Hospital Patients Research Articles

Analysis of reconstitution process, stability, stability of intravenous antibiotics in hospitalised patients in a private hospital

Introduction: reconstitution of sterile preparations is a series of changes in the drug from its original condition to a new product by dissolving or adding other ingredients carried out aseptically by the pharmacy. Aim: determine the suitability of the reconstitution technique, the suitability of stability (solvent type and solvent volume), and the suitability of the sterility of the reconstitution product. Methods: data collection obtained by observation is carried out with the help of a checklist that is adapted to hospital standard operating procedures (SOPs), Inject-able Drug Guide, guidelines for mixing inject-able drugs, and preparations. 48 processes of reconstitution of intravenous antibiotics were carried out in hospitals that could be observed as samples. Results: conformity to the preparation stage were 99%, the mixing stage was 73%, the labelling was 100%, and the labelling was 90%. In evaluating the stability of the solvent type category, the suitability of 100%. In the volume category of the solvent used, 90% were suitable, and 10% were unsuitable for the antibiotic’s cefotaxime 1 gram, vancomycin 1 gram, and sulbactam + ampicillin Na 1 gram. From the sterility test results, the reconstitution of ceftriaxone intravenous antibiotic preparations showed that the bacterial preparations were free of microorganisms (sterile). Conclusion: the personnel performing the reconstitution are nurses trained in intravenous antibiotic recovery. One of the factors that caused the reconstitution process not to be under the hospital's KSB was the lack of training and supervision from the hospital management. SPO recovery is not installed in an intravenous drug mixing room.

Can Artificial Intelligence and Machine Learning Techniques improve the ability to detect Sepsis and Septic Shock. A retrospective study of 218,562 adult patients in a university hospital

Can Artificial Intelligence and Machine Learning Techniques improve the ability to detect Sepsis and Septic Shock. A retrospective study of 218,562 adult patients in a university hospital

Clinic Management System

Abstract: As people’s levels of education rise particularly in medical industry the progress of our nation impacted by the inadequate health care patients in government hospitals occasionally have to wait hours to receive care. Although administration must maintain track of a vast number of files containing all patient information, this can occasionally result in redundant data and extra effort. This is the rationale for the proposal for the Online Clinic Management System, which is being developed with a web-based idea. An iterative waterfall model approach, dataflow, logical and entity relationship diagrams were among the techniques utilized in the system’s development. Were employed in the system’s design. Because all manual tasks in this system are being converted to computerized types, there would be no data redundancy during the registration process, records on patient details could be found more quickly, and patient waiting times before receiving medical treatment could be reduced. Keywords: computerized, health care, online clinic management system, and patient record.

Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores.

This prospective cohort study aimed to compare the predictive accuracy of outcome (survival/death) among trauma patients using various prognostic scores. Over 3 months, 240 trauma patients in a tertiary care hospital were assessed for demographic details, trauma characteristics, vital signs, Glasgow coma scale, arterial blood gas values, and lab markers. Injury severity score (ISS), revised trauma score (RTS), trauma and injury severity score (TRISS), and acute physiology and chronic health evaluation II (APACHE II) were applied at admission, 24 hours, and 48 hours post-admission. Road traffic accidents (55.83%) were the primary cause of trauma, followed by falls (33.75%) and violence (10.41%). The all-cause mortality rate was 23.33%, with 34.16% requiring ICU admission. Head injuries (65.83%) were both the most frequent injury site and cause of mortality. Analysis indicated that APACHE II outperformed other scores in predicting outcomes, with ISS following closely. The study concludes that trauma severity correlates with ICU admission and mortality, emphasizing APACHE II as a superior predictor, particularly for traumatic brain injuries leading to ICU admission and mortality. This study contributes to the existing body of knowledge by addressing the gap in comparing prognostic abilities among scoring systems for trauma patients. The unexpected superiority of APACHE II suggests its potential as a valuable tool in predicting outcomes in this specific patient population. Gupta J, Kshirsagar S, Naik S, Pande A. Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores. Indian J Crit Care Med 2024;28(5):475-482.

