FIGHT AGAINST SUPERBUGS IN A BURN CENTRE: ARE WE DOING ENOUGH

Objective: To determine the superbug infection in a burn centre, its impact on mortality/morbidity and to review all preventive/therapeutic steps taken to fight this menace. Study Design: Retrospective cross sectional study. Place and Duration of Study: Department of Burns & Plastic Surgery, Army Burn Centre, Combined Military Hospital Kharian, from Oct 2018 to Sep 2019. Methodology: A detailed retrospective audit of departmental data was carried out. Parameters like direct admission vs transferred patient, percentage of burns (Total Burn Surface Area-TBSA%), records of all burns related deaths and all culture/sensitivity reports were analysed using SPSS-20. As a standard practice in our unit blood, tracheal secretions and pus culture specimens of all patients are collected at the time of admission and then periodically fresh samples are taken every week or earlier when-ever required. Results: Out of 515 patients, 283 (54.95%) were children under the age of 12 years. The overall survival rate improved by 13.43% as compared to last year. Out of 584 bacteriology reports 396 (67.81%) were positive and 188 (32.19%) were negative. On culture 508 organisms were isolated, majority of which were Carbapenem Resistant Pseudomonas, Acinetobacter, Enterobacteriaceae and Methicillin resistant staphylococcus aureus. Conclusion: Multi drug resistant superbug infection is a worldwide menace. The best clinical practices, strict contact isolation, enhanced environmental cleaning and judicious use of appropriate antibiotics are the main strategies in this war. Need for newer more effective antibiotics cannot be overemphasized.

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Assessment of Inorganic Phosphate Intake by the Measurement of the Phosphate/Urea Nitrogen Ratio in Urine

Nutrients ◽

10.3390/nu13020292 ◽

2021 ◽

Vol 13 (2) ◽

pp. 292

Author(s):

María Victoria Pendón-Ruiz de Mier ◽

Noemí Vergara ◽

Cristian Rodelo-Haad ◽

María Dolores López-Zamorano ◽

Cristina Membrives-González ◽

...

Keyword(s):

Inorganic Phosphate ◽

Daily Intake ◽

Cross Sectional Study ◽

Normal Serum ◽

Dietary Recommendations ◽

Clinical Practices ◽

Cross Sectional ◽

Urea Nitrogen ◽

Inorganic P ◽

Nitrogen Ratio

In chronic kidney disease (CKD) patients, it would be desirable to reduce the intake of inorganic phosphate (P) rather than limit the intake of P contained in proteins. Urinary excretion of P should reflect intestinal absorption of P(inorganic plus protein-derived). The aim of the present study is to determine whether the ratio of urinary P to urinary urea nitrogen (P/UUN ratio) helps identify patients with a high intake of inorganic P.A cross-sectional study was performed in 71 patients affected by metabolic syndrome with CKD (stages 2–3) with normal serum P concentration. A 3-day dietary survey was performed to estimate the average daily amount and the source of P ingested. The daily intake of P was 1086.5 ± 361.3 mg/day; 64% contained in animal proteins, 22% in vegetable proteins, and 14% as inorganic P. The total amount of P ingested did not correlate with daily phosphaturia, but it did correlate with the P/UUN ratio (p < 0.018). Patients with the highest tertile of the P/UUN ratio >71.1 mg/g presented more abundant inorganic P intake (p < 0.038).The P/UUN ratio is suggested to be a marker of inorganic P intake. This finding might be useful in clinical practices to identify the source of dietary P and to make personalized dietary recommendations directed to reduce inorganic P intake.

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Cyberbullying, student nurses’ ethical awareness and the Covid-19 pandemic

Nursing Ethics ◽

10.1177/09697330211010280 ◽

2021 ◽

pp. 096973302110102

Author(s):

Ka Young Kim ◽

Jeong Sil Choi

Keyword(s):

