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Necrotizing fasciitis is a rare but extremely aggressive, life-threatening soft-tissue infection of the subcutaneous and fascial tissues often encountered in diabetic patients. The muscle tissues are generally spared. Clinical examination of the skin reveals streaking erythema and sometimes small blisters, arising in the region of an incidental puncture wound. Local induration is always found, and occasionally subcutaneous crepitation caused by gas in the soft tissues is encountered. Air in the soft tissues can usually be seen on plain radiographs in gas-producing clostridial infection. Serial exams are necessary to track the leading edge of the infection, which rapidly progresses in the direction of venous drainage. Emergent surgical debridement of devitalized tissues (sometimes necessitating amputation) along with antibiotics and intensive care treatment for hypotension are required to prevent death.

As you no doubt have heard, the 7.0-magnitude earthquake that struck Haiti last week is estimated to have affected at least a third of that nation’s population (approximately 3 million people), and the death toll has exceeded 200,000.

Port-au-Prince’s three largest medical centers have been devastated, and it has been reported that surgeons, ER doctors and nurses, and full surgical teams are desperately needed. In a briefing last Thursday, President Obama proclaimed that the greatest need is for water and medical supplies. In response, a multitude of relief organizations are mobilizing to provide support, including the American Red Cross and Doctors without Borders.

As a medical professional, you understand the need to act quickly and strategically in an emergency situation. You know that strong teamwork is essential, and prioritizing supplies and services is critical. As well, long-term follow-up is integral to the recovery process.

If you, or a colleague you know, is interested in donating resources and/or volunteering your time to aid in the medical and humanitarian crisis in Haiti, please click on the links below for more information on organizations providing relief:

• The American Red Cross – http://www.americanredcross.org
• Americares – http://www.americares.org
• Hopital Albert Schweitzer Haiti – http://www.hashaiti.org
• International Relief Teams – http://www.irteams.org/index.htm
• Médicins sans Frontiérs (MSF), or Doctors Without Borders – www.doctorswithoutborders.org
• Partners in Health of Boston – http://www.pih.org/home.html
• Project Medishare – http://projectmedishare.org
• World Health Organization – http://www.who.int/en/

December 29, 2009 — More frequent consumption of green tea is associated with a lower prevalence of depressive symptoms in the community-dwelling older population, according to the results of a cross-sectional study reported in the December issue of the American Journal of Clinical Nutrition.

"Green tea is reported to have various beneficial effects (e.g., anti–stress response and anti-inflammatory effects) on human health," write Hideko Takahashi, from Tohoku University Graduate School of Biomedical Engineering in Sendai, Japan, and colleagues. "Although these functions might be associated with the development and progression of depressive symptoms, no studies have investigated the relation between green tea consumption and depressive symptoms in a community-dwelling population."

The objective of the study was to evaluate the association between green tea drinking and depressive symptoms in 1058, community-dwelling, elderly Japanese subjects 70 years or older who widely consumed green tea. A self-administered questionnaire was used to determine green tea intake. The 30-item Geriatric Depression Scale was used to evaluate depressive symptoms, with a cutoff point of 11 indicating mild and severe depressive symptoms and a cutoff value of 14 indicating severe depressive symptoms. Antidepressant use was also considered to indicate depressive symptoms.

In this cohort, 34.1% had mild and severe depressive symptoms, and 20.2% had severe depressive symptoms. Compared with green tea consumption of 1 or less cup per day, odds ratios for mild and severe depressive symptoms were 0.96 for 2 to 3 cups (95% confidence interval [CI], 0.66 – 1.42) and 0.56 for 4 or more cups of green tea per day (95% CI, 0.39 – 0.81; P for trend = .001), after adjustment for confounding factors. Similar associations were seen for severe depressive symptoms.

"A more frequent consumption of green tea was associated with a lower prevalence of depressive symptoms in the community-dwelling older population," the study authors write.

Limitations of this study include cross-sectional design, preventing causal inferences; possible confounding factors; and lack of data on other psychiatric conditions, symptoms, or treatments. In addition, participants were more active and healthy than those who did not undergo the assessment, and the Geriatric Depression Scale is not designed for making a clinical diagnosis of depressive episodes.

"In the present study, higher green tea consumption (as measured by self-administered questionnaires) was significantly associated with a lower prevalence of depressive symptoms in community-dwelling elderly individuals," the study authors conclude. "This finding suggested that the consumption of green tea may have a potentially beneficial effect on the prevention of depressive symptoms. A prospective study or randomized trials are required to clarify the causality."

The Ministry of Education, Culture, Sports, Science and Technology of Japan; the Japan Atherosclerosis Prevention Fund; and the Ministry of Health, Labor, and Welfare of Japan supported this study. The study authors have disclosed no relevant financial relationships.

Am J Clin Nutr. 2009;90:1615-1622. Abstract

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