Prevalence of cagA, cagM, vacA and oipA genes in isolates of Helicobacter pylori obtained from hospital patients in Northeast Brazil.

Helicobacter pylori is a major cause of gastrointestinal disorders such as chronic gastritis, peptic ulcers, mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric cancer. It is estimated that around half of the world's population is infected with this pathogen, with underdeveloped countries reporting the highest frequencies. The genes cagA, cagM, vacA, and oipA are some of the most important virulence factors of H. pylori; however, there are no recent studies from Recife-PE demonstrating their frequency, and their relationship with severe gastric modifications. This work aims to use qualitative PCR to detect the virulence genes cagA, cagM, vacA, and oipA in H. pylori isolates obtained from patients in a public hospital in Recife (PE). We collected samples from the stomach's body and antrum of 147 patients, from which 71 (48%) tested positive for H. pylori. Among positive samples, the most frequently infected gender was female (44/71, 62%), and the most frequently infected age group was those above the age of 46 (31/71, 44%). Histological examination of H. pylori-positive samples revealed alterations other than chronic gastritis, including metaplasia and atrophy. The frequency of cagA, cagM, and oipA genes were identified in 84%, 56%, and 69% of the samples tested, respectively, as well as the vacA-s1m1 allelic combination (77%). However, there was no statistically significant variation in the occurrence of these genes, therefore they cannot be considered unique markers of severity in our setting. New research with larger samples and investigations of other genetic markers can aid uncover local risk factors and lead to a better understanding of H. pylori's pathogenesis.

Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment

BackgroundNo studies in China have assessed the guideline-concordance level of the first-course of non-small cell lung cancer (NSCLC) diagnosis and treatment and its relationship with survival. This study comprehensively assesses the current status of guideline-concordant diagnosis (GCD) and guideline-concordant treatment (GCT) of NSCLC in China and explores its impact on survival.MethodsFirst course diagnosis and treatment data for NSCLC patients in Liaoning, China in 2017 and 2018 (n=1828) were used and classified by whether they underwent GCD and GCT according to Chinese Society of Clinical Oncology (CSCO) guidelines. Pearson’s chi-squared test was used to determine unadjusted associations between categorical variables of interest. Logistic models were constructed to identify variables associated with GCD and GCT. Kaplan–Meier analysis and log-rank tests were used to estimate and compare 3-year survival rates. Multivariate Cox proportional risk models were constructed to assess the risk of cancer mortality associated with guideline-concordant diagnosis and treatment.ResultsOf the 1828 patients we studied, 48.1% underwent GCD, and 70.1% underwent GCT. The proportions of patients who underwent both GCD and GCT, GCD alone, GCT alone and neither GCD nor GCT were 36.7%, 11.4%, 33.5% and 18.4%, respectively. Patients in advanced stage and non-oncology hospitals were significantly less likely to undergo GCD and GCT. Compared with those who underwent neither GCD nor GCT, patients who underwent both GCD and GCT, GCD alone and GCT alone had 35.2%, 26.7% and 35.7% higher 3-year survival rates; the adjusted lung cancer mortality risk significantly decreased by 29% (adjusted hazard ratio[aHR], 0.71; 95% CI, 0.53–0.95), 29% (aHR, 0.71; 95% CI, 0.50–1.00) and 32% (aHR, 0.68; 95% CI, 0.51–0.90).ConclusionThe 3-year risk of death is expected to be reduced by 29% if patients with NSCLC undergo both GCD and GCT. There is a need to establish an oncology diagnosis and treatment data management platform in China to monitor, evaluate, and promote the use of clinical practice guidelines in healthcare settings.

Phylogenomic analyses of multidrug resistant Corynebacterium striatum strains isolated from patients in a tertiary care hospital in the UK.

