Cause Of Hospital Mortality Research Articles

Evaluation of the Reveal® AST (SPECIFIC) for Antimicrobial Susceptibility Testing from Positive Blood Culture Spiked with Carbapenem-Resistant Isolates.

As bloodstream infections and associated septic shock are common causes of mortality in hospitals, rapid antibiotic susceptibility testing (AST) performed directly on positive blood cultures is needed to implement an efficient therapy in clinical settings. We evaluated the Reveal® rapid AST system on a collection of 197 fully characterized carbapenem-resistant Enterobacterales, including 177 carbapenemase producers (CPE) spiked in blood culture bottles. The clinical categorization based on the Minimal Inhibitory Concentration (MIC) determination of eighteen antimicrobial molecules was compared to the clinical categorization based on the disk diffusion assay as a reference. The Reveal AST system provided results within a mean time to result of 5 h. Overall, the categorical agreement (CA) between the two techniques was 94.1%. The rates of very major errors (VMEs), major errors (MEs) and minor errors (mEs) were 3.8%, 3.7% and 5.6%, respectively. Imipenem was the antimicrobial with the lowest CA rate (78.7%), with rates of 15% VMEs and 10.7% MEs, but the performances were better when considering only the non-CPE category (CA of 89%). On this resistant collection of Enterobacterales with numerous acquired β-lactamases, the Specific Reveal assay proved to be useful for a rapid determination of AST compatible with a quick adaptation of the patient's antimicrobial treatment.

DuKA: A Dual-Keyless-Attention Model for Multi-Modality EHR Data Fusion and Organ Failure Prediction.

Organ failure is a leading cause of mortality in hospitals, particularly in intensive care units. Predicting organ failure is crucial for clinical and social reasons. This study proposes a dual-keyless-attention (DuKA) model that enables interpretable predictions of organ failure using electronic health record (EHR) data. Three modalities of medical data from EHR, namely diagnosis, procedure, and medications, are selected to predict three types of vital organ failures: heart failure, respiratory failure, and kidney failure. DuKA utilizes pre-trained embeddings of medical codes and combines them using a modality-wise attention module and a medical concept-wise attention module to enhance interpretation. Three organ failure tasks are addressed using two datasets to verify the effectiveness of DuKA. The proposed multi-modality DuKA model outperforms all reference and baseline models. The diagnosis history, particularly the presence of cachexia and previous organ failure, emerges as the most influential feature in organ failure prediction. DuKA offers competitive performance, straightforward model interpretations and flexibility in terms of input sources, as the input embeddings can be trained using different datasets and methods. DuKA is a lightweight model that innovatively uses dual attention in a hierarchical way to fuse diagnosis, procedure and medication information for organ failure predictions. It also enhances disease comprehension and supports personalized treatment.

Septicemia Due to Bed Sores in Patients Admitted at Mayo Hospital Lahore

In Pakistan infections, including septicemia and pneumonia, are the leading causes of hospital mortality, followed by malignancy and cardiovascular causes. Objectives: To find the frequency of septicemia in patients due to bed sores in Mayo Hospital Lahore. Methods: A cross-sectional research was carried out, and 101 septicemia-diagnosed patients from Mayo Hospital Lahore's different wards were included. The septicemia caused by bed ulcers was assessed. Hematological profile of patients were assessed. Results: Septicemia due to bed sores was seen in 18 patients out of which 9 were males and 9 were females. Bilirubin was low in males and females. Blood glucose was high in 6/9 males and normal in 5/9 females. Blood urea was high in majority of males and females. Conclusions: Septicemia due to bed sores was seen in patients. WBC, ALP and blood urea was high due to septicemia cause by bed sores. Platelets, ALT and AST were normal

Electrochemical point-of-care devices for the diagnosis of sepsis.

