ABSTRACT Bacterial keratitis caused by multidrug-resistant strains of Pseudomonas aeruginosa is a therapeutic challenge due to a limited number of active antimicrobials and rapid progression to corneal necrosis and perforation. To report the use of topical colistin and surgical tarsorrhaphy in a case of keratitis caused by extensively drug-resistant Pseudomonas aeruginosa in a patient with severe coronavirus disease-2019 (COVID-19) pneumonia. A 56-year-old male was admitted to the intensive care unit with clinical symptoms of severe COVID-19 pneumonia. During his stay in the unit, he developed rapidly progressive keratitis with Pseudomonas aeruginosa resistant to all drugs except for colistin on culture. Due to incomplete lid closure, a temporary tarsorrhaphy was performed, and a regimen of descending-dose topical colistin was initiated. After five weeks, keratitis resolved completely. Extensively drug-resistant Pseudomonas aeruginosa is an unusual cause of bacterial keratitis. We describe the safe and effective use of topical colistin in a case with severe corneal involvement.

RESUMO A ceratite bacteriana causada por cepas multirresistentes de Pseudomonas aeruginosa é um desafio terapêutico, devido à disponibilidade limitada de antimicrobianos e à rápida progressão para necrose e perfuração da córnea. O objetivo deste artigo é relatar o uso de colistina tópica e tarsorrafia cirúrgica em um caso de ceratite por Pseudomonas aeruginosa amplamente resistente a medicamentos em um paciente com pneumonia grave por COVID19. Um homem de 56 anos foi internado em uma unidade de terapia intensiva com sintomas clínicos de pneumonia grave por COVID19. Durante sua permanência na unidade de terapia intensiva, o paciente desenvolveu uma ceratite rapidamente progressiva, cuja cultura foi positiva para Pseudomonas aeruginosa resistente a todos os antimicrobianos, exceto colistina. Devido ao fechamento incompleto da pálpebra, foi realizada uma tarsorrafia temporária e foi instituído um esquema de colistina tópica em doses decrescentes. Após cinco semanas, a resolução completa da ceratite foi alcançada. Pseudomonas aeruginosa amplamente resistente a medicamentos é uma causa incomum de ceratite bacteriana. Este relato descreve o uso seguro e eficaz da colistina tópica em um caso com comprometimento corneano grave.

RESUMO A ceratite bacteriana causada por cepas multirresistentes de Pseudomonas aeruginosa é um desafio terapêutico, devido à disponibilidade limitada de antimicrobianos e à rápida progressão para necrose e perfuração da córnea. O objetivo deste artigo é relatar o uso de colistina tópica e tarsorrafia cirúrgica em um caso de ceratite por Pseudomonas aeruginosa amplamente resistente a medicamentos em um paciente com pneumonia grave por COVID19. Um homem de 56 anos foi internado em uma unidade de terapia intensiva com sintomas clínicos de pneumonia grave por COVID19. Durante sua permanência na unidade de terapia intensiva, o paciente desenvolveu uma ceratite rapidamente progressiva, cuja cultura foi positiva para Pseudomonas aeruginosa resistente a todos os antimicrobianos, exceto colistina. Devido ao fechamento incompleto da pálpebra, foi realizada uma tarsorrafia temporária e foi instituído um esquema de colistina tópica em doses decrescentes. Após cinco semanas, a resolução completa da ceratite foi alcançada. Pseudomonas aeruginosa amplamente resistente a medicamentos é uma causa incomum de ceratite bacteriana. Este relato descreve o uso seguro e eficaz da colistina tópica em um caso com comprometimento corneano grave.

