Effectiveness of Autologous Fat Transfer in the Treatment of Scar-Related Conditions: A Systematic Review and Meta-analysis.

BACKGROUND AND AIM: Autologous fat transfer (AFT) has been introduced as a potential treatment option for scar-tissue and its related symptoms. However, the scientific evidence for its effectiveness remains unclear. This meta-analysis aims to evaluate the available evidence regarding the effectiveness of autologous fat transfer for the treatment of scar-tissue and its related conditions. METHODS: PubMed/Medline database was queried from its inception till the end of November 2021. All the relevant studies assessing the effect of autologous fat transfer in the treatment of scar-related conditions were pooled in using a random-effects model. RESULTS: 9 studies (n=179) were included in the meta-analysis. Pooled analysis demonstrates significant improvement in all subscales of the POSAS patient score with most prominent in color 2.4 points (95% CI 1.78-3.041), stiffness 2.9 points (95% CI 2.33-3.45), irregularity 2.2 points (95% CI 1.093-3.297) and thickness 1.8 points (95% CI 0.804-2.719), respectively. Pain and itch improved relatively lesser, 1.3 points (95% CI 0.958-1.674) and 0.6 points (95% CI 0.169-1.215), respectively. The POSAS observer scale showed a relatively lower improvement with the least in vascularity 0.5 points (95% CI 0.098-0.96), pigmentation 0.8 points (95% CI 0.391-1.276) and surface area 0.8 points (95% CI 0.34-1.25). Thickness improved by 1.4 points (95% CI 0.582-2.3), relief 1.0 points (95% CI 0.461-1.545) and pliability 1.5 points (95% CI 1.039-2.036). CONCLUSION: Our findings demonstrate that autologous fat transfer (AFT) is a promising treatment for scar-related conditions as it provides beneficial results in the scar quality. Future research should focus on the long-term effects of AFT and high-level evidence studies such as, randomized controlled trials (RCTs) and cohort studies are required. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Visual Hallucinations After a Russell's Viper Bite.

Visual hallucinations (VHs) are extremely rare in snakebites. We report a case of Russell's viper bite in an otherwise healthy 55-y-old woman who presented to a hospital in south India with established clinical features of systemic and local envenomation, including coagulation failure, without any neurologic manifestations on admission. She reported simple VH on the third day, which abruptly stopped on the fifth day without any specific medications. Clinical, laboratory, imaging, and electrophysiological studies did not reveal any neuropsychiatric disorders. Including this case, only 5 cases of VH are documented in the literature, 2 following cobra and viper bites and 1 after a sea snake bite. Two cases were reported from Australia and 1 each from the United States, Iran, and India.

Organ transplantation in Arabian Gulf countries: ethical and legal practice and beyond.

Almost half a century ago, organ transplantation was introduced to Arabian Gulf countries. The criteria for diagnosing brain death among these countries is relatively similar, in which the main area of discrepancy is the number of physicians required to diagnose and their required specialties. Regarding the organs and tissues allowed for transplantation, they must possess an intrinsic regenerative ability if they are harvested from a living donor to avoid jeopardizing their health. To donate, Arabian Gulf countries follow an opt-in consent system, requiring the donor's informed consent before organ procurement. Live donors can be related or unrelated to the recipient, although the latter is subjected to variable restrictions among Arabian Gulf countries and prohibition in one of them. This is due to its implication in commercial trade. Furthermore, the Gulf Health Council was established to coordinate different health initiatives and programs between Gulf states, including organ transplantation, in an attempt to improve the health sector of all of its member states. Although organ trafficking is illegal in all Arabian Gulf countries, their penalty systems vary from barring physicians, subjecting them to fines or even imprisonment. As for the attitudes of people towards organ transplantation, the willingness to donate varies among these countries. The rate of organ transplantation remains low. This article aims to cover the history of organ transplantation, brain death diagnosis protocols, organ donation enrollment policies and conditions, as well as the issue of organ trafficking in Arabian Gulf countries.

Uterine Transplant: A Risk to Life or a Chance for Life?