Sepsis is a life-threatening dysfunction of organ systems caused by a dysregulated immune system because of an infectious process. It remains one of the leading causes of hospital mortality and of hospital readmissions in the United States. Mortality from sepsis increases with each hour of delayed treatment, therefore, diagnostic devices that can reduce the time from the onset of a patient's infection to the delivery of appropriate therapy are urgently needed. Likewise, tools that are capable of high-frequency testing of clinically relevant biomarkers are required to study disease progression. Electrochemical biosensors offer important advantages such as high sensitivity, fast response, miniaturization, and low cost that can be adapted to clinical needs. In this review paper, we discuss the current state, limitations, and future directions of electrochemical-based point-of-care detection platforms that contribute to the diagnosis and monitoring of sepsis.

Biophysical Changes of Leukocyte Activation (and NETosis) in the Cellular Host Response to Sepsis.

Sepsis, the leading cause of mortality in hospitals, currently lacks effective early diagnostics. A new cellular host response test, the IntelliSep test, may provide an indicator of the immune dysregulation characterizing sepsis. The objective of this study was to examine the correlation between the measurements performed using this test and biological markers and processes associated with sepsis. Phorbol myristate acetate (PMA), an agonist of neutrophils known to induce neutrophil extracellular trap (NET) formation, was added to whole blood of healthy volunteers at concentrations of 0, 200, and 400 nM and then evaluated using the IntelliSep test. Separately, plasma from a cohort of subjects was segregated into Control and Diseased populations and tested for levels of NET components (citrullinated histone (cit-H3) DNA and neutrophil elastase (NE) DNA) using customized ELISA assays and correlated with ISI scores from the same patient samples. Significant increases in IntelliSep Index (ISI) scores were observed with increasing concentrations of PMA in healthy blood (0 and 200: p < 10-10; 0 and 400: p < 10-10). Linear correlation was observed between the ISI and quantities of NE DNA and Cit-H3 DNA in patient samples. Together these experiments demonstrate that the IntelliSep test is associated with the biological processes of leukocyte activation and NETosis and may indicate changes consistent with sepsis.

Differential Effects of Cytokine Versus Hypoxic Preconditioning of Human Mesenchymal Stromal Cells in Pulmonary Sepsis Induced by Antimicrobial-Resistant Klebsiella pneumoniae.

Background: Pulmonary sepsis is a leading cause of hospital mortality, and sepses arising from antimicrobial-resistant (AMR) bacterial strains are particularly difficult to treat. Here we investigated the potential of mesenchymal stromal cells (MSCs) to combat established Klebsiella pneumoniae pneumosepsis and further evaluated MSC preconditioning and pre-activation methods. Methods: The potential for naïve and preconditioned MSCs to enhance wound healing, reduce inflammation, preserve metabolic activity, and enhance bacterial killing was assessed in vitro. Rats were subjected to intratracheal K. pneumoniae followed by the intravenous administration of MSCs. Physiological indices, blood, bronchoalveolar lavage (BAL), and tissues were obtained 72 h later. Results: In vitro assays confirmed that preconditioning enhances MSC function, accelerating pulmonary epithelial wound closure, reducing inflammation, attenuating cell death, and increasing bacterial killing. Cytomix-pre-activated MSCs are superior to naïve and hypoxia-exposed MSCs in attenuating Klebsiella pneumosepsis, improving lung compliance and oxygenation, reducing bacteria, and attenuating histologic injuries in lungs. BAL inflammatory cytokines were reduced, correlating with decreases in polymorphonuclear (PMN) cells. MSCs increased PMN apoptosis and the CD4:CD8 ratio in BAL. Systemically, granulocytes, classical monocytes, and the CD4:CD8 ratio were reduced, and nonclassical monocytes were increased. Conclusions: Preconditioning with cytokines, but not hypoxia, enhances the therapeutic potential of MSCs in clinically relevant models of K. pneumoniae-induced pneumosepsis.

