ICU Wards Research Articles

Cross-sectional Hospital-based Investigation on Clinical Characteristics of Pediatric Staphylococcus aureus Isolates in a Beijing Hospital from 2013 to 2022.

Staphylococcus aureus (S. aureus) was a prevalent pathogenic bacterium among children. Due to the extensive use of antibiotics, the sensitivity of S. aureus to these drugs has gradually declined. Since the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has emerged and spread worldwide, becoming a primary cause of both healthcare-associated (HA) and community-acquired (CA) infections. This retrospective study aimed to highlight the significance of S. aureus among bacteria isolated from children in Beijing, China, and to elucidate its antimicrobial resistance patterns. Data on all S. aureus infections from 2013 to 2022 were collected from the microbiology department of Beijing Children's Hospital. Only the first isolate from the same kind of specimen was analyzed. Antimicrobial susceptibility tests were carried out by Vitek 2 automated system (bio Mérieux, France) or Kirby-Bauer disc diffusion method, according to the guidelines recommended by the Clinical and Laboratory Standards Institute (CLSI). During the decade-long research period, a total of 47,062 bacterial isolates were isolated from 433,081 submitted specimens, with 6477 of these isolates identified as S. aureus. The majority of patients with S. aureus infections belonged to the age group of infants under one-year-old, accounting for 37.9% of cases. S. aureus isolates were predominantly found in the Pneumology Department, and the most common source of these isolates was lower respiratory tract specimens, comprising 34.3% of the total. The resistance rates of S. aureus to penicillin and erythromycin were notably high, at 89.5% and 73.8%, respectively. In contrast, the resistance rates to linezolid, vancomycin, rifampicin, and moxifloxacin were remarkably low, at 0.0%, 0.0%, 1.3%, and 3.9%, respectively. The detection rate of MRSA was 27.8%. MRSA isolates were predominantly found in the newborn group, ICU, and sterile body fluids. In our study, the most prevalent specimen type was derived from the lower respiratory tract, whereas the highest positive rate was observed in ear secretions. These findings underscored the pressing necessity for ongoing antimicrobial resistance (AMR) surveillance and the revision of treatment guidelines, particularly given the elevated detection of MRSA in ICU wards, sterile body fluids, and the neonatal age group. MRSA exhibited significant resistance to all β-lactam antibiotics, erythromycin, and ciprofloxacin. Therefore, future research endeavors should prioritize examining specific antimicrobial resistance populations and potential intervention strategies, as these were vital in mitigating the dissemination of antimicrobial-resistant isolates.

National Early Warning Score 2 to Predict ICU Admission of COVID-19 Patients in Bangladeshi Cohort

Objective: To assess the predictive accuracy of the National Early Warning Score 2 (NEWS 2) for early prediction of clinical deterioration (ICU admission) of COVID-19- infected patients in Bangladesh. Methods: Data from 244 patients with COVID-19 infection admitted from July 2021- September 2021, to the Aichi Hospital Ltd, Bangladesh, were retrospectively reviewed. Consecutive adult patients with laboratory-confirmed COVID-19 initially admitted to non- ICU wards were included. Categorical and quantitative variables were expressed as numbers (percentages) and median (interquartile range, IQR). We evaluated the predictive performance of NEWS2 to predict ICU admission by comparing the area under the receiver operating characteristics curve (AUROC) at thresholds 5 and 7 and assessed its association with ICU admission by performing multivariate logistic analyses. STATA conducted all the statistical analyses. Results: Among the included 218 patients, 68 patients were transferred to ICU. The AUROC was 0.96 (Standard error 0.01, 95% confidence interval 0.93-0.98), revealing that NEWS2 at hospital admission was a good predictor of ICU admission. A NEWS2 threshold of 5 had higher sensitivity than a threshold of 7 (72.06% and 29.41%). A point of 7 also had high specificity (99.33% and 63.33%) and a high positive predictive value than a threshold of 5 (95.24% vs. 47.12%). The NEWS2 entries 5 and 7 were related to ICU admission found in multivariate logistic regression analysis. Conclusion: Our results suggest that NEWS2 at hospital admission is a good predictor for ICU admission of COVID-19 patients in Bangladesh. Screening patients at admission with this tool may identify patients at risk of clinical deterioration and help in better management. EWMCJ Vol. 12, No. 1&2, January-July 2024: 60-65