Being inherently different from any other lifesaving organ transplant, uterine transplantation does not aim at saving lives but supporting the possibility to generate life. Unlike the kidneys or the liver, the uterus is not specifically a vital organ. Given the non-lifesaving nature of this procedure, questions have been raised about its feasibility. The ethical dilemma revolves around whether it is worth placing two lives at risk related to surgery and immunosuppression, amongst others, to enable a woman with absolute uterine factor infertility to experience the presence of an organ enabling childbirth. In the year 2000, the first uterine transplantation, albeit unsuccessful, was performed in Saudi Arabia from where it has spread to the rest of the world including Sweden, the United States and now recently India. The procedure is, however, still in the preclinical stages and several ethical, legal, social and religious concerns are yet to be addressed before it can be integrated into the clinical setting as standard of care for women with absolute uterine factor infertility.

Breaking your heart-A review on CPR-related injuries.

Cardiopulmonary resuscitation (CPR) has been shown to increase survival after cardiac arrest, but is associated with the risk of acquired injuries to the patient. While traumatic chest wall injuries are most common, other injuries include upper airway, pulmonary and intra-abdominal injuries. This review discusses the risk factors and prevalence of CPR-related injuries.

Abortion of Fetus with Down's Syndrome: India Joins the Worldwide Controversy Surrounding Abortion Laws.

Abortion continues to be a moral and ethical dilemma in medicine. While abortions in general have always faced social stigmas, the abortion of fetuses with Down's syndrome in particular remains the subject of debate across the globe. In India, under the Medical Termination of Pregnancy Act, abortion is legal under prescribed circumstances only till 20 weeks of gestation. Laws for abortion after 20 week of gestation are ill defined. In a recent ruling of the Supreme Court in India, a woman was denied the right to abortion of her 26 week old fetus. With this ruling, India has joined the rest of the world in the debate surrounding abortion laws and the ethics of abortion.

Sanitary Worker's Death Unnerves Pakistan's Health Care Ethics to the Core.

Health care ethics is a sensitive domain, which if ignored, can lead to patient dissatisfaction, weakened doctor-patient interaction and episodes of violence. Little importance has been paid to medical ethics within undergraduate medical education in developing countries such as Pakistan. Three doctors in Pakistan are currently facing an official police complaint and arrest charges, following the death of a sanitary worker, who fell unconscious while cleaning a drain and was allegedly refused treatment as he was covered in sewage filth. The medical license of the doctors in question should be cancelled, if found guilty following a thorough investigation into the case. The 'right to life' has been universally assured by all moral, cultural and legal codes and no society can ever argue against the sacredness of a human life. It is quite clear that the aforesaid doctors' actions are not only against the core principles of the physicians' code, but also go against the doctrine of human rights. If serious efforts on an urgent basis are not made by the regulatory and governing bodies, one can definitely expect similar incidents for at least a few more decades before any noticeable change is seen.

Russell's Viper Envenomation-Associated Addisonian Crisis.

Snakebite envenomation is an important public health problem in tropical countries. We report a case of bilateral adrenal hemorrhage in a 28-y-old man with Russell's viper bite that occurred in the Sathyamangalam forest range in the Indian state of Tamil Nadu. In this case, a combination of early bite recognition, hospital-based supportive care, corticosteroid therapy, and timely administration of polyvalent antivenom resulted in a favorable clinical outcome.

Consented Autopsy and the Middle-East.

Consented autopsy is almost non-existent in the Middle-East where established social and cultural beliefs regarding the procedure might discourage family members from requesting a consented autopsy. Evidence suggests that new information is obtained from consented autopsies. It would not be in the best interest of medicine if social and cultural misconceptions succeed in erasing the existence of consented autopsies entirely.

Personalized Medicine in a New Genomic Era: Ethical and Legal Aspects.