Clinical Practice ◽

Nursing Students ◽

Nursing Intervention ◽

Cross Sectional Study ◽

Hierarchical Regression ◽

Clinical Practices ◽

Ethical Awareness ◽

Cross Sectional ◽

Cyberbullying Victimization ◽

Cyber Ethics

Background: The global COVID-19 pandemic has increased cyber communication, causing nursing students’ clinical practice to be held in cyberspace. Thus, it is essential to ensure that nursing students develop comprehensive cyber ethics awareness. Moreover, cyberbullying is becoming more widespread and is an increasingly relevant new concept. Objectives: This study aimed to assess the experiences of cyberbullying among nursing students during clinical practice and determine the effects of cyberbullying victimization and cyber environments on their cyber ethics awareness. Research design: Data for this descriptive cross-sectional study were collected in July 2020 using a self-reported questionnaire and analyzed using hierarchical regression. Participants and research context: The study included data from 291 nursing students with more than 6 months of clinical experience who were enrolled in two nursing universities in two cities in South Korea. Ethical considerations: This study was conducted after obtaining approval from the Institutional Review Board of G University. Written, informed consent was obtained from all participants. Results: Cyberbullying victimization experiences during clinical practice were few. The most common cyberbullies of work- and person-related cyberbullying were nurses and classmates, respectively. Discussion: Cyber ethics awareness was affected by cyber anonymity and the perceived seriousness of cyberbullying; cyberbullying related to clinical practices was a new factor that significantly affected cyber ethics awareness. Conclusions: Hospitals and nursing universities should develop a multi-dimensional, comprehensive, and effective nursing intervention education program to be integrated into the nursing curriculum to enhance cyber ethics awareness and reduce cyberbullying of nursing students.

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Knowledge and attitudes of nursing professors and students concerning the interface between spirituality, religiosity and health

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692011000500019 ◽

2011 ◽

Vol 19 (5) ◽

pp. 1205-1213 ◽

Cited By ~ 25

Author(s):

Claudia de Souza Tomasso ◽

Ideraldo Luiz Beltrame ◽

Giancarlo Lucchetti

Keyword(s):

Religious Affiliation ◽

Cross Sectional Study ◽

Religious Practices ◽

Sectional Study ◽

Clinical Practices ◽

Cross Sectional ◽

Knowledge And Attitudes ◽

The University ◽

Common Barriers

This study compares the knowledge and attitudes of nursing professors and students concerning the interface between spirituality, religiosity and health. A cross-sectional study was conducted with 30 nursing professors and 118 students. The results reveal that more than 95% of the participants had some religious affiliation, 96% believed that spirituality considerably influences patients' health, and 77% wished to address this subject. However, only 36% felt prepared for it and most believed that the university did not provide the necessary information. No statistical differences were found between the religious practices of nursing professors and students, though a marked difference was found in their clinical practices and opinions concerning spirituality and its inclusion in the program's curriculum. The most common barriers to addressing such a subject were: fear of imposing one's own beliefs, lack of time, and fear of offending patients.

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Molecular detection of blaOXA-23gene and blaOXA-51 gene in carbapenem resistant strains of Acinetobacterbaumannii in patients with ventilator associated pneumonia at tertiary care hospital

Journal of the Pakistan Medical Association ◽

10.47391/jpma.01537 ◽

2021 ◽

Vol 71 (11) ◽

pp. 2576-2581

Author(s):

Saima Ishtiaq ◽

Sidrah Saleem ◽

Abdul Waheed ◽

Arslan Ahmed Alvi

Keyword(s):

Acinetobacter Baumannii ◽

Tertiary Care ◽

Carbapenem Resistance ◽

Conventional Polymerase Chain Reaction ◽

Diffusion Method ◽

Military Hospital ◽

Care Hospital ◽

Acinetobacter Baumanii ◽

Cross Sectional ◽

Carbapenem Resistant

Objective: To evaluate carbapenem resistance and to detect blaOXA-23 and blaOXA-51 genes in carbapenem-resistant acinetobacter baumanii isolates recovered from patients having pneumonia secondry to ventilation. Methods: The cross-sectional study was conducted from July 2017 to June 2018 at the Department of Microbiology, University of Health Sciences, Lahore, Pakistan, and comprised endotracheal aspirates / tracheobroncheal lavage samples from patients irrespective of age and gender who developed pneumonia after being on the ventilator for 48 hrs at the Combined Military Hospital, and Jinnah Hospital, Lahore. The samples were inoculated on MacConkey and blood agar and aerobically incubated at a temperature of 370C for 18-24 hours. The isolated organisms were further assessed by standard morphological, cultural and biochemical profile. Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method. Carbapenem-resistant acinetobacter baumannii were checked for carbapenemase production using Modified Hodge Test. Conventional polymerase chain reaction and agarose gel electrophoreses were performed to detect blaOXA-23 and blaOXA-51 genes. Data was analysed using SPSS 17. Results: Out of 157 samples, 92(58.6%) yielded growth of bacteria, and, among them, 39(42.4%) were identified as acinetobacter baumannii. All (100%) acinetobacter baumannii cases showed resistance to carbapenem, were producing carbapenemase enzyme, and were positive for blaOXA-51 gene. The blaOXA-23 gene was amplified in 38(97.4%) isolates. Conclusion: BlaOXA-23 gene appeared to be the major cause of carbapenem resistance. Continuous...

