the community. Most patients were male (57.6%), with a mean age of 68.97 ± 15.5 years. The lungs were the most common foci of infection (75.6%). Most common co-morbid illnesses were hypertension (54.5%) and diabetes mellitus (39.4%). Forty eight percent were on mechanical ventilatory support. Ninety five percent had invasive devices most notably indwelling urinary catheter (43%) and internal jugular catheter (13.6%). Fifty six percent (56.1%) received antibiotics prior to onset of S. maltophilia infection. Thirty six percent (36%) had polymicrobial infections associated with S. maltophilia. The organisms most frequently isolated were Klebsiella pneumonia (29.2%), Pseudomonas aeruginosa (25%), and Staphylococcus aureus (16.7%). Sixty percent of the isolates were fully susceptible to the recommended antibiotics. Only 1.5% were found to be multi-drug resistant. Majority (57.6%) of the patients were discharged improved, while 4.5% died due to S. maltophilia infection and 25.8% died from other causes mostly myocardial infarction.
CONCLUSION: Stenotrophomonas maltophilia infections were mostly hospital acquired. Most of the organisms were isolated from the respiratory tract. Most commonly associated co-morbid illnesses included hypertension and diabetes mellitus. Other associated factors included mechanical ventilatory support, prior antibiotics use, and presence of indwelling catheters. Most of the isolates remained susceptible to the recommended antibiotics, however, a fraction were resistant, most notably to Cotrimoxazole. Majority of the patients were discharged improved. Mortality attributable to S. maltophilia was only 4.5%.

Human ; Male ; Female ; Middle Aged ; Adult ; Stenotrophomonas Maltophilia ; Pseudomonas Aeruginosa ; Staphylococcus Aureus ; Catheters, Indwelling ; Urinary Catheters ; Diabetes Mellitus ; Myocardial Infarction ; Klebsiella

Objective: To determine the effect of pre-operative isometric exercise (PIE) on vascular caliber of pediatric chronic kidney disease (CKD) Stage 2-5D patients. Materials and Methods: This is a single-blind, randomized, single-center trial of 28 CKD patients. Fourteen participants allocated in the intervention group (PIE) were provided with a handgrip device and performed handgrip exercise consisting of two sets of 30 contractions daily while another 14 participants did not perform the exercise and were considered as controls (NE). For both groups, Duplex Ultrasonography was performed at baseline, four and eight weeks post-intervention. Results: Twenty-four CKD patients were included and analyzed. The mean age was 15.8 (+/- 1.9) years. There were 16 (66.7%) females and eight (33%) Males, 10 (41.7%) underweight (<18 kg/m2 ), 23 (95.8%) right-handed, 12 (50%) with Chronic Glomerulonephritis, and 10 (41.7%) with stage 2 CKD. Both the intervention and control group revealed a statistically significant increase in the caliber of the non-dominant cephalic (ante-cubital) vein at four- and eight-weeks post-intervention. Conclusion PIE might not significantly impact vessel diameter in pediatric CKD population as compared to adult CKD patients. Further studies on reliability of ultrasonography of blood vessels utilizing a larger sample size and more controlled milieu are recommended.
Renal Insufficiency, Chronic

Purpose. Differences in language and literacy impede our understanding of the impact of disability around the world. Since function is primarily action, the computer-animated Language Independent Functional Evaluation (L.I.F.E.) might bypass the use of written or verbal scales. This study validates L.I.F.E. in a developing world population. Methods. Families were randomly chosen from the city centre, suburban ‘ger’ districts and countryside of Arvaikheer, Mongolia. The L.I.F.E. and cross-translated Mongolian Barthel Index were administered in random order. Demographics including subjective observation of disability were gathered. L.I.F.E. scores were converted to Barthel equivalents. Results. One hundred sixty eight persons completed the test. Persons with observed disability had lower L.I.F.E. scores (64.55 vs. 94.53, p<0.001). L.I.F.E. and Barthel scores related well. (Spearman’s rho=0.757, p<0.001; for persons with observed disability Pearson r=0.820, p<0.001). Individual functions all had high interclass correlations (40.75), except bowel and bladder, which had moderate correlations. Qualitative inquiry found the L.I.F.E. was preferred over the Barthel. Conclusions. Using L.I.F.E., function can be measured without language or literacy. L.I.F.E. expands our ability to measure and compare the prevalence of disability and the impact of rehabilitation across regions perhaps leading to more rational allocation of resources.

