Fulminant necrotizing fasciitis due to Vibrio parahaemolyticus.

Necrotizing soft-tissue infection due to Vibrio parahaemolyticus is unusual. We report a case of necrotizing fasciitis due to V. parahaemolyticus in a 92-year-old woman with a history of chronic renal failure, diabetes mellitus and malnutrition. Clinical evolution was fulminant and the patient died 6 h after admission. A review of all cases previously reported showed that the infection occurred in patients with underlying diseases through ingestion of raw oysters or inoculation via traumatic injury in marine environments. The mortality rate of all reviewed cases was 42.8 %. In conclusion, V. parahaemolyticus should be considered a possible causative agent of necrotizing fasciitis, especially in patients with underlying disease. Early diagnosis and prompt aggressive debridement associated with antibiotic therapy are essential in order to save the patient's life, because clinical evolution can be fulminant and mortality rates are high.

Unidad de observación de urgencias para pacientes geriátricos: beneficios clínicos y asistenciales / Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits

Introducción Evaluar el impacto asistencial de la creación de una unidad de observación de urgencias para pacientes ancianos dependiente de un servicio de geriatría en un hospital general.Material y métodos Estudio descriptivo y prospectivo de los pacientes ingresados en la unidad de observación de urgencias para geriatría durante el año 2006.Resultados Se valoraron 749 pacientes que permanecieron en la unidad una media (desviación estándar) de 37 (16) h. La edad media fue de 86 (7) años, el 57% eran mujeres, la mitad presentaba deterioro físico y deterioro cognitivo moderado a grave. El 35% procedía de residencias de ancianos. El motivo de ingreso más frecuente fue enfermedad cardiorrespiratoria crónica reagudizada. Se detectaron múltiples síndromes geriátricos, los más frecuentes fueron inmovilidad, lesiones cutáneas por presión y trastornos conductuales asociados a demencia. Al 70% de los pacientes se les dio alta a domicilio habitual después de que se los estabilizó para su seguimiento en las consultas de geriatría y en el hospital de día (39%), en atención geriátrica domiciliaria (11%) o por su médico de atención primaria o de residencia (20%). En el mes posterior reingresó el 17% y falleció el 7,7%, sobre todo los pacientes que tenían mayor edad y deterioro funcional. Tras el inicio de la unidad se observó una disminución del porcentaje de ingresos en la unidad geriátrica de agudos del 18,2%. Conclusiones Las unidades de observación de urgencias para pacientes ancianos pueden ser adecuadas al nivel asistencial para valoración geriátrica y tratamiento de reagudizaciones de enfermedades crónicas, lo que puede contribuir al ahorro de estancias hospitalarias y a la optimización de la atención en otros niveles asistenciales geriátricos, ambulatorios y domiciliarios (AU)

Introduction To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. Material and methods We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006.Results A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. ConclusionsMedical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings(AU)

[Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits]. / Unidad de observación de urgencias para pacientes geriátricos: beneficios clínicos y asistenciales.

INTRODUCTION: To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. MATERIAL AND METHODS: We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006. RESULTS: A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. CONCLUSIONS: Medical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings.