Risk Of Accidental Injury Research Articles

Efficacy of Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy in Combination with Fluoroscopy versus Fluoroscopy as a Single Imaging Modality

Abstract Background Renal stone is one of the most common renal diseases worldwide. There are several modalities for treatment of renal stone disease, one of these modalities is the use of percutaneous nephrolithatomy (PCNL) surgery which can be done either under fluoroscopic or ultrasound guidance which has significantly reduced x-ray exposure risk to medical personnel and patients. Objective To evaluate the efficacy of the ultrasound-guided PCNL in combination with fluoroscopy to minimize exposure time to radiation, risk of accidental injury to adjacent organs, blood loss and increased stone clearance rate versus usage of fluoroscopy as a single imaging modality in PCNL. Patients and Methods This prospective randomized comparative clinical trial study was conducted on 40 patients for the treatment of stone(s) located in the kidney more than 2 cm or refractory to shockwave therapy, patients were divided into 2 groups, 20 patients each; Group I: ultrasound-guided PCNL in combination with fluoroscopy and Group II: use of fluoroscopy as a single imaging modality, the study was carried on at Urology department, Faculty of medicine, Ain Shams University and Urology department, Theodor Bilharz Research Institute. Results As regard post operative complications in studied groups, in group I, there were 3 patients (15%) with post-operative fever versus 4 patients (20%) in group II. In group I, there was 1 patient (5%) with post-operative leakage versus 3 patients (15%) in group II. In group II, there was 1 patient (5%) with post-operative blood transfusion versus 0 patients (0%) in group I with no statistical difference. With respect to post-operative hospital stay and need for second operation between studied groups, there was a highly statistical significant (p-value < 0.001) increased post- operative hospital stay in group II (3.5 ± 1.05) when compared with group I (1.9 ± 0.9). While, as regard need for second operation and type of the operation, there were no statistical differences between the studied groups. But, there was high statistical significant difference (p-value < 0.001) decreased x-ray exposure time in group I (43.2 ± 11.3 sec) when compared to group II (314 ± 84.2 sec). Conclusion Combined ultrasonic and fluoroscopic guided PCNL had shorter x-ray exposure time. Combined ultrasonic and fluoroscopic guided PCNL had less Hb drop and intraoperative complications. However it still had longer surgery duration. Combined ultrasonic and fluoroscopic guided PCNL showed less postoperative pain and analgesic consumption. Combined ultrasonic and fluoroscopic guided PCNL had shorter hospital stay. Regarding the outcome and complications, in general, there is no statistical significant difference between these two groups.

The Anatomy of the Thoracic Duct and Cisterna Chyli: A Meta-Analysis with Surgical Implications.

Background: The thoracic duct (TD) and the cisterna chyli (CC) exhibit a high degree of variability in their topographical and morphometric properties. Materials and Methods: PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to identify all studies that included information regarding the morphometric and topographical characteristics of the TD and CC. Results: The most frequent location of the TD termination was the left venous angle, with a pooled prevalence of 45.29% (95% CI: 25.51-65.81%). Moreover, the TD terminated most commonly as a single vessel (pooled prevalence = 78.41%; 95% CI: 70.91-85.09%). However, it divides into two or more terminating branches in approximately a quarter of the cases. The pooled prevalence of the CC was found to be 55.49% (95% CI: 26.79-82.53%). Conclusions: Our meta-analysis reveals significant variability in the anatomy of the TD and CC, particularly regarding TD termination patterns. Despite the predominance of single-vessel terminations, almost a quarter of cases exhibit branching, highlighting the complexity of the anatomy of the TD. These findings demonstrate the importance of detailed anatomical knowledge for surgeons to minimize the risk of accidental injury during head and neck, as well as thoracic surgeries. Our study provides essential insights that can enhance surgical safety and efficacy, ultimately improving patient outcomes.

Increased safety in periodontal surgery: Doppler ultrasound for detection of relevant palatal blood vessels-A proof-of-concept and cross-sectional study.

