Intensive Care Unit Ward Research Articles

Abstract #1407691: Identifying Causes and Improving Hypoglycemia in Hospitalized Patients

A significant cause for adverse outcomes in hospitalized patients is hypoglycemia. It is known to increase morbidity and mortality, lengthen hospital stay, and subsequently increase health care costs. Therefore, reducing inpatient hypoglycemia is an urgent concern that must be addressed. The purpose of our study is to investigate the prevalence of hypoglycemic episodes and identify the causes and risk factors leading to hypoglycemia in the hospital setting. We performed a retrospective cross-sectional analysis of adult patients 18 years and older who were admitted to our hospital and had a hypoglycemic event, defined as glucose ≤55 mg/dL, between February 2022 and May 2022. A chart review was conducted to identify cause and associated comorbidities. We evaluated 667 episodes of hypoglycemia occurring in 409 adult patients hospitalized during a twelve-week period at a tertiary care hospital. Forty-six percent of the patients had diabetes mellitus. Fifty percent of the hypoglycemic incidents occurred in the intensive care unit (ICU) and surgical wards. Hypoglycemia occurred most frequently due to decreased caloric intake related to critical illness and fasting orders (40%) followed by insulin-induced hypoglycemia (32%). Other causes included spontaneous hypoglycemia and discrepancy between serum and capillary blood glucose (26%) and unexplained hypoglycemia due to insufficient data (3%). Hypoglycemic events were most frequently caused by decreased caloric intake due to critical illness, fasting orders, and insulin administration. Less than half of the patient population had diabetes. Therefore, improving nutritional status in critically ill patients and optimizing their glycemic monitoring/insulin management are two identified areas where intervention can improve inpatient hypoglycemia rates.

Çocuklarda COVİD-19 Şiddeti ile D Vitamini Arasındaki İlişki

Objective: It is suggested that vitamin D regulates the immune response in infectious and autoimmune diseases. In our study, we aimed to compare vitamin D levels in pediatric patients with severity of COVID-19 disease and a healthy control group.
 
 Material and Methods: Retrospectively, we compared the serum vitamin D levels in patients between 1 month and 18 years of age who were followed up with the diagnosis of COVID-19 in the pediatric intensive care unit (PICU) and pediatric ward of Necip Fazıl City Hospital with as a control group healthy children who outpatient between March 2020 and November 2020.
 
 Results: Fifteen pediatric patients hospitalized in the COVID PICU and 25 pediatric patients hospitalized in the COVID pediatric service and 40 children in the healthy control group were included. Vitamin D level in PICU was found to be lower than inward median (min-max) was 11.69 (3-27) ng/mL vs 20.8 (6.3-36.8) ng/mL (p=0.005).
 
 Conclusion: In our study, we showed that vitamin D deficiency may be a risk factor for having severe COVID-19 disease. Vitamin D supplementation can help the treatment of severe clinical disease COVID-19 by balancing the immune system and response to infection.

Off-label and unlicensed medicine prescribing in university hospital paediatric wards in Finland: A prospective study.

The aim of this research is to study the prevalence of prescribing medicines for off-label (OL) use and unlicensed (UL) medicines for children during hospitalization in 2021 and to assess changes compared with 2011. The study included all patients aged <18 years who were treated in the neonatal intensive care unit (NICU) or general paediatric ward of Kuopio University Hospital (KUH), Finland, during 4 weeks in April and May 2021. Their background data and daily information on medicine prescriptions were collected from patient records. The prescriptions were classified as OL, UL or on-label/approved. The type of OL category was defined. Altogether, 165 children aged 0-17 years (median 3.2 years) were treated in the paediatric wards (46 in the NICU and 119 in the general ward). In total, 1402 prescriptions were made for 153 children (93%). The proportion of OL and UL prescriptions decreased significantly from 55% in 2011 to 45% (age-adjusted proportion) in 2021 (P< .001). The proportion of patients receiving at least 1 UL medicine prescription decreased from 53% in 2011 to 30% (age-adjusted proportion) in 2021 (P< .001). About 76% of hospitalized children were still prescribed either OL prescription or UL medicine in 2021. The prescriptions for OL use and UL medicines were less prevalent in 2021 than 2011, but still a majority of hospitalized children were prescribed either medicine for OL use or UL medicine in 2021. This indicates a persisting need for approved medicines in children suggesting that revision of EU Paediatric Regulation 2007 is necessary.