Factors Affecting Incidence of Ventilator-Associated Pneumonia With Multidrug-Resistant Microbes in Intensive Care Unit

Ventilator-associated pneumonia (VAP) with multidrug-resistant (MDR) microbes is one of the leading causes of hospital mortality. In this study, the risk factors of pneumonia with MDR microbes are investigated. This work was a retrospective study conducted at 2 academic centers and 3 intensive care units (ICUs). All patients who were clinically suspected VAP and had a positive microbial culture have been included in this study from late March 2018 to mid-June 2019. Patients were divided into 2 groups: MDR and non-MDR. Clinical and paraclinical (CBC, microbial culture, CXR) findings of these patients were recorded and reviewed. Then, using the multivariate analysis, the factors affecting the incidence of VAP with MDR microbes were investigated. Out of the 1854 patients admitted to the ICU, 110 of them have been diagnosed with VAP using X-ray and microbiological findings, and MDR microbes were separated in the culture of 85 patients. The mean age range of the patients was 60 ± 20 years and 75% of them were male. In univariate analysis, the factors affecting the incidence of MDR VAP were as follows: length of stay in the ICU, length of stay in other wards, history of admission in ward before ICU, duration of mechanical ventilation, and diabetes. In multivariate analysis, diabetes (odds ratio, 2.66; 95% confidence interval, 0.9–7.8; P = 0.002), history of admission in ward before ICU (odds ratio, 10.25; 95% confidence interval, 3.17–33.1), and a combination of the 3 factors related to the length of exposuring health care environment which named FAC, were independent risk factors of infection with MDR microbes. Hence, the FAC variable includes the length of stay in ICU, duration of mechanical ventilation, and length of stay in other wards.

Criteria for choosing antibiotic therapy for surgical sepsis in children

BACKGROUND: Sepsis is one of the leading causes of hospital mortality in children. A decisive role in improving the results of treatment of this group of patients belongs to early diagnosis and pathogenetic therapy.&#x0D; AIM: This study optimizes the diagnosis and intensive care of surgical sepsis in children based on clinical and laboratory criteria and bacteriological monitoring.&#x0D; MATERIALS AND METHODS: The study period is 20182020. The study subjects were children (n = 73) with surgical pathology (diffuse purulent peritonitis, bacterial destruction of the lungs, post-traumatic brain hematomas, injuries of the abdominal organs, and others). Clinical and laboratory parameters were analyzed, and microbiological monitoring was performed to determine antibiotic sensitivity.&#x0D; RESULTS: Patients who developed sepsis had a pronounced hypermetabolic syndrome, which was manifested by tachycardia and tachypnea, hyperthermia, low levels of albumin, and total protein in the blood. Protein catabolism in patients was accompanied by a decrease in globulins (IgG) synthesis and the development of a secondary immunodeficiency state. Both gram-positive and gram-negative microorganisms were involved in developing surgical sepsis in children, increasing the proportion of the latter. Given the high proportion of multi-resistant flora, empirical combined de-escalation antibiotic therapy (ABT) with broad-spectrum antibiotics was prescribed. This was followed by its revision based on microbiological monitoring and clinical and laboratory data of the patient with sepsis. Studies have shown the effectiveness of complex intensive care in 86.3% of cases. Mortality occurred in 13.7% of cases. Patients with severe surgical pathology died: fecal, generalized peritonitis, severe traumatic brain injury + coma with irreversible neurological disorders, and urosepsis against the background of chronic renal failure after repeated surgical interventions.&#x0D; CONCLUSIONS: Early diagnosis of sepsis, rational ABT under the control of microbiological monitoring, non-aggressive infusion therapy, and active sanitation of the surgical infection focus contributed to a decrease in mortality in this category of patients.