To evaluate the suitability of a Doppler ultrasound probe in detecting the greater palatine artery or its greater branches non-invasively. The palatal mucosa of 108 participants (median age 34 years, 51 female) was systematically divided into transversal sectors, each aligning with the positions of the upper molars (M), premolars (P) and canine teeth (C), aiming to facilitate precise and consistent localization of the detected palatal blood vessel across different patients. Blood flow of the palatal blood vessels, presumably, was located by scanning the palatal vault bilaterally using an 8-MHz ultrasound probe linked to a transducer. The distance to the corresponding tooth was measured using a millimetre-scale periodontal probe. Within the regions of M2 to P1, the ultrasound transducer gave a delimitable acoustic pulse signal in 80%-98% of all measurements. The measured median distances between the determined position of the artery and the corresponding teeth ranged from 13 to 15 mm, with smaller distances in the anterior region. In several sectors, the distance was significantly higher for men (C: p = .048; P1: p = .041, M1: p < .01; M2: p = .034). Use of the Doppler ultrasound transducer might be a promising approach to non-invasively detect relevant palatine blood vessels preoperatively. It, therefore, might have the potential to reduce the risk of accidental injury during palatal surgery.

Effects of sensor ear tags with twin pin fixing system on health and well-being of cattle.

A sensor ear tag (SET) containing Global Positioning System (GPS), accelerometer, Radio-Frequency Identification (RFID), and Bluetooth technologies was tested for wearing comfort and compliance with animal welfare requirements in cattle in a free stall barn and on summer pasture in Switzerland. The SET was equipped with a long-lasting battery via solar panel and used a «twin pin» fixing system. Right ears of 12 newborns and 26 adolescent animals were tagged with the SET. While left ears were tagged simultaneously with official ear tags in newborns, the adolescent animals already carried the official ear tags. The newborns stayed in a free stall barn during the entire experiment, while adolescent animals were housed in a free stall barn and on pasture during summer. All animals developed crusts beginning on day 7 after tagging with the SET. Pain reactions were observed occasionally in the first two weeks. Ear growth in newborns during 11 months of observation did not differ between ears with SET and official ear tags. Cortisol concentration in saliva of newborns decreased in the first week after tagging which is physiological for this age group. In older animals cortisol concentrations in saliva were not affected. We registered 19 incidences in 11 animals with the SET, that required veterinary or staff intervention. Two animals lost the SET with ear injury. Scars due to tag migration were observed in ears of all newborns after the 9th month of observation. In conclusion, SET with a weight of 32 g that need a twin pin fixation in cows do not seem to induce systemic or local inflammations more frequently compared to official ear tags; however, the higher risk of accidental injuries and migration in ear cartilage would not meet Swiss welfare standards and the attachment to the ear needs to be improved for general use.

Assessment of Perceived Factors of Road Safety in Rural Left-Behind Children’s Independent Travel: A Case Study in Changsha, China

The disparity between urban and rural development in China has resulted in the significant migration of rural laborers to urban areas, giving rise to a growing population of left-behind children in rural areas. The number of accidental injuries among these children traveling independently is increasing, suggesting that road safety in rural areas should be of concern. This study explored factors affecting road safety for left-behind rural children traveling independently. The data were collected from a survey conducted in four villages in Changsha, China. The study used a variety of methods, including spatial syntax, linear regression analysis, Pearson correlation analysis, and stepwise regression analysis, to analyze factors affecting road safety for rural left-behind children traveling independently. The study revealed significant differences in road safety perceptions among rural left-behind children and their guardians. Road safety perceptions were significantly higher for left-behind children. Factors such as plant density, turning angle, road scale, road slope, recognizable signs, internal corner space, animal danger, enclosure type, electronic tools, monitoring facilities, strangers, and social concerns were found to be significantly related to road safety perceptions of left-behind children traveling independently. The findings suggested that left-behind children who travel independently in rural areas face a potential risk of accidental injuries. These results can be used by decision makers to improve the rural road environment and to provide useful assistance for the healthy growth of left-behind children.