Investigating the relationship between lymphocyte cells apoptosis and DNA damage and oxidative stress and therapeutic and clinical outcomes of COVID-19 elderly patients

BackgroundWhile COVID-19 has been controlled and deaths have decreased, the long-term consequences of COVID-19 remain a challenge we face today. This study was conducted to determine the relationship between the apoptosis of lymphocyte cells with DNA damage and oxidative stress and the therapeutic and clinical outcomes of elderly patients with COVID-19.MethodsThis study was conducted from April 2020 to May 2021 (the period of severe attacks of the epidemic peak of COVID-19) and September 2022 (the post-COVID-19 period). The study groups included elderly patients with COVID-19 hospitalized in the ICU and normal wards of the hospital as well as elderly patients with influenza. A polymerase chain reaction was used to check the validity of the studied diseases. The Annexin V/Propidium Iodide method was used to evaluate the level of apoptosis. Genotoxic effects and DNA damage were assessed by the comet assay method. Total antioxidant status (TAS), total oxidant status (TOS), and myeloperoxidase activity (MPO) were measured by photometric methods.ResultsThe highest level of apoptosis in peripheral blood lymphocytes and the highest level of DNA damage were observed at both times in the intubated-ICU and non-intubated-ICU groups. In all groups, there was a significant increase in peripheral blood lymphocyte apoptosis levels and DNA damage levels compared to the healthy control group (p < 0.01). The level of apoptosis and DNA damage decreased significantly in the post-COVID-19 period (p < 0.01). In the investigation of oxidative stress biomarkers, the oxidative stress index, including TOS and MPO levels, increased in patients (p < 0.01), and the TAS level decreased (p < 0.01).ConclusionIt shows that the apoptosis of lymphocyte cells, DNA damage, and oxidative stress can be effective in prognostic decisions and is a suitable predictor for diagnosing the condition of patients with viral infections such as COVID-19 and influenza.

Methemoglobinemia Outbreak in a Neonatal ICU and Maternity Ward

Methemoglobinemia Outbreak in a Neonatal ICU and Maternity Ward

Early identification of the nosocomial spread of vancomycin-resistant Enterococcus faecium by Fourier-transform infrared spectroscopy and performance comparison with PFGE and WGS

ABSTRACT Early detection of disseminating vancomycin-resistant Enterococcus faecium (VREfm) in ICU wards is crucial for outbreak identification and the implementation of prompt infection control measures. Genotypic methods like pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) are costly and time-consuming, hindering rapid response due to batch dependency. Fourier-transform infrared spectroscopy (FT-IR) offers the potential for real-time outbreak detection and reliable strain typing. We utilized FT-IR to identify clonal VREfm dissemination and compared its performance to PFGE and WGS. Between February through October 2023, an unusually high number of VREfm were recovered at a tertiary hospital in Barcelona. Isolates were examined for antimicrobial susceptibility, carriage of vanA/vanB genes and clonality was also studied using FT-IR, PFGE, and WGS. Routine FT-IR inspections revealed recurring VREfm clustering during the outbreak's initial weeks. In total, 104 isolates were recovered from 75 patients and from multiple wards. However, only one isolate was recovered from an environmental sample, suggesting the absence of environmental reservoirs. An ST80 vancomycin-resistant (vanA) E. faecium strain was the main strain responsible for the outbreak, although a few additional VREfm strains were also identified, all belonging to CC17. PFGE and cgMLST (WGS) yielded identical clustering results to FT-IR, and WGS confirmed vanA/vanB gene carriage in all VREfm isolates. Infection control measures led to a rapid decline in VREfm isolates, with no isolates detected in November. FT-IR spectroscopy offers rapid turnaround times, sensitivity, and reproducibility, comparable to standard typing methods. It proved as an effective tool for monitoring VREfm dissemination and early outbreak detection.