Corynebacterium striatum is an emerging nosocomial pathogen. This is the first report showing the presence of three distinct multidrug resistant lineages of C. striatum among patients in a UK hospital. The presence of ErmX, Tet(W), Bla and AmpC proteins, and mutations in gyrA gene are associated with the resistance to clindamycin, doxycycline, penicillin and moxifloxacin, respectively. These strains are equipped with several corynebacterial virulence genes including two SpaDEF-type and a novel pilus gene cluster, which needs further molecular characterisation. This study highlights a need of developing an active surveillance strategy for routine monitoring and preventing potential cross-transmission among susceptible patients.

Assessment of disease pattern and drug utilization among neurology intensive care unit patients in a developing country: an observational analysis

ABSTRACT Objective This study aimed to assess the disease pattern and drug utilization among admitted patients in a tertiary-care hospital’s neuro ICU. Methods A prospective observational cohort study was conducted between August 2022 and January 2023. Patients of any age and gender admitted to the neuro ICU were included, but those who declined to participate were excluded. Demographics, clinical, and medication details were consistently gathered and maintained until discharge. The World Health Organisation (WHO)/International Network of Rational Use of Drugs (INRUD) prescribing indicators and the Anatomical Therapeutic Chemical (ATC) classification/Defined Daily Dose (DDD) system were used to evaluate drug use. Results A total of 516 patients were included, predominantly male (65.1%), with an average age of 54.6 ± 15.07 years. The most common diagnosis was stroke (72.3%), followed by seizure disorders (6.6%), and central nervous system infections (5.4%). Patients received an average of 7.8 medications, 32.3% prescribed by generic name, 16.0% antibiotics, 74.1% injection, and 100% essential drugs. A (28.5%), C (19.2%), N (17.3%), J (19.2%), B (13.5%), and R (2.3%) were commonly prescribed ATC classes of medications. Number of DDDs was maximum for pantoprazole, and furosemide. Based on discharged status, 41.0% were discharged on request, 24.8% against medical advice, 23.8% routine, and 10.2% mortality during hospitalization. Conclusion Our study reveals a high prevalence of hemorrhagic stroke, especially among men, diverging from global ischemic stroke trends. Irregular hypertension treatment is the primary cause, exacerbated by low healthcare knowledge in rural areas, where patients often discharge themselves due to socioeconomic reasons. Urgent public awareness campaigns and further research are needed to address this elevated hemorrhagic stroke incidence.

Systematic review and meta-analysis of hepatitis E seroprevalence in Southeast Asia: a comprehensive assessment of epidemiological patterns

The burden of hepatitis E in Southeast Asia is substantial, influenced by its distinct socio-economic and environmental factors, as well as variations in healthcare systems. The aim of this study was to assess the pooled seroprevalence of hepatitis E across countries within the Southeast Asian region by the UN division.The study analyzed 66 papers across PubMed, Web of Science, and Scopus databases, encompassing data from of 44,850 individuals focusing on anti-HEV seroprevalence. The investigation spanned nine countries, excluding Brunei and East Timor due to lack of data. The pooled prevalence of anti-HEV IgG was determined to be 21.03%, with the highest prevalence observed in Myanmar (33.46%) and the lowest in Malaysia (5.93%). IgM prevalence was highest in Indonesia (12.43%) and lowest in Malaysia (0.91%). The study stratified populations into high-risk (farm workers, chronic patients) and low-risk groups (general population, blood donors, pregnant women, hospital patients). It revealed a higher IgG—28.9%, IgM—4.42% prevalence in the former group, while the latter group exhibited figures of 17.86% and 3.15%, respectively, indicating occupational and health-related vulnerabilities to HEV.A temporal analysis (1987–2023), indicated an upward trend in both IgG and IgM prevalence, suggesting an escalating HEV burden.These findings contribute to a better understanding of HEV seroprevalence in Southeast Asia, shedding light on important public health implications and suggesting directions for further research and intervention strategies.Key pointsResearch QuestionInvestigate the seroprevalence of hepatitis E virus (HEV) in Southeast Asian countries focusing on different patterns, timelines, and population cohorts.FindingsSporadic Transmission of IgG and IgM Prevalence:• Pooled anti-HEV IgG prevalence: 21.03%• Pooled anti-HEV IgM prevalence: 3.49%Seroprevalence among specific groups:High-risk group (farm workers and chronic patients):• anti-HEV IgG: 28.9%• anti-HEV IgM: 4.42%Low-risk group (general population, blood donors, pregnant women, hospital patients):• anti-HEV IgG: 17.86%• anti-HEV IgM: 3.15%Temporal Seroprevalence of HEV:Anti-HEV IgG prevalence increased over decades (1987–1999; 2000–2010; 2011–2023): 12.47%, 18.43%, 29.17% as an anti-HEV IgM prevalence: 1.92%, 2.44%, 5.27%ImportanceProvides a comprehensive overview of HEV seroprevalence in Southeast Asia.Highlights variation in seroprevalence among different population groups.Reveals increasing trend in HEV seroprevalence over the years.Distinguishes between sporadic and epidemic cases for a better understanding of transmission dynamics.

