Characteristics of Older People from a Poor Residential Environment in Okinawa, Japan: An Emergency Department-Based Cross-Sectional Study

<b><i>Background:</i></b> Evidence for what diseases occur more commonly in older people from a poor residential environment (PRE) is limited. <b><i>Objective:</i></b> We investigated characteristics, especially the underlying reason (disease) for visiting an emergency department (ED), of older people from a PRE in ED settings. <b><i>Methods:</i></b> A cross-sectional study was conducted on people aged ≥65 years who presented to the EDs of 2 hospitals in Okinawa, Japan, between 2015 and 2019. PRE cases were identified by searching relevant words, such as a house overflowing with garbage from hoarding or housing squalor (<i>gomi-yashiki</i> in Japanese), in electric medical records. Controls (2 controls per case) were randomly selected from those without a PRE, with both living at home and matching each PRE case for age and sex. Characteristics of interest between cases and controls were compared using a χ² test. <b><i>Results:</i></b> PRE cases (<i>n</i> = 67), compared with controls (<i>n</i> = 134), were more often transported by ambulance (79.1% vs. 61.9%; <i>p</i> = 0.01). A family member or relative (43.4%) or professional supporter (20.8%) called an ambulance for most PRE cases. PRE cases were more likely to visit the ED due to injury/fracture (16.4% vs. 8.2%), rhabdomyolysis (11.9% vs. 1.5%), undernutrition/dehydration (10.4% vs. 1.5%), and cancer (9.0% vs. 5.2%) than controls (<i>p</i> &#x3c; 0.001). PRE cases had a higher prevalence of being underweight (35.4% vs. 14.9%), dementia (41.8% vs. 16.4%), decubitus ulcer (29.9% vs. 8.2%), living alone (73.1% vs. 23.1%), and receiving public welfare assistance (35.8% vs. 9.0%) than controls (all <i>p</i> ≤ 0.001). <b><i>Conclusion:</i></b> In EDs, older people from a PRE exhibited certain diseases and characteristics.

The global burden of decubitus ulcers from 1990 to 2019

There are no studies assessing the epidemiology and burden of decubitus ulcers at global, regional, and national levels. We aim to report this issue from 1990 to 2019 by extracting data from the Global Burden of Disease Study (GBD) 2019 and stratifying it by age, gender, and socio-demographic index (SDI). Globally, the number of prevalent cases of decubitus ulcers in 2019 is 0.85 (95% UI 0.78 to 0.94) million. The age-standardized rates of prevalence, incidence, and years lived with disability (YLDs) in 2019 are 11.3 (95% UI 10.2 to 12.5), 41.8 (37.8 to 46.2), and 1.7 (1.2 to 2.2) per 100,000 population, and compared with 1990, it has decreased by 10.6% (95% UI 8.7% to 12.3%), 10.2% (8.2 to 11.9%), and 10.4% (8.1 to 12.5%), respectively. In addition, the global prevalence rate of decubitus ulcers increases with age, peaking at the > 95 age group among men and women. At the regional and national levels, we observe a positive correlation between age-standardized YLDs and SDI. Malaysia, Saudi Arabia, and Thailand experienced the most significant increases in age-standardized prevalence rates at the national level. Finally, we concluded that the age-standardized prevalence, incidence, and YLDs rates of decubitus ulcer declined from 1990 to 2019, with significant regional differences. In order to monitor the dynamic changes of decubitus ulcers burden, it is recommended to improve the quality of decubitus ulcer health data in all regions and countries.

