Intensive Care Unit Ward Research Articles

Impact of Irrational Use of Antibiotics Among Patients in the Intensive Care Unit on Clinical Outcomes in Sudan.

Intensive Care Unit (ICU) is a specialized ward where critically ill patients are admitted to provide intensive health care Inappropriate antimicrobial therapy (AMT) and high mortality rates were documented in the ICU. The influence of irrational use of empiric antibiotics on clinical outcomes in ICU patients is not well studied in Sudan. This study aims to determine the rational use of antibiotics and its impact on clinical outcomes among ICU patients. Using data collection form, a retrospective longitudinal study was conducted among ICU patients at Omdurman Military Hospital, Khartoum State. Patients admitted from January 2019 to December 2019 were included in the study. Patients who stayed in ICU < 48 hr were excluded. Appropriateness of AMT is assessed using culture sensitivity test (CST) and the American Society of Infectious Diseases (IDSA) guideline. Among 102 patients, 54.9% male, one-third of patients developed nosocomial infections, 80.4% received empiric therapy with broad-spectrum antibiotics. The CST is done in 19%, and 43% patients are prescribed inappropriate AMT. Inappropriate AMT is associated with recurrent infections 38.4% (p=0.028) and high mortality 33.8% (p=0.014). Overall mortality rate 63.7% ICU patients. Elevated mortality in nosocomial 57.8%, decreased with inappropriate AMT in 21.6% patients. Significantly higher mortality rates 90.7% among uncontrolled infections (p<0.001), 80.6% nosocomial infections (p=0.001), and 76.7% renal compromised (p=0.002). Empirical AMT reduces the frequency of nosocomial infections, which has an impact on mortality. Inappropriate AMT is significantly associated with uncontrolled infections and lower mortality. Implementing a restrictive infectious control system and effective stewardship programs in hospital ICU wards is recommended.

Antibiogram of Acinetobacter baumannii isolated from Intensive Care Unit at Prof. dr. I.G.N.G. Ngoerah Hospital in 2020-2022

Background: Acinetobacter baumannii infection is a severe problem since it tends to be multi-resistant to many antibiotics. This study aimed to determine the prevalence of A. baumannii isolated from blood, urine, and sputum cultures and their antibiotic resistance patterns. Methods: Data of A. baumanii isolated from clinical specimens of Intensive Care Unit (ICU) wards patients were collected retrospectively from laboratory records in the Clinical Microbiology Department of Prof. Dr. I. G. N. G. Ngoerah General Hospital during 2020-2022. Identification and antimicrobial susceptibility tests were conducted using the Vitek-2 Compact system (bioMérieux, France). Isolates resistant to ≥ 3 antibiotic classes were categorized as multidrug-resistant (MDR) A. baumanii. Results: A. baumanii collected from sputum, blood, and urine in Intensive Care Unit (ICU) wards were 63%, 13%, and 7.5% from 2020 until 2022. Most A. baumanii isolates in 2020, 2021, and 2022 were susceptible to Amikacin, which was 75%, 78%, and 76%, respectively. Furthermore, the isolates that were susceptible to Trimethoprim/Sulfamethoxazole were 66%, 81%, and 72%, followed by Tigecycline, 80%, 61%, and 56% respectively. A. baumanii, however, showed low sensitivity to Meropenem even though susceptibility is getting higher each year. Almost all the isolates were resistant to ceftriaxone. Conclusions: Acinetobacter baumannii isolates isolated during 2020-2022 showed high resistance to penicillin, cephalosporin and fluoroquinolones. Although A. baumanii was resistant to carbapenem, its susceptibility tends to increase throughout the 3 years of this study. These data could be considered for empirical therapy of A. baumanii infections.

Healthcare Equipment and Personnel Reservoirs of Carbapenem-Resistant Acinetobacter baumannii Epidemic Clones in Intensive Care Units in a Tunisian Hospital.

