Trend of suicide by self-immolation in a 13-year timeline: was the COVID-19 pandemic a potentially important stressor?

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.

Analysis of reconstructive methods in surgical treatment of nasal skin defects.

Background/Aim: Surgeons often face with the problem when selecting a reconstructive method for nasal skin defects. The aim of this study was to determine functional and aesthetic character-istics of different reconstructive methods used for skin defects in different regions of the nose. Methods: The study involved 44 patients with basocellular carcinoma in nasal area. The nasal skin was divided into four subunits: the tip, the alar lobules, the side-walls and the dorsum. The average skin defect size was 10 mm in diameter. Local flaps and full thickness skin grafts were used in the study. We analyzed the functional and esthetic results of dif-ferent reconstructive methods used for nasal defects in different regions of the nose 12 months after the surgery. Results: The study shows that different reconstructive methods produce dif-ferent functional and esthetic results in the same nasal subunits and that the same reconstructive method produces different re-sults in different nasal subunits. Conclusions: Estimation the postoperative functional and esthetic characteristics of different reconstructive methods is one of the basic preconditions of suc-cessful reconstruction.