Assessment and comparison of microalbuminuria in obese and nonobese children

Background Fatty liver, metabolic syndrome, and cardiovascular disease are just a few of the well-known cardiometabolic complications associated with childhood obesity. Microalbuminuria (MA) is a sign of early kidney impairment, as seen in adults, and recent research supports its presence in children with obesity as well as its potential relationship with cardiometabolic variables. Both adults and children share this well-established pathophysiological theory. Indicated a close connection with the main aspect of fatness, such as IR, through the renal hemodynamic effects of insulin. More scientific consideration must be given to the assessment of primary kidney injury in obese children, given the pathological and prognostic implications of this association in everyday practise (counting an elevated danger of developing long term renal disorder over time). Method case-control study is going to be conducted among the patients of AVBRH hospital. A total of thirty participants with fifteen obese and fifteen non obeses controls were included in this study. Result The expected result of the study can determine the correlation between obesity and microalbuminuria, The value of microalbuminuria is high in obese patients as compared to nonobese patients. Conclusion The risk of problems in obese patients can be predicted using microalbuminuria, which can help lower the overall morbidity and mortality associated with renal function. Complications

#2311 Comparative analysis of knowledge and attitude regarding deceased donation in health care workers and the general population

Abstract Background and Aims Kidney transplantation is widely regarded as the best treatment option for end stage kidney disease. Despite being introduced over 40 years ago, the rate of kidney transplantation in Bangladesh is still very low at an average yearly rate of below 200 transplants over the last 5 years. Lack of donors and financial constraints have emerged as the biggest obstacles. Until recently, live related transplantation was the only option. There have been only 2 deceased transplantations last year, both from the same donor. In order to understand these low rates, we aim to understand the prevailing knowledge and attitude towards transplantation in the community and among the health care workers (HCWs) and how much they differ. Method This cross-sectional study has been ongoing since May 2022. It is a self-administered survey using a paper-based questionnaire, developed by the Asian Society of Transplant, asking about the respondent's knowledge and attitude regarding deceased organ donation in Bangladesh. The survey was administered in both HCWs and non-HCWs using a pre-tested questionnaire. The HCWs were recruited from 9 hospitals across Bangladesh and the non-HCWs were recruited from Universities, attendants accompanying patients in hospital waiting areas and a few offices. Convenient sampling technique was used. Data was analyzed by statistical analysis software (SAS) studio. Results Data was collected from 1351 respondents, 874 (65.6%) were HCWs and 458 (34.4%) were non-HCWs. Among the HCWs, 131 (15%) were doctors, 745 (85.2%) were nurses and 130 (14.9%) were final year medical students. Among the non-HCWs, business (10.3%), acting (8.9%) and teaching (4.4%) were the predominant professions. The mean age of the respondents was 36.4 (±14.1) years, 65.5% were female. The HCWs were significantly younger and had more females, mostly owing to the large sample of nurses. Twenty percent of the non-HCWs never heard about deceased donation compared to 3.4% HCWs (p < 0.0001). 