General Teaching Hospital Research Articles

Coping during the COVID-19 pandemic in the cleaning staff of a public hospital

The COVID-19 pandemic, in addition to generating physical conditions and consequences in the population, caused psychosocial disorders, for which people developed levels of coping with stress, causing difficulties in the cognitive and behavioral capacity of those affected, being a of the most affected populations the cleaning staff who worked in health institutions. The purpose of the study was to determine how the cleaning and cleaning staff of the Ambato General Teaching Hospital coped with stress during the SARS-CoV-2 pandemic. This is an observational, descriptive, cross-sectional cohort study with random probabilistic sampling. The Perceived Stress Scale-10 adapted to COVID-19 (EPP-10-C) was used. The main results show that, for the most part, the cleaning staff presented a moderate level of coping with stress during the COVID-19 pandemic. However, many also registered a mild level of coping. Finally, it was observed that the cleaning staff had developed different levels of coping, which allowed for reducing the impact on mental health.

Efficacy of the use of Cervical Epidural Anesthesia in Shoulder Girdle Surgery

Introduction: The study of the efficacy of the cervical epidural block in shoulder girdle surgery allows us to identify the most frequent complications in order to prevent them and to be able to compare this technique with others. Objective: To describe the efficacy of the use of cervical epidural anesthesia in shoulder girdle surgery. Methods: Observational, descriptive and cross-sectional study at the Martín Chang Pug Teaching General Hospital in the Neuritis municipality, Camagüey province, between January 2021 and December 2022. The sample consisted of 25 patients undergoing shoulder girdle surgery who underwent surgery. Cervical epidural anesthesia was applied. Results: There was a predominance of males (18 out of 25 patients), and most of the patients were between 19 and 59 years old. Patients classified as ASA II (17 patients) predominated. Heart rate and mean arterial pressure followed a Gaussian distribution at 30 and 60 min after starting the cervical epidural block (df: 25; p>0.05). Both heart rate, mean arterial pressure, and partial oxygen saturation decreased significantly 60 min after the anesthetic technique was applied, but remained within normal limits. 100% of them reported having felt satisfied with the anesthetic procedure. Conclusions: The hemodynamic values remained within normal limits in the first hour of the intraoperative period, and all the patients were satisfied with the results of the analgesia achieved by this method. The use of cervical epidural anesthesia in shoulder girdle surgery is effective and safe.

Navigating ACL Injuries Amid the COVID-19 Pandemic: A Retrospective Analysis.

Introduction In the United Kingdom, musculoskeletal injuries represent a substantial proportion of primary care appointments, and within this category, acute knee injuries are prominent in accident and emergency department cases. Notably, diagnosing anterior cruciate ligament (ACL) injuries is a recognized challenge, often leading to extended diagnostic delays. The COVID-19 pandemic has significantly affected the management of musculoskeletal disorders, driven by reduced surgical capacities, creating a backlog of patients awaiting necessary surgical interventions. Delayed ACL reconstruction poses risks of prolonged knee instability and secondary injuries. To address these concerns, this study evaluates the impact of COVID-19 on the timeline from ACL injury diagnosis to MRI and surgical intervention, with a specific focus on an internal acute knee clinic pathway designed to expedite the evaluation, diagnosis, and management of soft tissue knee injuries. Methods In this cross-sectional study, we retrospectively reviewed all the patients who underwent primary ACL reconstruction from January 2019 to November 2022 in a district general teaching hospital (DGH). Besides demographic data of the patients, we recorded the dates of injury, primary presentation, first knee specialist review, knee MRI, and ACL reconstruction surgery, as well as the injury-to-surgery, injury-to-MRI, and MRI-to-surgery periods. Patients were divided based on the date of operation to pre- and post-COVID, and outcomes were compared to see the possible effects of COVID-19. Data were analyzed using a quantitative and qualitative test with a P < 0.05 significance level. Results Our cohort included 97 patients, and the mean age of patients was 30.6 years (17-53 years). The median time of injury-to-MRI was 46.5 days during the pre-COVID period, which decreased to 44 days in the post-COVID period (P = 0.596). The median time of injury-to-surgery was 287.5 days during the pre-COVID period, which increased to 289 days in the post-COVID period (P = 0.019). The median MRI-to-surgery duration was 200 days during the pre-COVID period, which increased to 225 days in the post-COVID period (P = 0.006). Around 35% of patients had an MRI prior to getting evaluated by a specialist. Conclusion The COVID-19 pandemic had a significant impact on the management of ACL injuries, with delays in elective knee clinics and surgery potentially leading to delays in the diagnosis and management of such injuries. However, our study showed that the delay from ACL injury to subsequent surgery actually reduced post-pandemic due to hospital-based acute knee pathway, which is particularly important in the context of associated meniscal injury that can worsen while patients wait for surgery.

