Super-infection by multiple microorganisms in COVID-19 patients.

Introduction: This study aimed to describe the clinical characteristics of patients with COVID-19 co-infected with multiple multidrug-resistant bacteria. Methods: Patients hospitalized in the AUNA network between January and May 2021, diagnosed with COVID-19 and at least two other infecting microorganisms, were retrospectively included in the analysis. Clinical and epidemiological data were extracted from clinical records. The susceptibility levels of the microorganisms were determined using automated methods. Antibiotic resistance was established among infecting bacteria accounting for ≥5 isolates. Results: A total of 27 patients (21 male and 6 female patients) met the inclusion criteria, with a maximum of eight co-infecting bacteria or fungi during admission time. Seven patients (25.9%) died, with a higher but not significant lethality among women (50% vs. 19.0%). A total of 15 patients presented at least one established comorbidity, with hypertension being the most frequent. The time elapsed between COVID-19 diagnosis and hospital attendance was 7.0 days, with that of patients with a fatal outcome being longer than that of living patients (10.6 vs. 5.4). Up to 20 different microorganisms were isolated, with Pseudomonas aeruginosa being the most common (34 isolates). In general, antibiotic resistance levels were high, especially in Acinetobacter baumannii isolates, with resistance levels of 88.9% to all antimicrobial agents tested, except colistin (0%). Conclusion: In conclusion, the present results show the presence of multiple microorganisms that co-infect COVID-19 patients. When fatal outcome rates are in the range of other reports, the presence of a series of multidrug-resistant microorganisms is of concern, showing the need to reinforce control measures to limit the expansion of almost untreatable microorganisms.

Disc stability after condylar discopexy with open surgery technique: a case report

Of the temporomandibular joint (TMJ) pathologies, temporomandibular disorders (TMD) of discdisplacement present several clinical signs and symptoms, the main ones being joint pain me-asured with the visual analogue scale (VAS) reporting on average VAS>6, and functional inca-pacity measured in mm of mouth opening, reporting on average <30mm in cases of TMD. The present case corresponds to a patient with limitation of mouth opening <15mm, joint pain VAS= 8, and functional limitation. The subject's condition was diagnosed clinically and by magnetic resonance imaging (MRI). The patient presented a Wilkes VI lateral dislocation of the left cond-yle disc without reduction, treated with open surgery discopexy, with disc fixation by monocryl suture and retrodiscal thermocoagulation. The patient showed a significant improvement in the removal of pain and in joint function. In clinical checkups at 1 month, 3 months, 6 months and 1 year, the patient showed decrease of pain levels, from VAS= 8 to VAS= 0, and mouth opening of <15mm to 36mm in the last checkup. Clinical and imaging evaluation at 4 years shows disc stability, with maximum mouth opening of 36 mm, with no disc displacement and clinically asymptomatic VAS = 0. In this case, discopexy with open surgery achieved improvements in functional capacity and removal of pain at short term. Long-term stability was associated with anatomical functions without alteration and without relapse of the symptomatology.

Women's post-rape experiences with Guatemalan health services.

We conducted a qualitative study to examine the critical pathways of 23 women survivors of sexual assault who navigated health care-based services in six states in Guatemala. We also captured the components of quality health care that were important to them, including the experience of the waiting room, being able to make active decisions, providing informed consent, and receiving emotional support. Our results from the in-depth, semi-structured interviews indicate the importance of creating and strengthening mechanisms for social support and trauma-informed, competent, and sensitive health services to accompany women as they move toward rebuilding their lives post-sexual violence.

[Profile of the treated elderly hypertensive patient]. / Perfil del hipertenso adulto mayor tratado.

BACKGROUND: There is concern about the consequences that hypertension has on the well being and mortality of elderly people. AIM: To compare the morbidity and mortality of young and old treated hypertensive subjects. MATERIAL AND METHODS: Retrospective analysis of hypertensive subjects treated and followed for a period of 10 +/- 9 years. Subjects that started treatment at an age of less than 65 years and those that started treatment after 65 years of age, were analyzed separately. The antihypertensive drugs used for treatment and blood pressure reduction were similar in both groups. RESULTS: Subjects that started treatment after 65 years of age (157 females and 133 males) had lower serum cholesterol levels and a higher prevalence of end organ damage than their younger counterparts. Women over 65 had a higher body mass index than women of less than 65. Males over 65 years had a higher prevalence of diabetes than younger males. Mortality and complications of hypertension were higher in subjects that started treatment after 65 years of age. CONCLUSIONS: The higher mortality of subjects that start hypertensive treatment after 65 years of age, is indicative of the need to detect and treat hypertension at the earliest possible moment.