The genome of two completely unrelated individuals is quite similar apart from minor variations called single nucleotide polymorphisms which contribute to the uniqueness of each and every person. These single nucleotide polymorphisms are of great interest clinically as they are useful in figuring out the susceptibility of certain individuals to particular diseases and for recognizing varied responses to pharmacological interventions. This gives rise to the idea of 'personalized medicine' as an exciting new therapeutic science in this genomic era. Personalized medicine suggests a unique treatment strategy based on an individual's genetic make-up. Its key principles revolve around applied pharmaco-genomics, pharmaco-kinetics and pharmaco-proteomics. Herein, the ethical and legal aspects of personalized medicine in a new genomic era are briefly addressed. The ultimate goal is to comprehensively recognize all relevant forms of genetic variation in each individual and be able to interpret this information in a clinically meaningful manner within the ambit of ethical and legal considerations. The authors of this article firmly believe that personalized medicine has the potential to revolutionize the current landscape of medicine as it makes its way into clinical practice.

Authorship: Few Myths and Misconceptions.

This article seeks to address and dispel some of the popular myths and misconceptions surrounding authorship of a scientific publication as this is often misconstrued by beginners in academia especially those in the developing world. While ethical issues in publishing related to authorship have been increasingly discussed, not much has been written about the myths and misconceptions of who might be an author. Dispelling these myths and misconceptions would go a long way in shaping the thoughts and plans of students, junior faculty and researchers in academia especially in the developing world.

An autopsy case of iatrogenic tracheoesophageal fistula secondary to tracheostomy.

Tracheoesophageal fistula (TEF) is an uncommon but life-threatening sequel of prolonged use of a cuffed tracheostomy tube. We describe a patient who developed a TEF after a tracheostomy done for management of head injury due to a road traffic mishap. The patient subsequently died of sepsis after bilateral bronchopneumonia. To the best of our knowledge, this is the first autopsy case of iatrogenic TEF after tracheal intubation reported in forensic literature.

The eye in forensic practice: In the living.

Eye examination plays an important role when living individuals are forensically investigated. The iris colour, retinal scans and other biometric features may be used for identification purposes while visual impairments may have legal implications in employment, driving and accidents. Ocular manifestations provide clues regarding substance abuse, poisoning and toxicity, and evidence of trauma, abuse or disease can be revealed along with psychological traits and lifestyle. Thus, the eye is a valuable tool in forensic investigations of living subjects, providing identifying characteristics along with health information. This review focuses on the medico-legal aspects of the eye's contribution when the living are subjected to forensic examination.

The eye in forensic practice: In the dead.

Post-mortem examination of the eye provides valuable forensic information yet is often overlooked. This brief review focuses on determining the cause/manner of death and post-mortem interval. External eye findings like corneal haziness and tache noire, combined with post-mortem changes in the iris, lens, retina and vitreous humour, can help estimate time since death. Ocular biometrics (iris/retinal scans) may facilitate identification. Age-related ocular changes can provide insights. The eye offers clues into personality (corneal tattooing, trichotillomania) and cause of death (petechiae in strangulation, retinal haemorrhages in abusive head trauma). Ocular trauma and underlying eye disease may be evident. Toxicology of vitreous humour can detect drugs/poisons. As a window into systemic disease and age-related changes, the eye aids pathology interpretations and, accordingly, post-mortem examinations have value. Ocular findings should not be overlooked in forensic examinations as they provide distinct information in determining cause/manner of death and post-mortem interval.

Striving toward safe abortion services in Nepal: A review of barriers and facilitators.

Background and Aims: Despite the decriminalization of abortion in Nepal in 2002, unsafe abortion is still a significant contributor to maternal morbidity and mortality. Nepal has witnessed a significant drop in abortion-related severe complications and maternal deaths owing to the legalization of abortion laws, lowered financial costs, and wider accessibility of safe abortion services (SAS). However, various factors such as sociocultural beliefs, financial constraints, geographical difficulties, and stigma act as barriers to the liberal accessibility of SAS. This review aimed to determine key barriers obstructing women's access to lawful, safe abortion care and identify facilitators that have improved access to and quality of abortion services. Methods: A systematic search strategy utilizing the databases PubMed, CINAHL, Scopus, and Embase was used to include studies on the accessibility and safety of abortion services in Nepal. Data were extracted from included studies through close reading. Barriers and facilitators were then categorized into various themes and analyzed. Results: Of 223 studies, 112 were duplicates, 73 did not meet the inclusion criteria, and 18 did not align with the research question; thus, 20 studies were included in the review. Various barriers to SAS in Nepal were categorized as economic, geographic, societal, legal/policy, socio-cultural, health systems, and other factors. Facilitators improving access were categorized as economic/geographic/societal, legal/policy, socio-cultural, and health systems factors. The patterns and trends of barriers and facilitators were analyzed, grouping them under legal/policy, socio-cultural, geographic/accessibility, and health systems factors. Conclusion: The review identifies financial constraints, unfavorable geography, lack of infrastructure, and social stigmatization as major barriers to SAS. Economics and geography, legalization, improved access, reduced cost and active involvement of auxiliary nurse-midwives and community health volunteers are key facilitators.