Factors affecting do-not-attempt-resuscitation (DNAR) decisions among adult patients in the emergency department of a general tertiary teaching hospital in China: a retrospective observational study

ObjectiveDo-not-attempt-resuscitation (DNAR) orders are designed to allow patients to opt out of receiving cardiopulmonary resuscitation in the event of a cardiac arrest. While DNAR has become a standard component of...

Pediatric Hospitalizations at Rural and Urban Teaching and Nonteaching Hospitals in the US, 2009-2019

National analyses suggest that approximately 1 in 5 US hospitals closed their pediatric units between 2008 and 2018. The extent to which pediatric hospitalizations at general hospitals in rural and urban communities decreased during this period is not well understood. To describe changes in the number and proportion of pediatric hospitalizations and costs at urban teaching, urban nonteaching, and rural hospitals vs freestanding children's hospitals from 2009 to 2019; to estimate the number and proportion of hospitals providing inpatient pediatric care; and to characterize changes in clinical complexity. This study is a retrospective cross-sectional analysis of the 2009, 2012, 2016, and 2019 Kids' Inpatient Database, a nationally representative data set of US pediatric hospitalizations among children younger than 18 years. Data were analyzed from February to June 2023. Pediatric hospitalizations were grouped as birth or nonbirth hospitalizations. Hospitals were categorized as freestanding children's hospitals or as rural, urban nonteaching, or urban teaching general hospitals. The primary outcomes were annual number and proportion of birth and nonbirth hospitalizations and health care costs, changes in the proportion of hospitalizations with complex diagnoses, and estimated number and proportion of hospitals providing pediatric care and associated hospital volumes. Regression analyses were used to compare health care utilization in 2019 vs that in 2009. The data included 23.2 million (95% CI, 22.7-23.6 million) weighted hospitalizations. From 2009 to 2019, estimated national annual pediatric hospitalizations decreased from 6 425 858 to 5 297 882, as birth hospitalizations decreased by 10.6% (95% CI, 6.1%-15.1%) and nonbirth hospitalizations decreased by 28.9% (95% CI, 21.3%-36.5%). Concurrently, hospitalizations with complex chronic disease diagnoses increased by 45.5% (95% CI, 34.6%-56.4%), and hospitalizations with mental health diagnoses increased by 78.0% (95% CI, 61.6%-94.4%). During this period, the most substantial decreases were in nonbirth hospitalizations at rural hospitals (4-fold decrease from 229 263 to 62 729) and urban nonteaching hospitals (6-fold decrease from 581 320 to 92 118). In 2019, birth hospitalizations occurred at 2666 hospitals. Nonbirth pediatric hospitalizations occurred at 3507 hospitals, including 1256 rural hospitals and 843 urban nonteaching hospitals where the median nonbirth hospitalization volumes were fewer than 25 per year. Between 2009 and 2019, the largest decreases in pediatric hospitalizations occurred at rural and urban nonteaching hospitals. Clinical and policy initiatives to support hospitals with low pediatric volumes may be needed to maintain hospital access and pediatric readiness, particularly in rural communities.

