Actualización en fascitis necrotizante

Necrotizing fasciitis is defined as a rapidly progressive infection of the skin and soft tissue that usually involves severe systemic toxicity. The incidence of this infection has increased in the last few decades and is estimated to affect one out of every 100,000 inhabitants in western European countries. This disease is the most serious form of skin and soft tissue infection, due to rapid destruction and necrosis of the fascia and subcutaneous fat, and the development of shock and multiorgan failure in about one third of patients.Although there are several predisposing factors for the development of the disease, especially for type I, or polymicrobial, necrotizing fasciitis, many patients are young and have no underlying chronic diseases, as is the case for type II, or streptococcal, necrotizing fasciitis. The diagnosis is mainly clinical, and urgent surgical consultation is required as soon as possible once suspicion is high, as the main determinant of mortality is the delay in surgical treatment. Overall mortality remains high, affecting more than 25% of patients. Surgical debridement is the mainstay of treatment, along with hemodynamic support and broad-spectrum antibiotics.     

FACTORS THAT PROMOTE AND PREVENT PREPARATION FOR FUTURE CARE NEEDS: PERCEPTIONS OF OLDER CANADIAN,GERMAN, AND U.S. WOMEN

The risk of needing help with household tasks or of requiring care in old age increases. Using semi-structured, qualitative interviews, beliefs about the usefulness versus uselessness of planning ahead for future care needs (FCN) were investigated in 23 East German, 10 U.S., and 10 Canadian elderly-community dwelling women ( S 65 years). Primary reasons in favor of planning for FCN were: gaining a feeling of security regarding the future, avoiding being a burden to potential helpers, and coping with one's present health conditions. Factors that prevent planning for FCN were: the difficulty foreseeing FCN, the lack of resources to plan, and low levels of perceived vulnerability. The women dealt with the contradictions between these factors that promote and prevent preparation by making general plans which could be adapted in the case of needing help by developing alternative plans or by avoidance of thinking about possible future health crises.     

THE ROLE OF GENDER AND SUICIDE PRECIPITANT IN ATTITUDES TOWARD NONFATAL SUICIDAL BEHAVIOR

This study examined factors affecting young adults' attitudes about nonfatal suicidal behavior. It evaluated how respondent sex, respondent gender identity, the precipitant of the suicidal act (i.e., a relationship loss, an achievement failure, or a physical illness), and gender of the suicidal person influence reactions to a suicidal decision. In this study of nonfatal suicidal behavior, like in studies of suicide, attitudes were least negative when the suicidal act was in response to a physical illness. Men were more likely to agree with and accept the suicidal decision than women. Androgynous persons, on the other hand, tended to view the decision to kill oneself as foolish, independent of precipitant. They also reported less agreement, acceptance, and sympathy for such decision. The implications of these findings for the prevention of suicidal behaviors are considered. Because gender seems to play a role in the acceptability of suicidal behavior, prevention programs ought to explicitly examine gender issues in attitudes toward suicidal behavior.