Medicine Unit Research Articles

Parathyroid Adenoma at the Parapharyngeal Space Detected on 99mTc-Sestamibi SPECT/CT.

A 77-year-old woman was diagnosed with primary hyperparathyroidism, and initial cervical ultrasonography found no parathyroid lesion, and she was referred to the nuclear medicine unit for dual-phase 99mTc-sestamibi (MIBI) scan. The scintigraphy unveiled heterogeneous uptake patterns across bilateral thyroid lobes, corresponding to the thyroid nodules, alongside a marked focal uptake with delayed tracer washout in the right oral region. The SPECT/CT pinpointed a MIBI-avid nodule within the right parapharyngeal space, indicative of parathyroid ectopia. An ectopic parapharyngeal parathyroid adenoma is exceptionally rare. MIBI scan plays a pivotal role in detection of ectopic parathyroid adenoma at unexpected sites.

Pregnancy Outcomes in Women with Low and Ultra-Low Ejection Fraction: A Retrospective Study in a Tertiary Care Center

The data about pregnancy while having a low ejection fraction are scarce, since pregnancy is not recommended for women with an ejection fraction of less than 30%. There is an increased risk of obstetrical complications and adverse maternal-fetal outcomes. Pregnancy is a rough journey for this group of patients. However, a successful pregnancy can be achieved when cardiac complications are managed during pregnancy. The early recognition of women at risk of cardiovascular events and early referral can optimize the maternal and neonatal outcomes with close collaboration between the maternal-fetal medicine specialist and the cardiologist. The study’s aim was to assess the experience of our tertiary center with regard to the adverse maternal outcome for women with an ejection fraction ≤ 30% compared to those with an EF > 30% in our tertiary center. The fetal and obstetric outcome for pregnancies with an EF ≤ 30% was compared to that for pregnancies with an EF > 30%. Methodology: After receiving the approval of the local Ethical Board Review, a retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSHRC) in the city of Riyadh, Kingdom of Saudi Arabia. Our study population included women with cardiomyopathy (acquired or congenital) who were followed up or delivered in KFSHRC from the period of January 2004 till March 2020. Cases were identified by reviewing the database from the Cardiac Center Echocardiograph and maternal fetal medicine unit. The data on the maternal and fetal outcome were gathered from the hospital medical records. An adverse maternal outcome included: death, hospitalization due to decompensated heart failure, and worsening cardiovascular status during pregnancy. Adverse fetal outcomes included: miscarriages, termination of pregnancy, FGR, and placental insufficiency. Obstetrics complications included: complications related to the mode of delivery, antepartum hemorrhage, postpartum hemorrhage, or preeclampsia. Results: Our study included 44 subjects, examining the differences between those with an ejection fraction greater than 30 (n = 21 subjects) and those with an ejection fraction less than or equal to 30 (n = 23) with respect to demographics, co-morbidities, and outcomes (maternal, pregnancy, fetal, ultrasound, and baby). There was no evidence of any differences in the demographics. From among the co-morbidities, there was a statistically higher rate of dilated cardiomyopathy and lower rate of rheumatic heart disease in those with a lower ejection fraction. Also, women with a lower ejection fraction tended to deliver through a means other than simple vaginal delivery. There was a significant association (p = 0.0296) indicating that individuals with a lower ejection fraction tended to have a lower gestational age at delivery. The information on whether the pregnancy resulted in a live birth was available for all but one of the mothers. Across all the mothers, 32 (74%) resulted in a live birth and 11 did not. The percentage of pregnancies resulting in a live birth in the group for which the ejection fraction was greater than 30 was 90% and that in the group for which the ejection fraction was less than or equal to 30 was 59% (p = 0.0339). From among the ultrasound and baby outcomes, only the rate of the babies being discharged alive differed statistically between the two ejection fraction groups, with those mothers having a lower ejection fraction experiencing fewer babies being discharged alive (p = 0.0310). Conclusions: In conclusion, women with a low ejection fraction are at an increased risk of maternal-fetal complications. In our study, the lower the EF (≤30) the worse were the fetal and neonatal outcomes; however, in terms of the maternal outcomes, it was the same whether the EF was low or ultra-low. Yet, these groups of patients need to be counseled about the facts of poor obstetrical outcomes with an emphasis on preconceptual counseling.