Assessment of Institution Related Mentorship Factors Influencing Clinical Competences of Diploma Nursing Students at Coast General Teaching and Referral Hospital, Mombasa

Assessment of Institution Related Mentorship Factors Influencing Clinical Competences of Diploma Nursing Students at Coast General Teaching and Referral Hospital, Mombasa

Molecular epidemiology, risk factors, and outcomes of carbapenem-resistant Klebsiella pneumoniae infection in a tertiary hospital in eastern China: for a retrospective study conducted over 4 years.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) have been extensively disseminated worldwide, resulting in increased mortality. We performed a retrospective analysis of the epidemiology and risk factors for the outcome of CRKP infection in a general teaching hospital in China. A molecular and clinical study was conducted for 98 CRKP in a tertiary hospital from January 2013 to December 2016. Carbapenemase gene detection, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) were performed. Logistic regression was also used to identify the risk factors associated with 30-day mortality. The production of KPC carbapenemase was the main resistant mechanism, and KPC carbapenemase increased annually with a significant difference. However, the molecular outcome revealed the dominance and diversity in CRKP with 24 sequence types (STs) and 59 PFGE types (PTs). The ST11 CRKP strains, which showed a significant increasing trend year by year, were documented as predominant in our study. Additionally, the predominant ST11 CRKP corresponding to PT10 and PT15 continued to exhibit their characteristic patterns. Importantly, the newly identified PT09 and PT16 strains, corresponding to the ST11 lineage, were only discovered in 2016. Meanwhile, factors affecting 30-day mortality and ST11 proportionality with CRKP infection were assessed, and ST11, appropriate empirical treatment, and hospital stays were found to be independently associated with 30-day mortality. The ST11 CRKP strains played a dominant role in the process; however, the homology of these strains was polymorphic, and the advantage clusters were subject to changes through evolution. Furthermore, in addition to appropriate empirical treatment and hospital stays, ST11 CRKP was independently associated with 30-day mortality. To the best of our knowledge, this association was reported for the first time.

Prognostic factors in renal cell carcinoma: A single‑center study.

Renal cell carcinoma (RCC) is a heterogeneous and complex disease with numerous pathophysiologic variants. ~40% of patients succumb due to the progression of the disease, making RCC the most fatal of the common urologic malignancies. Prognostic factors are indicators of the progression of the disease, and the precise determination of these factors is important for evaluating and managing RCC. In the present study, it was aimed to determine and find associations among the histopathological features of RCCs and their impact on survival and metastasis. This is a cross-sectional study of RCC cases who have undergone partial or radical nephrectomy from March 2008 to October 2021 and have been pathologically reviewed at Shorsh General Teaching Hospital in Sulaimani, Iraq. The data in the pathology studies were supplemented by follow-up of the patients to obtain information about survival, recurrence and metastasis. In total, 228 cases of RCC were identified, among whom 60.5% were men and 39.5% were women, with a median age of 51 years. The main tumor types were clear cell RCC (71.1%), papillary RCC (13.6%), and chromophobe RCC (11%). Various measures of aggressiveness, including tumor necrosis, sarcomatoid change, microvascular invasion, and parameters of invasiveness (invasion of the renal sinus and other structures), were significantly correlated with each other, and they were also associated with reduced overall survival and an increased risk of metastasis on univariate analysis. However, on multivariate analysis, only tumor size and grade, and microvascular invasion retained statistical significance and were associated with a lower survival rate. In conclusion, pathological parameters have an impact on prognosis in RCC. The most consistent prognostic factors can be tumor size and grade, and microvascular invasion.