Carbapenem resistance among Gram-negative isolates collected from patients in ICU and non-ICU hospital wards in Hong Kong: SMART 2017–2020

To estimate carbapenem resistance in Pseudomonas aeruginosa and Enterobacterales isolated from infected patients in intensive-care unit (ICU) and non-ICU hospital wards in Hong Kong. Isolates of P. aeruginosa (ICU, n=35; non-ICU, n=264) and Enterobacterales (ICU, n=129; non-ICU, n=1390) were collected in four Hong Kong hospitals in 2017-2020. CLSI broth microdilution MICs were interpreted by CLSI 2021 M100 breakpoints. β-lactamase genes were identified in imipenem-, imipenem/relebactam-, and ceftolozane/tazobactam-non-susceptible isolates. Ceftolozane/tazobactam demonstrated potent in vitro activity against both P. aeruginosa (ICU, 88.6%; non-ICU, 98.5%) and Enterobacterales (96.1% susceptible; 97.1%). Percent susceptible values for P. aeruginosa isolates from ICU and non-ICU patients were: meropenem (ICU, 74.3%; non-ICU, 84.1%) and imipenem (68.6%; 73.1%). Only one of 77 isolates tested for β-lactamase genes carried a carbapenemase (VIM-2). Percent susceptible values for Enterobacterales isolates from ICU and non-ICU patients were: meropenem (100%; 99.4%), ertapenem (100%; 98.0%), and imipenem (88.4%; 88.6%). 62 Enterobacterales isolates were tested for β-lactamase genes. Only three isolates carried a carbapenemase gene; two (both Escherichia coli) were metallo-β-lactamase-positive (both NDM-5) and one (Klebsiella pneumoniae) was OXA-48-like-positive. Carbapenem-nonsusceptible isolates of P. aeruginosa were common (>15% of isolates). P. aeruginosa percent susceptible values to ceftolozane/tazobactam (97.3% susceptible overall) were ≥14% higher than carbapenems for both ICU and non-ICU isolates. Carbapenemases were rare among both P. aeruginosa (one isolate) and Enterobacterales (three isolates). Most Enterobacterales isolates tested from ICU and non-ICU patients in Hong Kong hospitals in 2017-2020 were susceptible to meropenem and ertapenem (≥98%); imipenem was less active (89% susceptible).

Neurological and (neuro)psychological sequelae in intensive care and general ward COVID-19 survivors.

Coronavirus disease 2019 (COVID-19) affects the brain, leading to long-term complaints. Studies combining brain abnormalities with objective and subjective consequences are lacking. Long-term structural brain abnormalities, neurological and (neuro)psychological consequences in COVID-19 patients admitted to the intensive care unit (ICU) or general ward were investigated. The aim was to create a multidisciplinary view on the impact of severe COVID-19 on functioning and to compare long-term consequences between ICU and general ward patients. This multicentre prospective cohort study assessed brain abnormalities (3 T magnetic resonance imaging), cognitive dysfunction (neuropsychological test battery), neurological symptoms, cognitive complaints, emotional distress and wellbeing (self-report questionnaires) in ICU and general ward (non-ICU) survivors. In al, 101 ICU and 104 non-ICU patients participated 8-10 months post-hospital discharge. Significantly more ICU patients exhibited cerebral microbleeds (61% vs. 32%, p < 0.001) and had higher numbers of microbleeds (p < 0.001). No group differences were found in cognitive dysfunction, neurological symptoms, cognitive complaints, emotional distress or wellbeing. The number of microbleeds did not predict cognitive dysfunction. In the complete sample, cognitive screening suggested cognitive dysfunction in 41%, and standard neuropsychological testing showed cognitive dysfunction in 12%; 62% reported ≥3 cognitive complaints. Clinically relevant scores of depression, anxiety and post-traumatic stress were found in 15%, 19% and 12%, respectively; 28% experienced insomnia and 51% severe fatigue. Coronavirus disease 2019 ICU survivors had a higher prevalence for microbleeds but not for cognitive dysfunction compared to general ward survivors. Self-reported symptoms exceeded cognitive dysfunction. Cognitive complaints, neurological symptoms and severe fatigue were frequently reported in both groups, fitting the post-COVID-19 syndrome.

