OBJECTIVES: Increasing colonization by beta-lactam-resistant Gram-negative bacilli (BR-GNB) represents a risk for infections and bacterial resistance spread, both in hospitals and the community. Hemodialysis patients and their household contacts regularly transit between these environments. This study investigated the clinical and epidemiological characteristics of BR-GNB colonization in hemodialysis patients and their household contacts, as well as the genetic relationship between their isolates.METHODS: A cross-sectional study was conducted on hemodialysis patients at a hospital-associated dialysis center in Medellín, Colombia and their household contacts. Clinical and epidemiological information was collected. Colonization was assessed from stool or rectal swab samples. Bacterial identification and susceptibility were determined using chromogenic media and Vitek-2. Molecular characterization included beta-lactamase detection by polymerase chain reaction, multiple-locus sequence typing (MLST), pulsed-field gel electrophoresis, and identification of Escherichia coli phylogroups by the Clermont protocol.RESULTS: This study included 36 hemodialysis patients and 90 household contacts. Colonization by BR-GNB occurred in 58.3% of patients and 22.2% of household contacts. The main beta-lactamase detected was CTX-M group-1 (40.5%). In 3 of the 9 homes that had more than 1 colonized individual, a genetic relationship was found. MLST showed a high diversity in E. coli isolates, and the most frequent phylogroups were B1 and B2.CONCLUSIONS: These results show a high frequency of colonization and the presence of potentially pathogenic BR-GBN both in hospitals and the community. This highlights the importance of populations who move between those 2 environments, and the need to prevent the spread of bacterial resistance outside hospitals.

During pregnancy, physical, hormonal, and psychological changes may occur from conception to labor. Balance is also impacted throughout this time, leading to symptoms such as vertigo and unsteadiness. These symptoms may appear at any time and can cause disability and physical impairment. Little has been published about vertigo in pregnancy. We performed a narrative review of vertigo in pregnant patients. Vertigo in pregnant females may be associated with hormonal changes in peripheral structures and inner ear organs. Meniere’s disease, vestibular migraine, and benign paroxysmal positional vertigo are usually exacerbated during pregnancy. Specific changes to hearing and proprioception in the physical examination are also noted between the second and third trimester of pregnancy. These symptoms are usually seen in pregnant patients throughout this time. Some types of vertigo may be exacerbated and others may present at any time of pregnancy. Further research is needed to understand the clinical and pathological association of audiovestibular symptoms during pregnancy.

The COVID-19 pandemic generated high workloads given the high volume of seriously ill patients; conditions that could increase the risk of adverse events (AE). This study analyzed the frequency of AE in patients with COVID-19 and their effect on mortality, hospital stay and costs. This retrospective cohort study included in-patients with COVID-19 at a single hospital between March 2020–June 2021. Exposure was the occurrence of at least one AE. Hospital stay, costs and death were considered outcomes. Clinical information and direct costs were obtained from medical and billing records. Generalized linear models were used to estimate the association measures. 405 patients were included, 55.8% (n=226) men, median age 56 years (IQR: 41.0–70.0) and with a history of hypertension (26.2%; n=106), diabetes mellitus (13.8%; n=56) and obesity (13.8%; n=56). The incidence of AE was 13.3% (n=54), 29 patients presented more than one AE, for a total of 70 events. Most events (74.3%; n=52) were preventable and the most frequent were healthcare-associated infections (50%; n=35), phlebitis (14.3%; n=10) and pressure ulcers (12.9%; n=9). AE prolonged hospital stay (change rate: 1.57; 95%CI: 1.26–1.95; P=0.001) and increased direct healthcare costs (change rate: 1.20; 95% CI: 1.03–1.39, P=0.019). Likewise, the risk of death was 56% higher in patients with AE. Pandemics are unexpected events that present challenges to safe healthcare. Improving quality policies, monitoring compliance with protocols and providing ongoing education are strategies to prevent AE such as healthcare-associated infections, which increase hospital costs and stay.

Background: Atrial fibrillation (AF) and heart failure (HF) are highly prevalent conditions associated with significant morbidity and symptom burden.Hypothesis: This study compared the evolution over time of functional class and quality of life (QoL) in patients with HF according to the presence of AF.Methods: A retrospective cohort study was conducted at an outpatient heart failure clinic in Colombia, between 2020 and 2022. Functional class (based on the New York Heart Association classification) and QoL (measured by the Minnesota Living with Heart Failure Questionnaire), were analyzed at baseline, 3 months, 6 months, and the last visit. The simultaneous impact of AF and left ventricular ejection fraction was analyzed using a generalized estimation equation model.Results: Among the 440 patients (median age 74 years, 56.6% men), 41.4% with AF, and 65.2% with reduced ejection fraction (HFrEF). Over time, functional class improved in both groups, with a more significant improvement in patients without AF. Patients with AF and HFrEF were more likely to remain in worse functional classes (OR: 2.77; 95% CI: 1.37–5.62). Similar trends were observed in QoL questionnaire, with sustained improvement after 3 months. However, AF negatively affected the physical dimension in patients with HFrEF, increasing the QoL questionnaire score by up to 4%.Conclusions: The presence of AF and reduced ejection fraction was associated with a lesser improvement in functional class and physical dimension of QoL questionnaire, emphasizing the importance of early detection and management of AF as part of comprehensive HF care.