Care pathway for patients hospitalized with venous thromboembolism.

Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a potentially fatal disease with a multifactorial nature, impacting different medical and surgical specialties. Recently, new guidelines and direct oral anticoagulants facilitated early discharge for most DVT patients and non-severe PE patients. The aim of this study is to illustrate the distribution of VTE patients throughout the hospital and map their care pathway from Emergency Department (ED) to hospital discharge. This multicenter retrospective cross-sectional study included all hospitalized patients with a VTE code from 39 hospitals between 2018 and 2019. Data were analysed using JupyterLab, with subgroup analyses based on mode of entry, diagnosis location and thrombosis site. A total of 23,199 hospitalizations were analysed, involving 17,718 patients a median age 66 years [52-78] and man-to-women ratio 1.05. Among these, 10,747(46.3%) had PE and 4176(18.0%) had lower limb DVT. The ED was the primary entry point for 31.2% of cases, followed by gastroenterology, surgery, geriatrics, and internal medicine. Patients admitted through ED patients were most frequently transferred to internal medicine, cardiovascular and intensive care units (ICU). The median hospital stay was 9 days [4-21], with ICU stays being the longest (mean 15 days [8-27]). Notably, 1357 patients (18.8%) of VTE patients were discharged within 48 h of ED admission. This study is the first to portray the distribution and care pathways of VTE patients across hospital departments. Despite recent clinical guidelines, many patients still require inpatient management, highlighting the need for dedicated care pathway.

Impact of the Implementation of a Short Stay Observation Unit Associated With Admitter-Rounder Model Onto Other Internal Medicine Units in a French University Hospital.

Few data on the impact of specific interventions against Emergency Rooms 'or Hospitals overcrowding are available in France. In the present report, we retrospectively investigated the impact of the implementation of a short-stay observation unit associated with the admitter-rounder model, especially onto the other in-patient internal medicine units in a French University Hospital. During the first 100 days, 242 patients were admitted into the short-stay observation unit. The median length of stay (LOS) was 5 days, but it was lower during the first and third parts with the admitter-rounder model than during the second part without: 4 versus 6 days (p = 0.007). Internal medicine bed-spaced patients accounted for 19.5% of the bed-spaced patients during the study period versus 28.1% during the same period the previous year (p = 0.04). The median LOS increased significantly in two units of internal medicine: 10 versus 8 days (p = 0.005) and 10 versus 8 days (p = 0.01) during the study period versus the same period the previous year, respectively. The reduced number of Internal Medicine bed-spaced patients, the reduced LOS of patients in short-stay observation unit when associated with the admitter-rounder model and the increase of LOS among some of the in-patient internal medicine units observed in this study should be evaluated elsewhere.

Predictive value of technetium-99m sodium pertechnetate thyroid scintigraphy in determining the permanence of congenital hypothyroidism

Objectives: We aim to investigate the predictive value of [99mTc] pertechnetate thyroid scintigraphy in determining the permanence of congenital hypothyroidism (CH). Material and Methods: A retrospective analysis of [99mTc] pertechnetate thyroid scans performed for evaluation of CH at the Nuclear Medicine Unit of a hospital in Hong Kong between January 1, 2008, and December 31, 2018, was conducted. Scintigraphic findings and parameters at diagnosis, including thyroid stimulating hormone (TSH), free thyroxine (fT4), gender, and gestational age, were reviewed. The need for lifelong thyroxine replacement therapy was reviewed. Results: The study included 85 subjects, with 74 (87.1%) presenting with eutopic thyroid and 11 (12.9%) showing thyroid dysgenesis. Patients with scintigraphic evidence of thyroid dysgenesis required permanent thyroid hormone replacement therapy. Among the patients with eutopic thyroid, a higher TSH level was associated with the need for lifelong thyroid hormone replacement therapy (cutoff TSH value 18.72 mIU/L, sensitivity 77.3% and specificity 53.8%). Gender, gestational age, and fT4 did not show significant differences between the transient and permanent CH groups in patients with eutopic thyroid. Conclusion: Scintigraphic findings of thyroid dysgenesis indicate a high prevalence of permanent CH. In patients with eutopic thyroid, higher TSH levels predict the requirement for lifelong thyroid hormone replacement therapy. These results provide insights into the prediction of CH and aid in individualized treatment decisions for patients with CH.

