Bed Side Research Articles

SAT536 A Case of Papillary Thyroid Cancer in Multiple Cervical Lymph Nodes, But Not Found in Thyroid Tissue on Pathology

Abstract Disclosure: M.A. Green: None. G.Y. Kim: None. Introduction:As technology advances, imaging becomes increasingly frequent and within the thyroid gland nodules can often be detected. After detection comes evaluation and lymph nodes within the neck are an integral part of this step. For that reason, fine needle aspiration (FNA) of cervical lymph nodes is known to lend a hand toward diagnosis. Here we present a patient who was diagnosed with Papillary Thyroid Cancer (PTC) from FNA pathology of a lymph node, but PTC was not noted within pathology of the thyroid tissue after total thyroidectomy. Case Presentation: This patient is a 34 year-old female with a history of ovarian cancer who presented to the clinic for a thyroid nodule and Hashimoto’s disease. A bed side ultrasound noted a right upper pole 1.6 x 0.6 x 0.6 cm thyroid nodule and a solid 1.8 x 1.5 x 0.8 cm nodule superior to the isthmus likely representing a delphian lymph node. As well, significant cervical lymphadenopathy was seen. A biopsy of the right upper pole nodule was nondiagnostic on FNA, but the delphian lymph node superior to the isthmus was positive for PTC. The patient then underwent total thyroidectomy and right and central neck lymph node dissections. Interestingly, PTC was noted in 3 of 27 lymph nodes in the central compartment, 5 of 18 lymph nodes excised with the thyroid tissue with extranodal extension, and 5 of 24 lymph nodes in the right neck compartment, but not noted in the thyroid tissue itself. The largest metastatic dimension of PTC within the cervical lymph nodes was noted to be 3 cm. The pathology noted a 1.0 cm tumor in the right lobe “approaching skeletal muscle” and psammoma bodies within the left lobe. After the patient’s surgery her stimulated thyroglobulin reported as 0.21 NG/mL and thyroglobulin antibody 2 IU/mL. She was then able to receive 30 mCi of I 131 sodium iodide. TSH maintained at goal on levothyroxine 200 mcg daily. Discussion: Diagnosis of PTC within multiple cervical lymph nodes, but not noted on thyroid pathology is very uncommon. It is highly unlikely in our patient that a cancer within the thyroid does not exist and there are theories to postulate this unique finding. These include missed pathology on the dissection, tumor regression prior to removal, or possibly ectopic tissue as the source of PTC. Although in our patient, given the significant amount of positive cervical lymph nodes, it is hard to believe that ectopic tissue away from the neck was the source or that tumor regression occurred. The pathological findings of psammoma bodies suggest the presence of PTC that spread to the lymphatic system. As well, the nature of thyroid removal leads to some destruction of tissue prior to evaluation. This case highlights the importance of thorough lymph node evaluation as a complete part of preoperative PTC assessment. Presentation Date: Saturday, June 17, 2023

Apixaban and rivaroxaban's physiologically-based pharmacokinetic model validation in hospitalized patients: A first step for larger use of a priori modeling approach at bed side.

When used in real-world conditions, substantial interindividual variations in direct oral anticoagulant (DOAC) plasma concentrations are observed for a given dose, leading to a risk of over- or under-exposure and clinically significant adverse events. Physiologically-based pharmacokinetic (PBPK) models could help physicians to tailor DOAC prescriptions in vulnerable patient populations, such as those in the hospital setting. The present study aims to validate prospectively PBPK models for rivaroxaban and apixaban in a large cohort of elderly, polymorbid, and hospitalized patients. In using a model of geriatric population integrating appropriate physiological parameters into models first optimized with healthy volunteer data, observed plasma concentration collected in hospitalized patients on apixaban (n = 100) and rivaroxaban (n = 100) were adequately predicted (ratio predicted/observed area under the concentration curve for a dosing interval [AUCtau ] = 0.97 [0.96-0.99] geometric mean, 90% confidence interval, ratio predicted/observed AUCtau = 1.03 [1.02-1.05]) for apixaban and rivaroxaban, respectively. Validation of the present PBPK models for rivaroxaban and apixaban in in-patients represent an additional step toward the feasibility of bedside use.