Design, development, implementation, and evaluation of a severe drug–drug interaction alert system in the ICU: An analysis of acceptance and override rates

Background and objectiveThe override rate of Drug-Drug Interaction Alerts (DDIA) in Intensive Care Units (ICUs) is very high. Therefore, this study aimed to design, develop, implement, and evaluate a severe Drug-Drug Alert System (DDIAS) in a system of ICUs and measure the override rate of this system. MethodsThis is a cross-sectional study that details the design, development, implementation, and evaluation of a DDIAS for severe interactions into a Computerized Provider Order Entry (CPOE) system in the ICUs of Nemazee general teaching hospitals in 2021. The patients exposed to the volume of DDIAS, acceptance and overridden of DDIAS, and usability of DDIAS have been collected. The study was approved by the local Institutional Review Board (IRB) and; the ethics committee of Shiraz University of Medical Science on date: 2019-11-23 (Approval ID: IR.SUMS.REC.1398.1046). ResultsThe knowledge base of the DDIAS contains 9,809 severe potential drug-drug interactions (pDDIs). A total of 2672 medications were prescribed in the population study. The volume and acceptance rate for the DDIAS were 81 % and 97.5 %, respectively. The override rate was 2.5 %. The mean System Usability Scale (SUS) score of the DDIAS was 75. ConclusionThis study demonstrates that implementing high-risk DDIAS at the point of prescribing in ICUs improves adherence to alerts. In addition, the usability of the DDIAS was reasonable. Further studies are needed to investigate the establishment of severe DDIAS and measure the prescribers’ response to DDIAS on a larger scale.

Effectiveness of supervised implementation of an oral health care protocol on ventilator-associated pneumonia patients in intensive care units: a double-blind multicenter randomized controlled trial

The available scientific evidence suggests a significant association between oral bacteria and the incidence of ventilator-associated pneumonia (VAP). The aim of this study was to determine the effectiveness of an oral health protocol in the prevention of ventilator-associated pneumonia. In this multi-center RCT, conducted in the intensive care units of neurological patients in three general teaching hospitals of two provinces located in the west of the Iran, a consecutive sample of 200 intubated patients were initially recruited. Patients were randomly allocated to the intervention (received oral health care based on evidence-based oral health protocol) or control (routine oral health care) groups. Both groups received their prescribed treatment regimen for seven consecutive days. The percentage of VAP diagnoses as main outcome assessed using clinical pulmonary infection score (CPIS). The rate of VAP in the intervention and control groups was 5% and 64%, respectively. The intervention reduced the risk of VAP by 97% and this difference was statistically significant (P <0.001). The chance of VAP occurrence in patients with lower levels of consciousness in univariate and multivariate analysis was significantly higher (OR: 2.38; 95%CI: 1.11-5.26) P <0.05). The results of our study suggest that the use of a dynamic supervised oral health care guideline is more effective than the routinely used protocols in the intensive care units of hospitals.

Molecular Investigation of Protein and Genes Resistance Mechanisms in Acinetobacter baumannii Isolates Recovered from Diverse Clinical Specimens in AL-Diwaniyah Province

The Search included 300 different clinical specimens from patients at Al-Diwaniyah General Teaching Hospital were collected for the study From September to December 2022. These specimens comprised blood, urine, burns, and wounds. 40(13.3%) A.baumannii out of 300 isolates. The focus of the study is to characterize the CarO protein, Int-2 and blaoxa-51 resistance mechanisms in Acinetobacter baumannii isolates recovered from different specimens. The samples were taken from various clinical specimens, which were then dispersed as follows: 40 isolates were tested for antibiotic susceptibility using the (Antibiotic Susceptibility Test-AST) on 15 (37.5%) swabs from burns, 10 (25%) swabs from wounds, 10 (25%) from urine, and 5 (12.5%) from blood samples. All isolates were found to be antibiotic-resistant, with the exception of polymyxin B, which had a 30% sensitivity rate and a 70% resistance rateThe gene Caro was found in 10 (25%) of the 40 isolates genetically analyzed using the PCR method, the gene Int-2 was found in 8 (20%) of the 40 specimens, and the gene blaOXA-51 was found in 19 (47.5%) of the 40 isolates. These results show that the gene Caro is present in proteins that encode the enzyme Carbapenemase. The findings of this investigation confirmed previous findings that bacteria have substantial polymyxin B resistance and are resistant to the majority of antibiotics. For the diagnosis of this bacteria, the blaOXA-51 gene was regarded as a diagnostic marker (A baumannii). In Conclusion Polymerase chain reaction technique was found to be simple and useful tool for detection of outer membrane protiens carO. Class 2-Integron was found to be carried by A. baumannii isolates and antibiotic resistance genes were distributed on this integron.