PREVENTION OF PULMONARY COMPLICATIONS IN THORACIC ANESTHESIOLOGY

Introduction. Pulmonary complications are one of the most common after surgery on the thoracic cavity. Although the incidence of pulmonary complications is gradually decreasing, recent studies have shown that they still occur in 26% -38% of cases. Pulmonary complications are also a major cause of hospital mortality and may be an independent risk factor for worse long-term survival [1, 2, 3].&#x0D; The goal of the work. Therefore, the aim of the work was to improve the results of treatment of patients after thoracic surgery by developing an algorithm for anesthesia for perioperative prevention of pulmonary complications.&#x0D; Materials and methods. The study was performed on 192 patients with diseases of the thoracic cavity (esophagus, lungs, mediastinum), underwent surgery in the thoracoabdominal department of the Shalimov’s National Institute of Surgery and Transplantation. Retrospective control group – 96 patients after thoracic surgery, which used conventional methods of perioperative management. The study group – 96 patients after thoracic surgery, which used perioperative anesthesia algorithm for the prevention of pulmonary complications. Statistical software EZR v. 1.54 was used for statistical calculations (graphical user interface for statistical software R version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria).&#x0D; Results and discussion. One-factor analysis revealed a relationship (p = 0.001) of the risk of complications with the method of prevention of pulmonary complications. When conducting a multifactor analysis, it was found that the proposed method of prevention of pulmonary complications can reduce (p = 0.001) the risk of development, HR = 0.27 (95% CI 0.13-0.58) compared with the control group (with standardization by sex, weight, ASA of the patient). Pulmonary complications developed in 33 (34.4%) patients of the control group and in 13 (13.5%) patients of the study group, the difference was statistically significant, p = 0.001. Thus, the use of the proposed technique reduces (p = 0.001) the risk of complications, HR = 0.39 (95% CI 0.22 - 0.70) compared to traditional methods.&#x0D; Conclusions. Thus, the developed algorithm for the prevention of pulmonary complications after thoracic surgery has significantly improved the results of surgical treatment of patients by reducing the number and reducing the risk of these complications by 2.5 times (from 34.4% in patients in the control group to 13.5% in patients in the study group).

Use of oral anti-diabetic drugs and risk of hospital and intensive care unit admissions for infections

BackgroundSepsis is one of the leading causes of hospital mortality, and diabetes is a risk factor for the development of infections. Although strong evidence has shown an association between metformin and reduced risk of infections, the risk of developing infections with newer classes of oral anti-diabetic drugs (OADs) has been less certain. Our study aims to examine the association between outpatient OAD use and hospital admissions for infections. MethodsThe study cohort included 1.39 million adults with diabetes utilizing the Veterans Health Affairs Corporate Data Warehouse. Multivariate logistic regression was used to estimate the effect of each drug class on hospital admission for infection while adjusting for covariates. ResultsAfter adjusting for covariates, those who took metformin during the study period had 3.3% lower odds of hospital admission for infection compared to those who were never on metformin (OR 0.97, 95% CI 0.95-0.98). OADs that were associated with a statistically significant increased odds of being admitted included meglitinides (OR 1.22, 95% CI 1.07-1.38), SGLT2 inhibitors (OR 1.16, 95% CI 1.08-1.24), alpha-glucosidase inhibitors (OR 1.09, 95% CI 1.04-1.15), and DPP4 inhibitors (OR 1.04, 95% CI 1.01-1.06). ConclusionsMetformin was associated with lower odds of hospital admission for infection while meglitinides, SGLT2 inhibitors, alpha-glucosidase inhibitors, and DPP4 inhibitors were associated with higher odds of admission for infection.