Therapeutic Plasma Exchange among Myasthenia Gravis Patients Attended at Referral Neurosciences Hospital in Bangladesh: A Single Centre Experience

Background: Therapeutic Plasma Exchange (TPE) is an effective therapeutic procedure for treating Myasthenia Gravis (MG). Objectives: The aim of study was to evaluate demographics, indications, adverse reactions and outcome of therapeutic plasma exchange in myasthenia gravis patients. Methodology: This prospective observational study was conducted in the Department of Transfusion Medicine at National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh from August 2014 to June 2022. All patients with Myasthenia Gravis who received therapeutic plasma exchange as a treatment during hospitalization were included in this study. Data were systematically recorded and these were variables of demographics, clinical indications, numbers of sessions, volume of exchanged plasma, clinical responses and complications during or after the procedure. Results: A total number of 72 patients had undergone 275 sessions of therapeutic plasma exchange among which 52(72.2%) cases were male and the mean age was 39.5±13.11 years. For each patient the number of therapeutic plasma exchange session and volume of plasma exchange were 3.69±1.016 (Range 2 to 7) and 2266.7±361.53 ml (Range 1400 to 3100) respectively. Anti-acetylcholine receptor antibody (Anti-ACR Ab) was positive in 44(61.1%) cases. Myasthenic crisis (n=45, 62.5%) was the most common indication of therapeutic plasma exchange followed by preoperative preparation for thymectomy (n=16, 22.2%) and worsening of myasthenic weakness (n=11, 15.3%). In 275 sessions of therapeutic plasma exchange, overall incidence of adverse reaction was in 26(9.45%) cases. Mild allergy (n=9, 3.27%) and pyrexia (n=5, 1.82%) were most commonly reported. Hypotension was reported in 4(1.46%) cases. Reactions were mild and were reversed by bed side managements. Response to treatment was observed in 80.5% (n=58) patients. 2(2.8%) patients of Myasthenia Gravis died; but death was unrelated to therapeutic plasma exchange. Conclusion: Therapeutic plasma exchange is rapidly effective therapy for myasthenic crisis, progressive myasthenia gravis and prior to thymectomy operation and it has adequate safety profile. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):16-23

Is Carboxyhaemoglobin an Effective Bedside Prognostic Tool for Sepsis and Septic Shock Patients?

Proper management of sepsis poses a challenge even today, with early diagnosis and targeted treatment being the most important steps. Easy, cost-effective bedside tools are needed in order to pinpoint towards the outcome of sepsis or septic shock. This study aims to find a correlation between Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) severity scores, the Neutrophil-Lymphocytes Ratio (NLR) and carboxyhaemoglobin (COHb) levels in septic or septic shock patients with the scope of establishing a bed side cost-effective prognostic tool. A pilot, prospective, observational, and ongoing study was conducted on 61 patients admitted with sepsis or septic shock according to the SEPSIS 3 Consensus definition. We followed clinical and paraclinical parameters on day 1 (D1) and day 5 (D5) after meeting the inclusion criteria. On D1 we found a statistically significant positive correlation between each severity score (p <0.0001), r = 0.7287 for SOFA vs. APACHE II with CI: 0.5841-0.8285, r = 0.6862 for SOFA vs. SAPS II with CI: 0.5251-0.7998 and r = 0.8534 for APACHE II vs. SAPS II with CI: 0.7663 to 0.9097. On D5 we observed similar results: a significant positive correlation between each severity score (p <0.0001), with r = 0.7877 for SOFA vs. APACHE II with CI: 0.6283 to 0.8836, r = 0.8210 for SOFA vs. SAPS II with CI: 0.6822 to 0.9027 and r = 0.8880 for APACHE II vs. SAPS II., CI: 0.7952 to 0.9401. Nil correlation was found between the severity scores, NLR and COHb on D1 and D5. Cost-effective bedside tools to pinpoint towards the outcome of sepsis are yet to be found, however the positive correlation between the severity scores point out to a combination of such tools for prognosis prediction of septic or septic shock patients.