Safety of hyperbaric oxygen therapy in non-emergent patients with a history of seizures: A retrospective cohort study.

Hyperbaric oxygen therapy (HBOT) is well established as a treatment for various medical conditions. However, it poses a risk of oxygen toxicity, which can cause seizures particularly in individuals with pre-existing seizure disorders. Consequently, seizure disorders are considered a relative contraindication to HBOT. Despite this, the relative risk of HBOT-induced seizures in this patient population remains unclear. This retrospective cohort study aims to evaluate the safety of HBOT among patients with pre-existing seizure disorders. After obtaining approval from the Research Ethics Board, we retrospectively reviewed the patient charts of individuals with a history of seizures who were referred to the Rouge Valley Hyperbaric Medical Center and Toronto General Hyperbaric Medicine Unit for HBOT between January 2020 and December 2023. Relevant demographic information, past medical history, and HBOT session treatment protocols, such as the treatment pressure set in absolute atmospheric pressure (ATA) and number of air breaks, were recorded. The collected data was analyzed using descriptive statistics. A total of 43 patients were referred to HBOT during the study period, and 21 patients did not proceed with the treatments. In total, 634 HBOT sessions were administered to 22 patients in monoplace chambers with five-minute air breaks, and one patient experienced a seizure event. Each patient completed an average of 29 (range 3-60) sessions lasting 90-120 minutes at 1.8 ATA (n = 3), 2.0 ATA (n = 18), or 2.4 ATA (n = 1). Fifteen patients were on oral antiseizure medications during the HBOT course. The overall incidence of seizures was one in 634 treatments. While patients with a history of seizures may develop seizure activity during HBOT, the majority can safely undergo treatment when predetermined protocols are followed. With careful management and adherence to established protocols, HBOT can be a viable treatment option for those with seizure histories.

Assessing quality of health care in the context of patient satisfaction from patients’ perspective among a physical therapy and rehabilitation unit

Health service policies are evolving into qualified health care providing best possible outcomes as well as focused on patient satisfaction. Hence the qualification valued health care includes patient satisfaction measurements, it is suggested to get feedbacks during the assessment of outcomes from the patient’s perspective. Aging of the world population accelerates demand on rehabilitation medicine which means recovering impairments so is directly related with quality of life. This study measures the patient satisfaction among 286 patients referring to outpatient clinics and receiving therapy within Physical Medicine and Rehabilitation Unit of City Hospital in Balikesir, Turkey. Results showed 63.4 ± 2.6 years mean of age and female majority (63.6%). Region of therapy included 9.8% for total body, plegic syndromes, 19.6% for neck, 25.2% for shoulder, 21.6% for knee and 23.8% for lumbar regions. Patients are grouped in two according to ‘yes’ or ‘no’ answer of the question ‘Do you agree with you have benefit from applied treatment, does the treatment met your expectations?’. 274 patients (95.8%) were agree with therapy met their expectations. Article discusses one of the valid patient satisfaction questionnaire as evidence based outcome measures. In divisions the means of query scores were 3.9 for technical quality, 4.2 for communication with therapist, 3.6 for physical comfort, 3.9 for communication with secretary, 4.1 for communication with doctor, 3.5 for accessibility and 3.5 for cleanliness. Comparison of means among groups did not seem statistically significant as result of Mann–Whitney U test, p > 0.05. In conclusion in the context of qualified health service providing, it is essential to get feedback from health care receivers to measure satisfaction and this needs improvement of generally valid questionnairres. Improved communication and greater provider sensitivity towards patients can enhance patient satisfaction resulting as meeting the expectation.

First year of in-house forensic neuropathology consultations in Helsinki, Finland.

