Prevalence, characteristics, and associated factors of dyskalemia in Moroccan intensive care units over a 28-month period: A cross-sectional correlational study

To determine the prevalence of subclinical bacteriuria and its natural clinical course over a 3-month period in healthy female dogs. Observational, prospective, cross-sectional study. 101 healthy client-owned female dogs. In all dogs, screening clinicopathologic tests and bacteriologic culture of urine were performed. In culture-positive dogs, subclinical bacteriuria was confirmed by 2 positive culture results within 2 weeks and dogs were reevaluated at 3 months. The prevalence of subclinical bacteriuria in healthy female dogs was 9 of 101 (8.9%). Three-month follow-up data were available for 8 of 9 dogs with subclinical bacteriuria. Four dogs had persistent bacteriuria, and 4 had transient bacteriuria. No dogs with subclinical bacteriuria developed clinical signs during the 3-month observation period. Subclinical bacteriuria was diagnosed in 6 of 51 (12%) young and middle-aged dogs and 3 of 50 (6.0%) senior and geriatric dogs. No significant difference was found in the prevalence of subclinical bacteriuria with age. Results suggested that subclinical bacteriuria is a nonprogressive condition in healthy female dogs and can be persistent or transient. No significant difference in the prevalence of subclinical bacteriuria in young and middle-aged dogs versus senior and geriatric dogs was detected. No dogs with subclinical bacteriuria developed clinical signs requiring antimicrobial treatment during the 3-month observation period. Healthy female dogs with subclinical bacteriuria may be a population of dogs in which antimicrobial treatment is unnecessary.

BackgroundSmoking is a plausible risk factor for COVID-19 progression and complications. Smoking cessation digital platforms transcend pandemic-driven social distancing and lockdown measures in terms of assisting smokers in their quit attempts.ObjectiveThis study aims to examine trends in the number of visitors, followers, and subscribers on smoking cessation digital platforms from January to April 2020 and to compare these traffic data to those observed during the same 4-month period in 2019. The examination of prepandemic and postpandemic trends in smoking cessation digital platform traffic can reveal whether interest in smoking cessation among smokers is attributable to the COVID-19 pandemic.MethodsWe obtained cross-sectional data from daily visitors on the SmokeFree website; the followers of six SmokeFree social media accounts; and subscribers to the SmokeFree SMS text messaging and mobile app interventions of the National Cancer Institute’s SmokeFree.gov initiative platforms, which are publicly available to US smokers. Average daily percentage changes (ADPCs) were used to measure trends for the entire 2020 and 2019 study periods, whereas daily percentage changes (DPCs) were used to measure trends for each time segment of change within each 4-month period. Data analysis was conducted in May and June 2020.ResultsThe number of new daily visitors on the SmokeFree website (between days 39 and 44: DPC=18.79%; 95% CI 5.16% to 34.19%) and subscribers to the adult-focused interventions QuitGuide (between days 11 and 62: DPC=1.11%; 95% CI 0.80% to 1.43%) and SmokeFreeTXT (between days 11 and 89: DPC=0.23%; 95% CI 0.004% to 0.47%) increased, but this was followed by declines in traffic. No comparable peaks were observed in 2019. The number of new daily subscribers to quitSTART (ie, the teen-focused intervention) trended downward in 2020 (ADPC=−1.02%; 95% CI −1.88% to −0.15%), whereas the overall trend in the number of subscribers in 2019 was insignificant (P=.07). The number of SmokeFree social media account followers steadily increased by <0.1% over the 4-month study periods in 2019 and 2020.ConclusionsPeaks in traffic on the SmokeFree website and adult-focused intervention platforms in 2020 could be attributed to an increased interest in smoking cessation among smokers during the COVID-19 pandemic. Coordinated campaigns, especially those for adolescents, should emphasize the importance of smoking cessation as a preventive measure against SARS-CoV-2 infection and raise awareness of digital smoking cessation platforms to capitalize on smokers’ heightened interest during the pandemic.

Background: Invasive candidiasis management through the rapid initiation of appropriate antifungal therapy has been shown to be associated with the better prognosis, improved clinical outcome and reduced mortality in critically ill patients. Therefore, selection of an appropriate antifungal therapy should be based on the distribution of candida species and the pattern of antifungal resistance. This study aimed to assess the prevalence of candidemia and associated subtypes following severe sepsis in non-neutropenic critically ill patients. Methods: This study was a cross-sectional study that was conducted on severe sepsis patients stayed at least seven days in intensive care unit. Patients less than 18 years old, pregnant and breastfeeding patients, immunocompromised patients, neutropenic patients, patients with concurrent use of antifungal medicines and cytotoxic agents were excluded.To asses the candidemia, one mililiter of patients’ blood sample was collected. Sample analysis was performed by Real-Time PCR and high resolution melting curve analysis method. Results: Thirty-one critically ill patients were recruited in this study over 12-month period. Candidemia with a detection limit of 100 pg per 0.2 ml blood sample was not recognized in any of the included patients. Conclusion: The present result indicates low incidence of candidemia in the targeted intensive care units, but other factors such as small sample size, exclusion of patients with compromised immune system and the low fungal load at the time of sampling may also account for our observation. (www.actabiomedica.it)

To induce status epilepticus (SE) followed by the subsequent onset of spontaneous recurrent seizures, thus characterizing a new model of temporal lobe epilepsy in a nonhuman primate. Male and female marmosets (Callithrix jacchus) (n = 18), ages between 2 and 8 years, were injected with domoic acid (0.5-4 mg/kg, i.p.) or saline, and behaviorally assessed with regard to the presence of acutely induced seizures and for < or = 6 months for spontaneous seizures. Injection of doses ranging from 3.5 to 4 mg/kg either did not induce SE or resulted in fatal SE. Even a 5-min SE duration (SE blockade resulting from diazepam injection) proved lethal to marmosets within 1 h of domoate administration, regardless of intensive care and monitoring of the animals. Animals injected with doses ranging from 0.5 to 3 mg/kg that developed only a few minor convulsive signs were allowed a 6-month survival period for the assessment of spontaneous epileptic events. At the end of the experiment, 6-month period, or acute intoxication associated with SE induction, animals were deeply anesthetized and had their brains subjected to histologic processing for Nissl and delta-FosB. For the animals injected with domoate that did not develop SE (i.e., those that survived), we could not detect any behavioral signs of spontaneous epileptic seizures in the 6-month observation period, and only minor indications of neuropathologic changes (i.e., neuronal death) over Nissl-stained sections, as well as some small changes in the staining for delta-FosB in a few of the animals. Systemic administration of domoic acid to marmosets is not effective for the generation of a model of chronic temporal lobe epilepsy. Administration of domoic acid at doses that do not lead to SE also did not lead to the development of temporal lobe epilepsy or clear-cut behavioral changes over a 6-month period.

To evaluate the predictive validity of the self-extubation risk assessment tool (SERAT) in intensive care patients. Unplanned extubation is an important complication in intensive care units (ICUs). Physicians and nurses working in the ICU would benefit by having access to a tool that could reliably identify patients at risk for unplanned extubation. The SERAT is a risk stratification scheme developed to identify patients at risk for deliberate self-extubation. A prospective, diagnostic study. Over a 3-month period, 256 patients who were admitted in one of five ICUs in four hospitals in Flanders (Belgium) were studied. The Glasgow Coma Scale and the Bloomsbury Sedation Score were completed by nurses at the start of each shift, i.e. three times per day. Independent nurse researchers collected data on planned or unplanned extubation and placed the data in the SERAT classification scheme. Five self-extubations and three accidental extubations occurred during the 3-month study period, yielding an incidence of 4.47% that corresponded to 0.56 unplanned extubations per 100 ventilation days. Using the highest accuracy model, we determined that the SERAT had a sensitivity of 100%, specificity of 90%, negative predictive value of 100%, positive predictive value of 1.2% and accuracy of 90%. Although the SERAT can correctly identify patients at risk for deliberate self-extubation, its use also produces a high number of false-positive identifications. Further research is necessary to evaluate how the false-positive rate can be reduced, and subsequently, the predictive validity of the SERAT can be improved. Because of the high number of false positives, the use of the SERAT in clinical practice to date is not advocated. The positive predictive value has to be improved to avoid the implementation of intensive interventions in patients who are not at risk.

To investigate the specificity of the electrocardiographic diagnosis of ST-segment elevation myocardial infarction in the critical care unit setting. Retrospective observational cohort analysis. An 880-bed tertiary care teaching hospital with 120 intensive care unit beds. The population included medical, surgical, trauma, and neurosurgical intensive care unit patients. Electrocardiograms were systematically collected to include all consecutive recordings over a 15-month period in which the interpretation software indicated ***ACUTE MI***. Patient demographics, markers of intensive care unit complexity, and hospital mortality were ascertained. The electrocardiograms were then further evaluated by a blinded, board-certified cardiologist for agreement or disagreement with the interpretation software. Serum troponin measurements obtained within 96 hrs of electrocardiogram acquisition were used to determine the likelihood of myocardial infarction. Over the 15-month study period, the interpretation software diagnosed ST-segment elevation myocardial infarction in 67 of 2243 intensive care unit patients (2.99%) who had an electrocardiogram performed. In the final study population of 46 cases with electrocardiographic ST-segment elevation myocardial infarction, 85% had peak troponin elevation<5 ng/mL, a strong suggestion against clinical ST-segment elevation myocardial infarction. The cardiologist agreed with the computer interpretation in 39% (18 of 46) of cases, but of those 18 patients, only six showed a significant rise in the troponin level. The cardiologist disagreed with the computer interpretation in 60.9% (28 of 46) of cases and of those, one patient had a marked elevation of the cardiac troponin. ST-segment elevation myocardial infarction in the intensive care unit is a relatively common electrocardiographic reading both by standard interpretation software and by expert evaluation. In contrast to nonintensive care unit patients who present with chest pain, the electrocardiographic ST-segment elevation myocardial infarction diagnosis seems to be a nonspecific finding in the intensive care unit that is frequently the result of a variety of nonischemic processes. The vast majority of such patients do not have frank ST-segment elevation myocardial infarction.

More than 18 million adults in the United States abuse alcohol, a prevalence 5 times higher than that of hepatitis C. Chronic alcohol use of greater than 80 g/day for more than 10 years increases the risk for hepatocellular carcinoma (HCC) approximately 5-fold; alcohol use of less than 80 g/day is associated with a nonsignificant increased risk for HCC. The risk for HCC in decompensated alcohol induced cirrhosis approaches 1% per year. The risk does not decrease with abstinence, and HCC can occur in a noncirrhotic liver. Alcohol use in chronic hepatitis C doubles the risk for HCC as compared with the risk in hepatitis C alone. Furthermore, there may be synergism between alcohol and hepatitis C in the development of HCC, and in these patients HCC may occur at an earlier age and the HCC may be histologically more advanced. Studies in the United States and Italy suggest that alcohol is the most common cause of HCC (accounting for 32%-45% of HCC). The mechanisms by which alcohol causes HCC are incompletely understood, but may include chromosomal loss, oxidative stress, a decreased retinoic acid level in the liver, altered DNA methylation, and genetic susceptibility. Alcohol use is increasing in many countries, suggesting that alcohol will continue to be a common cause of HCC throughout the world.

Clinical decision-making in the intensive care setting frequently requires the physician to obtain additional resource information. Physicians typically consult with colleagues, use personal medical books or files, or use library materials. Clinical librarians may also be used. This study evaluates the effectiveness of an ongoing clinical librarian program in the intensive care setting. During a 3-month period, house officers in the medical and coronary ICUs in a major teaching hospital asked the clinical librarian 66 patient-care questions. Attached to the information selected by the clinical librarian was a questionnaire asking how the information was applied. There was an overall response rate of 65.1%. House officers indicated that the information: a) aided in diagnosis (37.2%), b) contributed to a better understanding of the therapy (51.2%), and c) resulted in improved patient management (30.2%). In some instances, the information was multibeneficial. The clinical librarian spent an average of 47 mins/question, and accumulated an average computer charge of $3.59. Personnel and on-line charges over the 3-month study period averaged $45/question. Clinical librarian programs may deliver patient-specific information in a timely, cost-effective manner. This information has an impact in the intensive care setting.

Identify the impact of COVID-19 lockdown restrictions on the vitamin D status of individuals in the west of Ireland. Cross-sectional study. Adults who had wintertime serum 25(OH)D analysis completed in Galway University Hospital. A total of 16,725 participants (2015-2020 (n = 13,449) and 2020-2021 (n = 3276)). Baseline demographics; sex, age, origin of the sample and the date of sample collection. Median serum vitamin D and serum vitamin D3 concentrations were higher in the 5-month period from October-February 2020-2021 (61nmol/L (± 36-85nmol/L) and 60nmol/L (± 34-85nmol/L)) respectively, than for the corresponding 5-month period (October-February) in 2015-2020 (53nmol/L (± 32-78nmol/L) and 51nmol/L (± 30-77nmol/L)) respectively. These changes coincided with a decline in the prevalence of deficiency. In the 5-month period October-February 2020-2021, 19.2% of the population were vitamin D deficient (< 30nmol/L) compared to 22.5% in the corresponding 5-month period in 2015-2020, and 38.1% were vitamin D deficient (< 50nmol/L) in the 5-month period October-February 2020-2021 compared to 46.6% in the corresponding 5-month period in 2015-2020. Males were more likely to be deficient at both thresholds (p < 0.001). For the total cohort, at the < 30nmol/L threshold, inpatients (25.5%) and nursing home residents (34.1%) had higher prevalence of deficiency. Vitamin D levels were higher in the 5-month period of October-February 2020-2021, and this precipitated a decline in deficiency at both thresholds, indicating that lockdown coincided with enhanced vitamin D status. We postulate that it may be attributable to changes in diet and/or supplementation, or increased sun exposure, but further confirmatory studies are required.

Cirrhosis, diabetes mellitus, impaired glucose tolerance, insulin resistance, and protein calorie malnutrition are important issues in cirrhotic patients because they can increase the progression of liver disease and worsen its prognosis. To determine the prevalence of diabetes mellitus, impaired glucose tolerance and insulin resistance in cirrhotic patients being evaluated for liver transplantation and their impacts on a 3-month follow-up, and to compare fasting glycemia and oral glucose tolerance test. A cross-sectional study was performed in consecutively included adult patients. Diabetes mellitus was established through fasting glycemia and oral glucose tolerance test in diagnosing diabetes mellitus in this population. HOMA-IR and HOMA-beta indexes were calculated, and nutritional assessment was performed by subjective global assessment, anthropometry and handgrip strength through dynamometry. Diabetes mellitus was found in 40 patients (64.5%), 9 (22.5%) of them by fasting glycemia and 31 (77.5%) of them by oral glucose tolerance test. Insulin resistance was found in 40 (69%) of the patients. There was no relationship between diabetes mellitus and the etiology of cirrhosis. Protein calorie malnutrition was diagnosed in a range from 3.22% to 45.2% by anthropometry, 58.1% by subjective global assessment and 88.7% by handgrip strength. Diabetes mellitus identified by oral glucose tolerance test was related significantly to a higher prevalence of infectious complications and deaths in a 3-month period (P = 0.017). The prevalence of diabetes mellitus, impaired glucose tolerance, insulin resistance and protein calorie malnutrition is high in cirrhotic patients on the waiting list for liver transplantation. There were more infectious complications and/or deaths in a 3-month follow-up period in patients with diabetes mellitus diagnosed by oral glucose tolerance test. Oral glucose tolerance test seems to be indicated as a routine practice in this population.

BackgroundIndividuals living with sickle cell disease (SCD) have significantly increased emergency department (ED) use compared to the general population. In Saudi Arabia, health care is free for all individuals and therefore has no bearing on increased ED visits. However, little is known about the relationship between quality of life (QoL) and frequency of acute care utilization in this patient population.MethodsA cross-sectional study was conducted on 366 patients with SCD who attended the outpatient department at King Fahad Hospital, Hofuf, Saudi Arabia. Data were collected through self-administered surveys, which included: demographics, SCD-related ED visits, clinical issues, and QoL levels. We assessed the ED use by asking for the number of SCD-related ED visits within a 6-month period.ResultsThe self-report survey of ED visits was completed by 308 SCD patients. The median number of SCD-related ED visits within a 6-month time period (IQR) was four (2-7 visits). According to the unadjusted negative binomial model, the rate of SCD-related ED visits increased by (46, 39.3, 40, and 53.5 %) for patients with fever, skin redness with itching, swelling, and blood transfusion, respectively. Poor QoL tends to increase the rate of SCD-related ED visits. Well education and poor general health positively influenced the rate of SCD-related ED visits. Well education tends to increase the rate of SCD-related ED visits by 50.2 %. The rate of SCD-related ED visits decreased by 1.4 % for every point increase in general health.ConclusionSaudi patients with sickle cell disease reported a wide range of SCD-related ED visits. It was estimated that six of 10 SCD patients had at least three ED visits within a 6-month period. Well education and poor general health resulted in an increase in the rate of SCD-related ED visits.

This paper is a report of a study to determine changes over a 3-month period among older people with dementia living in long-term care settings, related to: (1) changes in body mass index, and (2) health outcomes and associated factors. Nutritional deficiencies are common problems among older people, but frequently unrecognized, both in long-term care settings and in the community. A cross-sectional design with repeated measures of body weights and medical record reviews was adopted. The study was conducted in 2003 in two long-term care facilities for older people with dementia in Taiwan. Fifty-five residents participated in the study. Eighteen percent of the residents were under-nourished (body mass index <18.5). There was a trend toward decreasing body mass index over the 3-month study period. Residents with low body mass index tended to need assistance at mealtimes. Nineteen residents, many receiving naso-gastric tube-feeding, experienced adverse health events during the study period. Dependency in eating was the major factor differentiating residents with normal or low body mass index values, and also in distinguishing those who experienced adverse health outcomes. Assessment of eating ability, mode of feeding and measurement of body weight can be used by nurses in long-term care settings for early identification of the nutritional status of older people with dementia.

Intensive Care Unit (ICU) services are expensive, and therefore appropriate utilisation is imperative. Delayed discharges impact on the efficiency and effectiveness of ICU services. This study examines the prevalence and reasons for delayed discharge. Cross sectional study. We enrolled a prospective sample of all patients admitted to a 22-bed ICU over a 6-month period. Medical staff in ICU informed nursing shift coordinators when patients could be discharged. Nursing shift coordinators maintained a record of discharge times, delays and reasons for delay. Discharge was considered delayed if the patient was not relocated from the ICU within 8 hours of being considered eligible by ICU medical staff. Of 652 recorded discharges, 176 were delayed (27%). Unavailable ward beds (81%) were cited as the main reason for delay in discharge. Median delay time was 21.3 hours (range, 10 minutes to 26 days). These delays were predicted by greater patient acuity on ICU admission, patient deterioration while waiting for transfer to the ward, principal admitting diagnosis, discharge destination and weekend discharge. Improvement in bed management and discharge processes (the only factors directly controllable by the hospital) is essential to reduce delays in discharge from ICU. Reducing discharge delays would free up beds for other admissions; may result in a cost saving for the hospital through more efficient resource utilisation; and, ultimately, would benefit patients.

Reduced quality in patient care is associated with impaired mental health among healthcare professionals. Hospital staff experience intense stress and are at high risk of burnout. The study aimed to demonstrate whether inhaling essential oils using sticks improved the well-being of healthcare professionals working in the emergency, intensive care, anaesthesia and operating theatre departments of our hospital. The effects of aromatherapy on stress and anxiety were also studied. This randomised, single-centre, crossover study was open-label. Healthcare professionals were given a mixture of essential oils to inhale in stick form (sweet orange, lavender, marjoram and ylang ylang) for 2 months, starting either immediately or after a 2-month control period without essential oils. The order was determined by randomisation. The primary outcome was the WHO-5 well-being index, ranging from 0 to 100. A total of 51 participants were randomised, 49 of whom were retained for analysis. Twenty-six professionals received aromatherapy for 2 months immediately after randomisation, followed by a 2-month period without essential oils, while the remaining 23 participants started with a 2-month control period with no intervention. The WHO-5 well-being score, expressed as the least-square mean ± standard error, was significantly increased after the aromatherapy period compared to the control period (65.9 ± 1.8 vs. 60.4 ± 1.8, p-value = 0.0142). There was also a significant reduction in the general anxiety and perceived stress scores. Aromatherapy could be an interesting way of improving the well-being of healthcare professionals, reducing their anxiety and perceived stress levels. The complementary use of aromatherapy, an inexpensive method, seems promising but needs to be confirmed by larger scale studies with a robust methodology. The protocol was registered on ClinicalTrials.gov (NCT05373849) on 4 May 2022.

Background: Medication errors in healthcare settings, including outpatient and hospital environments, pose a significant risk to patient safety. These errors can arise from incorrect dosages, drug interactions, contraindications, or inappropriate drug combinations. Methods: This study aimed to assess the logical prescription of albumin according to guidelines and patient safety for inpatients in the intensive care units of Imam Reza Hospital in Mashhad through a cross-sectional study. Methods: Data were collected over a 3-month period from albumin prescriptions in intensive care units, using a checklist based on information from prescription forms, patient files, and consultations. Results: The study found that 60.57% of albumin prescriptions were reviewed by DUE unit, with 51.53% complying with guidelines and 48.47% not. The highest prescription rate was in the Intensive Care Unit of Heart Surgery (ICUOH), at 36.83%, and the lowest in the Neonatal Intensive Care Unit (NICU), at 0.63%. The patient safety parameter, calculated based on correct/incorrect albumin prescriptions according to guidelines, showed an average safety of 67.10% across prescribing units and 62.34% based on indications. It reduced the financial burden caused by inappropriate prescriptions approximately $21,390 through DUE process. Conclusion: The research highlights the importance of continuous guideline-base DUE on rational drug utilization, patient safety and hospitals costs.