Medical Bulletin 09/ November/ 2024 - Video

A tightly tied waist cord of the underskirt (petticoat) traditionally worn under a saree, particularly in rural parts of India, may lead to what has been dubbed 'petticoat cancer,' warn doctors in the journal BMJ Case Reports after treating two women with this type of malignancy. The petticoat is usually tied very tightly around the waist with a cord. The tight cord of the petticoat often leads to dermatoses related to chronic friction and maceration, resulting in dermatitis and depigmentation. In rare cases, chronic friction may lead to the development of squamous cell carcinoma.

This phenomenon has previously been described as "saree cancer," but it is the tightness of the waist cord that's to blame, researchers point out. The first case concerned a 70 year old woman who sought medical help because of a painful skin ulcer on her right flank that she had had for 18 months and which wouldn't heal. The skin in the surrounding area had lost its pigmentation. She wore her petticoat underneath her saree which was tightly tied around her waist. A biopsy specimen revealed that she had a Marjolin ulcer, also known as squamous cell carcinoma.

The second case concerned a woman in her late 60s who had had an ulcer on her right flank that wouldn't heal for 2 years. She had worn a traditional type of saree called a 'lugda' every day for 40 years, tied very tightly around the waist without an underskirt. A biopsy specimen revealed that she too had a Marjolin ulcer. The cancer had already spread to one of the lymph nodes in her groin when she was diagnosed.

Authors recommend wearing a loose petticoat beneath the saree to ease pressure on the skin, and to wear loose clothing if skin problems develop to allow the area to heal.

Reference: Rusia K, Madke B, Kumar P, et al, Petticoat cancer: Marjolin ulcer of the waist in South Asian women (a site-specific malignancy), BMJ Case Reports CP 2024;17:e262049.

Exercise-only programmes help cut the severity of the ‘baby blues’ and the risk of major clinical depression in new mums, finds a pooled data analysis of the available evidence, published in the British Journal of Sports Medicine.

But at least 80 weekly minutes of moderate intensity exercise, such as brisk walking, water aerobics, stationary cycling, and resistance training with bands, weights, or body weight are needed to achieve the effects, the findings show.

The researchers looked for relevant studies published up to January 2024 that compared various interventions, including nothing, education, and standard care with exercise to treat depression and anxiety, 12 weeks after, and within the first 12 months of, giving birth. In all, 35 unique studies out of an initial haul of 1152, involving 4072 participants from 14 countries, were included in the systematic review.

The frequency of exercise interventions ranged from 1 to 5 days a week, lasting anything from 15 up to 90 minutes a session. They included aerobic exercise, strength training, stretching, yoga as well as combinations of these. Pooled data analysis of the study results showed that compared with no exercise, exercise-only interventions were associated with less severe symptoms of depression and anxiety after giving birth and an almost halving in the odds (45%) of developing major postpartum depression. Starting the intervention before 12 weeks had elapsed after giving birth was associated with a greater reduction in depressive symptoms than starting it later.

And the greater the exercise volume the greater was the reduction in the severity of depressive symptoms. But the minimum threshold required for achieving a moderate reduction in symptom severity was clocking up at least 80 weekly minutes of moderate intensity exercise, on at least 4 days of the week. The researchers note the considerable variability among the tools used to assess depression and anxiety outcomes in the included studies, and the fact that most of them were carried out in high income countries. Depression and anxiety can also occur together, and it’s not clear how exercise affects this combination, they add.

Reference: Deprato A, Ruchat S, Ali MU, et al, Impact of postpartum physical activity on maternal depression and anxiety: a systematic review and meta-analysis, British Journal of Sports Medicine Published Online First: 05 November 2024. doi: 10.1136/bjsports-2024-108478

A trial published in Nature Medicine that had shown how psilocybin therapy affects individuals with anorexia nervosa. In a recent study researchers explored psychedelic medicine's potential for treating one of psychiatry's most challenging conditions. This new Emerging Topic review reveals both promising outcomes and important limitations that could shape future treatment approaches.

The study published in Psychedelics, offers a unique first-hand perspective on how psilocybin treatment impacts patients with anorexia nervosa, a condition that maintains the highest mortality rate among psychiatric illnesses and has historically resisted conventional treatments.

“Our findings suggest that psilocybin may be helpful in supporting meaningful psychological change in a subset of people with anorexia nervosa,” says Dr. Stephanie Knatz Peck, lead author of the study. “What's particularly interesting is that 60% of participants reported a reduction in the importance of physical appearance, while 70% noted quality-of-life improvements and shifts in personal identity.”

Key findings from the trial include:

• 90% of participants ranked their psilocybin session among their top five most meaningful life experiences

• Four out of ten participants showed clinically significant reductions in eating disorder psychopathology

• Treatment effects were most pronounced in shape and weight concerns

• Changes in psychological outlook didn't automatically translate to weight restoration

The study employed a single 25mg dose of psilocybin combined with specialized psychological support before, during, and after administration. While the results show promise, they also highlight the complexity of treating anorexia nervosa, suggesting that psychedelic therapy might work best as part of a comprehensive treatment approach rather than a standalone intervention.

Reference: Stephanie Knatz Peck et al, Psychedelic treatment for anorexia nervosa: A first-hand view of how psilocybin treatment did and did not help, Psychedelics (2024) url.genomicpress.com/2p8c5kp3

In a recent paper published in Mayo Clinic Proceedings researchers describe clinicians must engage in “compassionate communication” as part of the treatment process. They have identified so-called “never words” that should not be said under any circumstances; offer methods for clinicians to identify their own never words; and provide more helpful language to use instead.

“Communicating the nature, purpose and intended duration of often complex treatments, and setting realistic expectations about what they offer still comes up against timeless patient experiences: fear, intense emotions, lack of medical expertise, and the sometimes unrealistic hope for cure,” researchers write. The “intense, daunting nature of these conversations” may cause clinicians to resort to learned communication habits or declarative statements.

Even a single word may scare patients and families, make them feel disempowered, and possibly negate the effectiveness of shared decision making.

“Never-words are conversation stoppers,” the researchers write. “They seize power from the very patients whose own voices are essential to making optimal decisions about their medical care.” Utilizing clinician surveys, the researchers identified never words, including:

“There is nothing else we can do.”

“She will not get better.”

“Withdrawing care.”

“Circling the drain.”

“Do you want us to do everything?”

“Fight” or “battle.”

“I don’t know why you waited so long to come in.”

“What were your other doctors doing/thinking?”

In another study specific to cancer care, clinicians were asked for words or phrases they would never use with a patient, with the top results including:

“Let’s not worry about that now.”

“You are lucky it’s only stage 2.”

“You failed chemo.”

Health care professionals can start a dialogue by inviting honest, thoughtful inquiries and responses from patients and families. “They should learn to recognize words and phrases that unintentionally frighten, offend, or diminish agency and work to reimagine their own communication,” the researchers stated. Medical groups and educators can bring attention to never words in multiple ways, the researchers said, including by integrating the discussion into courses and professional development.

Reference: Never-Words: What Not to Say to Patients With Serious Illness, Lee Adawi Awdish, Rana et al., Mayo Clinic Proceedings, Volume 99, Issue 10, 1553 - 1557