Neonatal Multisystem Inflammatory Syndrome Associated with COVID-19 Exposure in Two Cases from Iran

Introduction: Immune dysregulation happens after exposure to corona virus disease-2019 (COVID-19) and affects many organs. It is confirmed with a positive COVID-19 test history, fever, and the involvement of 2 or more organs, but it is hard to diagnose in neonates. Case Presentation: There were 2 Persian neonates admitted to the Neonatal Intensive Care Unit or neonatal ward of the Children’s Medical Center, Tehran, Iran, with sepsis in this case presentation. The trunk and extremities were affected by macular rashes in both cases. COVID-19 tests in both cases were negative, but both of their mothers were affected by COVID-19 before delivery. In both cases, systemic and macular rashes responded to corticosteroids. Conclusions: Macular rash can present multisystem inflammatory disease in neonates. Neonates with a positive history of COVID-19 in parents or relatives should be considered for this syndrome.

Clinical Profile and in Hospital Outcome of Acute Poisoning Cases Admitted in Tertiary Care Hospital: A Prospective Observational Study

Objectives: Acute poisoning is a medical emergency. Data are scarce from the Indian subcontinent regarding the profile and outcome of patients presenting with acute poisoning admitted to intensive care unit (ICU). Hence, the present study was undertaken to assess the clinical profile and hospital outcome of acute poisoning cases admitted in tertiary care hospitals. Material and Methods: A total of 148 patients with acute poisoning aged &gt;18 years and admitted in the intensive care unit and medicine wards of tertiary care hospital during a period of 1 year from September 1, 2019, to August 31, 2021, were studied. Results: Poisoning was more common in the 21–30 years age group (42.57%) with male predominance (55.41%). Poisoning with suicidal intention constituted 81.76%: 44.59% of cases seeking medical help within 2–4 h. In 81.76% of cases, route of poisoning was oral. Organophosphorus was the most common acute poisoning (28.38%), and most common symptoms were nausea/vomiting. Complications noted were ventilator-associated pneumonia (VAP) (4.72%), renal failure (6.08%) and hepatic failure (2.7%). Mortality was seen in 11.49% of cases. Out of 148 cases, 121 were of suicidal poisoning, while 14 patients out of them expired so psychiatric evaluation of 107 patients can be made and out of that all patients had some underlying psychiatric illness. Patients requiring ventilatory support constituted 25.67% of cases. Conclusion: Clinical profile of acute poisoning depends on the nature of compound/poison, quantity of compound consumed/exposed, first aid received at the primary care level and time taken to shift the patient from primary care level to tertiary care level. In-hospital mortality mostly depends on the dedicated facilities available at the tertiary care level in addition to the factors described above for clinical profile.

Is intensive care necessary after major thoracic surgery? A propensity score-matched study.

This study aims to compare the surgical results, complications, mortality rates, and inpatient costs in two patient groups followed, whether in the intensive care unit or general ward after a major thoracic procedure and to examine clinical and surgical factors related to the development of complications. Between January 2018 and June 2021, a total of 485 patients (150 males, 335 females; mean age: 58.3±13.2 years; range, 22 to 86 years) who underwent a major thoracic surgery in our clinic were retrospectively analyzed. The patients were divided into two groups as the intensive care unit patients (n=254) and general ward patients (n=231). In the former group, the patients were followed in the intensive care unit for a day, while in the general ward group, the patients were taken directly to the ward. The groups were compared after propensity score matching. All patients were analyzed for risk factors of morbidity development. After propensity score matching, 246 patients were enrolled including 123 patients in each group. There was no statistically significant difference between the groups in any features except for late morbidity, and inpatient costs were higher in the intensive care unit group (p<0.05). In the multivariate analysis, age, American Society of Anesthesiologists Class 3, and secondary malignancy were found to be associated with morbidity (p<0.05). In experienced centers, it is both safe and costeffective to follow almost all of the major thoracic surgery patients postoperatively in the general ward.