STUDENT’S PERCEPTION TOWARDS CLINICAL LEARNING ENVIRONMENT AT A MEDICAL COLLEGE, CHITWAN

Background: Clinical learning environment is an environment where the nursing student is systematically exposed in simulation laboratories and with real patients to learn and practice on their own for better clinical outcomes leading to quality nursing services. This study aimed to assess the nursing students’ perception towards clinical learning environment. Methods: A descriptive cross-sectional study was conducted among 98 nursing students studying in Generic Bachelor of Science in Nursing (B. Sc. Nursing) and Bachelor in Nursing Sciences (BNS) in School of Nursing, Chitwan Medical College, selected using probability stratified proportionate random sampling technique. Structured self- administered questionnaire; Modified Clinical Learning Environment Inventory was used to collect the data and analyzed using Chi-Square test. Results: The findings of the study revealed that, median age of student was 22 years with the range of 19-29 years. Majority of students (64.3%) were from academic program Bachelor of Science in Nursing and 84.7% studied nursing on their own will. Study showed that majority of students (74.5%) had positive perception towards clinical learning environment and the level of perception was found to have statistically significant association with adequacy of patient flow during posting, availability of articles for clinical procedure and use of different clinical teaching methods such as bed side presentation and simulation (p&lt;0.05). Conclusions: Nearly three fourth of the students have positive perception towards clinical learning environment. Many factors such as availability of adequate number of patients, adequate resources tend to influence clinical learning environment. The study results suggest the need of using clinical teaching methods to improve the clinical learning.

Modeling surface water and groundwater interactions for seepage losses estimation from unlined and lined canals

ABSTRACT This study utilized the Slide2 model to simulate surface water and groundwater interactions and estimate seepage losses from unlined and lined irrigation canals. Firstly, it was validated for an unlined canal passing through an unconfined, homogenous, and isotropic infinitely porous depth. Results revealed that the Slide2 model accurately simulated the seepage flow and estimated the seepage losses with R 2 = 0.99 and MAPE = 3.6%. Accordingly, the Slide2 model runs 54 scenarios to explore the effect of different groundwater table (GWT) locations below the canal berm, canal berm widths, and liner properties, such as liner hydraulic conductivity and thickness on the seepage losses from unlined and lined irrigation canals. The results concluded that when the GWT was above the canal surface water level (CSWL), the seepage losses tended to be lower, ensuing an inflow to the canal bed and inner side slope. Conversely, when the GWT was below the CSWL, the seepage losses tended to be higher, ensuing an outflow to the surrounding unsaturated soil. In contrast, the GWT did not affect seepage losses from lined canals. Also, a wider berm resulted in fewer seepage losses, while the canal berm was less effective for lined canals. In addition, the results proved the lining ability to reduce seepage losses. Thus, the average reduction percentage of the seepage losses for lined canal scenarios was 99.87%. Also, a thick liner could decrease the seepage losses maximally by 48.52%, regardless of the GWT location below the canal berm.

484. ROBOTIC ASSISTED PRONE ESOPHAGECTOMY USING VERSIUS PLATFORM: A PROMISING APPROACH

Abstract Background Esophagectomy for cancer is a complex procedure with high morbidity. Minimally invasive approach offers the benefits of minimal access across the different fields required during this operation. Robotic surgery is becoming an integral part of modern practice. It holds the potential of more precision especially in narrow thoracic space. Currently, Many Robotic platforms exist. This video aims to demonstrate the feasibility of Robotic Mc Keown esophagectomy in the prone position using Versius platform. Methods 56 years old male patient presented with grade I dysphagia of 3 months duration. His complete assessment revealed an 11 cm long invasive non keratinizing squamous cell carcinoma located in the mid esophagus (cT3N1M0). Marked regressive course of the lesion occurred with neoadjuvant chemoradiation. Robotic assisted Mc Keown esophagectomy was performed in the prone position. Thoracic phase was performed with the robotic approach. Bed side units and Port placement is illustrated in the video. The abdominal phase was accomplished laparoscopically. Finally, the stomach was pulled up and the esophagogastric anastomosis was done in the neck. Results No intraoperative adverse events were encountered. The improved vision, dexterity and articulation of instruments facilitated the identification of the thoracic duct, ligation of azygos vein tributaries and dissection of the recurrent laryngeal lymph nodes. Instrument clash was insignificant due to patient’s wide chest cavity and optimal positioning of ports and bed side units improving ergonomics. The operative time of the thoracic phase was 310 min. Blood loss was 300 mL. The postoperative course was uneventful except for chest infection which improved on conservative measures. The length of stay was 18 days. Pathology revealed complete clinical response with 0/25 lymph node yield. Conclusion Robotic assisted esophagectomy is feasible and can be safely performed using Versius robotic platform. The enhanced visualization and articulation enabled meticulous dissection of the recurrent laryngeal lymph nodes. Patient positioning, optimal port and bed side units placement were keys to achieving minimal instrument clash. Further research is needed to confirm these findings and to compare the long-term oncological outcomes and cost effectiveness of this modality. Video links: https://we.tl/t-rpkTHvNlXI or https://drive.google.com/drive/folders/1tOsFPrEBUHBpVn8C9jF7BGoNxlYPuBjq?usp=sharing.

Utility of lower tube voltage scans in reducing exposure of healthcare workers within computed tomography room to scattered radiation.

The aim of this study was to estimate the effect of tube voltage on the scattered dose in a computed tomography (CT) room. To this end, we conducted experiments using anthropomorphic phantoms and a CT scanner at different tube voltages during CT. The scattered dose was measured using an electronic pocket dosemeter at 50-cm intervals from the centre of the gantry. The structure of the CT room was measured at 57 points (28 points in the front of the gantry (on the bed side), 6 points on the side of the gantry and 23 points behind the gantry) to be up to 200cm. We compared the scattered dose distributions between 80 and 120 kVp at heights of 50, 100 and 150cm above the floor surface. The scattered dose was reduced by ~30% when the tube voltage was reduced from 120 to 80 kVp.

The Predictive Value of Urinary Trypsinogen-2 Dipstick for Early Diagnosis of Acute Pancreatitis in Intensive Care

Abstract Background Acute pancreatitis is a sudden inflammation in the pancreas, with potential and variable involvement of adjacent organs or other organ systems. Aim of the Work to evaluate the rule of urinary trypsinogen-2 using dipstick test in the diagnosis of acute pancreatitis. Patients and Methods This cross-sectional study was carried out in surgical intensive care unit, Ain Shams University hospitals, during a period of 6 months. Forty five patients were included in our study, thirty patients were diagnosed as acute pancreatitis and fifteen patients weren’t diagnosed as acute pancreatitis through cross sectional study. All patients were subjected to full history taking, full clinical examination, laboratory investigations including serum levels of renal function tests, CBC, total and direct bilirubin, liver enzymes, alkaline phosphatase, INR, amylase and lipase. Urinary trypsinogen-2 dipstick test was done. Also, radiological examinations were done using ultrasonography of abdomen and pelvis, computed tomography of the abdomen. Results The most common cause of acute pancreatitis was gall stone obstructive pancreatitis (70%) and we found that serum amylase and lipase were elevated in (83.3% and 86.7% respectively) in acute pancreatitis patients. While the sensitivity of urinary trypsinogen-2 dipstick test was 93.3% in acute pancreatitis patients. The specificity of serum amylase, serum lipase was 73.3% for both of them, while the specificity of urinary trypsinogen-2 was 100% in diagnosis of acute pancreatitis. Conclusion In-conclusion urinary trypsinogen-2 dipstick test is a promising low cost, bed side and easy test to be done in the diagnosis of acute pancreatitis.

Elastomeric, fillable infusion pumps: an overview for clinical practice.

Due to advances in elastomeric pump technology, there are now devices available that can be filled with intravenous (IV) therapy at the bed or chair side. These devices are safe, reliable and enable the patient to be mobile when having their infusion. The Surefuser™+ elastomeric infusion pump is available in multiple configurations and allows patients to remain independent and receive IV therapy infusions in their own homes. The pump can also be used in the acute healthcare setting where traditional electronic infusion pumps may not be available. This article provides an overview of the Surefuser+ elastomeric infusion pump, its features and mode of action and how it can be used in clinical practice.

Determination of Weed Control Efficiency of Pre-Rice Cropping Cassava/Legume Intercrops and Different Weed Management Practices in Low Land Rice at Badeggi Central Nigeria

The experiment was conducted at the lowland experimental field of National Cereals Research Institute, Badeggi. (90 45N, 600 7E, Alt, 70.57 m) in the Southern Guinea Savannah Agro-ecological zone of Nigeria in 2020-2022 cropping seasons The study was to evaluate the effect of pre-rice cropping cassava/legume intercrops and different weed management practices on weed control efficiency, growth and productivity of low land rice. The trial was conducted in two stages. The first (preceding intercropping) The treatments consisted of Mucuna puriens, Cowpea, Soybean, Lablab purpureus and Aeschynomene histrix that were intercropped with cassava (IIT 427 variety), sole cassava and natural fallow were also included as treatments. These were laid out in a Randomized Complete Block Design and replicated three times. Cassava/legume intercropping was carried out in January using residual moisture on raised beds that were prepared manually. Plot size used was 12.5 x 5 m with alley way of 0.5 m. Beds were constructed at 2.5 m long, 0.5 m wide and 0.75 m high. Planting of Cassava was done on the top sides of beds in two rows with the intra-row spacing of 0.5 (ten stands per bed) and planting of legumes were 0.5 m x 9.25 inter and intra-row spacing respectively except for soybean which was planted drilled at 5 cm intra row spacing immediately the beds were constructed. The cassava/legume cropping was harvested in August The second trial was the planting of rice on the plots previously cropped with cassava/legume intercrops. The trial was laid out in split plot design. Cassava/legume intercrop systems were allocated to the main plot, while weed management practices:- (i) Application of 4. 0 (propanil at 1.44 kg a.i. ha-1 plus 2,4 D at 0.80 kg a.i ha-1 ( Orizo plusR, at the rate of 2.24 kg a.i ha-1 at 3 weeks after transplanting (WAT) followed by hand weeding at 6 WAT (ii) two hand weedings at 3 and 6 WAT (iii) one hand weeding at 3 WAT, and (iv) weedy check were put into the sub plots with size of 12.5 x 5 m for main plots while and sub plot size was 3 x 5 m three replications. The results of treatments indicated that rice planted after cassava/Mucuna, cassava/Aeschynomene intercrops under two hand weeding and herbicide followed by one hand weeding produced lower density and dry matter. Weed control efficiency was higher in rice planted after cassava/mucuna intercrop. Weed reduction percentage range from 25-45 %, 30-50 % and 45-65 % in rice grown after cassava/legume intercrop compared to rice after fallow in 2011, 2012 and 2013 respectively. Higher rice plant height, higher number of rice tiller/stand were recorded in rice grown after cassava/Mucuna, cassava/Aeschynomene. Rice panicles per m2 and rice grain yield were increased by 72.9%, 83.6% and 84.1% in 2011, 2012 and 2013, respectively, with two hand weeding when compared with zero weeding. Rice planted after natural fallow under zero weeding produced higher weed density which resulted in poor rice performances. Rice planted after cassava Mucuna consistently controlled weed growth while cassava/cowpea and cassava Aeschynomene performed much better in rice production hence should be adopted as cropping systems for farmers

Combined treatment of muscle tension dysphonia: voice therapy with instrumental postural rehabilitation.

This investigation aimed to propose a new rehabilitation technique that combines voice exercises and instrumental postural rehabilitation for patients with muscle tension dysphonia (MTD). We enrolled nine dysphonic patients (8 women and 1 man, aged 22-55 years). Voice assessment included strobovideolaryngoscopy, Maximum Phonation Time (MPT), perceptual evaluation by GRBAS scale and patient's self-rating by Italian version of the Voice Handicap Index (VHI). Vestibular function was evaluated by the Bed Side Examination and Video Head Impulse test (VHIT). Postural control was evaluated by Dynamic Posturography (DP) using the Sensory Organization Test (SOT) and analysing the Equilibrium Score (ES) and balance subsystems (somatosensorial, visual, vestibular). All cases underwent different types of voice exercises combined with balance training based on NeuroCom Balance Master Protocols, once a week for six 35-minutes sessions. After therapy, an improvement in MPT, VHI, GRBAS scores and endoscopic laryngeal features was obtained. DP results at baseline were normal and after therapy we showed a slight improvement of ES (somatosensorial and visual components). A combined rehabilitation technique for MTD, by improving the attention to postural control, allows for significant improvement in vocal symptoms.

Evidence based – Enteral feeding algorithm for Neurosurgery ICU/Ward

Enteral feeding is a procedure that is in practice internationally by nurses. Providing enteral feeding to the patients is an art and science of nursing that follows careful steps and principles. Nurses role is not only confined to administering enteral feed but also of educating, giving instructions to the family members, directing caregivers and significant others regarding initiating and maintaining enteral feeding, so that continuity of nutritional care is maintained even in the home setting. Once the patient is admitted in neurosurgical ICU, hemodynamic stability of the patient is utmost important, as hemodynamic instability of the patient may preclude the safe initiation of EN in the critical care patients. Initial stabilization is the key for patient survival followed by maintenance therapy like drugs, mobilization, position, continuous monitoring and nutrition. For determining the need of enteral feeding especially for neurosurgical and neurological patients three things should be given utmost importance i.e. Swallowing deficit, Unconsciousness (Level of consciousness) and Nutritional requirement. Can be easily remembered as pneumonic SUN.Confirming tube position is one of the critical step in effective enteral feeding practice in spite of that it has given least importance. It is recommended to confirm the tube position immediately after ryles’ tube insertion through radiologic methods which may be not feasible sometimes, therefore bedside methods can also be adopted Auscultation methods and Aspiration method are the most widely used method among all the bed side methods for confirming tube placement. Gastric residual volume is the amount aspirated from the stomach following administration of the enteral feed. An aspirate among of less than 500ml in 4-6 hours or less than 50% of last enteral feed is safe and indicates that GIT is functioning. Most patients nicely tolerate enteral feeding via gastric tube while few patients has delayed gastric emptying and high GRVs as a result of sedation, pain medications, hypothermia, decreased movement and the effect of being critically ill. Intolerance of enteral feeding is defined as more than 500ml or more than 50% of last enteral feeding. Though enteral feeding is the most popular procedure for ICU Nursing officer, but it is the most crucial in terms of deciding patient outcome. Effective enteral feeding requires through knowledge of initiation and maintenance of enteral feeding. Thus, this article propose simple algorithm to follow. Effectively delivering nutrition to the patient requires the help of dietitian and physician/surgeon to deal with its challenges that comes along with this golden feeding technique.

Assessing the feasibility of using an irregularly shaped Ta and spherical Ti bimodal powder blend on the powder spreadability process in powder bed fusion systems

The cost of additive manufacturing can be reduced if economical non-spherical powders are used. However, current flowability tests are inadequate to determine whether these powders can flow and spread well in powder bed systems. This paper presents a novel tool called the Universal Powder Bed designed to analyse the layer-spreading process of an electron beam melting system. The spreadability and feasibility of using a novel bimodal powder comprising of irregularly shaped tantalum and spherical titanium is investigated against three measures: area fraction of build surface covered with powder, surface roughness and composition of the powder bed. The characterisation techniques revealed that increasing layer thicknesses and slower rake speeds produced more efficiently packed powder layers and decreased the effects of segregation between opposite sides of the powder bed. This study shows that despite the segregation observed with bimodal powders, acceptable levels of spreadability can be produced by refining the spreading parameters.

The Impact of Nurses Job Stress Level on Patients Care in Tertiary Care Hospital

Nursing is dynamic in nature and nurses are often in high level of job stress because of hard job, work load and burden of responsibilities. These stressors can have negative effect on patient care. The focus of study was to evaluate the correlation of nurses’ job stress and quality of care delivered to patients. Objective: To assess the nurses job stress level and the association of job stress and patient care at tertiary care hospital. Methods: The descriptive cross-sectional study was conducted with 144 participants working in tertiary care hospital. The nurses were selected via convenient sampling technique. The duration of study was 6 months. The data were collected by demographic characteristics, Caring Dimension Inventory (CDI-25) and NIOSH Generic Job Stress Questionnaire. Results: The results of this study showed that numbers of females were more 126 (87.5%) and majority of participants in age limit of 21-30 were 92 (63.9%). Most of the participants were bachelor degree holder 137 (95.1) and official job holders were 127 (88.2) at that institute. Large numbers of participants were bed side nurses 124 (86.1%). Most of the nurses felt moderate level of job stress (76.4%) and provide poor patient care (43.1%). The p-value of 0.001 was indication of the conclusion that there were association between nurses’ job stress and patient care delivered to patient. Conclusions: There was significant relation between the job stress and patient care. The job stress had negative effect on patient care delivered to patient by nurses. It also reduced the nurses’ performance which maybe factor of poor patients’ outcome

Comparison of in hospital outcome of patients with and without distorted terminal portion of QRS complex on initial electrocardiogram in ST segment elevation myocardial infarction with GRACE scoring assessment

Distorted terminal portion of QRS complex on initial electrocardiogram in ST segment elevation myocardial infarction is a strong predictor of in hospital adverse outcome This observational prospective study was carried out in the department of cardiology, BSMMU, Dhaka from July 2014 to June 2015 to analyse admission ECG in patients of STEMI based on terminal portion of QRS complex and find out inhospital death, heart failure, cardiogenic shock and recurrent myocardial infarction, with GRACE scoring assessment. Total 60 patients with STEMI (age 54.33±10.37, 55M/5/F) were included in this study after analysing the selection criteria. We defined two ECG groups according to absence of distortion of terminal QRS (Group-I) and presence of distorted terminal QRS (Group-II) in two or more adjacent leads. Group-II further divided into pattern-A – J point originating at ³50% of height of R wave in leads with qR configuration and pattern B- S wave is absent in leads with RS configuration. Global Registry of Acute Coronary Events (GRACE) risk score was evaluated and compared in between two groups. Out of 60 patients of STEMI, 30 patients had distortion of QRS complex. There were 7 deaths, 16 heart failure, 3 cardigenic shock and no recurrent myocardial infarction. Hospital mortality and heart failure were found to be significantly higher in distorted QRS group (1 vs. 6 patients p=0.04; 4 vs. 12 patients p=0.02; respectively), cardiogenic shock of both groups did not show significant difference (0 vs. 3 patients p=0.075). Multiple logistic regression analysis using hospital mortality as dependable variable and all studied risk factors were independent variables, QRS distortion on admission ECG and Killip class were only variable found to be statistically significant (OR=7.25, p value &lt; 0.05 ; OR=16.25, p value&lt; 0.05 respectively). GRACE risk score was significantly high in distorted QRS group and low in without QRS distorted group (6 vs 15 patients p=0.014; 6 vs 16 patients p=0.007; respectively). Intermediate GRACE score did not show any statistically significant difference between two groups (p=0.77). Careful analysis of ECG which is simple, cheap, universally available bed side investigation may offer important prognostic information in patients with STEMI and would help in deciding which patients should go urgent myocardial revascularization procedure. Assessment of GRACE risk scoring is strongly encourage in everyday clinical practice as it provides reliable identification of STEMI patients who are at high risk of death. Bangladesh Medical Res Counc Bull 2022; 48(3): 211-218

Red cell distribution width, neutrophil lymphocyte ratio and interleukin 10 are good prognostic markers in multiple myeloma.

Multiple myeloma (MM) is still an incurable disease so we need to continue developing new diagnostic and prognostic options for its management. There are multiple prognostic factors for MM, but most of them are costly and time consuming. Hence comes the urge to identify bed side and low cost prognostic tools, that is why this study was aiming to identify in Egyptian MM patients. The study was carried on 60 newly diagnosed multiple myeloma patients and 20 age and sex matched healthy individuals as controls. Studied subjects were subdivided into two groups: Group I: 60 multiple myeloma patients which were subdivided into three subgroups: Stage I: 10 patients, Stage II: 17 patients, Stage III: 33 patients, Group II: 20 healthy controls. A progressive significant increase in IL-10, RDW, NLR, and beta2 microglobulin (β2M) with disease progression from stage I towards stage III as compared to the control group. However, IL-10, RDW, and NLR have the best prognostic efficiency value regarding to sensitivity, specificity and positive predictive value when compared with β2M. IL-10, RDW, and NLR are simple, easy and bedside tests (in the case of RDW, and NLR). They have high sensitivity and specificity when compared to β2M, which is a well-established prognostic factor that highlights the valuable role they play as prognostic markers in MM.

