ABSTRACT
The growth and aging of the population of Hawai'i with a high incidence of diabetes mandates a need for more effective strategies to manage the healing of complicated wounds. Maggot debridement therapy (MDT) is one alternative utilized with successful results. Observations have indicated that maggots have the ability to debride wound beds, provide anti-microbial activity and also stimulate wound healing in diabetic patients. None of the patients refused MDT due to aversion of this treatment modality and the majority of patients had minimal discomfort. In 17 of 23 patients with multiple co-morbidities, the treatment of their complex diabetic wounds by MDT resulted in improvement or cure. Maggot debridement therapy is an effective treatment of diabetic wounds.
Subject(s)
Amputation, Surgical , Diabetic Foot/therapy , Larva , Wound Healing , Wound Infection/therapy , Adult , Aged , Aged, 80 and over , Animals , Diabetic Foot/surgery , Female , Humans , Male , Middle AgedABSTRACT
Escherichia coli is a rare cause of bacterial endocarditis. We report a case of an elderly man with cirrhosis who developed bacterial endocarditis due to E.coli. We review the literature that summarizes a total of 41 cases, with a predominance of elderly women, diabetics, and patients with urinary tract infections and prosthetic heart valves. E.coli bacteremia may be mistakenly attributed to a more benign source such as urosepsis and overlooked as an indication of endocarditis. A delay in diagnosis may lead to higher mortality as the opportunity for early valve replacement in appropriate cases and more prolonged courses of antibiotics may not be considered.
Subject(s)
Endocarditis, Bacterial/diagnosis , Escherichia coli Infections/diagnosis , Heart Valve Diseases/diagnosis , Tricuspid Valve/microbiology , Heart Valve Diseases/microbiology , Humans , Male , Middle AgedABSTRACT
The growth and aging of the population of Hawaii mandates a need for more effective utilization of hospital beds. One approach is early hospital discharge and outpatient treatment. However, as the acuity of illness increases, satisfactory outcomes of outpatient treatment maybe difficult to achieve. We have utilized telemedicine to closely monitor acutely ill patients with infections, such as community-acquired pneumonia, skin and soft tissue infections, and urinary tract infection, in the home setting. Our treatment paradigm achieved satisfactory outcomes, cost savings, and at the same time resulted in more rapid convalescence than hospitalization.