Carbapenem-resistant Acinetobacter baumannii (CRAB) strains can cause severe and difficult-to-treat infections in patients with compromised general health. CRAB strains disseminate rapidly in nosocomial settings by patient-to-patient contact, through medical devices and inanimate reservoirs. The occurrence of CRAB in patients residing in the intensive care units (ICUs) of the Sahloul University hospital in Sousse, Tunisia is high. The objective of the current study was to determine whether the surfaces of items present in five ICU wards and the medical personnel there operating could serve as reservoirs for CRAB strains. Furthermore, CRAB isolates from patients residing in the ICUs during the sampling campaign were analyzed for genome comparison with isolates from the ICUs environment. Overall, 206 items were screened for CRAB presence and 27 (14%) were contaminated with a CRAB isolate. The items were located in several areas of three ICUs. Eight of the 54 (15%) screened people working in the wards were colonized by CRAB on the hands. Patients residing in the ICUs were infected with CRAB strains sharing extensive genomic similarity with strains recovered in the nosocomial environment. The strains belonged to three sub-clades of the internationally disseminated clone (ST2). A clone emerging in the Mediterranean basin (ST85) was detected as well. The strains were OXA-23 or NDM-1 producers and were also pan-aminoglycoside resistant due to the presence of the armA gene. Hygiene measures are urgent to be implemented in the Sahloul hospital to avoid further spread of difficult-to-treat CRAB strains and preserve health of patients and personnel operating in the ICU wards.

Evaluation of Antibiotics Used in COVID-19 Patients in West of Iran: A Descriptive Study

Introduction: In coronavirus disease (COVID-19), antibiotics are frequently prescribed to treat bacterial co-infections. Moreover, antibiotics are one of the pre-eminent essential drugs utilized in treatment. However, due to their high cost and association with resistance, their consumption pattern is important to be considered. In this regard, the first step is to optimize the use of these drugs. Objective: Regarding limited data on assessing the pandemic effect on antibiotics used in Iran, this study aimed to describe the evaluation of antibiotics used in COVID-19 patients during the COVID-19 pandemic in West Iran. Materials and Methods: A total of 350 COVID-19 patients were enrolled in hospitals, and their characteristics, such as age, sex, ward, beginning and conclusion dates, organization intervals, dose, and the type of antibiotic utilized, were assessed. It was found that 180 COVID-19 patients received systemic antibiotics. Antibiotic administration was analyzed based on a Defined Daily Dose (DDD) /100-bed days (expended per 100-bed occupied days). Results: A total of 180 (51.43%) of the COVID-19 patients received antimicrobials, comparable to 219.62 DDD/100-bed days. Moreover, 85% of the antimicrobials were infused, and 15% were oral. Among the wards, the highest rate was in the infectious and intensive care unit (ICU) wards and the lowest in the obstetrics and gynecology wards. Conclusion: The use of antibiotics in patients with COVID-19 was assessed as very high, which should be reviewed in terms of the association between misuse of antibiotics and the emergence of resistance.

Outcomes of Invasive and Noninvasive Ventilation in a Haitian Emergency Department.

Limited data exist on the outcomes of patients requiring invasive ventilation or noninvasive positive pressure ventilation (NIPPV) in low-income countries. To our knowledge, no study has investigated this topic in Haiti. We describe the clinical epidemiology, treatment, and outcomes of patients requiring NIPPV or intubation in an emergency department (ED) in rural Haiti. This is an observational study utilizing a convenience sample of adult and pediatric patients requiring NIPPV or intubation in the ED at an academic hospital in central Haiti from January 2019-February 2021. Patients were prospectively identified at the time of clinical care. Data on demographics, clinical presentation, management, and ED disposition were extracted from patient charts using a standardized form and analyzed in SAS v9.4. The primary outcome was survival to discharge. Of 46 patients, 27 (58.7%) were female, mean age was 31 years, and 14 (30.4%) were pediatric (age <18 years). Common diagnoses were cardiogenic pulmonary edema, pneumonia/pulmonary sepsis, and severe asthma. Twenty-three (50.0%) patients were initially treated with NIPPV, with 4 requiring intubation; a total of 27 (58.7%) patients were intubated. Among those for whom intubation success was documented, first-pass success was 57.7% and overall success was 100% (one record missing data); intubation was associated with few immediate complications. Twenty-two (47.8%) patients died in the ED. Of the 24 patients who survived, 4 were discharged, 19 (intubation: 12; NIPPV: 9) were admitted to the intensive care unit or general ward, and 1 was transferred. Survival to discharge was 34.8% (intubation: 22.2%; NIPPV: 52.2%); 1 patient left against medical advice following admission. Patients with acute respiratory failure in this Haitian ED were successfully treated with both NIPPV and intubation. While overall survival to discharge remains relatively low, this study supports developing capacity for advanced respiratory interventions in low-resource settings.