In July 2023, an in-house forensic neuropathology consultation pilot was established at the Helsinki office of the Forensic Medicine Unit, Finnish Institute for Health and Welfare. This offered an alternative to the previous practice of full outsourcing to a hospital neuropathology department. This paper aims to introduce the first year experiences of the pilot. The in-house consultant team comprised two forensic pathologists with special training in neuropathology. In-house consultations were offered for medico-legal autopsy cases with traumatic brain injury (TBI) and hypoxic-ischaemic encephalopathy. The in-house histology laboratory participated in the pilot, implementing beta-amyloid precursor protein (β-APP) stain at the end of the pilot year. An electronic database was also developed for data collection and reporting. The characteristics, costs, and duration of the first 25 consultation cases were reviewed. The cases involved mostly male decedents (84.0%) with TBI (84.0%). The median total cost of a pilot case was €624, which was substantially lower compared to the previous outsourced practice (€1013 per case + €38/84 for each microscope slide with special/immunohistochemical stain, respectively). After the implementation of β-APP stain into the in-house laboratory service, the median total cost of a pilot case was reduced further to €94. The median duration of an in-house consultation was 2.3 months. Thanks to a favourable in-house atmosphere, the first year experiences are encouraging. While the costs of the in-house consultation practice appear to be markedly lower than those of an external provider, both alternatives should be available for cases where sufficient expertise cannot be found in-house.

Distribution of type 2 diabetes mellitus in chronic hepatitis-c patient; A cross-sectional study conducted in Khyber Teaching Hospital and Khushal Medical Center Peshawar

Background: The prevalence of Hepatitis C virus infections (HCV) and Diabetes Mellitus (DM) is escalating and is associated with more morbidity and mortality. Patient with HCV are more prone to develop DM and this study aims to determine the distribution of DM in HCV patients. Methods: This descriptive cross sectional enrolled 160 HCV patients from 27th October 2020 till 26th April 2021 at Medicine Unit, Khyber Teaching Hospital (KTH) Peshawar and Khushal Medical Center (KMC) Peshawar. After ethical approval from KMC, the enrolled HCV patients were screened for DM. After detailed interview, blood samples were collected and subsequently processed for glycated hemoglobin A1C (HbA1C). The data were analyzed using SPSS version 22.0. Results: The mean age of the patients was 61.1±12.1 years. Similarly, the mean height, weight and body mass index (BMI) was 71.6±11.4 kg, 166.2±9.7 cm and 26.1±4.7 kg/m2 respectively. Family history of DM was positive in 30.6% patients while family history of obesity was positive in 23.8% individuals. The DM was prevalent in 31.3% HCV patients in which 58% were newly diagnosed. Statistical significant association was observed in HCV obese patient than non-obese patients with DM (p-value 0.03). Furthermore, obese patients were 12.4 times more likely to develop DM as compared to non-obese patients (OR, 95%CI 12.4 (5.52-28.5). Conclusion: DM is more common in HCV patients particularly if the patient is obese. It is necessary to screen and control earlier for the presence of type 2 diabetes mellitus and also rule out HCV infection among diabetic populations which is rarely done on population-based studies.

Impact of phytoestrogen use on the quality of life of perimenopausal or postmenopausal women in Sinaloa, Mexico

Introduction: menopause causes clinical symptoms that significantly impact women’s quality of life. Phytoestrogens, such as soy isoflavones, have been studied as treatment for climacteric syndrome, showing improvements in vasomotor and psychological symptoms.Objective: to determine the impact of the use of phytoestrogens (soy isoflavones) on the quality of life of women with perimenopause or postmenopause at Family Medicine Unit No. 55 of the Mexican Social Security Institute in Culiacán, Sinaloa, Mexico. Method: a randomized clinical trial was conducted with 44 women aged 45 to 60 with climacteric symptoms. Participants were assigned to an experimental group (EG), which received 50 mg of soy isoflavones every 24 hours, and a control group (CG), which received a placebo for 12 weeks. The Menopause Rating Scale was applied before and after the intervention to evaluate somatic, psychological, and urogenital symptoms. Descriptive and inferential statistics were used. Results: supplementation with soy isoflavones in the EG showed significant improvements in overall quality of life (Cohen d = 1,54), as well as in the somatic (d = 1,52) and psychological (d = 1,10) subscales, indicating a large effect (d > 0,80). However, the urogenital dimension showed no significant effect (d = 0). The CG experienced a significant deterioration in these subscales. Conclusions: soy isoflavones significantly improved the quality of life of women in perimenopause and postmenopause in the somatic and psychological dimensions, showing a large effect. No changes were observed in the urogenital dimension

