Neck Abscess Due to Pocket Shot: Is It Just the Tip of the Iceberg?

A 45-year-old Caucasian male presented to the emergency department for pain and swelling on the left side of his neck for the past 10 days. His medical history revealed that he was an intravenous (IV) drug abuser. Physical examination demonstrated a 5×5 cm red, swollen bump with a positive fluctuation on the left supraclavicular area concerning for an abscess. Fluid aspiration from the abscess was performed, and three sets of blood cultures were obtained, which later all came back positive for methicillin-resistant Staphylococcus aureus (MRSA). His initial blood tests revealed elevated levels of platelets, leukocytes, and C-reactive protein (CRP) and anemia. The computed tomography (CT) scan showed an enlarged pectoralis major with the presence of air. The retrosternal, infraclavicular, and supraclavicular regions also contained air. The clinical diagnosis was therefore supported by the laboratory results and imaging. Additionally, transthoracic echocardiography showed no vegetations, and transesophageal echocardiography was scheduled. Antibacterial treatment was initiated empirically from the emergency room with meropenem and vancomycin, planned for four weeks. Repeat cultures were obtained for the following three days, which were all negative. However, the patient left the hospital against medical advice and did not complete his antibiotic treatment. The risk of a peripherally inserted central catheter (PICC) line being misused for illegal narcotics was considered too high; hence, it was not recommended for continued IV antibiotic therapy at home. Those with a history of intravenous drug use, after using the most accessible injection sites, oftentimes resort to finding alternative and potentially more dangerous injection sites. The major veins of the neck, such as the jugular, subclavian, or brachiocephalic veins, are commonly used. This technique is referred to as a "pocket shot" by intravenous drug abusers (IVDAs). Apart from the apparent abscess, clinicians should oversee for other complications including underlying pus collections, pneumothorax, mediastinitis, osteomyelitis, and hemothorax.

Translation of the Pictorial Fit-Frail Scale Into the Greek Language and Examination of Its Validity and Reliability.

BACKGROUND: For the evaluation of frailty, a great variety of research tools are used internationally; however, only two have been translated and validated in Greek. The aim of the study was to translate the Pictorial Fit-Frail Scale (PFFS) into the Greek language and examine its validity and reliability. METHODS: Initially, the PFFS scale was translated into the Greek language through a six-step process. Subsequently, in a sample of 157 elderly patients (47.1% women), construct validity was examined with the known-groups method using the one-way ANOVA test and criterion concurrent validity by comparison with the Clinical Frailty Scale (CFS) using Pearson's correlation coefficient. Finally, inter-rater reliability and test-retest reliability were checked using the intraclass correlation coefficient. RESULTS: A comparison of known groups showed that older patients with greater dependence on activities of daily living, greater impairment of cognitive function, reduced mobility, balance, and swallowing disorders, as well as those who were socially withdrawn, scored higher on the PFFS scale, supporting the construct validity. The positive correlation between PFFS and CFS (r = 0.625, p ≤ 0.001) demonstrated the concurrent criterion validity of the PFFS scale. Intraclass correlation was excellent for both inter-rater reliability (0.951 (95% CI: 0.934-0.964)) and test-retest reliability (0.948 (95% CI: 0.930-0.962)). CONCLUSION: The translated PFFS scale in Greek is a valid and reliable tool.

Factors associated with health-related quality of life of informal caregivers of older patients and the mediating role of subjective caregivers' burden.

BACKGROUND: Caregiving has been associated with increased subjective burden and decreased health-related quality of life (HRQOL) for caregivers. The aim of the study was to clarify the precise relationship between caregivers' burden, caregivers' HRQOL, and other risk factors, considering that subjective burden was a risk factor for poor HRQOL, which may also mediate the effects of some known risk factors. METHODS: In this cross-sectional study, patients' and their informal caregivers' characteristics were recorded for 311 patient-caregiver dyads. Subjective caregiver burden and caregivers' HRQOL were assessed using the Zarit Burden Interview and the 12-item Short-Form Health Survey (SF-12), respectively. Mediation analysis was used to examine the relationships between variables. Caregivers' mental component summary (MCS) and physical component summary (PCS) scores were regarded as outcome variables, caregivers' subjective burden was considered the mediator, and patients' and caregivers' characteristics were treated as predictors. RESULTS: Caregivers' subjective burden was negatively related to both PCS and MCS of caregivers' HRQOL, after controlling for the effects of demographic and clinical variables. Moreover, significant associations, mostly indirect via caregivers' subjective burden, existed between caregivers' socio-demographic characteristics, duration of caregiving, patients' frailty status, patients' co-morbidity, and caregivers' HRQOL. CONCLUSION: Caregivers' subjective burden plays a major and mediating role on influencing caregivers' HRQOL. Our findings may direct future research and promote the implementation of interventions to reduce caregivers' burden and improve caregivers' HRQOL.