ABSTRACT
ABSTRACT: Introduction: SARS-COV2 infection, which was initially associated with respiratory manifestations only, can also cause gastrointestinal, kidney, neurological and cardiovascular symptoms according to some reports. Case presentation: A 36-year-old female patient attended the emergency department due to dyspnea, asthenia, adynamia, mild odynophagia. and headache. The patient's medical history included obesity, smoking, and working as a health care worker. Considering the symptoms, antimalarial and antiretroviral treatment was indicated to treat COVID-19, a diagnosis that was confirmed three days after admission. However, on the fourth day of treatment, the patient presented with polydipsia and macular, pruritic, and generalized rash. Due to suspicion of toxicoderma, the treatment was suspended, and the skin condition improved. After 8 days of hospitalization, the patient was discharged with biosecurity recommendations and mandatory isolation for 28 days. Conclusion: The described case is a report of toxicoderma in a patient with COVID-19 under treatment with antiretroviral and antimalarial drugs. Based on the findings, a thorough examination of skin and mucosa of patients with suspected or confirmed COVID-19 will undoubtedly contribute to the correct characterization of this new disease.
RESUMEN Introducción. La infección por SARS-COV2, que en principio se pensó solo causaba manifestaciones respiratorias, también puede ocasionar síntomas gastrointestinales, renales, neurológicos, cardiovasculares e incluso cutáneos según algunos reportes. Presentación del caso. Paciente femenina de 36 años quien asistió al servicio de urgencias por cuadró clínico consistente en disnea, astenia, adinamia, odinofagia leve y cefalea. Como antecedentes de relevancia se registró obesidad, tabaquismo y ocupación como trabajadora de la salud. Dados los síntomas, se indicó tratamiento antimalárico y antirretroviral para tratar COVID-19, diagnóstico que fue confirmado a los tres días de ingreso, pero al cuarto día de instaurado este manejo la mujer presentó polidipsia y rash macular, pruriginoso y generalizado. Por sospecha de toxicodermia, el tratamiento fue suspendido y con esto el cuadro cutáneo mejoró. Luego de 8 días de hospitalización, la paciente recibió el alta, junto con recomendaciones de bioseguridad y confinamiento durante 28 días. Conclusiones. El caso descrito corresponde a un evento de toxicodermia en una paciente con COVID-19 en manejo con antirretroviral y antimalárico. A partir de los hallazgos, se establece que la exploración minuciosa de piel y mucosas en los pacientes con sospecha o diagnóstico confirmado de COVID-19 puede ser de gran ayuda para la correcta caracterización de esta nueva enfermedad.
ABSTRACT
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The exponential increase in the request for laboratory tests of 25-Hydroxyvitamin D or [25 (OH) D has ignited the alarms and generated a strong call for attention, since it may reflect deficiencies in the standardization of clinical practice and in the use non-systematic scientific evidence for decision-making in real life, which allows to analyze the indications of the test, its frequency, interpretation and even to assess the impact for health systems, especially when contrasted with the minimum or almost. No effects of the strategy of screening or supplying indiscriminately to the general population, without considering a comprehensive clinical assessment of risks and needs of people. From a purely public health impact point of view, the consequence of massive and unspecified requests is affecting most of the health systems and institutions at the global level. The primary studies that determined average population intake values have been widely used in the formulation of recommendations in Clinical Practice Guidelines, but unfortunately misinterpreted as cut points to diagnose disease and allow the exaggerated prescription of nutritional substitution. The coefficient of variation in routine tests to measure blood levels of 25 (OH) D is high (28%), decreasing the overall accuracy of the test and simultaneously, increasing both the falsely high and falsely low values. The most recent scientific evidence analyzes and seriously questions the usefulness and the real effect of the massive and indiscriminate practice of prescribing vitamin D without an exhaustive risk analysis. The available evidence is insufficient to recommend a general substitution of vitamin D to prevent fractures, falls, changes in bone mineral density, incidence of cardiovascular diseases, cerebrovascular disease, neoplasms and also to modify the growth curve of mothers' children. They received vitamin D as a substitute during pregnancy. The recommendations presented in the document are based on the critical analysis of current evidence and the principles of good clinical practice and invite to consider a rational use of 25 (OH) D tests in the context of a clinical practice focused on people and a comprehensive assessment of needs and risks. The principles of good practice suggest that clinicians may be able to justify that the results of the 25 (OH) D test strongly influence and define clinical practice and modify the outcomes that interest people and impact their health and wellness. Currently there is no clarity on how to interpret the results, and the relationship between symptoms and 25 (OH) D levels, which may not be consistent with the high prevalence of vitamin D deficiency reported. For this reason, it is suggested to review the rationale of the request for tests for systematic monitoring of levels of 25 (OH) D or in all cases where substitution is performed. Consider the use of 25 (OH) D tests within the comprehensive evaluation of people with suspicion or confirmation of the following conditions: rickets, osteomalacia, osteoporosis, hyper or hypoparathyroidism, malabsorption syndromes, sarcopenia, metabolic bone disease.