Incidence of Injuries in Bhagawanpur, Siraha District, Nepal: a Door-to-Door Survey

Background: Rapid industrialization, increasing traffic hazards, and the hectic pace of modern life have exposed people to a greater risk of accidental injuries. We aimed to document the incidence of injuries in the Bhagawanpur Rural Municipality of Siraha District of Nepal and their pattern and cost of treatment. Methods: This cross-sectional study involved 12,935 participants in Bhagawanpur Rural Municipality. A door-to-door survey was conducted from June to August 2018 by face-to-face interview using a preformed semi-structured questionnaire designed for this study. The households were selected by probability proportion to size method from each ward. The variables included the number of injuries, patterns, and costs of treatment. Results: The incidence of injury was 5.3%. The majority (36.2%) belonged to the age group of 16-30 years. The fall injury occurred in 54.2% and superficial bruises affected 70% of injury. Minor injury contributed to about 89.8% and major injury was seen among 10.2% of the study participants. More than half (56%) of the individuals spent less than NPR 1500.00 for the treatment. Conclusion: The incidence of injury was 5.3% among people living in Bhagawanpur Rural Municipality of Siraha District. Most of them were young, and had minor injuries. Treatment costs for most of the injuries were less than NPR 1500.00.

Repeated irreversible electroporation in a locally advanced pancreatic cancer

It is reasonable to consider the technical possibility and oncological feasibility of the local tumor destruction in patients with locally advanced pancreatic cancer (PCa). Irreversible electroporation (IRE) is a non-thermal method of local tumor ablation, which uses non-thermal energy of high-voltage ultrashort electric fields localized between electrodes to create nanopores in the cellular wall with the following cellular death. The zone of impact can be accurately predicted using the location of the electrodes. A fairly clear and controlled ablation boundary without a clinically significant zone of perifocal tissue damage reduces the risk of accidental injury to the wall of a hollow organ. The method is based on a change in the permeability of the cell membrane and the development of apoptosis, which allows to act directly on the ducts and the great vessels infiltrated by the tumor without a high risk of damage. The presented case shows that IRE is advisable to use as a part of the combined treatment of patients with locally advanced PCa. There were no complications observed after the IRE. Radiological evaluations and pathologic reports showed an adequate long-term local control. Also, good results were obtained in the overall life expectancy, given that we are talking about unresectable ductal adenocarcinoma of the pancreas. The patient passed away in 39 months from the beginning of the treatment and in 26 months from the initial IRE. In case of local relapse, repeated electroporation with a good long-term result is also possible. The time to progression exceeded eleven months after electroporation performed for a local relapse. According to magnetic resonance imaging, both locoregional relapse and distant liver metastases were detected. The patient lived 16 months after a repeated IRE session and died of pulmonary embolism on the background of chemotherapy. Favorable prognostic factors are the presence of an objective response to previous conservative treatment, compliance with the parameters of electroporation, complete inclusion of tumor infiltration in the affected area.

Economic evaluation of a vision-based patient monitoring and management system in an acute adult and an older adult mental health hospital in England

Background and aims Patients on acute adult and older adult inpatient mental health wards are at an increased risk of accidental injuries and deliberate harm to self and others. A vision-based patient monitoring and management (VBPMM) system was designed by Oxehealth Limited to support ward staff to provide better and more efficient care and to reduce incidents. The VBPMM system uses an infrared-sensitive camera, installed in a patient’s room, that works with cleared medical device software to deliver contact-free vital sign and activity insights to clinical teams. Data from two studies undertaken at an English National Health Service (NHS) mental health trust were used to inform an early economic assessment of VBPMM implementation into acute adult and older adult mental health wards. Methods A cost calculator was used to compare the introduction of the VBPMM system as an adjunct to standard care versus standard care alone. Observational data were collected at two English NHS mental health trusts. Both compared data pre- and post-VBPMM implementation using a 12-month baseline period. The model estimated cost per occupied bed day, cost per patient, annual cost per average-sized ward, and total cost to NHS mental health trusts across England. Costs were modeled from an NHS perspective over a 12-month time horizon. Scenario analysis was conducted to test the uncertainty of results using statistical significance of key inputs. Results and conclusions This early analysis indicated that the VBPMM system is likely to be cost saving within both settings examined, with an estimated cost saving of £272 per acute adult mental health patient and £4,591 per older adult mental health patient. This translates to £22.3 and £63.3 million, respectively, across NHS mental health trusts in England every year. VBPMM, therefore, has the potential to augment standard care, leading to positive clinical outcomes and monetary savings.