Análisis de factores predictores de lesión residual dependientes de la paciente después de conización cervical

Introduction: in the care of women with precursor lesions of cervical cancer, preventing possible progression to invasive cancer without over-treating the high chances of regression is extremely important. Over time, different treatments and protocols have been tested in order to obtain the best results in the control of this condition with conservative techniques. Objective: to identify predictors of residual disease depending on the intrinsic characteristics of the patients with conization, due to high-grade epithelial lesions or with microinvasion. Methods: A prospective descriptive study was conducted to determine the relationship between the diagnosis of residual disease and clinical- epidemiological variables dependent on the patient, in 1090 patients with high-grade cervical epithelial lesions who were treated at the "Héroes del Baire" General Teaching Hospital on the Isle of Youth (Cuba) during the period 2014-2019. Result: a linear trend of the association of age and residual disease was observed, as well as an association with glandular disease, histological severity and infection by oncogenic serotypes of the human papillomavirus. HPV infection (OR=11.3), history of previous lesion (OR=9.8), persistence of viral infection (OR=4.9) and glandular involvement (OR=3.1) were the factors that showed the greatest association with residual disease. Conclusion: the severity and size of the lesion, the glandular extension and the persistent infection by the human papilloma virus were the predictive factors that contribute to the existence of residual lesion.

Ultrasound renal stone diagnosis based on convolutional neural network and VGG16 features

This paper deals with the classification of the kidneys for renal stones on ultrasound images. Convolutional neural network (CNN) and pre-trained CNN (VGG16) models are used to extract features from ultrasound images. Extreme gradient boosting (XGBoost) classifiers and random forests are used for classification. The features extracted from CNN and VGG16 are used to compare the performance of XGBoost and random forest. An image with normal and renal stones was classified. This work uses 630 real ultrasound images from Al-Diwaniyah General Teaching Hospital (a lithotripsy center) in Iraq. Classifier performance is evaluated using its accuracy, recall, and F1 score. With an accuracy of 99.47%, CNN-XGBoost is the most accurate model.

Impact of the COVID-19 pandemic on obstetrical care at a tertiary care facility in Mombasa, Kenya: Time-series analyses and staff perspectives.

The COVID-19 pandemic caused disruption in healthcare delivery due to reductions in both health facility capacity and care-seeking behavior. For women experiencing obstetric complications, access to comprehensive emergency obstetric care is critical for maternal and child health. In Kenya, pandemic-related restrictions began in March 2020 and were compounded by a healthcare worker strike in December 2020. We examined medical record data at Coast General Teaching and Referral Hospital, a large public hospital, and conducted staff interviews to understand how healthcare disruptions impacted care delivery and perinatal outcomes. Routinely collected data from all mother-baby dyads admitted to the Labor and Delivery Ward from January 2019 through March 2021 were included in interrupted time-series analyses. Outcomes included number of admissions and proportion of deliveries that resulted in caesarean sections and adverse birth outcomes. Interviews were conducted with nurses and medical officers to understand how the pandemic impacted clinical care. Pre-pandemic, the ward averaged 810 admissions/month, compared to 492 admissions/month post-pandemic (average monthly decrease: 24.9 admissions; 95% CI: -48.0, -1.8). The proportion of stillbirths increased 0.3% per month during the pandemic compared to the pre-pandemic period (95% CI: 0.1, 0.4). No significant differences were seen in the proportion of other adverse obstetrical outcomes. Interview results suggested that pandemic-related disruptions included reduced access to surgical theaters and protective equipment, and absence of COVID-19 guidelines. While these disruptions were perceived as impacting care for high-risk pregnancies, providers believed that overall quality of care did not diminish during the pandemic. However, they expressed concern about a likely increase in at-home births. In conclusion, while the pandemic had minimal adverse impact on hospital-based obstetrical outcomes, it reduced the number of patients able to access care. Emergency preparedness guidelines and public health messaging promoting timely obstetrical care are needed to ensure continuation of services during future healthcare disruptions.