INTRODUCTIONThis article aims to provide an overview of the epidemiology, medical and rehabilitation issues, current evidence for traumatic brain injury (TBI) rehabilitation, recent advances and emerging practices. Special TBI population groups will also be addressed.

MATERIALS AND METHODSWe included publications indexed in Medline and the Cochrane Database of Systemic Reviews from 1974 to 2006, relevant chapters in major rehabilitation texts and Physical Medicine and Rehabilitation Clinics of North America and accessed Internet publications.

RESULTSTBI has been implicated by the World Health Organisation to be a 21st century epidemic similar to malaria and HIV/AIDS, not restricted to the developed world. One third of patients may suffer severe TBI with long-term cognitive and behavioural disabilities. Injuries to the brain do not only damage the cerebrum but may give rise to a multisystem disorder due to associated injuries in 20% of cases, which can include complex neurological impairments, neuroendocrine and neuromedical complications. There is promising evidence of improved outcome and functional benefits with early induction into a transdisciplinary brain injury rehabilitation programme. However, TBI research is fraught with difficulties because of an intrinsically heterogeneous population due to age, injury severity and type, functional outcome measures and small samples. Recent advances in TBI rehabilitation include task-specific training of cognitive deficits, computer-aided cognitive remediation and visual-spatial and visual scanning techniques and body weight-supported treadmill training for motor deficits. In addition, special rehabilitation issues for mild TBI, TBI-related vegetative states, elderly and young TBI, ethical issues and local data will also be discussed.

Accidents, Traffic ; statistics & numerical data ; Brain Injuries ; complications ; prevention & control ; rehabilitation ; Humans ; Ossification, Heterotopic ; etiology ; Persistent Vegetative State ; rehabilitation ; Prognosis ; Rehabilitation ; methods ; Singapore ; Task Performance and Analysis

Mucormycosis is an invasive, rapidly progressive, life-threatening fungal infection, with a propensity for diabetic, immunosuppressed, and trauma patients. The classic rhinocerebral variation is most common in diabetic patients. While the cutaneous form is usually caused by direct inoculation in immunocompetent patients. Cutaneous mucormycosis manifests in soft tissue and risks involvement of underlying structures. Tibial osteomyelitis can also occur secondary to cutaneous mucormycosis but is rare. Limb salvage is typically successful after lower extremity cutaneous mucormycosis even when the bone is involved. Herein, we report two cases of lower extremity cutaneous mucormycosis in diabetic patients that presented as acute worsening of chronic pretibial ulcers. Despite aggressive antifungal therapy and surgical debridement, both ultimately required amputation. Such aggressive presentation has not been reported in the absence of major penetrating trauma, recent surgery, or burns.

INTRODUCTIONThis study determines the extent of, and factors associated with, delayed discharges for stroke patients from inpatient rehabilitation.

MATERIALS AND METHODSA retrospective cohort study utilising medical notes review was conducted at an inpatient rehabilitation centre in Singapore. Acute stroke patients (n = 487) admitted between March 2005 and December 2006 were studied. The primary measure was delayed discharge defined as an extension in inpatient stay beyond the planned duration. Factors associated with delays in discharge were categorised as individual, caregiver, medical and organisational.

RESULTSThere were a total of 172 delayed discharges (35.6%). The mean [standard deviation (SD)] length of stay was 40.5 days (SD, 19.5 days) and 25.8 days (SD, 11.4 days) for patients with delayed and prompt discharges, respectively. Mean extension of stay was 9.7 days (SD, 13.8 days). Caregiver-related reasons were cited for 79.7% of the delays whereas organisational factors (awaiting nursing home placement, investigations or specialist appointments) accounted for 17.4%. Four factors were found to be independently associated with delayed discharge: discharge to the care of foreign domestic helper, nursing home placement, lower admission Functional Independence Measure (FIM) motor score and discharge planning process.