Screening detects clinically significant hearing loss in patients with GU malignancies.

e18624 Background: Four in 10 people aged 60-69 have hearing loss in frequencies that mediate speech comprehension. Untreated losses undermine medication adherence, increase risk for accidental injury, and generate higher total healthcare expenditures. Genitourinary (GU) malignancies are most frequently diagnosed in people over 60, and these patients are commonly exposed to ototoxic treatments like platinum-based chemotherapy. We hypothesized that a significant number of GU patients would fail hearing screenings at levels reflecting clinically significant hearing loss. Methods: This is a prospective, two-cohort pilot study conducted at Tulane Medical Center. Consecutive patients with active GU malignancies who did not use hearing aids were enrolled in cohort A. The primary objective of cohort A (screening) was to determine the prevalence of hearing loss among GU patients. Cohort B (interventional) will investigate the efficacy of a non-custom amplifier in improving communication for patients with hearing loss. The hearing screening consisted of a 9-item Self-Assessment of Communication (SAC) and a 25 decibel (dB) pure tone hearing screening at 1 kHz, 2 kHz, 4 kHz via an Earscan3 portable audiometer with headphones in a quiet exam room. The primary endpoint was the proportion of patients who failed the hearing screening (missed ≥ 2/6 tones). The SAC generates a global handicap score (none, slight, mild-to-moderate, severe). Surveys identifying any amount of handicap were considered positive. Patients who failed screenings were offered referrals to audiology. Here, we present results from cohort A. Results: From 8/21 to 1/22, 66 patients were invited to participate. Nine patients screen-failed (n = 8 hearing aids; n = 1 uninterested). Cohort A enrolled 57 patients [median age 68 (33-86); 91% men; 60% prostate, 24% kidney and 14% bladder cancer]. Most patients (82%) had evidence of metastatic disease and 12%, 19%, 36%, 21% of patients were receiving chemotherapy, immunotherapy, hormonal therapy, and no active therapy, respectively. Twenty (35%) patients had prior exposure to neurotoxic chemotherapy. Forty patients (70%) met the primary endpoint. Compared to the pure tone screening, the SAC had a specificity of 94%, and a sensitivity of 40%. The SAC asks patients for a situation where they want to hear better; 61% of patients who volunteered a scenario (17/28) identified a complex listening environment like an outpatient encounter. A minority of patients (n = 3) accepted audiology referrals after failing screenings. Cohort B is actively enrolling. Conclusions: Clinically significant hearing loss was prevalent among patients with GU malignancies. Patients reported struggling in listening situations with auditory demands like outpatient encounters but were unable to self-identify losses and did not pursue audiology referrals after failed screenings. Interventional studies addressing this unmet need are warranted.

Firearms, Physicians, Families, and Kids: Finding Words that Work

Firearms, Physicians, Families, and Kids: Finding Words that Work

The effect of simulation-based education before a cadaver dissection course.