510 Co-design of an evidence and theory-based hospital deprescribing behaviour change intervention

Abstract Introduction 50% of older adults are prescribed a medicine that is unnecessary or harmful that should be deprescribed (1). CompreHensive geriAtRician-led MEdication Review (CHARMER) is a behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe. Five determinants of deprescribing have been prioritised and the following six Behaviour Change Techniques (BCTs) selected that now require designing (2): 1&amp;2. Pros and cons and salience of consequences to address misconceptions that deprescribing is risky, 3. Restructuring pharmacists working to facilitate contribution to deprescribing 4. Social comparison to address misconceptions that patients/carers are resistant to deprescribing 5. Action planning to prioritise deprescribing and 6. Incentivising deprescribing. Aim We aimed to co-design the content, mode of delivery and intensity of BCTs to develop a hospital deprescribing behaviour change intervention. Methods We maximum variation sampled three hospitals to represent contextual factors likely to influence CHARMER implementation: diversity of patient population, geography, IT infrastructure maturity and include a combination of larger teaching and smaller district general hospitals. We recruited geriatricians, pharmacists and staff likely to be involved in implementation to join one co-design panel per hospital. We convened two rounds of workshops with each hospital to design BCT prototypes following the five iterative steps of design thinking: empathise, define, ideate, prototype and test. We introduced geriatrician and pharmacist personas in round 1 and panels discussed how barriers and enabler influence practice through a journey mapping exercise, followed by brainstorming ideas for how BCT(s) to address them could be operationalised. Round 2 aimed to reach consensus about which of the Round 1 BCT operationalisation ideas were most promising, and then refine their content, mode of delivery and duration/intensity. Behavioural scientist and practitioner members of the research team prepared prototypes for feedback at a final workshop attended by the three hospital panels. Results The six BCTs were operationalised into an intervention comprising: (1 &amp; 2) 2-hour workshop with pros and cons activities and videos of salient patient cases (3) Weekly short face-to-face pharmacist:geriatrician deprescribing discussions (4) 5-minute videos of geriatricians navigating challenging deprescribing consultations (5) Hospital deprescribing action plan template (6)Dashboard updated weekly to benchmark deprescribing activity with other hospitals Automated prompts to flag high-risk patients for deprescribing and a primary and secondary care deprescribing forum were proposed as additional BCTs. These were later excluded as they address ‘memory, attention and decision processes’ and a ‘primary care social influence’ respectively which does not align with the determinants of deprescribing (1). Conclusion This study illustrates the integration of theory and co-design methodology for a hospital deprescribing behaviour change intervention. The development of an intervention that remains faithful to the underpinning mechanisms of action of behaviour change is a strength of this approach. Maximum variation sampling for hospital permitted representation of the ‘extremes’ of contextual factors but may result in an intervention that is not optimised for the majority. The intervention is undergoing feasibility testing across four English hospitals and will proceed to a definitive trial across 42 hospitals in Spring 2023 to determine effectiveness and cost effectiveness.