Genomic characteristics of carbapenem-non-susceptible Cronobacter sakazakii isolated from an ICU patient at the Songkhla Hospital, Thailand.

Cronobacter sakazakii is a pathogen that causes severe diseases such as meningitis and necrotizing enterocolitis in infants, associated with the consumption of rehydrated powder infant formula. We report a whole-genome sequence of carbapenem-non-susceptible C. sakazakii isolated from the nasopharynx of the patient admitted to the ICU ward, Songkhla Hospital, Thailand.

Evaluating the Effectiveness of Two Disinfection Processes on Bacteria Causing Nosocomial Infections in the Intensive Care Units of an Educational, Research, and Treatment Hospital in Semnan, Iran

Background: Disinfection is the process of killing pathogenic microorganisms on non-living surfaces. Selecting and using appropriate and standard disinfection methods can significantly reduce nosocomial infections. Objectives: This study aimed to determine the effectiveness of the disinfection process on bacteria causing nosocomial infections in an educational, research, and treatment hospital located in Semnan, Iran in 2021. Methods: In 2021, 156 samples were collected and analyzed for microorganism growth in a suitable culture medium from the surgical ICU, CCU, and internal wards of men at Kosar Hospital in Semnan. Samples were taken during three work shifts (morning, evening, and night) from breakfast tables, suction devices, ventilators or biopsy equipment, and rods at the patient's bed. Results: Before the disinfection process, 81.8% (27 cases) of the samples tested positive for various microorganisms. The most commonly grown microorganisms were Klebsiella (33.3%) and Staphylococcus (18.2%). The highest percentage of microorganisms developed after disinfection with Sayasept and sodium hypochlorite were seen at two and a half hours (26.3%) and two hours (26.7%), respectively. Disinfection with sodium hypochlorite significantly reduced the number of microorganisms grown in the post-disinfection period compared to before (P-value = 0.042), whereas disinfection with Sayasept did not show a statistically significant effect (P-value = 0.132). Conclusions: Using sodium hypochlorite greatly decreased the number of microorganisms in the post-disinfection period, despite the high number of microorganisms present before disinfection in the analyzed wards. It is vital to implement hygienic policies that ensure proper disinfection of hospital surfaces and provide adequate training, particularly emphasizing the use of sodium hypochlorite.

Early Hydrogen–Oxygen Gas Mixture Inhalation in Patients with Aneurysmal Subarachnoid Hemorrhage (HOMA): study protocol for a randomized controlled trial

BackgroundAneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening neurosurgical emergency with a high mortality rate. Delayed cerebral ischemia (DCI) and cerebral vasospasm (CVS) are delayed products of early brain injury (EBI), which may constitute the principal determinant of an unfavorable patient prognosis. Consequently, the mitigation of DCI and CVS assumes paramount significance in the pursuit of enhanced patient outcomes. However, except for oral nimodipine, there is no effective therapy available in the current guideline. Hence, the exigency arises to proffer novel treatment paradigms. The diversity of hydrogen therapeutic targets has been largely reported in basic research, unveiling its latent capacity to ameliorate EBI in aSAH patients.MethodsEarly Hydrogen–Oxygen Gas Mixture Inhalation in Patients with Aneurysmal Subarachnoid Hemorrhage (HOMA), a single-center, prospective, open-labeled, randomized controlled clinical trial, endeavors to evaluate the efficacy and safety of hydrogen–oxygen gas mixture inhalation therapy in aSAH patients. A cohort of 206 patients will be randomized to either hydrogen–oxygen gas mixture inhalation group (8 h per day, 3 L/min, hydrogen concentration of 67%, oxygen concentration of 33%) or oxygen inhalation group (8 h per day, 3 L/min, oxygen concentration of 33%) within 72 h after aSAH and treated for 7 days in the ICU ward. The primary outcomes are the incidence of DCI and CVS during hospitalization.DiscussionThe HOMA aims to evaluate the effectiveness of hydrogen–oxygen gas mixture inhalation therapy in preventing DCI or CVS and improving outcomes in aSAH patients. Notably, this is the first large-scale trial of hydrogen therapy in aSAH patients. Given that the Chinese population represents a significant portion of the global population and the increasing incidence of stroke due to aging, optimizing patient care is vital. Given the current challenges in aSAH patient outcomes, initiating more prospective clinical trials is essential. Recent research has shown hydrogen’s therapeutic potential, aligning with EBI in aSAH, driving our exploration of hydrogen therapy’s mechanisms in post-aneurysm rupture damage.Ethics and disseminationThe protocol for the HOMA study was approved by the Ethics Committee of Beijing Tiantan Hospital, Capital Medical University (KY 2022–020-02). All results of the present study will be published in peer-reviewed journals and presented at relevant conferences.Trial registrationClinicalTrials.gov NCT05282836. Registered on March 16, 2022.

A quality improvement study on how a simulation model can help decision making on organization of ICU wards

BackgroundIntensive Care Unit (ICU) capacity management is essential to provide high-quality healthcare for critically ill patients. Yet, consensus on the most favorable ICU design is lacking, especially whether ICUs should deliver dedicated or non-dedicated care. The decision for dedicated or non-dedicated ICU design considers a trade-off in the degree of specialization for individual patient care and efficient use of resources for society. We aim to share insights of a model simulating capacity effects for different ICU designs. Upon request, this simulation model is available for other ICUs.MethodsA discrete event simulation model was developed and used, to study the hypothetical performance of a large University Hospital ICU on occupancy, rejection, and rescheduling rates for a dedicated and non-dedicated ICU design in four different scenarios. These scenarios either simulate the base-case situation of the local ICU, varying bed capacity levels, potential effects of reduced length of stay for a dedicated design and unexpected increased inflow of unplanned patients.ResultsThe simulation model provided insights to foresee effects of capacity choices that should be made. The non-dedicated ICU design outperformed the dedicated ICU design in terms of efficient use of scarce resources.ConclusionsThe choice to use dedicated ICUs does not only affect the clinical outcome, but also rejection- rescheduling and occupancy rates. Our analysis of a large university hospital demonstrates how such a model can support decision making on ICU design, in conjunction with other operation characteristics such as staffing and quality management.

Prevalence and Antimicrobial Resistance Pattern of Uropathogenic Escherichia coli at a Tertiary Care Hospital: A Retrospective Study

Background: Uropathogenic Escherichia coli (UPEC) is the most common cause of urinary tract infection in humans including cystitis and pyelonephritis. Antimicrobial resistance (AMR) in UPEC is one of the global public challenges that is due to prevalent use of antibiotics in healthcare setting. Therefore, the purpose of this study is to investigate the frequency and antibiotic resistance pattern of UPEC isolated from patients admitted to Modares Hospital in Saveh, Iran. Methods: In this study, in total 633 isolates were evaluated. UPEC isolates were obtained from patients with urinary tract infection and identified using conventional microbiological protocols. Antibiotic resistance pattern of UPEC against different antibiotic were determined using disk diffusion method. SPSSTM software was used for statistical analysis Results: In this study, the most sample was related to outpatients and the lowest sample was related to the CCU wards. The highest antibiotic resistance showed against cephalothin (63.8%) and nalidixic acid (62.2%) antibiotics. The highest effective antibiotics for the tested UPEC was nitrofurantoin (90.7%) and gentamicin (77.3%). Cephalothin and nalidixic acid in hospitalized patients in ICU and emergency wards, respectively, showed the highest antibiotic resistance. Out of 633 UPEC, the rate of Multi Drug Resistant (MDR) isolates were 343 (54.2%). Conclusion: The result of this study highlighted the role of UPEC as one of the important cause of UTI in individuals. Also, nitrofurantoin then gentamicin are the most effective antibiotics against UPEC infections. Logical prescription of antibiotics and infection control strategies are needed for prevention and control of nosocomial infections especially urinary tract infection.