Evaluation and analysis of multidrug resistance- and hypervirulence-associated genes in carbapenem-resistant Pseudomonas aeruginosa strains among children in an area of China for five consecutive years.

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a growing threat. It is urgent to investigate the multidrug resistance and high virulence of CRPA to provide a basis for infection control and rational use of antibiotics. A retrospective study of 56 nonduplicated CRPA isolates was conducted. CRPA mainly came from the intensive care unit (ICU) and was mostly isolated from sputum samples. The carbapenem resistance rates of P. aeruginosa were 21.37% (2016), 10.62, 5.88, 10 and 13.87% from 2016 to 2020, respectively. Carbapenem-resistant enzymes and aminoglycoside-modifying enzyme-encoding genes were detected in all isolates, and extended-spectrum β-lactamase and cephalosporin enzyme-encoding genes were present in 96.43 and 80.38% of isolates, respectively. The detection rate of OprM showed a statistically significant difference (p < 0.05) between the ICU and other wards. Genes related to biofilms, membrane channel proteins, I integrons and efflux systems were detected in all isolates, with detection rates greater than 90%. CRPA was strongly virulent, and over 80% of isolates carried hypervirulence-associated genes (exoU, exoS, exoT, and exoY). The drug resistance rates of cefepime and piperacillin/tazobactam showed a statistically significant difference (p < 0.05) between strains with exoU (+) and exoU (-) (p < 0.05). Notably, out of the 7 individuals who died, 4 had extensively drug-resistant P. aeruginosa (57.14%). The detection rates of various resistance and virulence genes were high, and the coexistence phenomenon was serious. In clinical practice, antibiotics should be used reasonably based on different drug resistance genes to ensure the rationality and safety of patient medication.

Evaluating the Performance of Inpatient Wards in Hospitals Affiliated with Birjand University of Medical Sciences Using the Pabon-Lasso Model in the Years before and during the COVID-19 Pandemic

Background: Evaluating the performance of hospitals will increase effectiveness, efficiency, and quality of services provided and improves responding to the customer. Performance indicators are the most widely used tools for measuring the performance of hospitals. The prevalence of Covid-19 pandemic has affected health care systems at various levels with significant implications for health, the economy, and social structures. Therefore, the present study evaluates the performance of inpatient wards of hospitals affiliated with South Khorasan University of Medical Sciences in the years before and during the COVID-19 pandemic.&#x0D; Methods: The current study was cross-sectional, which was conducted during the years before (2018-2019) and during the outbreak of COVID-19 (2020-2021). The research population included all inpatient departments of hospitals affiliated with Birjand University of Medical Sciences (28 departments). The performance of services was analyzed using data collection form, and through the Pabon Lasso model, the efficiency of the hospital was analyzed. Excel 2018 was used to draw Paben Lasso diagram, describe the data, and check the process of change. Service performance and change process before and during the COVID-19 pandemic were examined using SPSS22 software and Paired sample t-test statistical test (The significance level was determined at 0.05).&#x0D; Results: The results of this study showed that in the years before and during the COVID-19 pandemic, the functional ratios of bed occupancy percentage decreased by 29.20 %, the average patient stay increased by 6.90 %, and the annual bed turnover rate decreased by 32.80%. The results of paired sample t-test with a significance level of 0.05 showed that there was a significant relationship regarding the internal wards and CCU (Coronary Care Unit) between 3 functional indicators: bed occupancy percentage, bed turnover rate and average patient stay; there was no significant relationship in the burn ward. After examining the wards of kidney and urinary tract surgery, ear, nose and throat surgery, orthopedics, psychiatry, pediatrics, infectious diseases, general surgery, open heart ICU (Intensive Care Unit), neurosurgery, and cardiovascular surgery, 2 functional indicators of bed occupancy percentage and bed turnover rate, in the ICU ward, the functional index of the percentage of bed occupancy, and in the neonatal wards, the NICU (Neonetal Intensive Care Unit), the average length of patient stay showed a significant relationship. After examining the efficiency of the wards, the number of efficient districts changed from 32.14 to 28.57 %, and the number of inefficient districts changed from 25 to 28.57 %. Moreover, positive changes in the efficiency status of the open heart and neonatal ICU departments and negative changes in the efficiency status of the pediatric, internal, psychiatric, and infectious wards were observed in the target period.&#x0D; Conclusion: With the arrival of COVID-19 pandemic, service performance and efficiency in hospitals affiliated with South Khorasan province decreased due to limited services to patients. During the years under study, on average, less than one third (30.36%) of hospital wards in the region were efficient, and had good performance; therefore, continuous periodic evaluation is recommended for policy makers to exploit the available resources using the Pabon Lasso model or other models.