Laparorrhaphy in patients with colorectal cancer. Enrique cabrera hospital. 2019-2021

Introduction: Until now, no ideal technique has been established that allows performing a laparotomic closure with a guarantee of greatly reducing the incidence of complications. Objective: To compare the results of abdominal wall closure using internal subtotal points (PS) and total points (PT) in patients operated on for colorectal cancer. Methodological design: An observational, descriptive, prospective and cross-sectional study was carried out at the General Teaching Hospital "Dr. Enrique Cabrera" between January 2019 and December 2021. Results: The median age in the PT group was 70 ± 18 years and in the PS 68 ± 18 years. 65% of the PT group and 61.7% of the PS were women. The tumor was located in the sigmoid colon in 35% of the PT cases and in 31.7% of the PS group. Surgery was urgent in 80% of the PT group and elective in 75% of the PS. The incision was medium supra and infraumbilical in 70% of the patients in the PT group and xipho-pubic in 66.7% of those in the PS. There was a median of 3 ± 2 and 1 ± 0 complications for the PT and PS group, respectively. The median hospital stay was 8 ± 6 days in the PT group and 7 ± 2 days in the PS. Conclusions: The results of the use of internal subtotal stitches in the closure of the abdominal wall were superior with respect to the total stitches.

Study of pyocyanin production and biofilm formation in clinical Pseudomonas aeruginosa

Pseudomonas aeruginosa is an opportunistic pathogen involved in many infections in respiratory system, urinary tract, pneumonia, wounds, and bacteremia. It has many mechanisms and virulence factors such as adaptation and survival in extreme environments. In this study, 32 isolates of P. aeruginosa were collected from Teaching Laboratories in Baqubah General Teaching Hospital and Al-Batool Teaching Hospital, Iraq. The isolates were identified based on morphological and biochemical tests and confirmed by Vitek 2 system. The isolates varied in their antibiotic resistance towered ceftazidime, ceftriaxone, ticarcillin/clavulanic acid, meropenem, aztreonam, imipenem by 100%,100%,100%, 68.75%, 28.12%, and 18.75%, respectively. The biofilm formation test revealed that 43.75% of P. aeruginosa isolates were strongly biofilm forming, 46.8% moderate, and 6.25% were non-biofilm forming. All the tested isolates were able to produce pyocyanin with varied concentration ranged between 17 µg/ml (isolate P2) to 31.5 µg/ml (isolate P7). This study revealed the ability of the clinical P. aeruginosa to produce high amount of pyocyanin which could be used in many applications.

Gunshot Injuries: Patterns, Presentations, and Outcomes of Civilian Hospital Experiences in a Developing Country Setting

Background: Gunshot injuries are considered a health burden as well as one of the intricate emergencies in civilian medical practice. In this study, we aim to determine the pattern of presentation and management outcome in a general hospital setting in a sub-Saharan African country.Methods: This is a retrospective, hospital-based study conducted between January 2015 and December 2019 in a general teaching hospital to review the clinical presentation and management outcome of gunshot injuries. All patients’ records were reviewed during the study period.Results: The total number of patients involved in the study was 157 with 83% male predominant. About 50% were from the age group 20–29 years that were most affected. The commonest anatomical site affected in the study was the lower limb (41.4%) and upper limb (22.9%), and most of the patients had been diagnosed with limb fractures (49.7%) and soft tissue injuries (28.7%). Wound debridement is the commonest procedure performed for 91 (58.0%) patients. The site of the pullet has a significant relation to the management outcome with a P-value of 0.002. Additionally, about 45% (72 patients) have stayed more than 20 days and it was affected significantly by the types of treatment provided, which has a significant relation to a hospital stay with a P-value of 0.00.Conclusion: Most of the patients in this study were young males. Upper and lower limb fractures were the most common presentations. Wound debridement, bone fixation, and laparotomy were the most common treatments with significant success rates, despite prolonged hospital stays.

COPD, diabetes, lymphopenia, and increased LDH cause higher mortality in hospitalized COVID-19 patients.

COPD, diabetes, lymphopenia, and increased LDH cause higher mortality in hospitalized COVID-19 patients.

Implementation of a digital early warning score (NEWS2) in a cardiac specialist and general hospital settings in the COVID-19 pandemic: a qualitative study

ObjectivesTo evaluate implementation of digital National Early Warning Score 2 (NEWS2) in a cardiac care setting and a general hospital setting in the COVID-19 pandemic.DesignThematic analysis of qualitative semistructured interviews...