ABSTRACT Bacterial keratitis caused by multidrug-resistant strains of Pseudomonas aeruginosa is a therapeutic challenge due to a limited number of active antimicrobials and rapid progression to corneal necrosis and perforation. To report the use of topical colistin and surgical tarsorrhaphy in a case of keratitis caused by extensively drug-resistant Pseudomonas aeruginosa in a patient with severe coronavirus disease-2019 (COVID-19) pneumonia. A 56-year-old male was admitted to the intensive care unit with clinical symptoms of severe COVID-19 pneumonia. During his stay in the unit, he developed rapidly progressive keratitis with Pseudomonas aeruginosa resistant to all drugs except for colistin on culture. Due to incomplete lid closure, a temporary tarsorrhaphy was performed, and a regimen of descending-dose topical colistin was initiated. After five weeks, keratitis resolved completely. Extensively drug-resistant Pseudomonas aeruginosa is an unusual cause of bacterial keratitis. We describe the safe and effective use of topical colistin in a case with severe corneal involvement.

The hemophilic pseudotumor is a very rare complication occurring in patients with severe hemophilia, and its management has not been standardized yet. We present the case of a 33-year old male patient who was admitted to the surgery ward in Dos de Mayo Hospital in Lima, Peru, who presented with a tumoral mass located in the left iliac fossa, which was painful when palpated, and it was associated with gait alterations. When the mass was excised, a giant hemophilic pseudotumor located in the retroperitoneum was identified. This is the first case describing the management of a hemophilic pseudotumor in our country, with satisfactory results at 12 months after surgery.

El pseudotumor hemofílico es una complicación muy rara vista en pacientes con hemofilia severa, y que cuyo manejo aún no se encuentra estandarizado. Se presenta el caso de un paciente varón de 33 años de edad admitido en el servicio de cirugía del Hospital Nacional Dos de Mayo por presentar una tumoración localizada en fosa iliaca izquierda, dolorosa a la palpación, asociada a alteración de la marcha. Realizada la exéresis, se identificó un pseudotumor hemofílico gigante ubicado en retroperitoneo. Este caso expone el primer reporte de manejo de pseudotumor hemofílico en nuestro país, con resultados satisfactorios a los 12 meses del posoperatorio.

Resumen Introducción. En Perú, durante el servicio social en salud se han reportado problemas como condiciones laborales riesgosas, mortalidad asociada a accidentes de tránsito y déficit de cobertura de aseguramiento. Objetivo. Describir los problemas percibidos y experimentados por los profesionales de salud que realizan el Servicio Rural y Urbano Marginal de Salud (SERUMS) en Ancash, Perú, y evaluar su asociación con la práctica de los profesionales y la categoría del establecimiento donde se realiza el SERUMS. Materiales y métodos. Durante abril del 2015, se realizó un estudio transversal analítico con profesionales de salud que realizaban el SERUMS en establecimientos del Ministerio de Salud de Ancash. Se aplicaron encuestas para recolectar datos generales, características y problemas del SERUMS. Resultados. Se analizaron 364 encuestas. El 79.3% de los participantes fue de sexo femenino, la edad promedio fue de 27.4±5.0 años, 80.0% percibió carencia de insumos, 54.4% percibió carga laboral excesiva, y 14.7% sufrió algún accidente de tránsito durante el SERUMS. Ser médico y laborar en establecimientos I-1 fueron factores asociados a haber sufrido accidentes de tránsito y otros imprevistos. Conclusiones. Los encuestados reportan carga laboral excesiva, carencia de insumos y accidentes. Los accidentes son más frecuentes en médicos y en establecimientos de categoría I-1.

Abstract Introduction: Social health services in Peru have certain problems such as unsafe work conditions, mortality associated with traffic accidents and poor insurance coverage. Objective: To describe the problems perceived and experienced by health professionals who render Rural and Urban Marginal Health Service (SERUMS in Spanish) in Ancash (Peru), and to evaluate their association with the profession and the category of the facilities where SERUMS is rendered. Materials and methods: In April 2015, an analytical cross-sectional study was carried out in professionals who were rendering SERUMS in facilities of the Ministry of Health in Ancash. Surveys were applied to collect general data, and characteristics and problems of SERUMS. Results: 364 surveys were analyzed. 79.3% were females, and the average age was 27.4±5.0 years. During SERUMS, 80.0% of participants perceived lack of supplies, 54.4% perceived excessive workload, and 14.7% suffered some traffic accident. Being a physician and working in I-1 health facilities were factors associated with suffering traffic accidents and other kind of accidents. Conclusions: Respondents reported excessive workload, lack of supplies, and accidents. Accidents were more frequent in physicians and in I-1 health facilities.