79.5% of the HCWs said they knew very little or not at all about deceased donation. The self-assessment was about similar in the non-HCWs. Only 11.6% HCWs said they received education about organ donation, compared to 20.5% of the non-HCWs (p = 0.0004). Regarding deceased donation, 36% HCWs had a positive attitude, 58.7% were neutral and 5.3% were negative. Among the non-HCWs, 30.5% were positive, 35.5% were neutral and 34% were negative (p < 0.0001). Regarding willingness, 11.1% HCWs were very willing to donate themselves, 61.3% were contemplating and 27.6% were unwilling. Among the non-HCWs, 11.2% were willing to donate, 48.8% were contemplating and 40% were unwilling. When asked to list all reasons for not willing to donate, lack of information was most common (64.8% HCWs, 49.6% non-HCWs), followed by fear of donation (12.5% HCWs, 25.9% non-HCWs) and religious beliefs (6.8% HCWs, 15.6% non-HCWs) (p < 0.0001). When asked about the most reliable sources of information in order to promote deceased donation, the opinion varied widely. The most popular ones were online contents (63.9% HCWs, 12.4% non-HCWs), outdoor events (36.2% HCWs, 21.2% non-HCWs) and TV advertises (30% HCWs, 6.1% non-HCWs) (p < 0.0001). Conclusion The overall knowledge regarding deceased donation was poor. Most people had a neutral attitude towards donation and were contemplating donation themselves. The HCWs were more willing to donate. Lack of information was the leading reason behind unwillingness. Online promotions were considered the best modality for future promotion.

Mortality Rate Related to Adverse Drug Reactions in Iraqi Patients: A Study Based on WHO Database

Background: Adverse drug reactions (ADRs) are unintended harmful effects caused by medications that can occur at any dose. ADRs are a significant contributor to hospital admissions and are responsible for numerous fatalities, particularly among older adults with multiple chronic illnesses who take multiple medications. Reporting ADRs is critical for identifying the harmful effects of medications and monitoring patients in hospitals. Objective: ADRs have a significant impact on mortality rates, but no previous studies in Iraq have focused on death-related reports. To address this problem, we conducted a study to assess mortality rates associated with ADRs in Iraq and identify the drugs most frequently involved. Methods: We collected the ADR reports of Iraqi patients that were registered as fatal from January 2010 to January 2024 in the World Health Organization (WHO) pharmacovigilance database, VigiBase. The case-non-case method will be used to investigate the reporting risk in Iraq versus the rest of the world. Results: A total of 329 fatal ADRs were found, and the mean age of affected patients was 36 years, with a male-to-female ratio of 1.25:1. Antineoplastic agents ranked first among drugs that caused fatal ADRs (38.4%), and pembrolizumab was the leading active ingredient (27 cases, 6.85%). Conclusions: This study is the first to identify and describe fatal ADRs in Iraq and found them less common in Iraq, and the risk is lower in Iraqi women compared to Iraqi men.

#1748 The burden of cardiorenal syndrome: epidemiological data and treatment: a one-center experience