The Impact of SARS-CoV-2 Pandemic on Antibiotic Prescriptions and Resistance in a University Hospital from Romania.

This paper aimed to evaluate the effects of the COVID-19 pandemic on prescription rates and antibiotic resistance in a university hospital. A retrospective study was conducted on the medical records of patients admitted to the Bihor Emergency Clinical County Hospital in Romania in 2019 (pre-pandemic) and 2021 (during the pandemic period). We evaluated the antibiotic consumption index (ACI) and susceptibility rates. The overall percentage of antibiotic prescribing increased in 2021, while the total number of patients decreased. Genito-urinary, digestive, respiratory infections, heart diseases and wounds were the most common conditions for antibiotic prescriptions, but the number of them decreased in 2021. There was a decrease in the proportion of antibiotics from the Watch and Reserve class and an increase in the proportion of antibiotics from the Access class. Antibiotic use has been reduced despite an increase in the number of patients, with a high consumption in the Watch group in the ICU wards. By contrast, surgical wards had the highest rate of antibiotic prescriptions, but a decrease in the number of patients. The patients who were administered antibiotics were hospitalized for diagnoses other than COVID-19. Almost all prescribed antibiotics displayed decreasing sensitivity rates. The number of isolated ESKAPE pathogens, except for Staphylococcus aureus methicillin-resistant strains, were increased. Strategies to control antibiotic prescriptions and the spread of resistant pathogens should be improved.

Nurses Knowledge and Attitude Regarding Infection Control Practices

Background: Infection control practices are crucial in minimizing the risk of healthcare-associated infections (HAIs) in hospital settings. Adequate knowledge and positive attitudes among nurses towards these practices are essential for effective implementation and patient safety. Objective: This study aimed to evaluate the knowledge and attitudes of nurses regarding infection control practices at a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted involving 150 registered nurses from various departments including ICU, ER, and pediatric wards. Participants were selected using a convenient sampling technique. Data were collected via a validated questionnaire assessing knowledge and attitudes toward infection control practices. Descriptive statistics, frequency distributions, and reliability analysis (Cronbach’s Alpha) were performed using SPSS version 25. Results: The study revealed that 47.3% (71/150) of nurses had excellent knowledge, 22.0% (33/150) had good knowledge, and 30.7% (46/150) had poor knowledge about infection control. Regarding attitudes, 94.7% (142/150) of nurses exhibited a positive attitude towards infection control measures. The majority of participants were young, with 97.3% (146/150) between the ages of 21-30. Experience levels varied, with 81.3% (122/150) having between 1 to 3 years of experience. Conclusion: The findings indicate that while there is a good level of knowledge and a very positive attitude towards infection control among nurses, continuous education and training are needed to address gaps in knowledge and ensure high standards of practice are maintained.