Thyroid Disorders in Patients with Type 2 Diabetes Mellitus

BACKGROUND Diabetes mellitus is a public health problem world wide. Diabetes and thyroid disorders influence each other and tend to coexist. The recognition of this relationship is essential for achieving treatment goals. So, we conducted this study to find out the prevalence of thyroid disorders in patients with type two diabetes mellitus presenting to the department of internal medicine and endocrinology unit. METHODS It was a descriptive cross-sectional study conducted in the Department of Internal Medicine and Endocrinology unit of Bir Hospital from June 2018 to May 2018. Ethical clearance was obtained from the institutional review committee. Patients with Type two diabetes mellitus were evaluated for thyroid dysfunctions. The various thyroid dysfunctions with gender, age, control of diabetes and duration of diabetes were studied. The results were analyzed by using the Statistical Package for the Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS The prevalence of thyroid dysfunction among 50 patients enrolled was 15(30%) ( n-n at 95% confidence interval). Thyroid dysfunctions were greater in females 10(66.66%) while 5(33.33%) in male. Out of 15 cases with thyroid dysfunctions, sub-clinical hypothyroidism was the most prevalent 11(22%) followed by primary hyperthyroidism in 2(4%), primary hypothyroidism in 1(2%), and sub-clinical hyperthyroidism in 1(2%). CONCLUSIONS The prevalence of thyroid dysfunctions was comparable from study from Eastern Nepal while higher than from study from Jordan and Greece. Sub-clinical hypothyroidism was the most frequently occurring thyroid dysfunction.

Implementation of an Early Referral Programme for Patients With Hand Arthralgia.

Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease. According to the European League Against Rheumatism (EULAR), the stages of RA progression include pre-RA, preclinical RA, inflammatory arthralgia, arthralgia with positive antibodies, arthralgia suspected of progressing to RA, undifferentiated arthritis and finally established RA. According to the Community Oriented Program for Control of Rheumatic Diseases (COPCORD), the prevalence of RA in Mexico is 1.6% [2], with approximately 10% of health problems addressed at the primary care level. To assess the implementation of an early referral programme for patients with RA and to reduce the time from symptom onset to specialist referral within the Mexican healthcare system. This was a prospective, observational cohort study conducted in family medicine units affiliated with the HGZ #17 of the IMSS, Delegación Nuevo León. A pilot early referral programme was implemented as follows. Phase 1: Patients presenting with hand arthralgia during the initial consultation were referred for a pre-consultation, where they were assessed using the EULAR classification criteria for clinically suspicious arthralgia. Phase 2: Patients meeting more than four of these criteria were scheduled for a direct appointment with a rheumatologist within 3-4 weeks. During the same timeframe, these patients were compared to 200 first-time referrals to rheumatology between April and October 2023 who followed the standard referral process. The following time intervals (measured in months) were evaluated: (A) From symptom onset to the first primary care consultation, (B) To the referral consultation, (C) To internal medicine, and (D) To rheumatology consultation. Patients diagnosed with RA in the early referral group were 14 out of 41 (34.1%) compared to 25 out of 200 (12.5%) in the standard referral group. The total duration from symptom onset to rheumatology consultation was 28.5 months (SD 35.07) in the standard referral group versus 5.4 months (SD 8.9) in the early referral group. The implementation of this early referral programme significantly reduced the time in months for patients to access rheumatologic care.

Association of Serum C-Reactive Protein (CRP) with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)

Background: Chronic obstructive pulmonary disease consists of Chronic Bronchitis & Emphysema. It is persistent airflow limitation, usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung. The cause is tobacco smoking, occupational dusts, indoor and outdoor air pollutions. Objective: To find out association between serum C - reactive protein with acute exacerbation of Chronic Obstructive Pulmonary Disease. Methods: A Cross-sectional comparative study was carried out at Outpatient and inpatient department of Medicine and Respiratory unit of Z.H. Sikder womens Medical College & hospital, Dhaka, Bangladesh from 1 year (July-2020 to june-2021). A total number of 100 subjects of both sexes age range of 40-75 years who fulfilling inclusion and exclusion criteria & attending outpatient and inpatient departments of the Medicine and Respiratory unit of Z.H. Sikder womens Medical College & Hospital, Dhaka within the time frame. The study subjects were then divided into three groups Group I (AECOPD), Group II (SCOPD), and Group III (Control group). Results: A total number of 100 subjects of both sexes were included in this study in the age range of 40-75 years. Most of the subjects belong to 51-60- & 61-70-years age groups. The mean ages of group 1 were 59.4±9.0; group 2 was 59.4±6.7 and group 3 was 59.5±10.8 and the of total subjects' mean age was 59.5±8.4. Men had a higher prevalence of chronic obstructive pulmonary disease than women. In this study 85.4% of the patients of acute exacerbation of COPD were male and 14.6% were female. The ratio was 5.83:1. The common symptoms during exacerbation are increased dyspnoea (78%), increase cough (73%), increased sputum production (68%), change in sputum color (66%). The mean FEV1/FVC ratio in percentage was 45.5±9.7% in AECOPD; 68.5± 9.7% in stable COPD. The mean value of serum CRP was 16.9±4.4 in AECOPD (group-1); 10.9±3 in stable COPD (group-2) and 5.1±1.7 in case ...

Skin lesions and the role of the internist: a series of clinical cases

The skin often acts as an indicator of underlying internal diseases and skin lesions that are difficult to diagnose are one of the reasons for hospitalization in internal medicine departments where patients frequently arrive after a long journey between different dermatology specialists and after ineffective or sometimes responsible for diagnostic delays. In this article, we will illustrate three clinical cases observed in our General Medicine Unit of the Ospedale del Mare in Naples in the last year that are characterized by diagnostic errors that misled our attention, the notable difficulty in the diagnostic classification, and the duration of hospitalization necessary to reach the correct diagnosis. The first case is that of a patient diagnosed with violin spider lesions who, after a 2-week hospitalization, was discharged with the diagnosis of non-Hodgkin’s lymphoma. In the second case, the patient was hospitalized for suspected lesions caused by Burger’s disease and was instead discharged with a lesion caused by mycosis fungoides. The third case is that of a patient hospitalized for suspected vasculitis and discharged with the diagnosis of drug-induced toxic epidermal necrolysis.

Demonstration of the effectiveness of complete decongestive treatment in secondary lymphedema developing after total knee arthroplasty.

The aim of the current study is to demonstrate the treatment results of patients with lymphedema that developed after total knee arthroplasty (TKA) and to compare these results with those of patients with secondary lymphedema non-TKA. A total of 63 patients diagnosed with secondary lymphedema and who received complete decongestive treatment (MLD + bandaging + exercise) at the lymphedema treatment unit of Istanbul Physical Medicine and Rehabilitation Training Research Hospital between June 1, 2023, and February 1, 2024, were included in our retrospective study. The circumference of both metatarsophalangeal joints was measured, and leg diameter measurements were made from the lateral malleolus to the proximal 10th, 20th, and 30th centimeters. Of the 63 patients included in this study, the average age in the TKA group (n = 17) was 69.23 ± 8.27years, and the BMI was 38.60 ± 6.52. In the non-TKA group (n = 46), the average age was 63.50 ± 14.05years, and the BMI was 34.57 ± 9.17. There was no statistical difference between the two groups in terms of demographic data, affected sides, and initial measurements of the patients (p > 0.05). The response to continued decongestive treatment was significantly higher in both the TKA and non-TKA groups (p < 0.05). However, there was no statistically significant difference in treatment response between the two groups (p > 0.05). Complete decongestive treatment is an effective method for treating lymphedema that develops after total knee arthroplasty. No difference in treatment response was found between patients with lymphedema following TKA and those with secondary lymphedema from other causes.