Occupational Challenges of Intensive Care Nurses During the COVID-19 Pandemic: A Qualitative Study.

The coronavirus disease 2019 (COVID-19) has been spreading rapidly as a pandemic and posed numerous challenges to healthcare workers (HCWs), especially nurses. This study aimed to investigate the occupational challenges experienced by intensive care unit (ICU) nurses in caring for patients with COVID-19. This qualitative study was conducted using a conventional content analysis method in September and October 2020. The study environment was the ICU wards dedicated to the patients of COVID-19 in a large hospital in east of Iran. The participants were selected by purposeful sampling method, and data were collected using semi-structured interviews with 17 nurses working in the COVID-19 ICUs. Data analysis was done with MAXQDA 2020. The data analysis led to the extraction of 6 main categories and 17 sub-categories. The main challenges included "payment system", "human resource management", "consumable resource supply", "psychological and ethical distress", "personal or family problems", and "staff motivation and welfare issues". Considering the key and important role of nurses in the healthcare system, particularly during the COVID-19 pandemic, it is necessary to increase their motivation by applying a fair and non-discriminatory payment system and paying special attention to psychological issues. Also, managerial support and provision of required facilities and manpower have a significant impact on reducing their occupational challenges in caring for patients with COVID-19.

Outcomes in COVID-19 Patients with Pneumonia Treated with High-Flow Oxygen Therapy and Baricitinib—Retrospective Single-Center Study

The aim of the study was to assess the effect of baricitinib on 28-day all-cause mortality and the progression of respiratory failure in patients needing transfer to the intensive care unit (ICU) with COVID-19 pneumonia treated with high-flow oxygen therapy. This retrospective study included hospitalized patients with COVID-19 pneumonia treated with high-flow oxygen non-invasive ventilation receiving standard of care (SOC) or SOC in addition to baricitinib. Data on patients' characteristics, pro-inflammatory markers, D dimer, and National Early Warning Score 2 (NEWS2) values were collected and compared between groups. The primary endpoint was 28-day all-cause in-hospital mortality and the secondary outcome was transfer to the ICU. The study included 125 patients. The primary outcome was observed in 44.8% of them: 27% in the baricitinib group vs. 62% in the SOC group, p < 0.001. Transfer to the ICU ward was significantly lower in the baricitinib group: 29% vs. 81%, p < 0.001. A significant improvement was observed when the baricitinib group was compared to SOC in procalcitonin, CRP, D-dimer, neutrophil-to-lymphocyte ratio values, and NEWS2. Treatment with baricitinib in addition to SOC was associated with reduced mortality and a lower prevalence of transfer to the ICU in hospitalized patients with COVID-19 pneumonia treated with high-flow oxygen non-invasive therapy.

Coping with the Burden of Care through Effective Management of Stress: A Study among Nurses in Selected COVID-19 Isolation Hospitals in the United Arab Emirates

The burden of providing care to patients during the COVID-19 pandemic escalated stress among nurses, which affected their mental health, and called for effective coping. The goal of this study was to correlate the burden of caregiving with the management of stress by nurses during the COVID-19 pandemic in the United Arab Emirates. We conducted this cross-sectional correlational study among the nurses in two hospitals in the United Arab Emirates. A non-probability voluntary sample (n = 64) was taken of nurses working in the intensive care unit (n = 41) and isolation wards (n = 24). The respondents completed two questionnaires via Google Forms, namely, the Professional Care Team Burden Scale and the 15-item Stress Management Inventory. The findings indicate that the nurses reported moderate (37.5%) to low (62.5%) levels of the burden associated with caregiving. There was a significant inverse correlation between the burden of care and three elements of the stress management inventory, namely developing resiliency (r = −.284, p = .023), short-term coping (r = −313, p = .012), and effective delegation (r = −.395, p = .001). However, there was no correlation between the burden of care and eliminating stressor elements. The findings suggest that when nurses increased their resilience, short-term coping strategies and effective delegation they tended to experience less burden of caregiving during the COVID-19 pandemic. We therefore recommend that health policymakers focus on supporting resilience, short-term coping strategies and effective delegation in the nursing work environment to reduce the burden of caregiving.

