Clozapine Use and Forensic Outcomes in Psychiatric Inpatients Deemed Incompetent to Stand Trial.

Referrals for competency restoration increased in the past decade, with the majority of incompetent to stand trial (IST) patients having schizophrenia; 25 percent of schizophrenia patients are treatment resistant. Clozapine is superior to other antipsychotics for treatment resistance but remains underutilized, particularly in forensic settings. Despite the impact of treatment resistance on the legal system, the literature on clozapine for IST patients is limited to two papers comprising 26 patients. A retrospective chart review was conducted of all IST admissions to a California hospital for 2014 to -2018, examining clinical and forensic outcomes in those newly started on clozapine and discharged. There were 191 new clozapine starts among IST patients, 92.7 percent of whom were diagnosed with schizophrenia or another psychosis. Over 90 percent were discharged on clozapine, and 36.1 percent were discharged on clozapine as trial competent; moreover, this cohort also had the shortest length of stay. This analysis indicates that most IST patients needing clozapine can be successfully treated, with a substantial proportion restored to trial competency. These data and earlier studies reinforce the concept that forensic programs have a medical duty to offer IST patients with severe mental illness a clozapine trial when indications exist for its use.

Psychological disorders in patients with orthopaedic oncological diseases and their coping strategies.

BACKGROUND: This study aimed to determine the prevalence and risk factors of anxiety and depression among orthopaedic oncology patients, their quality of life and coping strategies. METHODS: This cross-sectional study recruited patients from the outpatient orthopaedic oncology clinic at a tertiary institution. Data were collected from self-report questionnaires: Hospital Anxiety and Depression Scale Hospital Anxiety Depression Scale, World Health Organization Quality of Life (WHOQOL-BREF) and Brief Coping with Problems Experienced (Brief COPE). Risk factors were analyzed with multiple logistic regression. RESULTS: 191 patients were recruited. The median age was 39.4 years old (IQR 35.0). 29.8% had anxiety, 16.2% had depression, and 15.2% had mixed anxiety and depression. Quality of life median scores differed significantly between patients with anxiety and no anxiety and patients with depression and no depression (p < 0.001). Patients with mixed anxiety and depression had a more inferior quality of life (p < 0.001). Age, psychological health and radiotherapy were inversely associated with anxiety. Physical and psychological health were significantly associated with less depression. Ongoing chemotherapy was significantly associated with anxiety and depression. The commonest coping strategies were denial, behavioural disengagement, venting and self-blame. CONCLUSION: Anxiety and depression are prevalent among orthopaedic oncology patients. Patients with mixed anxiety and depression had a more inferior quality of life. Patients with ongoing chemotherapy had higher risks of anxiety and depression. The commonest coping strategies were denial, behavioural disengagement, venting and self-blame. Psychosocial evaluation followed by appropriate psychiatric referrals and consultations could be established to facilitate orthopaedic oncology patients during their course of treatment.

Is Sodium Carbonate in Snuff a Causative Factor for Oral Mucosal Lesions: A Cross-sectional Analysis.

AIMS AND OBJECTIVES: Nicotine absorption through the mucous membrane is directly proportional to pH, so the snuff is buffered to pH of 8-9 by adding sodium carbonate. The objective of the present study is to assess the impact of various forms of sodium carbonate in snuff on mucosal conditions. MATERIALS AND METHODS: The present cross-sectional study was conducted on 284 participants. Snuff users adding sodium carbonate were further splitted into two groups, that is, one group using sodium carbonate in premixed form, that is, (already mixed within pouches) and other group adding sodium carbonate separately (freshly mixed). The parametric one-way (ANOVA) of variance, stepwise regression analysis, and multiple logistic regression analysis have been done to narrate the relationship between variables of different forms of sodium carbonate in snuff and different oral conditions. RESULTS: The statistics of our study reveals highly significant relationship between snuff users using sodium carbonate in freshly mixed (0.001**) form than that of premixed form (P = 0.030*). CONCLUSION: The present study narrates that there seems to be liaison between the use of sodium carbonate in snuff and oral mucosal lesions.

Diabetes an inducing factor for dental caries: A case control analysis in Jammu.