Although the methods for medical education continue to evolve due to the development of medicines, the cadaver dissection course still plays a fundamental role. The cadaver dissection course allows students to learn to handle instruments correctly while actively exploring three-dimensional anatomy. However, dissection comes with the risk of accidental injury. In recent years, the number of classes offered for the cadaver dissection course has decreased while the amount of knowledge required in clinical medicine has increased. Simulation-based education (SBE) has been proven to be an effective educational method that enhances the development of practical skills by integrating learners' knowledge and skills. This study aimed to investigate the effect of SBE as a preparatory education course when taken prior to a medical student's enrollment in the cadaver dissection course. In the present study, an SBE assuming practical cadaver dissection course was performed in the Clinical Simulation Center. The frequency of injury rates per 1000h of cadaver dissection course was significantly less in 2017 and 2018 compared to that in 2016. Two years after the implementation of the SBE, average student self-efficacy scores and written examination scores significantly increased, whereas self-contentment scores were relatively unchanged. The results showed that the implementation of SBE decreased the incidence of injuries and improved students' overall self-efficacy scores and increased acquisition of knowledge evident on written examination score. Therefore, SBE as a preparatory education course may effectively promote the combined development of dissection skills and anatomical knowledge in the subsequent fundamental cadaver dissection course.

Exploring the Role of PPE Knowledge, Attitude, and Correct Practices in Safety Outcomes on Construction Sites

Despite alarming injury and fatality rates, construction workers continue to neglect the appropriate use of personal protective equipment (PPE). This research explores safety outcomes concerning knowledge, attitude, and practice in PPE use on Trinidad's construction sites. A questionnaire survey of 100 respondents and 20 interviews with site workers revealed that knowledge of action and attitude were better predictors than practice on the propensity of construction workers to be involved in near-misses and accidents. The research explains why there were no significant differences between safe work practices and the occurrence of near-misses or accidents. In addition, it was found that workers' attitudes toward PPE use were not mediated by on-site experience, but they were more related to their age and if they believed their safety was the responsibility of their supervisor. The research concludes that knowledge of action varied among educational groups; however, there was no significant difference between PPE training and workers with knowledge of PPE usage and calls for changes in the current educational program content and delivery. This research identifies accident causation factors and recommends measures for construction companies to achieve improved safety performance and reduce the risk of accidental injury or death.

The Sting of Sharp Objects: Low Risk for Kids, but Little Community Awareness: Laboratories and hospitals have well-defined approaches for needlestick and scalpel injuries, but fewer protocols and less education in community settings may contribute to improper disposal and heightened fears.

The Sting of Sharp Objects: Low Risk for Kids, but Little Community Awareness: Laboratories and hospitals have well-defined approaches for needlestick and scalpel injuries, but fewer protocols and less education in community settings may contribute to improper disposal and heightened fears.

Anatomic relationship between S2 sacroiliac screws' entry points and pelvic external branches of superior gluteal artery.

To study the relationship between the pelvic external branches of the superior gluteal artery and the entry area of the S2 sacroiliac screw to provide the anatomical basis and technical reference for avoiding the superior gluteal artery injury during the clinical screw placement. CTA imaging of superior gluteal artery of 74 healthy adults (37 males and 37 females) was randomly selected. The safe bony entry area ('safe area' for abbreviation) of S2 sacroiliac screw in the standard lateral view of the pelvis three-dimensional reconstruction CT image was determined by the CT auxiliary measurement software. The relationship between the pelvic external branches of the superior gluteal artery and the safe area of S2 sacroiliac screw was observed, and the cases in which the artery intersected the safe area were counted. The distance between the safe area and the superior gluteal artery branches closest to it was measured for the cases in which the artery and the safe area did not intersect. 21 of the 74 cases did not have a bone channel of horizontal S2 sacroiliac screw, so they were excluded from this study. In the remaining 53 cases, 12 cases had the deep superior branch of the superior gluteal artery through the safe area of S2 screw (22.6%), and 16 cases had the superficial branch of the superior gluteal artery through the safe area of S2 screw (30.2%). There was no obvious overlap feature and law between the safe area and the superficial and deep superior branches. In 20 cases of the 53 cases, the safe area of S2 screw was located between the deep superior branch and the superficial branch of superior gluteal artery (37.7%), and in 5 cases, the safe area of S2 screw was located behind the superficial branch of superior gluteal artery (9.4%). In the cases where the superior gluteal artery did not intersect the screw entry bony safe area, the part of superior gluteal artery closest to the safe area was located in front or back of the widest part of the safe area. The risk of accidental injury of the deep superior branch and superficial branch of the superior gluteal artery is high during the process of S2 sacroiliac screw placement. Even if the screw entry point is located in the bony safe area, the absolute safety of screw placement cannot be guaranteed. We strongly suggest that a careful and thorough plan is needed before surgery.