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Profile of Herpes Zoster Patients with Co-morbidities: Cross-sectional Observation at a Tertiary Level Hospital in Dhaka

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v16i2.55296 ◽

2021 ◽

Vol 16 (2) ◽

pp. 40-43

Author(s):

Md Shirajul Islam Khan ◽

Hossain Md Emran ◽

ATM Rezaul Karim

Keyword(s):

Herpes Zoster ◽

Secondary Infection ◽

Study Finding ◽

Cross Sectional Study ◽

Military Hospital ◽

Morbid Condition ◽

Cross Sectional ◽

Ulcer Disease ◽

History Of ◽

Irritable Bowel

Introduction: Herpes zoster (HZ) is characterized by an extremely painful vesicular rash, which may be complicated by secondary infection and post-herpetic neuralgia. To date, multiple risk factors associated with HZ have been established, including endocrine diseases, immunosuppressive conditions, cancers, and other chronic medical conditions. Objectives: To assess the profile of herpes zoster associated with co-morbid condition. Methods and Materials: This cross sectional study was conducted among purposively selected 130 HZ patients in the department of Dermatology and Venereology, Combined Military Hospital (CMH) Dhaka from January 2017 to December 2018. Data were collected through face to face interview using pretested semi-structured questionnaire. Results: Out of 130 patients, majority of the patients were male (69.2%) and mean age was 53.5±9.8 years and majority gave the history of chicken pox 60% and common site of involvement were chest (right and left) 33.1% and 48.5%, upper back (right and left) 30.8% and 43.1% and upper right arm 33.1%. About 66.9% patients gave the history of having co-morbid condition like Diabetes 30.8%, Stroke 9.2%, Hypertension 2.3%, Myocardial infarction 3.8%, Peptic ulcer disease 10.0%, Malignancy 2.3%, Tuberculosis 2.3% and Irritable bowel syndrome 2.3%. Conclusion: Based on our study finding, we can conclude that herpes zoster is a disease that is associated with other co-morbid conditions. If herpes zoster is an early manifestation of undiagnosed co-morbid condition, patients should undergo testing for undiagnosed disease when they present with herpes zoster. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 40-43

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ACCURACY OF THE UPPER LIP BITE TEST;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.01.589 ◽

2012 ◽

Vol 20 (01) ◽

pp. 132-138

Author(s):

MUHAMMAD ATIF ◽

MUHAMMAD ABDULLAH ◽

MUHAMMAD JAVAD YOUSAF ◽

Khalid Buland

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Difficult Intubation ◽

Predictive Value ◽

Elective Surgery ◽

Cross Sectional Study ◽

Military Hospital ◽

Upper Lip ◽

Cross Sectional ◽

Sensitivity Specificity

Objective: To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficultlaryngoscopic intubation. Study Design: Cross sectional Study. Place and duration of study: The study was carried out at Department ofAnaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009.Patients and Methods: Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled afterwritten informed consent. The airways of the patients were evaluated by using the modified Mallampati classification (MMP) and theUpper lip bite test (ULBT). MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view wasgraded by Cormack and Lehane classification (Gold standard). Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy werecalculated for both the tests separately by using the 2×2 table. Results: ULBT had a higher accuracy of 94%, specificity of 99.2% andpositive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%.Conclusions: The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that itbe compared with the other prevailing tests as well which are often used to assess difficult intubations.