Microbiological evaluation of the effectiveness of concurrent disinfection of the patient unit in intensive care

Introduction: The health environment can act as a reservoir for microorganisms. For microbiological control, it is necessary to effectively disinfect and to monitor the quality of this process. Aim: To evaluate, through microbial analysis, the effectiveness of concurrent disinfection of the patient care unit of patients receiving intensive care. Outlining: Cross sectional, descriptive, and observational. Microbiological cultures were performed in the patient's unit, before and after concurrent disinfection using 70% ethyl alcohol. The analysis of the cultures was performed by standard methodology. Results: 42 surfaces were investigated. At the time of pre-disinfection, contamination was identified on 26 (62.0%) surfaces, with the touch screen panels of the mechanical ventilators (6040 CFU/mL - 85.7%) being the ones with the highest microbial quantity (6040 CFU/mL - 85.7%), followed by bedside lockers (2380 CFU/mL - 57.1%) and the bed side rails (650 CFU/mL - 42.9%). After disinfection, 65.3% (17) of the surfaces achieved a total reduction in colony count. Implications: The importance of carrying out concurrent disinfection, with 70% ethyl alcohol, on inanimate surfaces with a high degree of contact with hands in the intensive care unit, for the reduction of the microbial load and promotion of a biologically safe environment for the patient was evidenced.

Practices Regarding Safe Urinary Catheterization among Healthcare Workers

Objective: To assess the knowledge and practices regarding safe urinary catheterization among health care workers Study Design: It was a Cross sectional observational study. Methodology: Ninety two health care workers were interviewed in two hospitals from April 2022 to July 2022. A questionnaire was designed about individual and departmental practices of urinary catheterization, including the practice of hand hygiene, wearing gloves, maintaining a sterile barrier and using a non-touch gentle insertion technique and post insertion catheter care. Results: Fifty respondents were doctors, while 42 were paramedics. Hand washing and using sterile gloves were reported by 67.3% and 91.2% respectively. 71.7% cleaned the area with antiseptic but only 56.5% practiced appropriate method. 67.3% had a separate sterile catheterization tray. 68.5% respondents inserted the catheter without touching its tip. Other safety measures including arrangement of prefilled syringe for inflation of balloon (89.1%), clear visualization of urethral meatus (90%), gentle insertion (84.7%), confirmation of urine flow (86.9%), and holding the catheter in place while balloon inflation (82.6%) were variably practiced. 61.9% had mistakenly passed the catheter into vagina instead of urethra at some occasion in life. 83.6% thought it necessary to hang the urine bag on bed side for safe care, but more than 84% frequently found the urine bags on the floor in their wards. Conclusion: Safe urinary catheterization practices need to be improved. Units must develop set protocols to reduce the incidence of catheter associated morbidity. This can be achieved by continuous training and audit within the department. Keywords: urinary catheter, urinary tract infection, patient safety.

Informed Consent in Surgical Patients Current Issues and Future Perspective

Objective: Informed consent is an essential and standard procedure in medical practice. The objective of the study was to evaluate the informed consent practices of surgeons at a university teaching hospital. Materials and Methods: A prospective cross sectional study was performed between the time duration of February 2022 till June 2022 at surgical and allied units of Dow University Hospital, DUHS Karachi, Pakistan Results: A total of 196 patients were interviewed on their first post-operative day at their bed side. . Patients were selected randomly from all surgical and allied departments of Dow university hospital, including Gynecology(36.22%), General surgery(34.18%), orthopedics(16.33%), ENT (6.12%), urology (2.55%), eye (2.55%), neurosurgery(1.53%) and maxillofacial(0.51%). 39.8% patients gave consent themselves while rest 55.1% and 5.1% consents were given by family members and parents. Only 23.47% patients or the representative who signed the consent, read the consent form before signing it Conclusions: To improve the quality of communication with the informed consent, a structured conversation helps physicians establish relationships with the patients, regarding the adequacy of the information provided. Keywords: Surgical Patients, informed consent, communication