Antibiotic Resistance Trends in Carbapenem-Resistant Gram-Negative Pathogens and Eight-Year Surveillance of XDR Bloodstream Infections in a Western Greece Tertiary Hospital.

Background: The increased prevalence of antibiotic resistance among Gram-negative bacteria presents a severe public health challenge, leading to increased mortality rates, prolonged hospital stays, and higher medical costs. In Greece, the issue of multidrug-resistant Gram-negative bacteria is particularly alarming, exacerbated by overuse of antibiotics and inadequate infection control measures. This study aimed to detect the prevalence of extensively drug-resistant (XDR) Gram-negative bacteria in a tertiary hospital in Western Greece over the last eight years from 2016 to 2023. Materials and Methods: In the present study, all Carbapenem-resistant (CR) Acinetobacter baumannii, K. pneumoniae and Pseudomonas aeruginosa. bloodstream isolates from patients hospitalized in the University General Hospital of Patras in Western Greece, from January 2016 to December 2023, were recorded. XDR strains were defined as non-susceptible to at least one agent in all but two or fewer antimicrobial categories (i.e., bacterial isolates remain susceptible to only one or two categories). The prevalence and distribution of these pathogens across different hospital wards and their susceptibility patterns to key antibiotics (aminoglycosides, trimethoprim-sulfamethoxazole, tigecycline, colistin, ampicillin-sulbactam, ceftolozane-tazobactam and ceftazidime-avibactam) were recorded. Results: A total of 1142 blood cultures growing carbapenem-resistant Klebsiella pneumoniae (CRKp), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA) were studied. In the present study, we found an increased resistance of both A. baumannii and K. pneumoniae in colistin. Acinetobacter baumannii had colistin resistance rates between 8.4% and 49.3%, showing a stable increase during the study period. K. pneumoniae showed an increased colistin-resistance rate in 2022 and 2023 (46.8% and 31.2%, respectively) Regarding P. aeruginosa, amikacin was almost inactive with a rate 68.4% and 87.5% in 2020 and 2023, respectively. Of all CR isolates, 69.3% were extensively drug-resistant (XDR). Acinetobacter baumannii had the highest percentage of XDR isolates (34.3%), followed by K. pneumoniae (26.8%) and P. aeruginosa (8.1%). Most XDR pathogens were isolated from the ICU (73.4%), followed by the internal medicine units (64%) and surgical units (22%). Conclusions: The rate of antimicrobial resistance and extensive drug resistance is alarmingly high, which calls for strict surveillance, control measures, and antibiotic stewardship to prevent the development of further resistance.

Authentic Nursing Leadership and Safety Climate Across Hospital Settings During the COVID-19 Pandemic: A Cross-Sectional Study.

To analyse the relationship between authentic nursing leadership and safety climates across hospital settings during the COVID-19 pandemic. Authentic nursing leadership shapes the safety climate by fostering positive perceptions of workplace policies, processes, procedures and practices that influence how safety is prioritised and addressed within an organisation. A cross-sectional study. Our study was conducted from December 2021 to December 2022 in six Brazilian hospitals. Participants were nursing staff working in General Medicine Units, Intensive Care Units (ICU) and Emergency Departments (ED) who provided care to patients with COVID-19. The Authentic Leadership Questionnaire and the Safety Attitudes Questionnaire were used to measure nursing staff perceptions of authentic leadership and safety climates. Data were analysed using descriptive and inferential statistics. 391 nursing staff across six hospitals participated. Self-awareness significantly enhanced perceptions of the safety climates. Additionally, being a Registered Nurse and working in the ICU were positively associated with achieving safe climates in the working environment. In contrast, working in EDs was significantly negatively related to safety climates. The COVID-19 pandemic underscored a lack of authentic nursing leadership and unsafe climates. Therefore, it is critical to implement educational strategies that foster authentic leadership, particularly focusing on self-awareness, to promote more positive safety climates. Ensuring that leadership and safety climates are relationship-focused is critical to enhancing patient outcomes. Nursing staff's perceptions of authentic leadership and safety climates are important in making more informed decisions about patient management. Since self-awareness increases positive perceptions of safety climates, nursing staff should exercise it to guide their actions in facing future health crises. STROBE guidelines. Higher self-awareness in relationships with others is a predictor of safety climates and can lead to enhanced patient outcomes.