Active surveillance of carbapenemase-producing Enterobacterales using genomic sequencing for hospital-based infection control interventions.

Whole-genome sequencing (WGS) is increasingly used to characterize hospital outbreaks of carbapenemase-producing Enterobacterales (CPE). However, access to WGS is variable and testing is often centralized, leading to delays in reporting of results. We describe the utility of a local sequencing service to promptly respond to facility needs over an 8-year period. The study was conducted at Royal Prince Alfred Hospital in Sydney, Australia. All CPE isolated from patient (screening and clinical) and environmental samples from 2015 onward underwent prospective WGS. Results were notified to the infection control unit in real time. When outbreaks were identified, WGS reports were also provided to senior clinicians and the hospital executive administration. Enhanced infection control interventions were refined based on the genomic data. In total, 141 CPE isolates were detected from 123 patients and 5 environmental samples. We identified 9 outbreaks, 4 of which occurred in high-risk wards (intensive care unit and/or solid-organ transplant ward). The largest outbreak involved Enterobacterales containing an NDM gene. WGS detected unexpected links among patients, which led to further investigation of epidemiological data that uncovered the outpatient setting and contaminated equipment as reservoirs for ongoing transmission. Targeted interventions as part of outbreak management halted further transmission. WGS has transitioned from an emerging technology to an integral part of local CPE control strategies. Our results show the value of embedding this technology in routine surveillance, with timely reports generated in clinically relevant timeframes to inform and optimize local control measures for greatest impact.

Comparison of costs associated with transcatheter mitral valve repair: PASCAL vs MitraClip in a real-world setting

AimsWe aimed to conduct a clinical process cost analysis to evaluate all upcoming costs of mitral valve transcatheter edge-to-edge repair (M-TEER) treatment using the MitraClip and the PASCAL repair system.MethodsFirst, we prospectively enrolled 107 M-TEER patients treated with either the PASCAL or MitraClip system and compared all upcoming costs during the M-TEER procedure and the associated in-hospital stay. Second, we retrospectively analysed 716 M-TEER procedures with regard to the occurrence of complications and their associated costs. All materials used in the catheterization laboratory for the procedures were evaluated. The cost analysis considered various expenses, such as general in-hospital costs, device costs, catheter laboratory and material costs.ResultsIn the prospective study, 51 patients were treated using the PASCAL system, and 56 were treated using the MitraClip system. The two groups had comparable baseline characteristics and comorbidities. The total in-hospital costs were 25 414 (Interquartile range (IQR) 24 631, 27 697) € in the PASCAL group and 25 633 (IQR 24 752, 28 256) € in the MitraClip group (p = 0.515). The major cost driver was initial material expenditure, mostly triggered by device costs, which were similar to the PASCAL and MitraClip systems. Overall intensive care unit and general ward costs did not differ between the PASCAL and MitraClip groups. In the retrospective analysis, M-TEER-related complications were rare but were associated with higher costs, mainly due to prolonged hospitalisation.ConclusionThe major cost driver of M-TEER was the material expenditure, which was mostly triggered by high device costs. The costs of treating patients were similar for the PASCAL and MitraClip systems. M-TEER-related complications are associated with higher costs, mainly due to prolonged hospitalisation. This analysis provides valuable insights into reducing expenses by modifying the process of M-TEER.

Hemodialysis: The Life Boat for AKI Patients in the COVID Cytokine Storm.

