Cutaneous myiasis in skin cancer and malignant wounds: a systematic review.

BACKGROUND: Cutaneous myiasis in patients with malignant wounds or skin cancer is a rare and undesirable event with limited epidemiological data. A subregister of reports, lack of education in the population, inadequate empirical treatments, and medical underestimation are components of a public health problem that threatens patients' lives. METHODS: We conducted a systematic review of the literature of cutaneous myiasis associated with malignant wounds and skin cancer, characterizing sociodemographic variables, risk factors, clinical and histological features, and treatment. Additionally, we present a demonstrative case with the adequate taxonomic evaluation. DISCUSSION: Cutaneous myiasis is an underestimated and poorly managed infestation, which can generate severe complications in oncological patients. This is the first systematic review in the literature about this clinical scenario, which provides information to the physician and clinical researcher about the epidemiological gaps and what has been published so far. CONCLUSIONS: Findings from the current review have helped to display the sociodemographic, epidemiological, and clinical behavior of myiasis in skin cancer and malignant wounds. Its contribution to the greater tumor tissue destruction is clear; however, more studies are required. The therapeutic management in these patients is equally clarified.

Frailty, Polypharmacy, and Health Outcomes in Older Adults: The Frailty and Dependence in Albacete Study.

BACKGROUND/OBJECTIVES: To investigate if polypharmacy modifies the association between frailty and health outcomes in older adults. DESIGN: Ongoing cohort study. SETTING: Albacete City, Spain. PARTICIPANTS: A total for 773 participants, 457 women (59.1%), over age 70 years from the FRADEA Study. MEASUREMENTS: Frailty phenotype, polypharmacy considered as the chronic use of 5 or more drugs, and comorbidity were collected at the baseline visit. Participants were categorized in 6 groups according to frailty and polypharmacy, and were followed up for 5.5 years (mean 1057 days, range 1-2007). Mortality or incident disability in basic activities of daily living was considered the main outcome variable. Hospitalization and visits to the emergency department were also recorded. The adjusted association between combined frailty status and polypharmacy with outcome variables was analyzed. RESULTS: The mean age of study population was 78.5 years. In this population, we identified a 15.3% (n = 118) of frail with polypharmacy, 3.4% (n = 26) of frail without polypharmacy, 35.3% (n = 273) of prefrail with polypharmacy, 20.3% (n = 157) of prefrail without polypharmacy, 10.3% (n = 80) of nonfrail with polypharmacy, and 15.4% (n = 119) of nonfrail participants without polypharmacy. Participants with frailty and polypharmacy had a higher adjusted risk of mortality or incident disability [odds ratio (OR) 5.3; 95% confidence interval (CI) 2.3-12.5] and hospitalization (OR 2.3; 95% CI 1.2-4.4), compared with those without frailty and polypharmacy. Frail and prefrail participants with polypharmacy had a higher adjusted mortality risk compared with the nonfrail without polypharmacy, hazard ratio 5.8 (95% CI 1.9-17.5) and hazard ratio 3.1 (95% CI 1.1-9.1), respectively. CONCLUSIONS: Polypharmacy is associated with mortality, incident disability, hospitalization, and emergency department visits in frail and prefrail older adults, but not in nonfrail adults. Polypharmacy should be monitored in these patient subgroups to optimize health outcomes.