ABSTRACT
Objetivo. Describir y comparar las frecuencias de los fenotipos de resistencia bacteriana de microorganismos obtenidos de pacientes en unidades de cuidados intensivos (UCI) y otros servicios de hospitalización (no UCI) públicos y privados de alta complejidad de Colombia. Métodos. Estudio observacional, analítico, retrospectivo y multicéntrico, en el cual se consolidaron los registros de los aislamientos bacterianos y los fenotipos de resistencia bacteriana de los microorganismos obtenidos de pacientes atendidos en UCI y no UCI de 79 hospitales públicos y privados de alta complejidad en el período de enero de 2007 a diciembre de 2009. La información se analizó con el programa WHONET® versión 5.5 (OMS) de acuerdo con las recomendaciones del Instituto de Estándares Clínicos y de Laboratorio 2009 y se resumió en un formato de extracción de datos en Excel®. Se realizó un análisis descriptivo en el cual se calcularon proporciones. El análisis de tendencias se realizó mediante la prueba de correlación de rangos de Spearman. Resultados. Las tendencias de los fenotipos de resistencia bacteriana de 2007 a 2009 muestran un comportamiento incremental en la proporción de Enterococcus faecium resistente a vancomicina, Klebsiella pneumoniae resistente a imipenem y a ciprofloxacina, Escherichia coli resistente a ceftazidima, y Enterobacter cloacae resistente a cefotaxima (ρ = 1, P < 0,01) y una disminución de la proporción de los fenotipos E. coli resistente a ciprofloxacina, K. pneumoniae resistente a ceftazidima, Staphylococcus aureus resistente a oxacilina, y Pseudomonas aeruginosa resistente a ceftazidima y a ciprofloxacina (ρ = 1, P < 0,01). Conclusiones. El análisis de tendencias presentado en este estudio constituye la línea de base para el establecimiento de un subsistema nacional de vigilancia epidemiológica. Las tendencias observadas muestran que la resistencia bacteriana a los antimicrobianos en el ámbito hospitalario es un fenómeno dinámico en Colombia y son evidencia de la emergencia de los fenotipos Efa-van y Kpn-imp en los hospitales.
Objective. Describe and compare the frequency of bacterial resistance phenotypes of microorganisms obtained from patients in intensive care units (ICU) and other (non- ICU) high-complexity public and private hospital services in Colombia. Methods. A retrospective observational, analytical, multicenter study was conducted. The records from January 2007 to December 2009 on bacterial isolates and bacterial resistance phenotypes of microorganisms obtained from ICU and non- ICU patients in 79 high-complexity public and private hospitals were consolidated. The information was analyzed with the WHONET® 5.5 (WHO) software, following the 2009 recommendations of the Clinical and Laboratory Standards Institute, and summarized on an Excel® spreadsheet. A descriptive analysis with the calculation of proportions was performed. The trends were analyzed with Spearman rank correlation. Results. The 20072009 trends for bacterial resistance phenotypes show increased percentages of vancomycin-resistant Enterococcus faecium, imipenem-resistant Klebsiella pneumoniae, ciprofloxacin-resistant K. pneumoniae, ceftazidime-resistant Escherichia coli and cefotaxime-resistant Enterobacter cloacae (r = 1, P < 0.01), and reduced percentages of ciprofloxacin-resistant E. coli, ceftazidime-resistant K. pneumoniae, oxacillinresistant Staphylococcus aureus, ceftazidime-resistant Pseudomonas aeruginosa, and ciprofloxacin-resistant P. aeruginosa (r = 1, P < 0.01). Conclusions. The trend analysis presented in this study is the baseline for establishing a national epidemiological surveillance subsystem. The trends observed reveal that bacterial resistance to antimicrobial drugs in hospitals in Colombia is a dynamic phenomenon, with evidence of the emergence of vancomycin-resistant E. faecium and imipenem-resistant K. pneumoniae phenotypes in the hospitals.