Interleukin-6 (IL-6), a biomarker of hyperinflammatory immune response, can be used to determine the severity of coronavirus disease 2019 (COVID-19) in patients with multi-organ involvement requiring critical care. The aim of our study is to understand the utility of hemodialysis, not only in terms of reducing renal burden, but also improving the outcome by tackling the COVID cytokine storm syndrome. In this prospective, observational study, 126 patients admitted to the COVID intensive care unit (ICU) wards were treated with hemodialysis for acute kidney injury (AKI). Patients' routine baseline blood parameters were evaluated. IL-6 was measured predialysis in all patients and on the day of discharge in the patients who survived. Out of total 126 patients, 79 were survivors and 47 were nonsurvivors. Among nonsurvivors, majority were older (P = 0.009). Both the groups had a higher percentage of males (78.72% and 55.69% in survivors and nonsurvivors, respectively). Mean neutrophil lymphocyte ratio (NLR) and D-dimer level were significantly higher in nonsurvivors compared to survivors (P < 0.001). Mean serum urea, creatinine, and IL-6 levels were significantly greater in nonsurvivors (P < 0.001). Mean number of hemodialysis sessions received by survivors was higher. The curve between delta IL-6 and delta serum creatinine for survivors showed a significant positive association (r = 0.819, P < 0.001). Our study establishes IL-6 as a poor outcome predictor in COVID ICU patients with AKI. It also emphasizes the use of hemodialysis as a cost-effective lifesaving therapeutic interventional modality to not only improve the renal outcome, but also curb the cytokine storm by reducing IL-6 levels.

An Agent-Based Modeling and Virtual Reality Application Using Distributed Simulation: Case of a COVID-19 Intensive Care Unit.

Hospitals and other healthcare settings use various simulation methods to improve their operations, management, and training. The COVID-19 pandemic, with the resulting necessity for rapid and remote assessment, has highlighted the critical role of modeling and simulation in healthcare, particularly distributed simulation (DS). DS enables integration of heterogeneous simulations to further increase the usability and effectiveness of individual simulations. This article presents a DS system that integrates two different simulations developed for a hospital intensive care unit (ICU) ward dedicated to COVID-19 patients. AnyLogic has been used to develop a simulation model of the ICU ward using agent-based and discrete event modeling methods. This simulation depicts and measures physical contacts between healthcare providers and patients. The Unity platform has been utilized to develop a virtual reality simulation of the ICU environment and operations. The high-level architecture, an IEEE standard for DS, has been used to build a cloud-based DS system by integrating and synchronizing the two simulation platforms. While enhancing the capabilities of both simulations, the DS system can be used for training purposes and assessment of different managerial and operational decisions to minimize contacts and disease transmission in the ICU ward by enabling data exchange between the two simulations.

Intensive care unit admission and associated factors in patients hospitalised for COVID-19: A national retrospective cohort study in Iran

ObjectivesThis study aimed to determine factors associated with intensive care unit (ICU) admission in patients hospitalised due to COVID-19.DesignRetrospective cohort.SettingConfirmed hospitalised patients from all over Iran were considered for the...

Impacts of antipsychotic medication prescribing practices in critically ill adult patients on health resource utilization and new psychoactive medication prescriptions.

Antipsychotic medications are commonly prescribed to critically ill adult patients and initiation of new antipsychotic prescriptions in the intensive care unit (ICU) increases the proportion of patients discharged home on antipsychotics. Critically ill adult patients are also frequently exposed to multiple psychoactive medications during ICU admission and hospitalization including benzodiazepines and opioid medications which may increase the risk of psychoactive polypharmacy following hospital discharge. The associated impact on health resource utilization and risk of new benzodiazepine and opioid prescriptions is unknown. What is the burden of health resource utilization and odds of new prescriptions of benzodiazepines and opioids up to 1-year post-hospital discharge in critically ill patients with new antipsychotic prescriptions at hospital discharge? We completed a multi-center, propensity-score matched retrospective cohort study of critically ill adult patients. The primary exposure was administration of ≥1 dose of an antipsychotic while the patient was admitted in the ICU and ward with continuation at hospital discharge and a filled outpatient prescription within 1-year following hospital discharge. The control group was defined as no doses of antipsychotics administered in the ICU and hospital ward and no filled outpatient prescriptions for antipsychotics within 1-year following hospital discharge. The primary outcome was health resource utilization (72-hour ICU readmission, 30-day hospital readmission, 30-day emergency room visitation, 30-day mortality). Secondary outcomes were administration of benzodiazepines and/or opioids in-hospital and following hospital discharge in patients receiving antipsychotics. 1,388 propensity-score matched patients were included who did and did not receive antipsychotics in ICU and survived to hospital discharge. New antipsychotic prescriptions were not associated with increased health resource utilization or 30-day mortality following hospital discharge. There was increased odds of new prescriptions of benzodiazepines (adjusted odds ratio [aOR] 1.61 [95%CI 1.19-2.19]) and opioids (aOR 1.82 [95%CI 1.38-2.40]) up to 1-year following hospital discharge in patients continuing antipsychotics at hospital discharge. New antipsychotic prescriptions at hospital discharge are significantly associated with additional prescriptions of benzodiazepines and opioids in-hospital and up to 1-year following hospital discharge.