Psychiatry training in Hungary, difficulties and advantages

Introduction While in theory our training program is quite satisfactory, in practise it often falls short. The first two years give a more general knowledge, including spending time at internal, ICU and neurological wards as well as attending a month-long course about communication, palliative care and basic legal principals important in healthcare. The second three years provide the opportunity to engage in profession-related rotations, like psychotherapy, psychiatric rehabilitation and addictology.Objectives The design in itself is clear, but the supervision for its enactment is insufficient. This leads to regional differences between the four faculties of our country, not everyone is able to partake in the supposedly mandatory rotations (mostly because of shortcomings in staff ) and the organization of our theoretical education varies greatly in each region to the point of non-existence in one area, since the COVID-19 pandemic started. The personal supervision of each psychiatry trainee also leaves much to be desired both on professional and – in psychiatry very important – mental levels. Competence and responsibility limits are often vague, and, especially in country hospitals, to much is expected of the resident (i.e. doing a nightshift alone, without direct supervision).MethodsIt is a positive thing that in theory there are standards in place, the problem is that they are more viewed as guidelines, than demands to be met. Nevertheless, some of the faculties provide well-organized education (even subdivided per year of training) and/or take rotations outside of the ‘home ward’ seriously. The opportunity to gain a basic knowledge in psychotherapy is also beneficial and a good aspect of our training. Easily accessible or even obligatory participation in psychotherapy for ourselves during our training however, is lacking.Results The decreasing number of psychiatry trainees sadly is a worldwide trend and Hungary is no exception. This poses more difficulties, i.e. making it harder to let a resident go on ‘outside’ rotations, especially from wards already struggling with staff shortages. Because of the latter, there is also little time to teach the trainees appropriately and pay them the attention they need.ConclusionsAll in all, there is much potential in our training program and its standards, also leaving room for substantial improvement in realizing the practical aspects. The decline in numbers of psychiatry trainees is worrisome and calls for more general intervention on a European or even global level.Disclosure of InterestNone Declared

Analysis of Nurses' Perceptions of Handover Practices: A Comparative Study in Different Medical Settings.

This article reports a comparative prospective study aimed to explore and compare nurses' perceptions of bedside clinical handover in 3 different settings (emergency unit, ICU, and medical ward). Results revealed that the participant nurses' perceptions varied significantly for different aspects of the handover process. Our data demonstrate department-specific variations in perceptions related to the adequacy, organization, relevance, availability of charts, use of charts for review, ease of following the information, and timeliness of the information.

The association between high-oxygen saturation and prognosis for intracerebral hemorrhage.

Concerns about the adverse effects of excessive oxygen have grown over the years. This study investigated the relationship between high oxygen saturation and short-term prognosis of patients with spontaneous intracerebral hemorrhage (sICH) after liberal use of oxygen. This retrospective cohort study collected data from the Medical Information Mart for Intensive Care III (MIMIC-III) database (ICU cohort) and a tertiary stroke center (general ward cohort). The data on pulse oximetry-derived oxygen saturation (SpO2) during the first 24 h in ICU and general wards were respectively extracted. Overall, 1117 and 372 patients were included in the ICU and general ward cohort, respectively. Among the patients from the ICU cohort, a spoon-shaped association was observed between minimum SpO2 and the risk of in-hospital mortality (non-linear P<0.0001). In comparison with minimum SpO2 of 93-97%, the minimum SpO2>97% was associated with a significantly higher risk of in-hospital mortality after adjustment for confounders. Sensitivity analysis conducted using propensity score matching did not change this significance. The same spoon-shaped association between minimum SpO2 and the risk of in-hospital mortality was also detected for the general ward cohort. In comparison with the group with 95-97% SpO2, the group with SpO2>97% showed a stronger association with, but non-significant risk for, in-hospital mortality after adjustment for confounders. The time-weighted average SpO2>97% was associated significantly with in-hospital mortality in both cohorts. Higher SpO2 (especially a minimum SpO2>97%) was unrewarding after liberal use of oxygen among patients with sICH and might even be potentially detrimental.