Is Homocysteine Associated with the Prognosis of Covid-19 Pneumonia.

Background/Aim. Coronavirus disease 2019 (COVID-19) is a life-threatening disease characterized by a prothrombotic state. Because homocysteine (Hcy) is a potential biomarker in thrombotic disease, this article aims to highlight the role of Hcy in the prognosis of COVID-19 pneumonia. Methods. This prospective study was conducted between April 2021 and December 2021 at the University of Health Sciences, Antalya Training and Research Hospital. 162 patients admitted to the emergency department for COVID-19 pneumonia and scheduled for hospitalization in the intensive care unit (ICU) or COVID-19 ward of the chest disease department were included in the study. Hcy levels and other necessary laboratory parameters were analyzed. Results. 134 patients were admitted to the COVID-19 ward and 28 to the ICU. Hcy levels were significantly higher in ICU patients than in ward patients (p : 0.001). Of the 134 patients, 55 later required ICU treatment for various reasons and were transferred to the ICU. Hcy (p : 0.010), ferritin (p : 0.041), and LDH (p : 0.010) were significantly higher in patients who were transferred to the ICU than in patients who remained in the ward. The Hcy level was associated with a poor prognosis. It was found that each unit increase in the Hcy level approximately doubled the risk of death in patients with COVID-19 (odds ratio: 1.753). Discussion. There are few studies examining the association between high Hcy levels and disease severity in COVID-19. Our study supports previous studies and shows the association between the need for intensive care and high Hcy levels. Conclusion. A high Hcy value is a helpful marker in determining the need for critical care on admission to the emergency department and a marker of poor prognosis in COVID-19 pneumonia.

Global Perspectives in Acute Kidney Injury: Spain.

Global Perspectives in Acute Kidney Injury: Spain.

A study on candiduria in neonates and infants from a tertiary care center, North India.

Candida albicans is the major cause of fungal UTI in neonates and infants but nowadays non albicans Candida is also increasing and these are mostly multidrug resistant. So it's important to know the species of candidal UTI for the proper management. This study was undertaken to determine the Candida species distribution in UTI along with their susceptibility pattern and outcome in infants and neonates admitted in different wards and ICU of our hospital. We also assess the incidence rate of candiduria in ICUs. Urine samples were collected from infants and neonates presented in pediatrics and neonatal ICU (intensive care units) and clinical wards with a clinical suspicion of candiduria and infants at risk of invasive candidiasis were also included in the study. Identification of Candida sp. was done by Gram's staining, germ tube test, chlamydospore formation on corn meal agar, color appearance on CHROM agar and also confirmed by MALDI-TOF Assay. Antifungal susceptibility was performed by using broth microdilution method as per the CLSI M27-A3/M27-S4. Urine samples were received from 219 infants, and Candida was isolated from samples from 52 infants (isolation rate 23.75%), of which 30 were admitted in pediatric or neonatal ICU and 22 in the wards. The incidence rate of candiduria in ICU was 3.25%. Candida albicans was the most frequently isolated species from the samples of infants in the wards (13/22 i.e. 59%), while Candida tropicalis was most frequently isolated from samples of infants in the ICUs (13/30 i.e. 43.34%). Candida glabrata was the least commonly isolated species and was only encopuntered in the ICU. There was no discrepancy between the results of conventional methods of identification and MALDI-TOF. Antifungal susceptibility was performed for 18 randomly selected isolates. All were found to be susceptible to caspofungin, micafungin, itraconazole, voriconazole, fluconazole, amphotericin B. High suspicion of candiduria is needed especially in ICU admitted infants and identification of candida at species level along with the susceptibility pattern is important for the better management of patients.

Low Early Antifactor Xa Target Achievement Rate of Low-Molecular-Weight Heparin for Treating Venous Thromboembolism in Patients in Intensive Care.

