Clinical Outcomes Among Elderly People With Burns.

Burns in the elderly are a public health concern. This study aimed to analyze etiology, clinical characteristics, and independent risk factors for outcomes of burns in elderly patients. This retrospective study included elderly patients (65 years and over) admitted to a major burn unit between 2006 and 2016. Demographic data, clinical characteristics and outcomes were analyzed. One hundred and thirty patients were included. Most were female (56.2%) and the highest incidence was among those aged 75-84 years. The median burn area was 10.5%. The incidence in winter (50%) was higher (p<0.001) and flame burns predominated (p<0.001). The mortality rate was 32.3%. Independent risk factors for death were older age, larger extent burns, need for escharotomy, and cardiac disease as comorbidity. Amongst the survivors, the median length of stay was 36 days. Development of pressure sores, need for skin grafts, larger extent burns, presence of full-thickness burns, and cardiac disease were shown to be significantly associated with increased length of stay amongst survivors. Preventive measures should target women aged between 75-84 years. Flame burns occurred more frequently in winter. Prognosis is related to age, extent of burns, need for escharotomy at admission, and cardiac disease.

Les brûlures du sujet âgé représentent un problème de santé publique. Cette étude rétrospective se penche sur les étiologies, les caractéristiques et l'évolution de cette pathologie. Elle concerne les 130 personnes de 65 ans et au-delà hospitalisés dans un CTB entre 2006 et 2016. Leur majorité (56,2%) étaient des femmes et la décennie 75-84 ans était la plus représentée. La surface touchée médiane était de 10,5%, les brûlures par flamme prédominaient (p<0,001) et il existait un pic hivernal (50% des brûlures, p<0,001). Les facteurs indépendants de mauvais pronostic étaient l'accroissement de l'âge et celui de la surface brûlée, la nécessité d'incision de décharge et les comorbidités cardiaques. La DMS médiane des survivants était de 36 jours. La survenue d'escarre, la présence de brûlure profonde (et corrélativement la nécessité de greffes), l'augmentation de la surface brûlée et l'existence d'une cardiopathie allongeaient la durée de séjour des survivants. La cible préférentielle des mesures préventive apparaît donc être la population féminine entre 75 et 84 ans. Les brûlures surviennent plus souvent en hiver et sont plus graves quand l'âge et la surface augmente, quand une incision de décharge est nécessaire et chez les "cardiaques".

[Microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers in a Portuguese hospital]. / Caracterização do perfil microbiológico e de sensibilidade antimicrobiana dos microorganismos isolados em úlceras diabéticas de doentes de um hospital Português.

OBJECTIVES: To determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers in a Portuguese hospital. METHODS: Microbiological data from ambulatory and hospitalized patients with diabetic foot infection during the year 2010 were retrospectively analysed. The profile of the isolated organisms was identified, regarding their prevalence both in the outpatient and inpatient settings. Multidrug-resistant organisms ( MDRO ) under surveillance program at the hospital and their antibiotic susceptibility tests were analysed. RESULTS: Gram-positive aerobes were most frequently isolated ( 59.6 % ) from outpatient diabetic foot ulcers. Staphylococcus was the main genus identified ( 49.8 % ), of which 70.0 % were methicillin-sensitive Staphylococcus aureus. Considering samples obtained from hospitalized patients, Gram-negative aerobes were dominant ( 63.3 % ), mainly Pseudomonas aeruginosa ( 35.5 % ). Staphylococcus aureus represented 22.2 % of all isolates, with 60.0 % methicillin-resistance. Extended spectrum ß-lactamase production and methicillin resistance was noted in 35.0 % and 38.0 % of all bacterial isolates, respectively. High levels of resistance were also documented for Pseudomonas aeruginosa and Acinetobacter baumannii complex. CONCLUSIONS: Epidemiological differences seem to exist between the outpatient and inpatient settings concerning the microbiological profile of clinically infected diabetic foot ulcers. MDRO are prevalent in this study. Other studies are needed in order to adapt empirical therapy to the portuguese reality.

[Varicose veins of lower limbs: progress in the surgical management]. / Varizes dos membros inferiores: Progressos no tratamento cirúrgico.

Varicose veins are part of the spectrum of Chronic Venous Disease. They are very prevalent, especially among women and involve mainly the great saphenous vein.Pathogenesis of varicose veins is complex and multifactorial. There is a valvular incompetence as well as a dilation in the vein wall. However, the sequence in which these mechanisms occur is unknown. Probably the valves become incompetent secondary to vein wall abnormalities.The first description of the surgical technique used today came in the transition from the nineteenth to the twentieth century. In the last decade, the great debate evolved around the new techniques of endovascular radiofrequency and laser ablation. These follow the global trend of Medicine to use less invasive techniques.This study, besides performing a contextualization and review of concepts about varicose veins, especially intends to launch the latest data on the state-of-the-art regarding the treatment of this disease, and stands on data collected from Pubmed.It gets clear that endovascular techniques are safe and effective, besides revealing better results in terms of postoperative morbidity when compared with classic surgery. However, the last decade was marked by constant improvements in techniques, creating difficulties in interpreting data presented in trials. Furthermore, there is progressively greater difficulty in randomizing patients, given their preference for less invasive procedures over traditional surgery. New trials on the long-term efficacy in addition to detailed analysis of costs will also be crucial for the implementation of these new methods.