[Morbidity and mortality of treated essential arterial hypertension in a 26 years follow up]. / Morbimortalidad de la hipertensión arterial esencial tratada en un seguimiento de 26 años.

BACKGROUND: Treatment has a definitive impact on mortality in hypertension. The magnitude of blood pressure reduction, the type of drug used and the associated risk factors may modulate the effect of treatment on mortality. AIM: To report the effects of treatment of essential hypertension, in a cohort followed for up to 26 years. PATIENTS AND METHODS: A cohort of 1,172 essential hypertensive patients followed up to 26 years. Patients were treated with different antihypertensive drugs, alone or in combination (diuretics, beta blockers, calcium channel blockers and angiotensin converting enzyme inhibitors) according to international rules and consensus. Subjects were followed until death or loss from follow-up. Blood pressure reduction was aimed to obtain figures near 140/90 mm Hg. Causes of death and complications were obtained from hospital records, phone and death certificates. Survival was studied using life tables (Kaplan Meier method and intention to treat analysis) and Cox proportional hazard analysis. RESULTS: Initial blood pressure dropped significantly from 181/109 to 154/92 mm Hg, p < 0.001. Mean follow-up time was 10.6 +/- 6.1 years. There were 143 cardiovascular deaths, 142 acute myocardial infarctions, 101 strokes, 83 subjects had cardiac failure and 49 had renal failure. The observed rates were 0.92% per year for cardiovascular mortality, 1.36% per year for coronary heart disease, 0.94% per year for stroke. CONCLUSIONS: Our mortality rate is lower than that found in classical randomized studies but similar or slightly higher than the more recent ones. Morbidity rates were also very similar. Except for mortality rate, frequency of complications did not change in comparison to our previous report after 15 year of follow up. Aging did not seem to negatively influence mortality rates in adequately treated hypertensive patients.

Cambios estructurales en la hipertensión arterial: regresión con la terapia; seguimiento a 12 años / Treatment induced regression of structural and functional changes associated with hypertension

Se estudian los cambios órgano-funcionales presentes en hipertensos primarios al ingreso a un Programa de tratamiento y su cambio a través del tiempo en 401 pacientes seguidos desde 1974 por 12 años y que tenían exámenes anuales completos. 216 eran H. y 185, M., edad x : 57+8,8 años (rango 34-71). Seguimiento x : 7,6 años. El avance lesional se definió según criterio OMS, el compromiso retinal según Wagener-Keith-Berger, el cardíaco por Rx (vol. cardíaco) y ECG (criterio HVI según Sokolw), el renal por creatininemia 1,4 mg%, N ureico y protinuria de 24 hrs. Los esquemas terapéuticos más utilizados fueron diuréticos, b-bloqueadores y vasodilatadores, solos o en diversas combinaciones. Los cambios órgano-funcionales se correlacionaron con la cuantía de la reducción de la PA, fijando como límite de normotensión una PA diastólica de pié 99 mmHG como promedio a través de todo el seguimiento. Al ingreso, 192 pac. (48%) estaban en etapa I OMS, 145 (36,6%) en etapa II y 64 (16%) en III. Del total, un 65% de los pac. redujo la PAD 99 mmHg., un 26% lo hizo a niveles entre 100 y 110 y un 9% mantuvo cifras sobre 110 mmHg. Hubo un 14% de abandonos. La HVI al ECG desapareció en un 29%, disminuyó en un 7% y empeoró en un 11%. El FO alterado mejoró en un 22%, se normalizó en un 14% y empeoró en un 1%. Si estaba normal se deterioró en un 9% de los casos. La función renal alterada se normalizó en el 38%, mejoró en el 2% y progresó en el 25% de los casos. Los pac. normotensados mantuvieron el ECG, la radiología y el FO normal con mayor frecuencia estadística que los no normotensados. Se concluye que en un seguimiento a largo plazo, los hipertensos tratados pueden revertir sus cambios parenquimatosos entre 14 y un 38% según el órgano "blanco" considerado