Abstract Background and Aims Cardiorenal syndrome (CRS) is an entity combining cardiac and renal dysfunction in a bi-directional way. Six subtypes of CRS have been described, all of which are associated with high morbidity and mortality rates. CRS treatment—no matter the subtype—is until nowadays a field of investigation, aiming to the reduction of fluid overload and venous congestion. The primary endpoint of this study was to estimate the frequency of cardiorenal induced AKI compared to other AKI etiologies in hospitalized patients. We furthermore aimed to determine the burden of the therapeutic regimen in hospitalization duration and renal deterioration. Method This is a retrospective, quantitative analysis of hospitalized adult patients in General Hospital of Athens Hippokration suffering from AKI of various etiologies. No age or sex limitations were used for the purposes of this study. Results A total amount of 1163 patients were enrolled over the course of 18 months. 430 (36.9%) of these patients were hospitalized in the cardiologic department, suffering from either acute or chronic heart failure (66.5% of which were men) with a mean age of 74.4 ± 11.4 years. Mean creatinine level at hospital admission was 2.7 ± 2 mg/dl. Out of these patients, 33.9% were treated using diuretics alone, while 25.5% also needed hemodialysis. Mean number of days of hospitalization was 9.4 ± 5.8 days and 11 ± 8.8 days, while creatinine exit was 2.9 ± 1.5 mg/dl and 4.2 ± 3 mg/dl respectively. Conclusion Cardiorenal syndrome is a quite common cause of AKI in patients being hospitalized. In our study, patients that needed treatment with diuretics compared to those requiring a combination of diuretics and hemodialysis had less days of hospitalization and a better kidney function outcome.

Evaluation of Antimicrobial Resistancein Clinical Isolates of Enterococcus spp. Obtained from Hospital Patients in Latvia

Background and Objective: Enterococci are typically found in a healthy human gastrointestinal tract but can cause severe infections in immunocompromised patients. Such infections are treated with antibiotics. This study addresses the rising concern of antimicrobial resistance (AMR) in Enterococci, focusing on the prevalence of vancomycin-resistant enterococcus (VRE) strains. Materials and Methods: The pilot study involved 140 Enterococci isolates collected between 2021 and 2022 from two multidisciplinary hospitals (with and without local therapeutic drug monitoring protocol of vancomycin) in Latvia. Microbiological assays and whole genome sequencing were used. AMR gene prevalence with resistance profiles were determined and the genetic relationship and outbreak evaluation were made by applying core genome multi-locus sequence typing (cgMLST). Results: The acquired genes and mutations were responsible for resistance against 10 antimicrobial classes, including 25.0% of isolates expressing resistance to vancomycin, predominantly of the vanB type. Genetic diversity among E. faecalis and E. faecium isolates was observed and seven potential outbreak clusters were identified, three of them containing sequence types ST6, ST78 and ST80. The prevalence of vancomycin resistance was highest in the hospital without a therapeutic drug-monitoring protocol and in E. faecium. Notably, a case of linezolid resistance due to a mutation was documented. Conclusions: The study illustrates the concerning prevalence of multidrug-resistant Enterococci in Latvian hospitals, showcasing the rather widespread occurrence of vancomycin-resistant strains. This highlights the urgency of implementing efficient infection control mechanisms and the need for continuous VRE surveillance in Latvia to define the scope and pattern of the problem, influencing clinical decision making and planning further preventative measures.