Systematic review of laryngohyoid fractures in fatal falls: A potential mimicker of strangulation.

Fractures of the laryngohyoid complex are classically associated with deaths due to strangulation. Recent studies, however, indicate the possible presence of such fractures in fatal falls. The primary focus of this systematic review is to analyze the characteristics of laryngohyoid fractures in the context of falls to aid in a more accurate interpretation of autopsy findings. Search for relevant literature occurred on PubMed on the 26th of October 2022, and Embase and Web of Science on the 5th of November 2022. Inclusion criteria included being a primary study, published in English, involving fatal falls and injuries to the laryngohyoid complex, and presenting sufficient details about the relevant cases. Four case reports and six descriptive retrospective studies were included in the final analysis yielding a sum of 38 cases. The risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Potential limitations of this study include the inclusion of case reports and studies published in English only. The cumulative male-to-female ratio was 23:15 with a mean age of 48 years old. The fall height ranged from standing height to 60 m. Forty-three fractures to the laryngohyoid complex were identified with the thyroid cartilage most commonly affected, followed by fracture of the hyoid bone, and finally the cricoid cartilage. While cases of falls did indeed display hallmark laryngohyoid findings classically displayed in strangulation, they also featured unique presentations such as fractures of the clavicle and a reduced prevalence of conjunctival petechiae.

Differentiating suicide from homicide in sharp-force fatalities with stab and/or incised wounds: A scoping review.

The majority of sharp-force fatalities with stab and/or incised wounds are homicides. However, suicidal sharp-force fatalities with stab and/or incised wounds are also reported. Thus, distinguishing suicidal stab and/or incised wounds from homicidal stab and/or incised wounds is significant from the forensic perspective. This scoping review primarily summarizes the existing research findings on the differentiation of suicide from homicide in sharp-force fatalities with stab and/or incised wounds. The literature was systematically searched on February 28, 2023, using the PubMed database. A search string formed by a combination of keywords related to suicide, homicide, and stab and incised wounds yielded 23 records. After applying the eligibility criteria, six records/studies met the inclusion criteria and were included in the present scoping review. Results showed that the predictive strength of various parameters, either individually or collectively, in diagnosing the manner of sharp-force fatality as suicide or homicide is not always hundred percent accurate. Some of the important predictors of the homicidal manner of death in sharp-force fatalities include clothing damage, presence of defense injuries, presence of injuries caused by another type of violence other than sharp-force, vertically oriented chest stabs, and sharp-force injuries in the head and back anatomical sites. Some of the important predictors of the suicidal manner of death in sharp-force fatalities include the presence of tentative injuries, sharp-force injuries to the wrist, and the presence of a suicide note.

Acute acalculous cholecystitis: a rare complication of snake bite.

Snake bite is an environmental and occupational hazard in many tropical and subtropical countries. It demands a high level of knowledge and skill in managing the envenomation syndrome. Herein, we describe a rare case of acute acalculous cholecystitis (AAC) that developed in a 36-year-old man after an Indian cobra (Naja naja) bite in the absence of any other predisposing factors for AAC. The probable mechanisms for the occurrence of AAC have been highlighted. Recognizing the possibility of such a complication after envenomation will definitely aid in early diagnosis and, subsequently, a better outcome.