ABSTRACT Objectives To estimate the prevalence of burnout syndrome (BOS) in Peruvian physicians and nurses in 2014 according to different cutoff points established in the literature. Materials and methods This was a cross-sectional and descriptive study based on the National Survey on User Satisfaction of Health Services for 2014 (ENSUSALUD-2014), which features two-stage probability sampling. BOS was identified by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) using different cutoff points to establish prevalence, including default values, terciles, and quartiles. Results Of the 5062 health professionals, 62.3% were women, 44.0% were physicians, 46.0% belonged to the MINSA, and 23.1% worked in Lima. The overall BOS prevalence was 2.8% (95% CI, 2.4-3.2), when default values were used; the prevalence was 7.9% (95% CI, 7.3-8.6) when quartiles were used as cutoff points and 12.5% (95% CI, 11.4-13.6) when terciles were used as cutoff points. The prevalence was higher in doctors than in nurses, regardless of the cutoff point used (3.7% vs. 2.1% using default values, 10.2 vs. 6.1% using quartiles, and 16.2 vs. 9.5% using terciles). Conclusions The prevalence of BOS in health workers differs within the same population when different cutoff points are used. The use of default values is recommended by the instrument author until specific cut-points for our country are obtained.

RESUMEN Objetivos Estimar la prevalencia del síndrome de burnout(SB) en los médicos y enfermeras del Perú en el año 2014, según los diferentes puntos de corte establecidos en la literatura. Materiales y métodos Estudio transversal y descriptivo basado en la Encuesta Nacional de Satisfacción de Usuarios en Salud del año 2014 (ENSUSALUD-2014) que cuenta con un muestreo probabilístico bietápico. El SB fue identificado mediante el Maslach Burnout Inventory -Human Services Survey (MBI-HSS) utilizando diferentes puntos de corte para establecer su prevalencia: valores predeterminados, terciles y cuartiles. Resultados De los 5062 profesionales de salud, 62,3% eran mujeres, 44,0% eran médicos, 46,0% pertenecían al MINSA y 23,1% laboraban en Lima. Se obtuvo una prevalencia global del SB de 2,8% (IC95%: 2,19-3,45) usando valores predeterminados; 7,9% (IC95%: 6,93-8,95) para puntos de corte según cuartiles; y 12,5% (IC95%:11,29-13,77) usando terciles. La prevalencia es mayor en médicos que en enfermeras, independientemente del punto de corte usado (3,7% vs 2,1% en valores predeterminados; 10,2 vs 6,1% con cuartiles, y 16,2 vs 9,5% mediante terciles). Conclusiones La prevalencia del síndrome en personal sanitario es distinta en una misma población, según se utilicen los distintos puntos de corte descritos. Se recomienda el uso de los valores predeterminados por el creador del instrumento, hasta obtener puntos específicos para nuestro país.

Objectives. To estimate the prevalence of burnout syndrome (BOS) in Peruvian physicians and nurses in 2014 according to different cutoff points established in the literature. Materials and methods. This was a cross-sectional and descriptive study based on the National Survey on User Satisfaction of Health Services for 2014 (ENSUSALUD-2014), which features two-stage probability sampling. BOS was identified by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) using different cutoff points to establish prevalence, including default values, terciles, and quartiles. Results. Of the 5062 health professionals, 62.3% were women, 44.0% were physicians, 46.0% belonged to the MINSA, and 23.1% worked in Lima. The overall BOS prevalence was 2.8% (95% CI, 2.4-3.2), when default values were used; the prevalence was 7.9% (95% CI, 7.3-8.6) when quartiles were used as cutoff points and 12.5% (95% CI, 11.4-13.6) when terciles were used as cutoff points. The prevalence was higher in doctors than in nurses, regardless of the cutoff point used (3.7% vs. 2.1% using default values, 10.2 vs. 6.1% using quartiles, and 16.2 vs. 9.5% using terciles). Conclusions. The prevalence of BOS in health workers differs within the same population when different cutoff points are used. The use of default values is recommended by the instrument author until specific cut-points for our country are obtained.