Impact of a newly established expert clinical pharmacological advice programme based on therapeutic drug monitoring results in tailoring antimicrobial therapy hospital-wide in a tertiary university hospital: Findings after the first year of implementation

Therapeutic drug monitoring (TDM) may be helpful in tailoring antimicrobial treatment, and expert interpretation of the results may make it more clinically useful. This study aimed to assess retrospectively the first-year impact (July 2021 to June 2022) of a newly established expert clinical pharmacological advice (ECPA) programme based on TDM results in tailoring therapy with 18 antimicrobials hospital-wide in a tertiary university hospital. All patients having ≥1 ECPA were grouped in five cohorts [haematology, intensive care unit (ICU), paediatrics, medical wards and surgical wards]. Four indicators of performance were identified: total ECPAs; total ECPAs recommending dosing adjustments/total ECPAs both at first and at subsequent assessments; and turnaround time (TAT) of ECPAs, defined as optimal (<12 h), quasi-optimal (12-24 h), acceptable (24-48 h) or suboptimal (>48 h). A total of 8484 ECPAs were provided for tailoring treatment in 2961 patients, mostly admitted in the ICU (34.1%) and medical wards (32.0%). The proportion of ECPAs recommending dosing adjustments was >40% at first assessment (40.9% haematology; 62.9% ICU; 53.9% paediatrics; 59.1% medical wards; and 59.7% surgical wards), and decreased consistently at subsequent TDM assessments (20.7% haematology; 40.6% ICU; 37.4% paediatrics; 32.9% medical wards; and 29.2% surgical wards). The overall median TAT of the ECPAs was optimal (8.11 h). The TDM-guided ECPA programme was successful in tailoring treatment with a wide panel of antimicrobials hospital-wide. Expert interpretation by medical clinical pharmacologists, short TATs, and strict interaction with infectious diseases consultants and clinicians were crucial in achieving this.

Identifying the Challenges of Intensive Care unit Caregiving in the Face of COVID-19 Pandemic: A Qualitative Study

Background: The COVID-19 pandemic created an unprecedented challenge for intensive care units (ICUs) compared to other clinical wards. In addition, it caused stressful conditions due to the increased mortality rates in these wards. Objectives: Since the identification of these challenges can serve as a road map for managers in future planning against crises, the present study aimed to identify the challenges of ICU caregiving during the COVID-19 pandemic. Methods: This qualitative study used conventional content analysis and was conducted using unstructured deep interviews with an open question and several co-constructive questions in 2023. A total of 23 ward heads, head nurses, nurses of ICU wards, nursing managers, and supervisors of six teaching hospitals affiliated with Isfahan University of Medical Sciences and Yazd Universities of Medical Sciences were included in the study through a purposive sampling method. Data analysis was performed with MAXQDA10 using qualitative content analysis with a conventional approach. Results: The challenges of ICUs in the COVID-19 pandemic were identified and categorized into six main categories and 14 sub-categories. The main categories included: inefficient management of resources, weaknesses in organization, challenges to laws and regulations/policies, structural challenges, weaknesses in educational processes, and mental challenges. Conclusion: The findings of this study showed that it is possible to provide quality services to patients by identifying the challenges affecting the management and provision of nursing services and taking appropriate measures to improve the quality of nursing services in the intended wards.

Rising Incidence of Post Covid Rhinocerebral Mucormycosis: An Otolaryngologists Prospective.

