Necrotizing soft tissue infections in intravenous drug users:a vascular surgical emergency

ObjectiveTo assess the short and long-term outcomes of necrotizing soft tissue infection (NSTI) in intravenous drug users (IVDU) in a regional vascular centre.MethodsThis was a retrospective analysis of all IVDUs with NSTI admitted to the regional vascular surgical unit between January 2009 and July 2014. Clinical outcome measures were interval between admission and surgery, length of ITU/HDU and hospital stays, post-operative complications, in hospital and one year mortality.Results25 patients were admitted. The median age was 39 years (range 30–53 years) with a female to male ratio of 1:3.3. The median interval between admission and surgery was 23 hours (range 2–195 hours), however, this was significantly less when the admitting specialty was directly to vascular surgery (median 4 hours, range 2–7) compared with other specialties (median 38 hours, range 7–195 hours). Ten patients required HDU/ITU care with a median duration of 4 days (range 1–12 days). Five patients (20%) required amputation, of whom two (40%) had a prosthetic limb fitted. There was one in hospital death (4%). Another patient died while awaiting limb fitting 4 months post discharge, giving a 1 year mortality of 8%.ConclusionsNSTI in IVDUs carries high risk of amputation with a very low rate of limb fitting. Intervention is significantly delayed when the admitting specialty is not vascular surgery, and half of these patients require HDU/ITU care, with significant morbidity and mortality. Early diagnosis and referral to vascular surgery is crucial in management of these patients

Vitamina K: metabolismo e nutrição Vitamin K: metabolism and nutrition

O objetivo desta revisão foi discutir aspectos que envolvem a compreensão do metabolismo da vitamina K e os recentes avanços quanto ao papel da vitamina na nutrição humana. São abordadas questões sobre as fontes da vitamina, sua absorção, distribuição e metabolismo, recomendações dietéticas, avaliação do estado nutricional relacionado à vitamina K e ainda fatores que afetam sua concentração plasmática. Diante das novas evidências sobre a participação da vitamina K no metabolismo ósseo, pesquisas adicionais são necessárias a fim de identificar as possíveis conseqüências à saúde, a longo prazo, de deficiência subclínica desta vitamina. Pesquisadores e comitês futuros encontram um desafio no que se refere a investigar novos requerimentos nutricionais da vitamina.<br>The aim of this study was to discuss the aspects that involve the understanding of vitamin K metabolism and recent advances of its role in human nutrition. The paper presents dietary sources, absorption, distribution in the body and metabolism of vitamin K, nutritional recommendations, evaluation of nutritional status related to the vitamin and factors influencing its plasmatic concentration. In the light of evidences about vitamin K role in bone metabolism, further studies are needed to identify the possible long-term consequences to health of subclinical vitamin K deficiency. A great challenge for researchers and further scientific committees will be certainly concerned with investigation of new nutritional requirements of the vitamin