Comparison between Lavender and Chamomile Essential Oils for Pain and Anxiety Reduction during Amniocentesis in Second Trimester Pregnancy: A Randomized Controlled Trial

Objective: To investigate the effectiveness of aromatherapy using lavender and chamomile essential oils, to alleviate pain and reduce anxiety during the amniocentesis procedure in second trimester pregnancy. Materials and Methods: The present was a randomized controlled trial approved by the Human Research Ethics Committee of Thammasat University (MTU-EC-OB-1-023/66) and registered in the Thai Clinical Trials Registry on June 29, 2023 (TCTR20230629001). The present study was conducted at the Maternal and Fetal Medicine Unit, Thammasat University Hospital, Pathum Thani, Thailand between July and November 2023. The participants were pregnant women undergoing amniocentesis. Participants were randomly assigned into three groups, lavender, chamomile, and normal saline, which was the control group. Participants in each group were instructed to inhale the assigned scent, lavender, chamomile, or normal saline, for 15 minutes prior to the amniocentesis procedure. For each participant, a cotton swab containing four drops of the assigned scent was held 10 centimeters from the participant’s nose. Pain and anxiety were recorded using visual analog scale (VAS) and visual facial anxiety scale (VFAS). Expected pain and anxiety were recorded before amniocentesis (Te), immediate after procedure (T0), and at 15 and 30 minutes after the procedure (T15 and T30). Results: One hundred fifty participants were allocated into three groups. To ensure comparability, demographic characteristics were matched across the three groups. The present study revealed that both lavender and chamomile lowered pain more than the control at 15 minutes after amniocentesis (T15), and only lavender can reduce pain during the procedure (T0). Both lavender and chamomile reduced anxiety more than the control 15 minutes after amniocentesis (T15), and only chamomile continued to reduce anxiety 30 minutes post procedure (T30). Thus, lavender proved to be more effective in managing pain during the amniocentesis procedure, whereas chamomile offers a prolonged effect in reducing anxiety, lasting up to 30 minutes post-procedure. Conclusion: Aromatherapy effectively reduces pain and anxiety associated with amniocentesis. In the present study. Both lavender and chamomile reduced pain at 15 minutes after the procedure, but only lavender has efficacy in pain reduction during the procedure. Both lavender and chamomile reduced anxiety 15 minutes after the procedure, but only chamomile continued to reduce anxiety 30 minutes post procedure. However, when comparing lavender and chamomile, there was no statistically significant difference in efficacy of pain or anxiety reduction. Keywords: Lavender; Chamomile; Aromatherapy; Essential oil; Amniocentesis; Pain; Anxiety

A Pressure Injury Prevention (PIP) Quality Improvement Pilot Of Sub-Epidermal Moisture Scanning In Acute Care

The objective of this study was to evaluate the impact of Sub-epidermal Moisture (SEM) assessments, in conjunction with risk and skin assessments, on facility acquired pressure injuries and the current standard of care: pilot. One 33-bed acute care Medicine unit was purposefully selected to participate in the six-week pilot based on availability of baseline data, a structured pressure injury prevention team, and leadership approval. SEM assessments were completed, in conjunction with risk and skin assessments, based on inclusion/exclusion criteria. SEM assessment enhanced early and anatomy specific interventions and reduced facility-acquired pressure injuries by 100%. The addition of SEM contributed to higher quality care and an estimated annual cost savings of $426,903 Canadian dollars.

Epidemiological changes among patients hospitalized in an internal medicine unit at Hospital Nacional Edgardo Rebagliati Martins in 2008 vs. 2018

Epidemiological changes among patients hospitalized in an internal medicine unit at Hospital Nacional Edgardo Rebagliati Martins in 2008 vs. 2018