#445 Octogenarians in hemodialysis: not everyone ages the same

Abstract Background and Aims The average life expectancy in Western Europe in 2022 was 79 years for males and 84 years for females. Over the past years, the number of ageing patients in hemodialysis (HD) has increased significantly in all countries. There are several considerations for dialysis maintenance in older patients with an increased burden of age-related problems. It is important to identify the specific characteristics of this elderly population to develop appropriate care strategies and to estimate future needs for renal support services. The aim was to describe the clinical characteristics of our prevalent dialysis population by age, with particular reference to octogenarians. Method In this retrospective observational study between 2008 and 2022, the medical charts of 253 prevalent HD patients in a referral university hospital were analyzed. Patients were divided into four groups according to their age (four age groups: ≤60, 61–70, 71–80, 80> years old). Patient demographics and comorbidities were compared between age groups. Percentage and type of AVF (arteriovenous fistula), primary failures, and AVF reparations were recorded at onset of HD and at follow-up. Interdialytic weigh gain (average for pre-dialysis measurement of three hemodialysis sessions per week for two weeks) was also informed. Results 57 patients older than 81 years underwent dialysis (mean age 85.2±3.3 years), 31 (54%) older than 84 years (11 women, 20 men). 48% of patients over the age of 80 had to start HD urgently. In octogenarian, length on time in hemodialysis was 4.3 ± 6.46 years, they were no differences based on age; vintage HD in women and men older than 84 years was 5.2 ± 3.4 years and 5.3 ± 3.7 years, respectively. Females accounted for 40.4%, higher than other age groups, but not statistically significant. None of the over-80s self-reported active smoking, with differences between groups (p=0,000). Diabetes was less common in the youngest and oldest patients (23.9%vs 49.1%vs 56.8% vs 43.9% for patients ≤60, 61-70, 71-80 and 80>age, respectively, p=0.001). Similar trends were observed for ischemic heart disease and peripheral vascular disease (3%vs23,6%vs25,7% vs15,7% and 9%vs27,3%vs24,3vs15,8%; p=0,000 and p=0,035, respectively). Among octogenarians, 36.8% had experienced heart failure, the highest proportion of any age group (14,9%vs23,6%vs25,7% vs36,8% for patients ≤60, 61-70, 71-80 and 80>age, p=0.046), but interdialytic gains were not greater in this group than in others (70%vs53,7%vs45,9%vs47,4% for patients ≤60, 61-70, 71-80 and 80>age, p=0.019). Chronic lung disease occurred significantly less often in octogenarians compared to younger patients (17,9%vs30,9%vs36,5%vs15,2% in the ≤60, 61-70, 71-80 and 80> age groups respectively (p=0.026). Cerebrovascular disease and active neoplasm did not differ based on age. Underlying chronic kidney disease was unknown in 28.1% of patients over 80 years of age. Diabetic nephropathy was the main known condition of nephropathy (16,4%vs27,3%vs23%vs15,8% for patients ≤60, 61-70, 71-80 and 80>age, p=0.052). (see Table 1). In all age groups, AVF was the most common VA in incident and in prevalent HD patients (52,2%vs61,8%vs62,2%vs 77,2% and 82,1%vs80%vs86,5%vs 78,9 % in the ≤60, 61-70, 71-80 and 80> age groups respectively (p=0,086, p=0,640)). Radio-cephalic made up the largest proportion of AVFs in the total population. VA primary failure is more common in octogenarians (1,5%vs16,4%vs10,8%vs19,3% for patients ≤60, 61-70, 71-80 and 80> age, p=0.010). There were no differences in the need for AVF repair between groups (see Table 2). Conclusion Our octogenarian HD population is a selected population with a lower-than-expected comorbidity burden compared to younger age groups. Very elderly patients are more compliant and survive more than five years after HD initiation. Although vascular access may be more difficult to achieve initially, the outcome is comparable to that of younger patients in our study. Strategies to best manage this vulnerable hemodialysis population remain to be explored.

Unraveling the enigma of long COVID: novel aspects in pathogenesis, diagnosis, and treatment protocols.

Long COVID, now unmistakably identified as a syndromic entity encompassing a complex spectrum of symptoms, demands immediate resolution of its elusive pathogenic underpinnings. The intricate interplay of diverse factors presents a complex puzzle, difficult to resolve, and thus poses a substantial challenge. As instances of long COVID manifest by repeated infections of SARS-CoV-2 and genetic predisposition, a detailed understanding in this regard is needed. This endeavor is a comprehensive exploration and analysis of the cascading pathogenetic events driven by viral persistence and replication. Beyond its morbidity, long COVID, more disabling than fatal, exacts one of the most substantial tolls on public health in contemporary times, with the potential to cripple national economies. The paper introduces a unified theory of long COVID, detailing a novel pathophysiological framework that interlinks persistent SARS-CoV-2 infection, autoimmunity, and systemic vascular pathology. We posit a model where viral reservoirs, immune dysregulation, and genetic predispositions converge to perpetuate disease. It challenges prevailing hypotheses with new evidence, suggesting innovative diagnostic and therapeutic approaches. The paper aims to shift the paradigm in long COVID research by providing an integrative perspective that encapsulates the multifaceted nature of the condition. We explain the immunological mechanisms, hypercoagulability states, and viral reservoirs in the skull that feed NeuroCOVID in patients with long COVID. Also, this study hints toward a patient approach and how to prioritize treatment sequences in long COVID patients in hospitals and clinics.