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Trends of Self-Medication Amongst the Patients Visiting the Out-Patient Department of Combined Military Hospital, Lahore

Esculapio ◽

10.51273/esc21.2516 ◽

2021 ◽

Vol 17 (1) ◽

pp. 30-33

Author(s):

Bushra Asif Ali Khan ◽

Faiza Muzahir ◽

Sahar Abdul Rauf ◽

Syeda Rubab Fatima ◽

Abida Pervaiz ◽

...

Keyword(s):

Public Awareness ◽

Cross Sectional Study ◽

Military Hospital ◽

Self Medication ◽

Related Factors ◽

Cross Sectional ◽

High Prevalence ◽

To Receive ◽

Previous Prescription ◽

Patient Department

Objective: The purpose of our study was to assess the trends of self-medication practices and to determine the prevalence, characteristics, related factors, and effects of self-medication among the patients conducted. Methods: This descriptive cross-sectional study was on patients of Combined Military Hospital Lahore on a sample size of 365. The data was collected and entered in a predesigned questionnaire about self-medication later analyzed using SPSS version 17.0. Results: The prevalence of self-medication was 95.3% and effectiveness was 87.7%. The common reasons for self-medication were prior knowledge of usefulness of remedy (63.3%), non-affordability of consultant charges (18.4%), and lack of time (21.9%). Frequently used medicines included antibiotics (30.1%), analgesics (69.6%), antipyretics (51.0%), and antihistamines (23.6%). Respondents claimed to receive information about these drugs from various sources including doctor (38.6%), previous prescription (31.8%), retailer seller (13.4%), family/friends (43.6%), media (7.9%) and other sources (1.6%). Conclusion: It had been concluded that there is a high prevalence of self-medication. There is a need to raise public awareness about the appropriate use in order to prevent potential hazards of self-medication. Key Words: trends, self-medication, out-patient department How to cite: Khan B.A.A, Muzahir F, Rauf S.A, Fatima S.R, Pervaiz A, Jamil S. Trends of self- medication amongst the patients visiting the out-patient department of Combined Military Hospital, Lahore. Esculapio.2021. 30-33

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Genome-Wide Identification of Carbapenem-Resistant Gram- Negative Bacterial (CR-GNB) Isolates Retrieved From Hospitalized Patients in Bihar, India

10.21203/rs.3.rs-1067347/v1 ◽

2021 ◽

Author(s):

Namrata Kumari ◽

Mukesh Kumar ◽

Amit Katiyar ◽

Abhay Kumar ◽

Pallavi Priya ◽

...

Keyword(s):

Resistance Genes ◽

Carbapenem Resistance ◽

Cross Sectional Study ◽

Clinical Isolates ◽

Cross Sectional ◽

Gram Negative ◽

Carbapenem Resistant ◽

Genome Wide ◽

Synergy Test ◽

Global Threat

Abstract Carbapenemase-producing clinical isolates are becoming more common over the world, posing a severe public health danger, particularly in developing nations like India. Carbapenem-resistant Gram-negative bacterial (CR-GNB) infection has become a fast-expending global threat with limited antibiotic choice and significant mortality. The aim of this study was to highlight the carbapenem-resistance among clinical isolates of hospital admitted patients in Bihar, India. A cross-sectional study was conducted with 101 clinical isolates of E. coli, K. pneumoniae, A. baumannii, and P. aeruginosa. All GNB isolates were tested for their antimicrobial susceptibility using double disc synergy test / modified hodge test (DDST/MHT) and subsequently confirmed carbapenemase-producing isolates were evaluated for carbapenem-resistance genes using whole-genome sequencing (genotypically) method. The overall percentage of carbapenem-resistance among GNB was (17/101) 16.83%. The AMR analysis demonstrates a significantly high prevalence of blaCTX−M followed by blaSHV, blaTEM, blaOXA and blaNDM β-lactams carbapenem-resistance genes among clinical isolates of GNB. Co-occurrence of carbapenemase-encoding genes with blaNDM was found in 70.6% of carbapenemase-producing isolates. Our study highlights the mechanism of carbapenem-resistance to curb the overwhelming threat posed by emergence of drug-resistance in India.