This study aimed to evaluate whether early antifactor Xa (anti-Xa) achieved the target range when venous thromboembolism (VTE) was treated with low-molecular-weight heparin (LMWH), based on body weight and renal function in patients treated in intensive care units (ICUs). Anti-Xa levels in patients treated with LMWH for VTE in ICU and medical wards between January 1,2021, and June 30,2022, were retrospectively assessed. The demographics, laboratory parameters, and early anti-Xa peak levels of patients were collected. All patients were followed up for 3months to collect VTE recurrence/bleeding events. Univariate and multivariate linear regression analyses were used to identify the factors affecting anti-Xa levels. A total of 108 patients were enrolled in this study, including 70 patients in ICU and 38 patients on medical wards. The early anti-Xa level (0.36 vs 0.61IU/mL, P<.001) and target achievement rate (21.4% vs 39.5%, P=.015) of patients in ICU were lower than those in medical wards. Multivariate linear regression showed that only antithrombin (AT) significantly affected anti-Xa levels in patients in ICU (β=0.008, 95%CI 0.005 to 0.011, P<.001). There was no significant difference in VTE recurrence events (11.8% vs 7.5%, P=.628) and bleeding events (29.4% vs 17.0%, P=.304) between the early anti-Xa within-target group and the early anti-Xa below-target group. Low anti-Xa peak levels are common in patients in ICU. AT activity should be monitored when using LMWH in critically ill patients.

Implementation of pharmacists’ monitoring for intravenous drug compatibility

BackgroundInjectable medication errors primarily occur during preparation and administration. Currently, South Korea is experiencing chronic pharmacist shortages. Moreover, pharmacists have not routinely conducted prescription monitoring for intravenous compatibility. In the...

The Relationship Between Cytokine Concentrations and Severity Scoring Index for Crimean-Congo Hemorrhagic Fever.

Background This study aimed to investigate the effects of serum high mobility group box-1 (HMGB1), interleukin (IL)-6, IL-8, IL-1β, IL-10, and tumor necrosis factor alpha (TNF-α) levels on disease severity and mortality in Crimean-Congo hemorrhagic fever (CCHF) patients. Materials and methods This study was performed prospectively in the intensive care unit (ICU) and infection ward of a tertiary hospital in the Republic of Türkiye.Patients aged 18 years and older diagnosed with CCHF were included. Results Our study included 30 patients, of whom 83.3% were male, where the mean age was 51.6±14.35 years. The most common clinical findings in patients were malaise (90%) and myalgia (63.3%). In our study, IL-1β levels were found to be 1173.6 (783.0-1823.0) pg/mL, IL-6 69.9 (56.8-133.1) pg/mL, IL-8 191.2 (152.8-516.9) pg/mL, TNF-α 129.5 (104.9-270.8), HMGB1 37.01 (29.26-75.18), and IL-10 190.1 (IQR: 147.8-387.8) pg/mL. The patients' median Severity Scoring Index (SSI) score was found to be 2.5 (1.8-5.5). There was a moderate correlation between the patients' SSI score and serum IL-6 (r=0.464, p=0.010), TNF-α (r=0.420, p=0.021), and IL-10 levels (r=0.518, p=0.003), and a weak correlation between serum HMGB1 (r=0.392, p=0.032). The correlation between SSI and creatine phosphokinase (CPK) levels (r=0.499, p=0.036) was observed to be moderate. Conclusion It was seen that IL-10, IL-6, TNF-α, HMBG-1, and CPK levels evaluated at the CCHF patients' time of admission to the clinic and SSI clinical score were found to be significantly related. It is clear that more studies with patients and groups of healthy volunteers are needed on this subject.

Maximizing the detection rate of hypoglycemia among preterm neonates admitted in Neonatal intensive care unit in Ethiopia, 2021