Mucormycosis or grimmer popular name, "black fungus" has evolved public concern in context of covid-19 pandemic, Covid Associated Mucormycosis (CAM) seen in Covid-19 pandemic and as a post covid sequelae. The present study was conducted to find out the incidence of the Mucormycosis, and to study its association with post-covid status and co-morbidities. A retrospective study conducted at tertiary care centre over a period of four months, involving all patients with mucormycosis of the paranasal sinuses suffering from or having a history of coronavirus disease. 59 patients had CAM, 47 patients had rhino-orbital Mucormycosis, followed by nasal and paranasal Mucormycosis in 8 patients, 3 patients with rhino-orbital-cerebral Mucormycosis, and one patient with pulmonary Mucormycosis. Diabetes mellitus was present in all 59 patients, 60.41% who had HbA1c > 10 (range 7-15), and 39.58% had HbA1c < 10 with range 6-13. Only 8.33% had controlled diabetes status, uncontroled hypertension and diabetes was seen in 34.02%. All patients were started with IV amphotericin B anti-fungal drug, and followed by oral posaconazole. Depending upon the extent of the disease surgical debridement was done in 52 patients. All patients had history of steroid intake. 7 mortality was there. Uncontrolled diabetes, over-zealous use of steroids, uncontrolled underlying primary disease or co-morbidities, prolonged hospitalization in intensive care unit or normal wards, and hyperventilation all these factors together aggravated the CAM. So it's proper management based on, prompt diagnosis, reversal of predisposing condition with proper medical and aggressive surgical debridement remain the corner stone for this deadly CAM.

Occupational Burnout among Nursing Professionals: A Comparative Analysis of 1103 Polish Female Nurses across Different Hospital Settings

Burnout is common in public trust professions that help people, particularly in healthcare. Professional burnout is a psychological syndrome of emotional exhaustion, depersonalization, and a lowered sense of personal achievement in individuals who work with other people. Research has also shown that occupational burnout can result from the incompetence of employees. This study aimed to examine the occupational burnout and coping strategies among nurses working in different hospital settings. A study group consisted of 1103 Polish female nurses working in non-invasive, intensive care, and surgical units. The following validated tools were used: the Maslach Burnout Inventory (MBI) and the Mini-COPE questionnaire. The largest contribution in occupational burnout was depersonalization (mean score of 51.57) and, to a lesser extent, emotional exhaustion (mean score of 47). The smallest impact was recorded for job satisfaction (mean score of 28.76). Nurses in surgical departments were younger, less burned out, and dealt with stress better than nurses in non-invasive and intensive care units. Nurses in non-invasive wards were the most burned out among the study sample. Nurses in intensive care experienced the least satisfaction from work. In conclusion, professional burnout in nurses depends on the hospital settings, and this specification should be considered in recognizing this problem among nurses. Considering coping strategies, the results suggest a need for tailored coping interventions and support programs specifically designed for nurses working in high-stress environments such as the intensive care unit and non-invasive ward. Given that surgical nurses demonstrated better coping strategies, there is an opportunity to share their best practices with nurses in the intensive care unit and non-invasive ward. In the long-term perspective, investing in the well-being of healthcare workers can lead to a more sustainable healthcare system. By reducing turnover rates and improving the quality of care, sustainable practices can improve the efficiency and effectiveness of healthcare systems.

COVID-19 hospitalized patients and oral changes: a case-control study.

To investigate the association between hospitalization for COVID-19 and oral changes, and to evaluate whether oral changes can indicate a higher risk of disease progression to death. This case-control study analyzed patients hospitalized (university hospital), including those in intensive care unit and clinical wards. The study group comprised 69 COVID-19 positive patients (PCR-test), while the control group included 43 COVID-19 negative patients. A dentist performed oral evaluations, and salivary samples were collected for calcium, phosphatase, and pH analysis. Sociodemographic data, hospitalization information, and hematological test results were collected from electronic-medical records. The presence of oral changes was assessed using chi-square tests, and the predicted risk of death was analyzed using binary logistic regression. COVID-19 positive patients had a significantly higher prevalence of oral changes compared to COVID-19 negative patients. The presence of any oral changes in COVID-19 positive patients indicated a 13-fold higher risk of mortality. "Bleeding ulcers," "pressure ulcers," and "angular cheilitis" were significantly associated with hospitalization for COVID-19. There may be an association between hospitalization for COVID-19 and the development of oral changes, including bleeding ulcers, pressure ulcers. and angular cheilitis. These oral changes may serve as potential indicator for disease progression an increased risk of death. COVID-19 hospitalized patients have a higher prevalence of oral changes, which indicate an increased risk of mortality. Oral medicine staff should be included in multidisciplinary teams to detect and treat these oral changes promptly.