Breast Cancer Treatment in a Patient with Decubitus Ulcer Infection Secondary to Spina Bifida: Surgical Resection versus Neoadjuvant Chemotherapy

Spina bifida (SB) is a congenital neural tube defect that often presents with neurological disability and decubitus ulcers. A 66-year-old woman with SB presented to our hospital with decubitus ulcers and was treated by a plastic surgeon. She was referred to our department because of a mass measuring 5 × 4 cm in the superolateral quadrant of the right breast. The size of the right axillary lymph node (LN) was 2 × 1 cm. A core-needle biopsy revealed an invasive ductal carcinoma. Total mastectomy and axillary LN dissection were planned. However, 2 days prior to surgery, the size of the mass and the LN rapidly increased to 7 × 4 cm and 3 × 2 cm, respectively. Furthermore, the enlarged LN was close to the thoracodorsal artery. Since complete resection was difficult, neoadjuvant chemotherapy was also administered. On day 11 of neoadjuvant chemotherapy, the patient was febrile and developed a decubitus ulcer infection at the buttock. The neutrophil count was within normal limits; thus, she was not diagnosed with febrile neutropenia. Follow-up computed tomography revealed a shrinking of the mass to 5 × 4 cm after the first cycle of neoadjuvant chemotherapy. After 17 days of antibiotic therapy and drainage, total mastectomy and axillary LN dissection were performed. Due to the risk of recurrence of infection, adjuvant chemotherapy was discontinued and hormone therapy was initiated. In conclusion, indications for chemotherapy should be carefully evaluated in SB patients with lower limb paralysis and decubitus ulcers.

Clinical Correlations Delirium and other Comorbid in Elderly with COVID-19 Infection

Background. Delirium is a common condition in geriatric patients. One of the trigger factors for this condition is an infection, such as COVID-19 infection. Elderly with COVID-19 show atypical symptoms such as delirium. Elderly patients with COVID-19 who present with delirium, either as a primary symptom or showing symptoms or signs, have a poor prognosis. This study were aimed to presents covid-19 elderly patient with comorbid delirium. Case presentation. A 77-year-old woman with disorientation for one day came to Emergency Department with her family. She had no history of headaches, blurred vision, or seizures. However, she had a fever, did not want to eat for three days, and had a purulent decubitus ulcer. The patient was diagnosed with acute delirium syndrome, confirmed COVID-19 with sepsis, malnutrition, hypercoagulation, grade III decubitus ulcer, suspected dementia, immobilization, total dependence. The patient admitted to the isolation ward. The patient had meropenem 500 mg every 12 hours, anticoagulants and favipiravir according to the dose and parenteral nutrition. Conclusion. Patients with COVID-19 who present with delirium, either as a primary symptom or presenting symptoms or signs, have a worse outcome. Delirium relationship with comorbid factors can increase mortality and morbidity in the elderly with COVID-19.

Clinical Correlations Delirium and other Comorbid in Elderly with COVID-19 Infection

Background. Delirium is a common condition in geriatric patients. One of the trigger factors for this condition is an infection, such as COVID-19 infection. Elderly with COVID-19 show atypical symptoms such as delirium. Elderly patients with COVID-19 who present with delirium, either as a primary symptom or showing symptoms or signs, have a poor prognosis. This study were aimed to presents covid-19 elderly patient with comorbid delirium. Case presentation. A 77-year-old woman with disorientation for one day came to Emergency Department with her family. She had no history of headaches, blurred vision, or seizures. However, she had a fever, did not want to eat for three days, and had a purulent decubitus ulcer. The patient was diagnosed with acute delirium syndrome, confirmed COVID-19 with sepsis, malnutrition, hypercoagulation, grade III decubitus ulcer, suspected dementia, immobilization, total dependence. The patient admitted to the isolation ward. The patient had meropenem 500 mg every 12 hours, anticoagulants and favipiravir according to the dose and parenteral nutrition. Conclusion. Patients with COVID-19 who present with delirium, either as a primary symptom or presenting symptoms or signs, have a worse outcome. Delirium relationship with comorbid factors can increase mortality and morbidity in the elderly with COVID-19.