Identifying hub genes of sepsis-associated and hepatic encephalopathies based on bioinformatic analysis—focus on the two common encephalopathies of septic cirrhotic patients in ICU

BackgroundIn the ICU ward, septic cirrhotic patients are susceptible to suffering from sepsis-associated encephalopathy and/or hepatic encephalopathy, which are two common neurological complications in such patients. However, the mutual pathogenesis between sepsis-associated and hepatic encephalopathies remains unclear. We aimed to identify the mutual hub genes, explore effective diagnostic biomarkers and therapeutic targets for the two common encephalopathies and provide novel, promising insights into the clinical management of such septic cirrhotic patients.MethodsThe precious human post-mortem cerebral tissues were deprived of the GSE135838, GSE57193, and GSE41919 datasets, downloaded from the Gene Expression Omnibus database. Furthermore, we identified differentially expressed genes and screened hub genes with weighted gene co-expression network analysis. The hub genes were then subjected to Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway functional enrichment analyses, and protein-protein interaction networks were constructed. Receiver operating characteristic curves and correlation analyses were set up for the hub genes. Finally, we explored principal and common signaling pathways by using Gene Set Enrichment Analysis and the association between the hub genes and immune cell subtype distribution by using CIBERSORT algorithm.ResultsWe identified seven hub genes—GPR4, SOCS3, BAG3, ZFP36, CDKN1A, ADAMTS9, and GADD45B—by using differentially expressed gene analysis and weighted gene co-expression network analysis method. The AUCs of these genes were all greater than 0.7 in the receiver operating characteristic curves analysis. The Gene Set Enrichment Analysis results demonstrated that mutual signaling pathways were mainly enriched in hypoxia and inflammatory response. CIBERSORT indicated that these seven hub genes were closely related to innate and adaptive immune cells.ConclusionsWe identified seven hub genes with promising diagnostic value and therapeutic targets in septic cirrhotic patients with sepsis-associated encephalopathy and/or hepatic encephalopathy. Hypoxia, inflammatory, and immunoreaction responses may share the common downstream pathways of the two common encephalopathies, for which earlier recognition and timely intervention are crucial for management of such septic cirrhotic patients in ICU.

Lightweight Video-Based Respiration Rate Detection Algorithm: An Application Case on Intensive Care

The video-based non-contact respiration detection technology can be used in many application scenarios to unobtrusively and ubiquitously monitor the physical state of living beings, and various researchers are currently working on this technology. The optical flow method in tandem with crossover point method is rather effective for respiration rate extraction. However, each method has one disadvantage: 1) the redundant feature points in the traditional optical flow method increase the computational effort and reduce the estimation accuracy; and 2) the traditional crossover point method suffers from crossover points unrelated to breathing movements. For these two challenges, two optimization points are proposed in this work: 1) optimize feature point space by combining spatio-temporal information; and 2) use negative feedback design to adaptively remove crossovers that are not related to respiratory movements. The performance of the proposed algorithm is validated by the Large-scale Bedside Respiration Dataset for Intensive Care (LBRD-IC), which is established using the actual surveillance videos acquired from ICU wards. The validity of the above two optimization points is verified by the ablation experiments. The influential analysis of computation time and video resolution on the performance of the proposed algorithm demonstrates that the proposed algorithm can be deployed to various application terminals to monitor the respiration rate of living organisms in real-time and with high accuracy. In addition, field measurements in the ICU ward have shown that our algorithm can measure respiratory signals of the single patient and multiple patients when only one surveillance camera is present. The dataset and the code are publicly available at: <uri xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">https://github.com/ShawnTan86/LBRD-IC-Dataset</uri> .

