High rates of suicide and attempted suicide using pesticides in Nickerie, Suriname, South America

Suicide and attempted suicide are identified as a serious mental health problem in Suriname, especially in the district of Nickerie. An epidemiological study in the Nickerie catchment area revealed high rates of suicide (48 per 100,000) and attempted suicide (207 per 100,000) on average in the years 2000–2004. Particularly remarkable is the high number of attempted suicides among males (49%), and the use of pesticides in both fatal (55%) and nonfatal suicidal behavior (44%). Probably this high incidence of suicidal behavior reflects the very poor economic situation of the district, poverty of most of the population, high levels of alcohol misuse, domestic violence, the rigidity of Hindustani culture regarding family traditions, the accessibility of pesticides, and the lack of future perspectives. Health care alone will not be sufficient to tackle this problem. One of the most urgent measures to prevent suicides is to stow away pesticides in locked cabinets with the key held by the proprietor

Quality of life in extended endonasal approaches for skull base tumours

Objective: To assess the quality of life (QOL) impact of extended endonasal approaches and nasoseptal flap reconstruction for benign skull base tumours Methods: A random sample of 110 patients undergoing either limited endonasal transphenoidal hypophysectomy or extended endonasal approaches (trans-cribriform, trans-sellar, trans-tuberculum, trans-pterygoid) for the removal of benign skull base tumours were asked to complete Rhinosinusitis Outcome Measure (RSOM-31) questionnaire. Results: A total of 91 patients returned the completed questionnaire. All patients in the limited approach group had pituitary adenomas, while patients in the extended group had a variety of tumours including adenomas with suprasellar or cavernous extension, chordomas, meningiomas, craniopharyngiomas and dermoids. Median time to completion of questionnaire was 1104 days in the limited group and 142 days in the extended approaches group. Although smell and headache were significantly worse in the group undergcing reconstruction with Haddad flap, there was no significant difference in overall, nasal, general, emotional or sleep quality of life between the two groups. Both smell and headache showed significant improvement with time. In linear regression, the single most important factor independently associated with overall worse RSOM-31 total scores was the presence of secreting adenomas. Conclusion: The use of nasoseptal flap appears to have a limited negative impact in nasal quality of life, mainly related to headache and reduced smell, both of which tend to improve with time. Hormone-secreting tumours have the most important adverse effect in quality of life extending in general, emotional, sleep and overall wellbeing, as reflected in RSOM 31 subscale

Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care.

The Netherlands Armed Forces use -80°C frozen red blood cells (RBCs), plasma and platelets combined with regular liquid stored RBCs, for the treatment of (military) casualties in Medical Treatment Facilities abroad. Our objective was to assess and compare the use of -80°C frozen blood products in combination with the different transfusion protocols and their effect on the outcome of trauma casualties.Hemovigilance and combat casualties data from Afghanistan 2006-2010 for 272 (military) trauma casualties with or without massive transfusions (MT: ≥6 RBC/24hr, N = 82 and non-MT: 1-5 RBC/24hr, N = 190) were analyzed retrospectively. In November 2007, a massive transfusion protocol (MTP; 4:3:1 RBC:Plasma:Platelets) for ATLS® class III/IV hemorrhage was introduced in military theatre. Blood product use, injury severity and mortality were assessed pre- and post-introduction of the MTP. Data were compared to civilian and military trauma studies to assess effectiveness of the frozen blood products and MTP.No ABO incompatible blood products were transfused and only 1 mild transfusion reaction was observed with 3,060 transfused products. In hospital mortality decreased post-MTP for MT patients from 44% to 14% (P = 0.005) and for non-MT patients from 12.7% to 5.9% (P = 0.139). Average 24-hour RBC, plasma and platelet ratios were comparable and accompanying 24-hour mortality rates were low compared to studies that used similar numbers of liquid stored (and on site donated) blood products.This report describes for the first time that the combination of -80°C frozen platelets, plasma and red cells is safe and at least as effective as standard blood products in the treatment of (military) trauma casualties. Frozen blood can save the lives of casualties of armed conflict without the need for in-theatre blood collection. These results may also contribute to solutions for logistic problems in civilian blood supply in remote areas

Introduction of TDFP, effect on blood product use and accompanying survival.

<p><i>TDFP</i> indicates thawed deep frozen plasma, <i>MT</i>: massive transfusion, <i>MTP</i>: Massive Transfusion Protocol, <i>RBC</i>: red blood cell, <i>DTC</i>: deep frozen thrombocyte concentrate, <i>pts</i>: patients.</p> <p><u>Upper panel</u>: <i>red</i> = RBC; <i>yellow</i> = frozen plasma; <i>blue</i> = frozen platelets.</p> <p><u>Middle panel</u>: <i>yellow</i>: (plasma + plasma of DTC):RBC ≥1:1.5, <i>blue</i>: DTC:RBC ≥1:5.</p> <p><u>Lower panel left</u>: <i>yellow</i>: (plasma + plasma of DTC)/RBC, <i>blue</i>: DTC/RBC, <i>circles</i>: MT pts, <i>squares</i>: non-MT pts.</p> <p><u>Lower panel right</u>: <i>black diamonds</i>: MT pts, <i>white diamonds</i>: non-MT pts.</p> <p>Time frames during the period studied:</p> <p>pre-MTP; pre-TDFP: 08/2006–10/2007, N = 25 MT / 55 non-MT</p> <p>post-MTP; pre-TDFP: 11/2007–03/2009, N = 24 MT / 59 non-MT</p> <p>post-MTP; post-TDFP: 04/2009–10/2010, N = 33 MT / 76 non-MT.</p

Transfused casualties and product use per month at MBTK.

<p><i>MTBK</i> indicates Multinational Base Tarin Kowt, <i>RBC</i>; red blood cells, <i>MTP</i>: Massive Transfusion Protocol, <i>nr</i>: number, <i>MT</i>: massive transfusion, <i>EC</i>: Erythrocyte Concentrate.</p> <p><u>Upper panel</u>: <i>black bars</i>: nr of MT patients, <i>green bars</i>: nr non-MT patients.</p> <p><u>Middle panel</u>: <i>orange</i>: sum of thawed deglycerolized RBC units, <i>purple</i>: sum of EC units.</p> <p><u>Lower panel</u>: <i>yellow</i>: sum of frozen plasma units, <i>blue</i>: sum of (plasma of) frozen platelets units.</p

Transfusion, injury and outcome of MT and non-MT patients, pre- and post-MTP.

<p><i>MT</i> indicates massive transfusion, <i>MTP</i>: Massive Transfusion Protocol, <i>RBC</i>: red blood cells; <i>Plasma</i>: frozen plasma; <i>PLT</i>: frozen platelets. <i>clear bars</i>: pre-MTP, <i>padded bars</i>: post-MTP, *: significantly different compared to pre-MTP.</p

Effect of additional selection criteria on mortality statistics.

<p>Effect of additional selection criteria on mortality statistics.</p

General Patient demographics.

<p>General Patient demographics.</p