Can vitamin D level be a marker for predicting risk in pulmonary thromboembolism? Comparative evaluation with pulmonary embolism severity index and CT angiography obstruction index

Background/Aim: Venous thromboembolism is a pathological process that is among the leading causes of hospital mortality, and many studies showed that vitamin D receptors have a role in thrombosis. This study aimed to investigate the effect of 25(OH)D deficiency on pulmonary thromboembolism and evaluate the pulmonary embolism severity index (PESI). Methods: Eighty-one patients over 18 years of age who underwent CT angiography with a pre-diagnosis of pulmonary embolism were included in this case-control study. Groups 1 and 2 consisted of 45 patients with pulmonary embolism (PE), and 36 patients without pulmonary embolism, respectively. The PE patients were divided into five groups in terms of age, gender, fever, systolic blood pressure, heart rate, respiratory rate, oxygen saturation, history of chronic lung disease and heart failure, mental status, and malignancy to calculate the PESI score. Classes 1 and 2 were classified as low-risk, and Classes 3, 4, and 5 as high-risk. The CT obstruction index (CTOI) was calculated in patients with pulmonary embolism. Vitamin D levels were noted. Results: No significant difference was observed between the groups in terms of age, gender, and body mass index values (P>0.05). 25(OH)D level was significantly lower in the pulmonary embolism group (7.2(3.3) vs. 8.7(7.0), P=0.028). The CTOI was significantly higher in the high-risk patient group (P=0.019). Conclusions: The evaluation of 25(OH)D levels may be beneficial in determining the risk of thromboembolism.

English

BACKGROUND The intensive care unit (ICU) is a special department of the hospital and health care setting that provides intensive nursing care and care to patients with the most severe and life-threatening illnesses and injuries that require accurate, continuous monitoring and support from specialist, medication, and equipment in order to maintain normal bodily functions. Nosocomial infections are one of the leading causes of mortality in hospitalised patients especially the critically ill patients in the intensive care unit. The purpose of the present study was isolation, identification, and detection of the antibiotic sensitivity pattern of pathogenic bacteria isolated from different clinical specimens of ICU patients under the effect of infection control in Sajer General Hospital in Saudi Arabia. METHODS In this cross-sectional study conducted from January 2020 to April 2020, 200 clinical samples, 40 blood, 45 urine, 50 tracheal aspirate, 30 post-surgical Caesarean section wound swabs, 20 central venous catheters and 15 pus swabs were collected from patients hospitalised in ICUs of Sajer General Hospital. Antibiotic sensitivity testing was performed with the diffusion-disk method for several antibiotics. RESULTS The rate of nosocomial infection among ICU patients due to Gram-negative bacteria is significantly higher than that recorded by Gram-positive bacteria (78.75 %, 21.25 %, respectively). The majority of frequent bacteria isolated from all clinical specimens were Klebsielleae pneumoniae 20 (25 %) followed by Pseudomonas aeruginosa 18 (22.5 %), Acinetobacter baumannii 15 (18.75 %), Escherichia coli 10 (12.50 %), Staphylococcus aureus 9 (11.25 %), Streptococcus pyogenes 6 (7.50 %) and enterococcus spp. 2 (2.50 %). K. pneumoniae, P. aeruginosa and E. coli achieved high sensitivity to imipenem and meropenem (100 %). A. baumannii showed high sensitivity to meropenem (100 %) and imipenem (93.33 %). Staph. aureus, Streptococcus pyogenes and enterococcus species showed high sensitivity to vancomycin (100 %). CONCLUSIONS The nosocomial infection is a major cause of mortality and morbidity in hospitals. The role of nursing care in the prevention of nosocomial infection has proven vital due to the emergence and spreading of different pathogenic bacteria. Close interactions between health care providers can save many more lives. KEY WORDS Intensive Care Units, Antibiotics Sensitivity Pattern, Nursing Infection Control