The Study of Lactate/Albumin Ratio as a Predictor of In-Hospital Mortality in Patients with Sepsis and Septic Shock in a Tertiary Care Hospital

Abstract Background: Sepsis is a common and deadly disease that is characterized by elevated levels of acute phase reactants such as high-sensitivity C-reactive protein, lactate dehydrogenase, ferritin, procalcitonin, interleukin (IL-6), tumor necrosis factor, and IL-1. These markers are often used for early diagnosis, management, and risk stratification in patients with septic shock, but they may not be accessible in resource-poor settings with financial constraints. This study aimed to investigate the potential use of the ratio between serum lactate and negative acute phase reactant serum albumin level as a prognostic marker for the outcome of sepsis in resource-poor and -constrained settings. Materials and Methods: The study was a prospective observational study that included 122 patients admitted to the intensive care unit and emergency ward with sepsis or septic shock. Ethical clearance was obtained from the Ethics Committee of Mysore Medical College and Research Institute, and informed consent was obtained from the patients and their attendants. Blood samples for analysis of arterial blood gases, albumin, and other biochemical parameters were collected on the 1st and 3rd days of admission. The outcome of the disease was compared to these parameters using statistical methods such as ANOVA and Chi-square tests with multivariate analysis. Results: The study population consisted of 54.09% males, with one-third of the patients belonging to the age group of 61–70 years. The mortality rate was 27%. The mean serum lactate level on day 1 was 1.7 ± 0.15 mmol/L and on day 3 was 2.65 ± 0.32 mmol/L. The mean serum albumin level on day 1 was 3.14 ± 0.14 g/dL and on day 3 was 3.03 ± 0.13 g/dL. The lactate/albumin ratio on day 1 was 0.49 ± 0.12 and on day 3 was 0.89 ± 0.1 and was positively correlated with the severity of sepsis and septic shock (P &lt; 0.001) and showed a greater significance than lactate or albumin alone. Conclusion: The serum lactate/albumin ratio is a highly sensitive marker that is noninferior to other high-cost biomarkers in assessing the daily prognosis of patients with sepsis in resource-poor and -constrained settings. This study suggests that the lactate/albumin ratio may be a cost-effective, novel, easily feasible, and relevant investigation for assessing the severity and mortality of sepsis and septic shock in rural resource-limited and financially poor hospital settings.

Nutrition care processes from intensive care unit admission to inpatient rehabilitation: A retrospective observational study

ObjectivesExtended duration of nutrition interventions in critical illness is a plausible mechanism of benefit and of interest to inform future research. The aim of this study was to describe nutrition processes of care from intensive care unit (ICU) admission to discharge from inpatient rehabilitation. MethodsThis was a single-center retrospective study conducted at a health care network in Melbourne, Australia. Adult patients in the ICU >48 h and discharged to inpatient rehabilitation within 28 d were included. Dietitian assessment data and nutrition impacting symptoms were collected until day 28. Data are presented as n (%), mean ± SD or median (interquartile range). ResultsFifty patients were included. Of the 50 patients, 28 were men (56%). Patients were 65 ± 19 y of age with an Acute Physiology And Chronic Health Evaluation II score 15.5 ± 5.2. ICU length of stay (LOS) was 3 d (3–6), acute ward LOS was 10 d (7–14), and rehabilitation LOS was 17 d (8–37). Patients assessed by a dietitian and days to assessment in ICU, acute ward, and rehabilitation were 43 (86%) and 1 (0–1); 42 (84%) and 1 (1–3), and 32 (64%) and 2 (1–4) d, respectively. Oral nutrition was the most common mode: 40 (80%) in the ICU and 48 (96%) on the acute ward and rehabilitation. There was at least one nutrition impacting symptom reported in 44 patients (88%). ConclusionsRehabilitation LOS was longer than in the ICU or acute wards, yet patients in rehabilitation were assessed the least by a dietitian and time to assessment was longest. Symptoms that impact nutrition intake were common; nutrition interventions beyond the acute care setting in critical illness need investigation.