Prevalence and Pattern of Diseases of The Skin and Subcutaneous Tissue in A Primary Care Area in Thailand

Objective: Information on the population-based prevalence study of skin diseases is still lacking. The study explores the prevalence and pattern of diagnosed skin diseases of the population in a primary care area of a university hospital in Thailand.Materials and Methods: Skin disease patients were identified using the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes (L00-L99). Retrospective data were obtained from the hospital electronic medical record between 2015-2019. The number of clinic visits and the number of skin disease diagnoses were counted. The five-year period prevalence was calculated by dividing the number of cases by the population in the primary care area.Results: During the five-year period, in a population of 29,969, we found 3,770 patients (12.6% of 29,969 population) who made 7,433 outpatient visits with the diagnoses of skin diseases. Infections of the skin and subcutaneous tissues were the most common (37.3%), followed by dermatitis (29.7%), urticaria and erythema (13.9%), other disorders of the skin and subcutaneous tissue (8.6%), and papulosquamous disorders (1.7%). The five-year period prevalence of skin diseases per 100,000 persons was as following: cellulitis (2,296), urticaria (1,682), psoriasis (177), atopic dermatitis (420), seborrheic dermatitis (227), alopecia areata (50), vitiligo (23), and pemphigus (10).Conclusion: Infection and dermatitis were the two most common skin diseases in the primary care area population. Atopic dermatitis, psoriasis, seborrheic dermatitis, and decubitus ulcer were less commonly found. Our prevalence data should be the “at least” prevalence of skin diseases due to possible underreporting.

Clinical Correlation Analysis of Complications in Elderly Patients with Sequelae of Stroke with Different Barthel Index in Tianjin Emergency Department

Objective. The Barthel index (BI) is the most commonly used measure of poststroke disability. The purpose of this article is to explore the different complications and severity of the sequelae of elderly stroke patients with different BI in the emergency department, so as to provide a theoretical basis for strengthening the treatment of elderly patients with stroke sequelae. Methods. A retrospective study was adopted, and 1896 patients were divided into two groups according to the BI: 823 patients in the bedridden group ( BI ≤ 40 points ) and 1073 patients in the nonbedridden group ( BI > 40 points ). The type and number of complications and APACHE II score were compared between the two groups. Results. Compared with the two groups, pneumonia, renal insufficiency, respiratory failure, and decubitus ulcer in the bedridden group had a higher incidence, but the incidence of upper gastrointestinal bleeding and fractures in the nonbedridden group was significantly higher ( P < 0.05 ). The APACHE II score of the patients in the bedridden group was higher than that of the nonbedridden group, and they were critical ( P < 0.001 ). And the number of complications was higher than that in the nonbedridden group. Moreover, the BI was negatively correlated with the APACHE-II score and the number of complications, and the APACHE II score was positively correlated with the number of complications ( P < 0.001 ). Conclusion. Different complications and severity of illness occur in elderly patients with sequelae of stroke after different BI in the emergency department.

Katupila (Securinega leucopyrus) A Boon for Bedsore- A Case Report

Pressure ulcer is a sequel of tissue necrosis and ulceration due to prolonged pressure. External pressure of more than 30 mmHg on the skin leads to ischemia (reduced blood flow) causing ischeohypoxia, necrosis and ulceration. It is more common between bony prominence and an external surface. It may be due to impaired blood supply, defective nutrition and neurological deficit. Ayurveda describes this type of non-healing ulcer in terms of <em>Dusta vrana</em>, in that context <em>Acharya Sushruta</em> had also mentioned it as “<em>Dirghakalanubandhi</em>” which suggests that these kind of ulcers take longer time to heal due to underlying reasons. This article is about the single case report of a 51-year-old male patient with a stage 3 decubitus ulcer over the right heel since 2 months. As decubitus ulcers especially of stage 3 is difficult to cure, ayurvedic management with internal medication and external therapy was performed in this reported case. For Internal medication, Tablet septilin (A Patent medicine of Himalaya pharmacy, India) and <em>Punarnavadi kashay</em> (A Patent medicine of Vaidhyaratnam pharmacy, India) was used for enhancement of better wound healing. For external application Paste Katupila and honey was applied for 30 days. According to the assessment, wound showed good response within 10 days and was completely healed in 30 days.