Algorithm for the prevention of pulmonary complications after thoracic surgeries

Annotation. The biggest problem after operations on the thoracic cavity is the number of pulmonary complications (according to various authors 26-38% of cases). Despite the development of numerous methods for the prevention and treatment of these complications, they remain one of the leading causes of hospital mortality and may be an independent risk factor for worse long-term survival. Therefore, the aim of the work was to improve the results of treatment of patients after operations on the thoracic cavity by developing an algorithm for anesthesia for perioperative prevention of pulmonary complications. Participated in the study 192 patients with diseases of the thoracic cavity (esophagus, lungs, mediastinum), operated on in the thoracoabdominal department of the National Institute of Surgery and Transplantology named after O.O. Shalimov. Retrospective comparison group - 96 patients after thoracic surgery, which used conventional methods of perioperative management. The study group consisted of 96 patients after thoracic surgery, who used a perioperative anesthesia algorithm for the prevention of pulmonary complications. Statistical software EZR v. Was used for statistical calculations. 1.54 (graphical user interface for statistical software R version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria). When conducting a multifactor analysis, it was found that the proposed method of prevention of pulmonary complications can reduce (p=0.001) the risk of development, HS=0.27 (95% CI 0.13-0.58) compared with the control group (with standardization by sex, weight, ASA of the patient). Pulmonary complications developed in 33 (34.4%) patients of the control group and in 13 (13.5%) patients of the study group, the difference was statistically significant, p=0.001. Thus, the application of the proposed technique reduces (p = 0.001) the risk of complications, BP=0.39 (95% CI 0.22 - 0.70) compared to traditional methods.

The causes of hospital mortality in methadone associated poisonings: analysis of the data from the Kyiv toxicological center for 2005–2019

Scientific interest in poisoning by synthetic opioids, in particular Methadone, is due to a significant increase in their number in Kyiv over the past 15 years and fatal consequences. The Aim of the Research. Is to identify the causes of fatal poisoning associated with methadone and to determine measures to prevent them. Materials and Methods. A retrospective analysis of medical data of 1340 patients with Methadone poisoning who were treated at the Toxicology Center in Kyiv in the period 2005–2019; including 38 fatalities cases. Results. The share of drug poisonings registered at the Kyiv Toxicology Center has increased from 15% to 42% over the past 30 years. The top five drugs and psychotropic substances in 2019 were Benzodiazepines, Methadone, Barbiturates, Amphetamines, and Marijuana. The number of Methadone poisonings in 2005–2014 increased 150 times. The main cause of poisoning is the use of illegal Methadone. There is a direct relationship between the growth of hospital mortality and the appearance of combined poisonings: Methadone-Ethanol (r = 0,79); Methadone-Ethanol-Amphetamines (r = 0,69); Methadone-Ethanol-Benzodiazepines (r = 0,61); Methadone-Ethanol-Cocaine (r = 0,43). According to the results of forensic medical studies of 38 patients who died as a result of Methadone poisoning, the following were identified: toxic hepato-nephropathy – 12 cases (31,57%); long-term soft tissue compression syndrome – 10 (26,31%); acute kidney damage – 4 (10,52%); aspiration of gastric contents – 7 (18,42%); apallic syndrome – 4 (10,52%). The direct effect of polymorbidity on mortality has been confirmed, which justifies the need for a personalized approach to intensive care. Conclusions. Today in Ukraine, combined illegal methadone poisoning is the most common type of drug poisoning, which has a severe course, high mortality, and requires long and complex treatment. Key Words: acute poisoning, methadone, combined poisoning, mortality.

MGP-AttTCN: An interpretable machine learning model for the prediction of sepsis.

With a mortality rate of 5.4 million lives worldwide every year and a healthcare cost of more than 16 billion dollars in the USA alone, sepsis is one of the leading causes of hospital mortality and an increasing concern in the ageing western world. Recently, medical and technological advances have helped re-define the illness criteria of this disease, which is otherwise poorly understood by the medical society. Together with the rise of widely accessible Electronic Health Records, the advances in data mining and complex nonlinear algorithms are a promising avenue for the early detection of sepsis. This work contributes to the research effort in the field of automated sepsis detection with an open-access labelling of the medical MIMIC-III data set. Moreover, we propose MGP-AttTCN: a joint multitask Gaussian Process and attention-based deep learning model to early predict the occurrence of sepsis in an interpretable manner. We show that our model outperforms the current state-of-the-art and present evidence that different labelling heuristics lead to discrepancies in task difficulty. For instance, when predicting sepsis five hours prior to onset on our new realistic labels, our proposed model achieves an area under the ROC curve of 0.660 and an area under the PR curve of 0.483, whereas the (less interpretable) previous state-of-the-art model (MGP-TCN) achieves 0.635 AUROC and 0.460 AUPR and the popular commercial InSight model achieves 0.490 AUROC and 0.359 AUPR.