The burden of hypoglycemia is high in resource limited countries, such as Ethiopia. However, there are no sufficient studies conducted in Ethiopia in general and in the study setting in particular in the previous era. Hence, this study aims to assess the proportion of hypoglycemia and associated factors among preterm neonates admitted to the neonatal intensive care unit at Debre Tabor Comprehensive Specialized Hospital, Ethiopia, in 2021. A hospital-based cross-sectional study was conducted from October 1 to December 30, 2021, at Debre Tabor Comprehensive Specialized Hospital in the neonatal intensive care unit ward. The data was entered in Epi-info 7 and exported to STATA version 14. A binary and multivariable logistic regression was computed at 95% confidence interval (CI). During bivariable analysis, variables having a p-value of less than 0.25 were chosen for multivariable logistic regression analysis, and variables having a p-value of less than 0.05 in multivariable analysis, were significant associations with the dependent variable. The study included 267 preterm neonates, and 23.59% (95% CI 18.9–29.1) were develop hypoglycemia. Moreover, 49 (18.35%) preterm neonates died during the study period. In this study, preterm neonates with hypothermia [Adjusted Odds Ratio (AOR = 4.5; 95 CI 3.4, 7.2)], birth asphyxia (AOR = 5.1; 95 CI 3.9, 27.1), seizure (AOR = 4.7; 95 CI 2.8, 17.8), and also preterm neonates born from diabetic mothers (AOR = 6.7; 95 CI 3.3, 27.2) were significantly associated with the occurrence of hypoglycemia in the neonatal intensive care. The proportion of hypoglycemia and associated factors among preterm neonates admitted to the neonatal intensive care unit at Debre Tabor Comprehensive Specialized Hospital was found to be high. The associated factors for the occurrence of hypoglycemia were discovered to be neonates with hypothermia, birth asphyxia, seizure, and neonates born with a diabetes mother. Thus, recognizing and treating the above associated factors is essential to preventing, and controlling hypoglycemia.

Extensively drug-resistant Acinetobacter baumannii: role of conjugative plasmids in transferring resistance.

Acinetobacter baumannii is one of the most successful pathogens that can cause difficult-to-treat nosocomial infections. Outbreaks and infections caused by multi-drug resistant A. baumannii are prevalent worldwide, with only a few antibiotics are currently available for treatments. Plasmids represent an ideal vehicle for acquiring and transferring resistance genes in A. baumannii. Five extensively drug-resistant A. baumannii clinical isolates from three major Jordanian hospitals were fully sequenced. Whole-Genome Sequences (WGS) were used to study the antimicrobial resistance and virulence genes, sequence types, and phylogenetic relationship of the isolates. Plasmids were characterized In-silico, followed by conjugation, and plasmid curing experiments. Eight plasmids were recovered; resistance plasmids carrying either aminoglycosides or sulfonamide genes were detected. Chromosomal resistance genes included blaOXA-66, blaOXA-91, and blaOXA-23, and the detected virulence factors were involved in biofilm formation, adhesion, and many other mechanisms. Conjugation and plasmid curing experiments resulted in the transfer or loss of several resistance phenotypes. Plasmid profiling along with phylogenetic analyses revealed high similarities between two A. baumannii isolates recovered from two different intensive care units (ICU). The high similarities between the isolates of the study, especially the two ICU isolates, suggest that there is a common A. baumannii strain prevailing in different ICU wards in Jordanian hospitals. Three resistance genes were plasmid-borne, and the transfer of the resistance phenotype emphasizes the role and importance of conjugative plasmids in spreading resistance among A. baumannii clinical strains.

Prescription pattern in ischemic heart disease inpatients at B. P. Koirala Institute of Health Sciences: a cross sectional study

Background: Drug utilization pattern studies seek to screen, evaluate and suggest appropriate modifications in prescription practices. It would help to make patient care rational and cost effective. Objective was to analyze the drug prescribing pattern for treatment of ischemic heart disease (IHD). Methods: A prospective cross-sectional observational study was conducted in patients of IHD admitted in intensive coronary care unit and medicine ward for the period of six months. Data were collected in preformed case record form. The data were analyzed for drug use indicators, demographic parameters, morbidities, pattern of drug use using Microsoft excel 2010. Results: A total of 145 patients were enrolled out of that 89 (61.38%) were males. The mean age was 60.01±12.71 years and majority (26.89%) belonged to age group of 61-70 years. A total of 1208 drugs were prescribed in 145 patients. Most frequently prescribed drugs were antiplatelet group of drugs 100% encounters, followed by hypo-lipidemics (98.62%). Average number of drugs per encounter was 8.33 and percentage of drugs prescribed by generic name was 5.04%. Conclusions: IHD was more common in males than females. The most commonly prescribed drug classes were anti-platelet drugs followed by hypolipidemic agents.