Objetivos.Estimar la prevalencia del síndrome de burnout(SB) en los médicos y enfermeras del Perú en el año 2014, según los diferentes puntos de corte establecidos en la literatura. Materiales y métodos. Estudio transversal y descriptivo basado en la Encuesta Nacional de Satisfacción de Usuarios en Salud del año 2014 (ENSUSALUD-2014) que cuenta con un muestreo probabilístico bietápico. El SB fue identificado mediante el Maslach Burnout Inventory -Human Services Survey (MBI-HSS) utilizando diferentes puntos de corte para establecer su prevalencia: valores predeterminados, terciles y cuartiles. Resultados. De los 5062 profesionales de salud, 62,3% eran mujeres, 44,0% eran médicos, 46,0% pertenecían al MINSA y 23,1% laboraban en Lima. Se obtuvo una prevalencia global del SB de 2,8% (IC95%: 2,19-3,45) usando valores predeterminados; 7,9% (IC95%: 6,93-8,95) para puntos de corte según cuartiles; y 12,5% (IC95%:11,29-13,77) usando terciles. La prevalencia es mayor en médicos que en enfermeras, independientemente del punto de corte usado (3,7% vs 2,1% en valores predeterminados; 10,2 vs 6,1% con cuartiles, y 16,2 vs 9,5% mediante terciles). Conclusiones. La prevalencia del síndrome en personal sanitario es distinta en una misma población, según se utilicen los distintos puntos de corte descritos. Se recomienda el uso de los valores predeterminados por el creador del instrumento, hasta obtener puntos específicos para nuestro país.

Objective: To identify associated factors with failure of antituberculous therapy in a primary health center in Chorrillos, Lima, Peru. Material and methods: Retrospective case control study with a 1:3 case-control ratio. A case was defined as a patient who discontinued the treatment for a period of 30 consecutive days or more, and a control as a patient successfully completing antituberculous therapy. The score for risk of failure measured in the health center (≥22) and demographic variables wereassessed. Odds ratios (OR) and95%confidenceintervals (CI) werecalculatedusing logistic regression. Results: Thirty-four cases and 102 controls were included. In the multivariate analysis, factors associated to a greater likelihood for a failure in antituberculous therapy were to have less than six years of education (OR: 22,2; 95% IC: 1,9-256,1) and to obtain a score greater or equal than 22 points in the test for risk of failure (OR= 21,4; 95% IC: 6,3-72,4). Conclusions: Failure of antituberculous therapy was associated with having less than six years of education and a score greater than or equal to 22 points in the test for risk of failure.

Objetivo: Identificar los factores asociados al abandono del tratamiento antituberculoso en un centro de salud de atención primaria del distrito de Chorrillos, Lima, Perú. Materiales y métodos: Estudio de casos y controles retrospectivo no pareado. Se definió como caso a los pacientes que abandonaron el tratamiento por un periodo de 30 días consecutivos o más y como controles a los pacientes que terminaron el tratamiento antituberculoso. Se evaluó el puntaje de riesgo de abandono que se realiza en el centro de salud (≥22), así como variables demográficas. Se calculó el odds ratio (OR) e intervalos de confianza al 95% (IC95%) usando regresión logística. Resultados: Se incluyó 34 controles y 102 casos. En el análisis multivariado se encontró que quienes cursaron menos de seis años de educación (OR: 22,2; IC95%: 1,9-256,1) así como quienes tenían un puntaje ≥ a 22 puntos en la prueba de riesgo de abandono (OR= 21,4; IC95%: 6,3-72,4) tenían mayor probabilidad de abandonar el tratamiento antituberculoso. Conclusión: El abandono del tratamiento antituberculoso está asociado con tener menos de seis años de educación y un score mayor a 22 puntos en la prueba de abandono de tratamiento antituberculoso.