Seizures, accidental injuries at work, and reasons for resignation in people with epilepsy

ObjectiveFew studies have examined seizures, accidental injuries at work, and reasons for resignation in people with epilepsy (PWE). We performed a questionnaire survey of PWE to identify the risk of injury at work, its relationship to different seizure characteristics, and reasons for resignation. MethodsWe distributed a questionnaire survey in the outpatient clinic of a single epilepsy center. Medical information was obtained retrospectively from medical records. ResultsOf 200 patients who received the questionnaire, 172 responded. Two-fifths of PWE had experienced seizures at work, but the risk of accidental injuries due to epileptic seizures was only 0.01 person/year (1.0%) and 0.018 injuries/year, whereas the risk of accidental injuries not related to seizures was 0.039 person/year (3.9%) and 0.083 injuries/year. All accidental injuries due to seizures at work were caused by seizures characterized by a fall and inappropriate behavior with impaired awareness. Most accidental injuries due to seizures at work were caused by seizures that occurred at least once a year. The types of injuries reported were bruising, abrasion, laceration, fracture, burn, and submersion injuries. A quarter of PWE had left previous jobs because of epilepsy, of these, about four-fifths reported that seizures at the workplace had interfered with their own or others' tasks. SignificanceThe risk of seizure-related injury is not high compared to the risk of injury not related to seizures, and most injuries due to seizures are not severe. The features of seizures with a fall, impaired awareness, and inappropriate behavior, as well as seizure frequency, should be considered when evaluating the risks associated with seizures in the workplace. Most PWE who had left their previous job because of epilepsy had experienced seizures at the workplace interfering with their own or others' tasks.

Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana'a, Yemen: Cross-Sectional Study.

BackgroundLaboratory staff handling blood or biological samples are at risk for accidental injury or exposure to blood-borne pathogens. Hepatitis B virus (HBV) vaccinations for laboratory staff can minimize these risks.ObjectiveThe aims of this study were to determine the prevalence of occupational exposure to needle stick injuries (NSIs) and assess HBV vaccination coverage among clinical laboratory staff in Sana’a, Yemen.MethodsA cross-sectional survey was conducted among clinical laboratory staff who were involved in handling and processing laboratory samples at the main public and private clinical laboratories in Sana’a. Data collection was done using a semistructured questionnaire. The questionnaire was divided into 3 parts. Part 1 included information on sociodemographic characteristics of participants. Part 2 included information on the availability of the personal protective equipment in the laboratories, such as lab coats and gloves. Part 3 included questions about the history of injury during work in the laboratory and the vaccination status for HBV.ResultsA total of 219/362 (60%) participants had been accidentally injured while working in the laboratory. Of those, 14.6% (32/219) had been injured during the last 3 months preceding the data collection. Receiving the biosafety manual was significantly associated with lower risk of injury. Out of those who were injured, 54.8% (120/219) had received first aid. About three-quarters of respondents reported that they had been vaccinated against HBV. The vaccination against HBV was significantly higher among laboratory staff who were working at private laboratories (P=.01), who had postgraduate degrees (P=.005), and who received the biosafety manual (P=.03).ConclusionsOccupational exposure to NSI is still a major problem among laboratory staff in public and private laboratories in Sana’a, Yemen. The high incidence of injuries among laboratory staff and the low rate of receiving first aid in laboratories combined with low vaccination coverage indicates that all laboratory staff are at risk of exposure to HBV. Therefore, strengthening supervision, legalizing HBV vaccinations for all laboratory staff, and optimizing laboratory practices regarding the management of sharps can minimize risks and prerequisites in Yemen.