Citokin vihar és kezelése kritikus állapotú betegeknél

Az utóbbi évtizedekben a szepszis/szeptikus sokk előfordulása világszerte megnőtt, és mivel a kórházi halálozás egyik legmeghatározóbb oka, így kiemelt gazdasági és egészségügyi jelentőséggel bír. Terápiájában a kórkép korai felismerése és az ezzel megkezdett adekvát folyadékreszuszcitáció, valamint szervtámogató- és antimikrobiális kezelések és infekciókontroll ellenére a halálozási arány továbbra is magas (20-50% a vizsgált populációtól függően). A halálozás csökkentésére irányuló kutatások egyik legígéretesebb területe az immunrendszer és ezzel együtt a gazdaszervezet fertőzésre adott válaszának modulációja, melyek közül a vértisztító eljárások tűnnek az egyik legígéretesebb módszernek. A szeptikus sokk korai szakaszában a szervezet fertőzésre adott diszregulált immunválasza következtében kialakuló „citokinvihar” mélyebb megértése és a megfelelő pontokon történő módosítása hozzájárulhat az infl ammatorikus-antiinflammatorikus rendszer közötti egyensúly helyreállításához. Jelen közlemény célja, az ezzel kapcsolatos ismeretek rövid összefoglalása.

Polymeric Materials with Antibacterial Activity: A Review.

Infections caused by bacteria are one of the main causes of mortality in hospitals all over the world. Bacteria can grow on many different surfaces and when this occurs, and bacteria colonize a surface, biofilms are formed. In this context, one of the main concerns is biofilm formation on medical devices such as urinary catheters, cardiac valves, pacemakers or prothesis. The development of bacteria also occurs on materials used for food packaging, wearable electronics or the textile industry. In all these applications polymeric materials are usually present. Research and development of polymer-based antibacterial materials is crucial to avoid the proliferation of bacteria. In this paper, we present a review about polymeric materials with antibacterial materials. The main strategies to produce materials with antibacterial properties are presented, for instance, the incorporation of inorganic particles, micro or nanostructuration of the surfaces and antifouling strategies are considered. The antibacterial mechanism exerted in each case is discussed. Methods of materials preparation are examined, presenting the main advantages or disadvantages of each one based on their potential uses. Finally, a review of the main characterization techniques and methods used to study polymer based antibacterial materials is carried out, including the use of single force cell spectroscopy, contact angle measurements and surface roughness to evaluate the role of the physicochemical properties and the micro or nanostructure in antibacterial behavior of the materials.

The Effect of Probiotics on Bacterial Pneumonia

Background: Pneumonia, as a fairly prevalent illness, is the main cause of hospital mortality. The major cause of mortality and morbidity of pneumonia is due to bacteria. The presence of multi-drug resistant pathogens and no response to treatment have aroused considerable interest in the use of probiotic components to prevent infections. Objectives: Given that few studies have evaluated the efficacy of probiotics in reducing bacterial pneumonia, the current aimed to evaluate the role of probiotics in decreasing pneumonia. Methods: This double-blind, randomized clinical trial study was conducted on 100 patients diagnosed with bacterial pneumonia in Shahid Beheshti Hospital, Kashan, Iran, during 2018. Patients were randomly classified into two groups (n = 50). One group (case) received two sachets of probiotic/daily for five days, and another group (control) received placebo. Moreover, patients in both groups received the same treatment protocol. All data were extracted from medical records. Chi-square test and independent t-test were used for analysis of data. P &lt; 0.05 was considered statistically significant. Results: No significant difference was seen between case and control groups regarding age, gender, and duration of symptoms before hospitalization (P &gt; 0.05), which implies a completely random classification of two groups. The mean duration of hospitalization, dyspnea, tachypnea, cough, fever, and crackles was significantly decreased in the case group compared to the control group (P &lt; 0.05). Conclusion: The use of probiotics can be effective in reducing the duration of dyspnea, tachypnea, cough, fever, and length of hospitalization. Therefore, probiotics may be considered a promising treatment for the development of new anti-infectious therapy. In addition, the usage of probiotics along with antibiotics is suggested for decreasing pneumonia complications and improving the efficacy of therapy.