OBJECTIVE: Diabetes mellitus (DM) is a common chronic disease and it has emerged as a major health-care problem. There are more chances of dentinal caries among diabetics than nondiabetics. DM is responsible for causing ascendancy in the proportion and activity of saliva that impacts the oral health. The objective of the present study is to evaluate the impact of various factors present in saliva on tooth decay amid type-II DM in Jammu. MATERIALS AND METHODS: The subjects in our analysis comprises of 50 patients with type-II DM and 50 controls within the age group of 30-60 years. Diabetic status was assessed by estimating random blood glucose levels. Dental findings were recorded using modified World Health Organization (WHO) Oral health survey-basic method 2013. Salivary samples from all the subjects were collected and sent to the laboratory for interpretation of pH, flow rate, and salivary calcium. The analysis of salivary components decayed tooth was carried using analysis of variance (ANOVA) and Pearson's correlation test. All the parameters were subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS) version 20.0. RESULTS: The results have shown a significantly lower values of salivary pH, flow rate, and calcium levels in diabetics than in nondiabetics. CONCLUSION: Within the limits of the present study, the results indicated that patients with type-II DM have high rate of dental caries and are at high risk of caries development. The decline in the salivary components will reduce capability of supporting the mineral compartment of tooth structure to resist the demineralization process by cariogenic potentials thereby creating a favorable environment for caries progression.

Oral health knowledge, attitude and practices of children and adolescents of orphanages in jodhpur city rajasthan, India.

OBJECTIVES: This study had twin objectives of assessing the oral health knowledge, attitude and practices and to assess the dental caries status and treatment needs among the orphan children of orphanages of Jodhpur city, Rajasthan, India. MATERIALS AND METHODS: This cross- sectional study was carried out on 100 children to assess the oral health knowledge, attitude and practices of children and adolescents of orphanages in Jodhpur city, Rajasthan, India. The data was collected on a pre-tested questionnaire which included 20 closed ended multiple-choice questions on perceived oral health status, knowledge of oral health and attitude, oral health practices, dietary habits and behaviour towards dental treatment. On completion of the questionnaire, each child underwent an oral examination and Dentition status and treatment needs index (WHO Oral Health Surveys- 1997) was recorded for each subject. RESULTS: Almost 93% of the children felt the necessity of maintaining oral hygiene. There were 69% of the children who believed that it was necessary to brush teeth after every meal, 51% children believed that regular tooth-brushing prevents all tooth problems and 93% children knew that tobacco is carcinogenic in nature. Also, it was found that 77% of the children believed that regular dental visits help in maintaining oral hygiene. CONCLUSION: Many of them had acquired knowledge on oral health. More than half of the study subjects were aware of the importance of keeping good oral hygiene, regular dental visits and harmful effects of tobacco.

Stretch and wrap style tourniquet effectiveness with minimal training.

UNLABELLED: The objective was to determine if proper application of the Stretch, Wrap, and Tuck Tourniquet (SWAT-T) would stop arterial flow and would occur with minimal training. METHODS: Fifteen undergraduates watched a 19 second video three times, practiced twice, and applied the tourniquet to volunteers at 10 locations: 3 above the elbow or knee and 2 below. RESULTS: Successful occlusion (60 second Doppler signal elimination) was more frequent than proper stretch (96 versus 75), more frequent on arms than legs (59 versus 37), and achieved before completed application (16 +/- 8 versus 33 +/- 8 seconds; each p < 0.05). Proper stretch (correct alteration of shapes printed on the tourniquet) was more frequent on legs than arms (30 versus 45; p <0.05). Applications were rated Easy (101), Challenging (37), Difficult (12) with discomfort None (53), Little (62), Moderate (34), Severe (1). The 8 appliers with <70% proper stretch rates received 10 minutes additional training and then retested at mid upper arm, mid-thigh, and below knee (24 applications) for improved proper stretch and occlusion (5 versus 18 and 10 versus 20; p < 0.01). CONCLUSIONS: Proper application of the SWAT-T is easy and can stop extremity arterial flow but requires some training for many appliers.

Herpetic lesion mimicking lower eyelid malignancy.

This photo-essay illustrates a case of a rapidly enlarging and ulcerated lower eyelid lesion in an HIV-positive man that was thought to be a malignant lesion. The biopsy revealed inclusions consistent with herpesvirus. This clinical entity should be considered in the clinician's differential diagnosis of eyelid lesions.