Shave Biopsy Instrument: An Ergonomic Modification of Razor Blade.

The razor blade has been used by dermatologists as an alternative tool for performing shave excision and biopsy owing to its superior sharpness and flexibility. It is inexpensive and freely available but the bare blade design carries the risk of accidental injury to the operator and patient. We describe an easy modification of the razor blade for better grip, control, and safety in obtaining cutaneous shave specimens.

Improving Access to Safe Anesthetic Care in Rural and Remote Communities in Affluent Countries.

Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions. The current landscape of anesthesia providers and their training is described. We also explore innovative strategies and emerging technologies that could better support physician-led anesthesia care teams working in rural and remote areas. Ultimately, we believe that it is the responsibility of specialist anesthesiologists and academic health sciences centers to facilitate access to high-quality care through partnership with other stakeholders. Professional medical organizations also play an important role in ensuring the quality of care and continuing professional development. Enhanced collaboration between academic anesthesiologists and other stakeholders is required to meet the challenge issued by the World Health Organization to ensure access to essential anesthesia and surgical services for all.

Light-based home-use devices for hair removal: Why do they work and how effective they are?

This review has the following objectives: Firstly, it provides an explanation of the evolution of laser/intense pulsed light (IPL) hair reduction modalities from high fluence professional devices to low fluence home-use appliances. Secondly, it summarises published literature reviews on home-use devices (HUDs) as evidence of their growing credibility. Thirdly, it proposes mechanistic differences in light delivery regimes and the resulting divergences in mode of action. An extensive literature search was performed to review the progress of laser/IPL-induced hair reduction and determine what evidence is available to explain the mode of action of professional and HUDs for hair removal. Establishing the likely biological mode of action of professional high-fluence systems versus home-use low-fluence appliances was performed by combining data obtained using ex vivo hair follicle (HF) organ culture and the clinical results involving human participants. Significant basic science and clinical evidence has been published to confirm the clinical efficacy and technical safety of many laser and IPL home-use devices for hair removal. Clearly, HUDs are different compared to professional systems both in terms of fluence per pulse and in terms of biological mechanisms underlying hair removal. Here we presented data showing that a single low fluence pulse of both 810 nm laser (6.6 J/cm2 , 16 ms) and IPL (9 J/cm2 , 15 ms and 6.8 J/cm2 , 1.9 ms) leads to induction of catagen transition. Catagen transition was characterized by morphological changes similar to what occurs in vivo with occasional detection of apoptosis in the dermal papilla and outer root sheath cells. This suggests that high hair reduction can be expected in vivo and longer-term treatment might result in HF miniaturization due to a cumulative effect on the dermal papilla and outer root sheath cells. In line with this hypothesis, in this review we demonstrate that long-term application of a commercially-available home-use IPL appliance resulted in persistent hair reduction (80%) one year after last treatment. These data are in line with what was previously reported in the literature, where clinical studies with home-use IPL appliances demonstrated high efficacy of hair reduction on female legs, armpits and bikini zones, with full hair regrowth after four treatments following cessation of IPL administration. Limitations of HUDs include lack of hair clearance for very dark skin types and low speed of treatment compared with professional devices. Numerous uncontrolled and controlled clinical efficacy studies and technical safety investigations on consumer-use appliances support many of the leading manufacturers' claims. Manufacturers make consumer appliances safe and easy to use by considering "human factors," needs and capabilities of a variety of users. Safety is of primary concern to manufacturers, regulators and standards bodies as these appliances may be accessible to children or their use attempted on unsuitable skin types without full awareness of potential side effects. Consumer cosmetic appliances are provided with warnings and obvious safety notices describing the nature of any ocular or dermal hazard and precautions for reducing risk of accidental injury, infection, etc. HUDs employing optical energy are provided with design and engineering controls such as safety switches, alarms and sensors to prevent their incorrect operation or eye exposure. In-vivo studies demonstrated that low fluence home-use hair removal devices can result in high hair reduction efficacy after a short treatment regime, while prolonged and less frequent (once in six weeks) maintenance treatment over a year can lead to high and sustained hair reduction even one year after cessation of treatment. Home-use hair removal devices can be a useful adjunct to professional in-office treatments with high professional awareness. There are sufficient positive arguments for practitioners to make the case to patients for HUDs as "companion" products to professional treatments. In addition, devices for hair removal can be used effectively as stand-alone products by the consumer if they are willing to adopt a regime of regular or frequent use. Further clinical studies involving dynamic observation of HF cycle stage and type (terminal vs. vellus) over the total duration of treatment, for example, using biopsies or non-invasive imaging are necessary to confirm the proposed mode of action of low fluence pulses in a combination with treatment and maintenance regimes. Lasers Surg. Med. 51:481-490, 2019. © 2019 Wiley Periodicals, Inc.