Causes of Mortality Among Patients Admitted in a Tertiary Hospital

Introduction: The analysis of causes of death in the hospital and identification and dealing with the causes of death, in one of the best strategies to increase longevity. This study, with the aim of better understanding of the causes of death and by taking into account all hospital wards, describes the causes of hospital mortality occurred in Sina educational and clinical hospital of Tabriz, in order to investigate demographic ,clinical and cause of death variables for each disease separately. Method: This study is done by the sectional descriptive method in 2018 in Sina educational and clinical hospital of Tabriz. This hospital is the most important center for admissions of poisoning and burns in the North West of Iran. For this purpose, after obtaining a license, records of all patients who are admitted to hospital since 21 March 2018 until 19 March 2019, were extracted from the archives center in an elective and emergency form. Demographic and clinical variables were extracted from records and recorded in the questionnaire. The sample in counting the mortality occurred during one year was 626 cases according to documentations, that 88 cases were eliminated from study due to containing incomplete information. The data were analyzed by descriptive tests and SPSS18. Findings: The mortality rate in this study was 1%. 56.5% of those who died were male. Most deaths occurred among patients of over 75 years old. Among the under-15 age group the highest mortality rate were for burns. The most common causes of mortality, were, respectively, burns (19.33%), cancer (16.86%), and infectious disease (16.57%) .Most deaths occurred in the special wards. In 61%, chronic and underlying diseases are reported. Conclusion: Since this hospital is the largest and most important teaching hospitals for burns, in the province, the most common causes of death in this study are result of burns. The high percentage of deaths from burns in children and young people shows the importance of informing the dangers of burn for preventing the occurrence of burns and control its effects.

STEMI, Cardiogenic Shock, and Mortality in Patients Admitted for Acute Angiography: Associations and Predictions from Plasma Proteome Data.

Acute myocardial infarction (AMI) remains a major cause of mortality and morbidity, and cardiogenic shock (CS) a major cause of hospital mortality after AMI. Especially for ST elevation myocardial infarction (STEMI) patients, fast intervention is essential.Few proteins have proven clinically applicable for AMI. Most proposed biomarkers are based on a priori hypothesis-driven studies of single proteins, not enabling identification of novel candidates. For clinical use, the ability to predict AMI is important; however, studies of proteins in prediction models are surprisingly scarce.Consequently, we applied proteome data for identifying proteins associated with definitive STEMI, CS, and all-cause mortality after admission, and examined the ability of the proteins to predict these outcomes. Proteome-wide data of 497 patients with suspected STEMI were investigated; 381 patients were diagnosed with STEMI, 35 with CS, and 51 died during the first year. Data analysis was conducted by logistic and Cox regression modeling for association analysis, and by multivariable LASSO regression models for prediction modeling.Association studies identified 4 and 29 proteins associated with definitive STEMI or mortality, respectively. Prediction models for CS and mortality (holding two and five proteins, respectively) improved the prediction ability as compared with protein-free prediction models; AUC of 0.92 and 0.89, respectively. The association analyses propose individual proteins as putative protein biomarkers for definitive STEMI and survival after suspected STEMI, while the prediction models put forward sets of proteins with putative predicting ability of CS and survival. These proteins may be verified as biomarkers of potential clinical relevance.