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A Novel Objective Approach Towards Physicians' Knowledge and Practice Patterns to Optimize Central Venous Catheter Placement: A Cross-sectional Study

10.22514/sv.2020.16.0052 ◽

2020 ◽

Keyword(s):

Intensive Care ◽

Central Venous Catheter ◽

Venous Catheter ◽

Cross Sectional Study ◽

Sectional Study ◽

Clinical Practices ◽

Central Venous ◽

Cross Sectional ◽

Study Objective ◽

Catheter Tip

Study objective: Central venous catheterization is an essential component of intensive care of critically ill patients, and proper positioning of the catheter is essential to prevent position-related complications. This study was conducted by using digital tape measurement to objectively assess clinician preferences for central venous catheter positioning based on specific position levels and landmarks on post-procedural chest radiographs. Design: A cross-sectional study using electronic questionnaire survey. Setting: Single academic teaching hospital participated in this study. Participants: The study enrolled 276 physicians from multiple clinical disciplines. Interventions: None. Measurements: A seven-level reference system labeled on a sample chest radiograph was used to identify the acceptable lower and upper limits and landmarks used to determine the optimal central venous catheter tip position as well as the pattern of clinical practices based on the specialty and level of experience of participants. Main results: Among the 276 respondents, the ratio of cumulative acceptance for the lower and upper catheter tip limit was 62% and 66.3% within a 4-cm range below or above the carina, respectively. Intensive care unit (ICU) physicians showed a greater tendency to choose a catheter tip 4 cm below and 6 cm above the carina (p = 0.004 and 0.002, respectively) as did experienced physicians (p = 0.007 and < 0.001, respectively). The commonest reason for catheter tip withdrawal was arrhythmia (50% of cases). Physicians in the ICU and experienced physicians were more concerned about the risk of cardiac perforation than other respondents (p < 0.001 and < 0.001, respectively). The carina was the most commonly used landmark in 71.7% of all physicians, although 50% of radiologists also used other landmarks. Conclusions: The acceptable limit of the catheter tip is 4 cm above and below the carina (-4 to +4), as determined on chest radiography, without a need for tip adjustment.

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Abstract 164: Treatment Differences in Acute Stroke By Mode of Transport

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a164 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Prasanthi Govindarajan ◽

Anisha Chandra ◽

David Ghilarducci ◽

Steve Shiboski ◽

Barbara Grimes ◽

...

Keyword(s):

Acute Stroke ◽

Demographic Data ◽

Patient Discharge ◽

Cross Sectional Study ◽

Primary Diagnosis ◽

Cross Sectional ◽

Discharge Data ◽

Patient Demographic Data ◽

Mode Of Transport ◽

Time Of Admission

Background: EMS (Emergency Medical Services) is an important component of the stroke chain of survival. While in hospital stroke time targets have shown to be better when prehospital providers provide advance notification, population-wide studies on thrombolysis rates (IV t-PA) for those who arrive by EMS is sparse. Objective: To examine differences in treatment rates for acute stroke by mode of transport. Methods: This is a cross-sectional study of all patients who were transported to hospitals in two Northern California counties by providers of a single EMS agency during a three year period. Patient demographic data, prehospital provider clinical assessment was obtained from the computerized prehospital transport records and patient location, hospital demographics, physician diagnosis and treatment rates were obtained from statewide administrative patient discharge data. The data sources were linked using probabilistic linkage methodology. Patients ≥18 years of age with validated ICD- 9 code for stroke were included. We excluded inter-facility transports and direct admissions. Results: Of 10,456 patients who had a hospital based discharge diagnosis of stroke, 3787 (36%) were transported by EMS. Mean age at the time of admission was 75 years (+/- 14); 55% (2093) were females, 65% (2471) were whites and 86% (3247) were Hispanics. Most of the patients had Medicare (72%, 2737) and 92% (3471) were transported from home. Majority of the patients were treated at stroke centers [n=3014, (80%)]) and at community hospitals [n=3664, (97%)]. Of 3757 patients with a primary diagnosis of stroke, 4% (150) were treated with IV t-PA. After controlling for covariates, patients transported by EMS had higher odds of treatment with IV t-PA (OR 2.6, 95 CI 1.9-3.3). Treatment at stroke centers (OR 1.5, 95 CI 1-2.2) and academic centers were independently associated with treatment rates (OR 2.4, 95 CI 1.6-3.6). Conclusions: Arrival by EMS to emergency department is associated with higher treatment rates with thrombolytics for acute stroke patients and efforts should be targeted to improve use of EMS for stroke.

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