Accidental injuries in patients with generalized tonic–clonic seizures. A multicenter, observational, cross-sectional study (QUIN-GTC study)

PurposePatients with epilepsy have a higher risk of accidental injuries. The aim of this study was to determine the incidence of accidental injuries and quality of life in patients with epilepsy and generalized tonic–clonic seizures and their association with patient-related factors. MethodsThis is an observational, cross-sectional, multicenter study of patients with epilepsy and primary generalized tonic–clonic seizures and/or focal to bilateral tonic–clonic seizures in the routine clinical practice of epilepsy clinics. In a single visit, demographic and clinical data and information on the type and severity of injuries were collected, and patients' quality of life was evaluated with the QOLIE-10 questionnaire. ResultsIn total, 406 patients with a median age of 41.1 years (range: 13–87) were included; 47.5% were women. Age at onset of tonic–clonic seizures was 25.4 (range: 0–83) years. Epileptic seizures were primary tonic–clonic (67.2%), focal to bilateral tonic–clonic (32.8%), focal with impairment of awareness (23.6%), focal without impairment of awareness (13.5%), absences (14.8%), and myoclonic (9.6%).Etiology was symptomatic or with unknown etiology focal (42.9%), genetic generalized (36.9%), symptomatic or with unknown etiology generalized (18.0%), and others (2.2%).The number of generalized tonic–clonic seizures in the last 12 months was as follows: 1 (41.9%), 2–5 (42.4%), and >5 (15.8%). Antiepileptic treatment at the time of the visit was monotherapy in 44.1% of the patients. The most commonly used drugs were levetiracetam (45.1%), valproate (20.7%), lamotrigine (20.0%), and perampanel (18.7%).In total, 59.6% of the patients had experienced at least one accidental injury associated with tonic–clonic seizures in the last 12 months, the most common being head injuries (35.5%), dental injuries (4.9%), burns (4.9%), and fractures (3.9%). A total of 25.1% had suffered at least one serious injury.The multiple logistic regression model showed that the factors associated with suffering an injury were the following: etiology (symptomatic or with unknown etiology focal and genetic generalized vs. symptomatic or with unknown etiology generalized, p = 0.0008 and p = 0.0077, respectively), number of seizures in the last year (2–5 vs. 1, p = 0.0115; >5 vs. 1, p = 0.0004), and psychiatric comorbidities (p = 0.0151).Patients with injuries had a worse quality of life than patients without injuries, according to the overall QOLIE-10 score (p = 0.0003). ConclusionsMore than half of the patients had accidental injuries related with seizures. Symptomatic or with unknown etiology focal epilepsy and genetic generalized epilepsy, >1 seizure in the last year, and concomitant psychiatric disease are the risk factors associated with accidental injuries in patients with tonic–clonic seizures, with the consequent worsening of quality of life.