Mortality Trends In Pre COVID And Pandemic Era In A Tertiary Care Setting

Objective: The coronavirus pandemic has emphasized stay-at-home and social distancing policies. Since the beginning of the outbreak of COVID-19, there has been a declining trend of hospital mortality indicating that the pandemic might keep patients from seeking emergency care in a hospital setting. This study was carried out to determine the mortality trends pre-COVID and pandemic periods in a tertiary care hospital. Methods: Study design: Retrospective observational study Place and Duration: 1st January 2019 to December 2021 at Federal Government Polyclinic (FGPC) Hospital Islamabad It was a retrospective review done on death data of pre-COVID (January-December 2019) and pandemic(January 2020-December 2021) period. Data on death was retrieved from medical male and female wards, medical ICU and isolation ward. The mortality rate was measured for both pre-COVID and pandemic periods along with co-morbid for the pandemic period. Descriptive statistics were measured with the SPSS software version. 23. Association with age, gender and mortality was observed using a chi-square test taking p value ≤ 0.05 as significant. Result: In this study of the 366 deaths, the average age of patients in the pre-COVID and pandemic era was57.40±17.910 and 64.31±16.065 respectively. The males and females were 50.9% and 49.1% in the pre-COVID period while 61.5% and 38.5% in the pandemic period. The frequency of deaths was 46.7% in the pre COVID and 53.3% in the pandemic period with a p-value &lt;0.05. Patients with co-morbid died more in the pandemic era. Conclusion: It was observed that hospital mortality trends were in decline during the COVID-19 pandemic in our setting which may be associated with lockdown, decreased access to the hospitals or fear of going to hospital.

AIDP BEFORE AND AFTER COVID-19 IN ALGERIA: SHORT COHORT STUDY

Acute inflammatory demyelinating polyradiculoneuropathy is an immune-mediated polyneuropathy (AIDP) that manifests in the form of an acute, ascending, areflexic, progressive and symmetrical paralysis. The primary infection usually from the respiratory or gastrointestinal tract and can be bacterial or viral, and during the pandemic SARS -COV2 and COVID-19 vaccine may also lead to it Life-threatening complications can occur as a result of Acute inflammatory demyelinating polyradiculoneuropathy Syndrome, such as: Severe Autonomic Cardiovascular Dysfunction and respiratory distress. We will report cases who were admitted to the ICU at Lamine Debaghine hospital between 2018 and 2023 presenting major complications and their evolution under ICU ward assistance. CATEGORY: Resuscitation and Anesthesia, Emergency Medicine KEYWORDS: Acute inflammatory demyelinating polyradiculoneuropathy syndrome, dysautonomia, ICU, AIDP, Guillain-Barre.

Investigation of carbapenem-resistant Enterobacterales isolates at a tertiary laboratory in Pretoria, South Africa.

This study aimed to investigate phenotypic and genotypic characteristics of carbapenem-resistant Enterobacterales isolates (CRE) at a tertiary laboratory in South Africa. A total of 99 CRE isolates were collected between 2019 and 2021. Carbapenemase production was tested using modified carbapenem inhibitory method. Colistin susceptibility testing was performed using the ComASP™ Colistin broth microdilution method. Conventional PCR assays were conducted for detection of mcr-1 gene and common carbapenemase genes (blaVIM, blaNDM, blaIMP, blaKPC, blaOXA-23, blaOXA-51 and blaOXA-48). Rep-PCR assay was conducted to determine the genetic relatedness of the study isolates. Majority of the isolates were Klebsiella pneumoniae (83%). Carbapenem resistant K. pneumoniae cluster was observed from ICU and surgical ward samples. Colistin resistance was observed in 13% (12/93) of the isolates namely, in 11 K. pneumoniae and one Enterobacter cloacae. The blaOXA-48 (65%) was the most prevalent gene detected followed by blaNDM (25%) and blaVIM (22%). Several K. pneumoniae isolates concomitantly carried multiple carbapenemase genes with one isolate carry up to 5 five genes blaVIM, blaNDM, blaOXA-48, blaOXA-23 and blaOXA-51. The mcr-1 gene was not detected in the isolates. Rep-PCR assay showed that most isolates matched cluster A (50%). The high prevalence of blaOXA-48, blaNDM and emerging colistin resistant isolates is of concern for patient management at this institution and needs close monitoring. Rep-PCR is a valuable tool in establishing infection clusters in resource-limited settings.