Association of multidrug-resistant bacteria and clinical outcomes in patients with infected diabetic foot in a Peruvian hospital: A retrospective cohort analysis.

OBJECTIVE: To evaluate the association of multidrug-resistant bacteria (MDRB) and adverse clinical outcomes in patients with diabetic foot infection (DFI) in a Peruvian hospital. MATERIALS AND METHODS: This retrospective cohort study evaluated patients treated in the Diabetic Foot Unit of a General Hospital in Lima, Peru. MDRB was defined by resistance to more than two pharmacological groups across six clinically significant genera. The primary outcome was death due to DFI complications and/or major amputation. Other outcomes included minor amputation, hospitalization, and a hospital stay longer than 14 days. Relative risks were estimated using Poisson regression for all outcomes. RESULTS: The study included 192 DFI patients with a mean age of 59.9 years; 74% were males. A total of 80.8% exhibited MDRB. The primary outcome had an incidence rate of 23.2% and 5.4% in patients with and without MDRB, respectively (p = 0.01). After adjusting for sex, age, bone involvement, severe infection, ischemia, diabetes duration, and glycosylated hemoglobin, MDRB showed no association with the primary outcome (RR 3.29; 95% CI, 0.77-13.9), but did with hospitalization longer than 14 days (RR 1.43; 95% CI, 1.04-1.98). CONCLUSIONS: Our study found no association between MDRB and increased mortality and/or major amputation due to DFI complications, but did find a correlation with prolonged hospitalization. The high proportion of MDRB could limit the demonstration of the relationship. It is urgent to apply continuous evaluation of bacterial resistance, implement a rational plan for antibiotic use, and maintain biosafety to confront this threat.

Correlation between stress and lifestyle in teachers at some schools in Lima, Peru, during telework in 2020.

BACKGROUND: Stress and unhealthy lifestyle are serious problems in public health and education, particularly due to their significant relevance in the context of the COVID-19 pandemic. OBJECTIVES: To determine the correlation between stress and lifestyle in teachers at some schools in Lima, Peru, during telework in 2020. METHODS: This observational, quantitative, analytical, cross-sectional study was conducted in 217 school teachers from Lima. Lifestyle was measured using the FANTASTIC questionnaire; stress was measured using the Teaching Stress Scale (ED-6), comprised of the anxiety, depression, maladaptive beliefs, work pressure and poor coping dimensions. The Spearman correlation between numerical variables, and the difference of the FANTASTIC score according to the categorical variables, were analyzed with the Mann-Whitney U test or Kruskal-Wallis test, as necessary. Multivariable analysis was done with a multiple linear regression model to find raw and adjusted ß (ßa). RESULTS: The median of the ED-6 scale was 81 (RI: 64-105). Sixty-four percent of the teachers had a good-excellent lifestyle; 27.2%, regular; and 8.49%, bad-dangerous. The FANTASTIC score had an inverse correlation with ED-6 (ßa: -0.16, 95%; CI: -0.20 to -0.12) adjusted for age and cohabitation with children. Likewise, teachers between 40 and 49 years old (ßa: 2.89, 95%; CI: 0.17 to 5.62) had a better lifestyle; and teachers who lived with children (ßa: -5.48, 95%; CI: -7.89 to -3.06), a worse lifestyle. CONCLUSIONS: As stress increased, the lifestyle quality worsened in teachers at some schools in Lima, Peru, during telework in 2020.

Infarto de médula espinal después de quimioembolización de tumor de mama bilateral: un reporte de caso / Spinal cord infarction after chemoembolization of bilateral breast tumor: a case report

El infarto de médula espinal es una entidad poco común que puede ser causada por procedimientos intervencionistas, como la quimioembolización aplicada a los tumores de mama, a pesar de su alto nivel de seguridad. Se presenta el caso de una mujer de 51 años con dolor torácico y hemorragia por lesión neoplásica friable de mama bilateral sin mejoría tras medidas conservadoras. Después de la embolización de las arterias tumorales, el paciente desarrolló paraparesia crural e hiporreflexia global de las extremidades inferiores. La resonancia magnética mostró hiperseñal en la médula espinal anterior, lo que sugiere isquemia / infarto de la médula espinal en el territorio de la arteria espinal anterior. Si bien la quimioembolización se considera un procedimiento seguro, es necesario reconocer sus riesgos inherentes, como el infarto de médula espinal, para evitar riesgos innecesarios en el paciente. A pesar de ser una complicación extremadamente rara, su incidencia aumenta gradualmente y es necesario estudiar sus causas, puesto que es potencialmente fatal.

Spinal cord infarction is a rare entity that can be caused by interventional procedures such as chemoembolization applied for breast tumors, despite its high level of safety. This is the case of a 51-year-old female with chest pain and hemorrhage from a friable neoplastic lesion of the bilateral breast without improvement after conservative measures. After embolization of the tumor arteries, the patient developed crural paraparesis and global lower extremity hyporeflexia. MRI showed hypersignal in the anterior spinal cord, suggesting ischemia/infarction of the spinal cord in the territory of the anterior spinal artery. Although chemoembolization is considered a safe procedure, it is necessary to recognize its inherent risks such as spinal cord infarction, in order to avoid unnecessary risks in the patient. Despite being an extremely rare complication, its incidence increases gradually and its causes need to be studied as it is potentially fatal.