CONCLUSIONSOur study suggests that caregiver and organisational factors were main contributors of delayed discharge. Targeted caregiver training and the provision of post-discharge support may improve the confidence of caregivers of patients with greater motor disability. The use of structured discharge planning programmes may improve the efficiency of the rehabilitation service. To reduce delays, problems with the supply of formal and informal post-discharge care must also be addressed.

Aged ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Patient Discharge ; Rehabilitation Centers ; Retrospective Studies ; Singapore ; Stroke Rehabilitation

Background: Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol. Methods: A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing. Results: The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4–23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar. Conclusions This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population.

Specific anti-venom used to treat scorpion envenomation is usually obtained from horses after hyperimmunization with crude scorpion venom. However, immunized animals often become ill because of the toxic effects of the immunogens used. This study was conducted to evaluate the toxic and immunogenic activities of crude and detoxified Tityus serrulatus (Ts) venom in sheep during the production of anti-scorpionic anti-venom. Sheep were categorized into three groups: G1, control, immunized with buffer only; G2, immunized with crude Ts venom; and G3, immunized with glutaraldehyde-detoxified Ts venom. All animals were subjected to clinical exams and supplementary tests. G2 sheep showed mild clinical changes, but the other groups tolerated the immunization program well. Specific antibodies generated in animals immunized with either Ts crude venom or glutaraldehyde-detoxified Ts venom recognized the crude Ts venom in both assays. To evaluate the lethality neutralization potential of the produced sera, individual serum samples were pre-incubated with Ts crude venom, then subcutaneously injected into mice. Efficient immune protection of 56.3% and 43.8% against Ts crude venom was observed in G2 and G3, respectively. Overall, the results of this study support the use of sheep and glutaraldehyde-detoxified Ts venom for alternative production of specific anti-venom.
Animals ; Antibodies ; Horses ; Immunization Programs ; Mice ; Scorpion Venoms ; Scorpions ; Sheep* ; Venoms*

OBJECTIVEThis study was designed to investigate the optimal combination of known osteogenic biomaterials with shape conforming struts to achieve calvarial vault reconstruction, using a canine model.

METHODSEighteen adolescent beagles were divided equally into 6 groups. A critical size defect of 6 x 2 cm traversed the sagittal suture. The biomaterials used for calvarial reconstruction were demineralised perforated bone matrix (DBM), recombinant human bone morphogenetic protein-2 (rhBMP2) and autogenous platelet-rich plasma (PRP). The struts used were cobalt chrome (metal) or resorbable plate. The groupings were as follows: 1) DBM + metal, 2) DBM + PRP + metal, 3) DBM + PRP + resorbable plate, 4) DBM + rhBMP2 + metal, 5) DBM + rhBMP2 + PRP + metal, and 6) DBM + rhBMP2 + resorbable plate. Animals were euthanised at 3 months post-surgery. There was no mortality or major complications. Analysis was performed macroscopically, histologically, and with computed tomography (CT).

RESULTSThere was complete bony regeneration in the rhBMP2 groups only. Non-rhBMP2 groups had minimal bony ingrowth from the defect edges and on the dural surface, a finding confirmed by CT scan and histology. PRP did not enhance bone regeneration. Shape conformation was good with both metal and resorbable plate.

CONCLUSIONrhBMP2 but not PRP accelerated calvarial regeneration in 3 months. The DBM in the rhBMP2 groups were substituted by new trabecular bone. Shape molding was good with both metal and resorbable plate.

Animals ; Biocompatible Materials ; Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; pharmacology ; Bone Regeneration ; physiology ; Dogs ; Models, Animal ; Postoperative Care ; Recombinant Proteins ; pharmacology ; Reconstructive Surgical Procedures ; Skull ; growth & development ; pathology ; surgery ; Transforming Growth Factor beta ; pharmacology