[Diabetic foot osteomyelitis: is conservative treatment possible?]. / Osteomielitis de pie diabético: ¿es posible un manejo conservador?

INTRODUCTION: The aim of the present study is to determine the proportion of foot ulcers, complicated by osteomyelitis in diabetic patients, that heal without amputation. Furthermore, an attempt is made to analyze the main clinical and microbiological characteristics of episodes, and to identify potential predictive factors leading to the failure of conservative treatment. METHODS: A prospective observational study was carried out between 2007 and 2009 on diabetic patients with a foot lesion and attending a diabetic foot clinic. A percutaneous bone biopsy was required to be included in the study. RESULTS: A total of 81 episodes of diabetic foot osteomyelitis in 64 patients were evaluated. Staphylococcus aureus (28/81) and coagulase negative Staphylococcus (22/81) were the most frequent organisms isolated. Among the gramnegative group (34/81), non-fermenting gram negative bacteria were the most prevalent organisms isolated (14/81). Conservative treatment was successful in 73% of episodes. After a logistic regression analysis using the most significant prognostic variables, only lesion size greater than 2cm independently predicted failure of conservative treatment. Culture guided antibiotic treatment was associated with a better prognosis. CONCLUSION: Conservative treatment, including culture-guided antibiotics, is successful without amputation in a large proportion of diabetic patients with diabetic foot osteomyelitis. Considering empiric therapy directed at non-fermenting gramnegative bacteria could be advisable in some cases, because they are frequently isolated in our setting.

Risk factors for later hospitalization of patients discharged from an emergency department with nonsevere COVID-19 symptoms. / Factores de riesgo de rehospitalización en pacientes con COVID-19 leve tras el alta desde el servicio de urgencias.

OBJECTIVES: To describe the clinical course of patients discharged from the emergency department (ED) with nonsevere coronavirus disease 2019 (COVID-19) and explore possible risk factors for later hospitalization. MATERIAL AND METHODS: Patients with nonsevere COVID-19 who were discharged from the ED were included prospectively. We explored risk factors for hospitalization after discharge. RESULTS: Seventy-four patients were included; 17 (23%) were hospitalized after discharge. Three (4%) of the 17 patients died. Age, lymphopenia, a high Charlson Comorbidity Index, and a shorter delay between the onset of symptoms and the first visit to the ED were associated with hospitalization afterwards, although on multivariate analysis only time less than 6 days between symptom onset and the first ED visit was associated with later hospitalization (odds ratio, 4.62; 95% CI, 1.08-19.7). CONCLUSION: More than 20% of ED patients with nonsevere COVID-19 require hospitalization later.

OBJETIVO: Describir la evolución clínica de pacientes con COVID-19 leve tras el alta de urgencias y analizar los posibles factores de riesgo para una posterior hospitalización. METODO: Pacientes con COVID-19 leve dados de alta desde urgencias fueron prospectivamente incluidos. Los factores de riesgo de hospitalización fueron evaluados. RESULTADOS: Se incluyeron 74 pacientes y 17 (23%) requirieron hospitalización, de los cuales 3 (4%) fallecieron. La edad, la linfopenia, un mayor índice Charlson y un menor tiempo desde el inicio de los síntomas hasta la primera consulta a urgencias se asociaron a hospitalización, aunque en el análisis multivariado únicamente un tiempo desde el inicio de síntomas a la consulta a urgencias - 6 días se asoció a hospitalización (OR: 4,62: IC 95%: 1,08-19,7). CONCLUSIONES: Más del 20% de pacientes con COVID-19 leve dados de alta desde urgencias requiere hospitalización.

[The interarm blood pressure difference in the critically ill patient]. / Diferencias de presión arterial entre brazos en el paciente crítico.

BACKGROUND AND OBJECTIVE: To evaluate the prevalence of a difference in systolic blood pressure (SBPd) ≥ 10 mmHg between arms in patients admitted in a Critical Care Unit and to examine the clinical characteristics associated with such blood pressure difference. METHODS: Observational cross-sectional study. Two blood pressure measurements in each arm were carried out at unit admission. The firstly measured arm was chosen at random. RESULTS: One-hundred and sixty-eight patients were studied, with a mean age of 61 (SD=16), 67.3% male and 45% with a previous hypertension diagnosis. On admission, 27.4% presented SBPd ≥ 10 mmHg. Among them, 54% had higher SBP in the right arm and 46% in the left one. A SBPd ≥ 10 mmHg was associated with a previous hypertension diagnosis (67.4 versus 36.9%; P<.001) and with reduced consciousness (76.1 versus 52.5%; P=.006). CONCLUSIONS: Over a quarter of critically ill patients have a SBPd ≥ 10 mmHg between arms. This feature is associated with a previous hypertension diagnosis and reduced consciousness. It should be assessed in the future if the choice of a control arm would help improve patient's care as it would become a more accurate guide for hemodynamic management.