A cross sectional study measuring injury mortality and its associated factors among adult patients in comprehensive specialized hospitals in Amhara National Regional State, Ethiopia

Background: Injury has become a life-threatening community health problem related to vital morbidity and mortality worldwide. Approximately 90% of injury-related deaths occurred in low- and middle-income countries. There is limited data that addresses the outcomes of injuries in adult trauma patients at the time of discharge to improve the outcome of trauma care in developing countries, including Ethiopia. Therefore, this study aimed to determine the mortality following injury and its associated factors among adult patients in comprehensive specialized hospitals in Amhara’s national regional state. Methods: An institution-based cross-sectional study was conducted among 596 adult trauma patients admitted between January 1, 2018 and December 30, 2020.. A systematic random sampling technique was employed to select the study participants. Data were collected from patient charts and registry books by using a data extraction tool. Data were entered into Epi-data version 4.6, and analysis was done using Stata version 16. The binary logistic regression model was fitted, and both bi-variable and multi-variable logistic regression analyses were employed. Result: A total of 581 adult trauma patient charts with a recorded rate of 97.5% were included in the final analysis. The overall mortality outcome of injury at discharge was found to be 8.3% (95% CI: 6%–10.5%). Age 26–40 years [AOR: 3.35 (95% CI: 1.35–8.33)], revised trauma score 10 [AOR: 3.11, (95% CI: 1.39–6.99)], duration of time before arrival in hospital >24 hours [AOR: 3.61 (95% CI: 1.18–11.02)], and surgical management in hospital [AOR: 0.25 (95% CI: 0.12–0.54)] were predictors of mortality in patients with injuries. Conclusion: In this study, the mortality outcome of injury is considerably high, and the middle age group, late presentation to the hospital, lower revised trauma score, and surgical management were significantly associated with the mortality outcome of injury on discharge from the hospital. Therefore, it is better if clinicians emphasize traumatically injured patients, especially for middle age groups, and lower revised trauma scores.

STUDY OF ANTIBIOTIC RESISTANCE AT REGIONAL LEVEL

The introduction of antibiotics revolutionized medicine, dramatically reducing deaths and illnesses caused by infections. However, decades of overuse have accelerated the evolution of microorganisms, leading to a critical challenge: antibiotic resistance. This research aims to investigate the regional risk factors contributing to antibiotic resistance among the Poltava region population. Materials and methods. 100 patients of the 2nd Municipal Clinical Hospital and the Regional (Republican) Center for Emergency Medical Aid and Disaster Medicine of Poltava were included in the study. Data collection was carried out from November 2023 to March 2024. Patients were offered a series of 11 questions. Research results. This study has revealed the following antibiotic usage patterns among the residents of the Poltava region. It has been found that 22% of respondents are currently undergoing treatment, 8% in the last month, 36% in the last year, and 34% of the respondents tool the treatment for more than a year. When using antibiotics without a prescription, 30% of patients consulted a pharmacy, 52% trusted the Internet, 10% chose the cheapest medicine, and 8% followed advertisements. For subsequent illnesses, 76% of respondents used antibiotics they had taken before: amoxicillin (42%), ciprofloxacin (28%), azithromycin (22%), and chloramphenicol (8%). While 80% reported following prescribed antibiotic regimens, 20% interrupted treatment prematurely due to perceived improvement. Despite 84% acknowledging the importance of completing antibiotic courses, a concerning 16% were unaware of this crucial practice. Interestingly, 11% reported using antibiotics for preventive purposes (before getting sick). However, a positive trend emerged: 85% of respondents confirmed undergoing testing for bacterial susceptibility before receiving antibiotics. Only 9% reported amoxicillin as ineffective. When antibiotics were ineffective, 46% of respondents consulted a doctor, 24% took no action and waited for the antibiotic to take effect, 21% stopped one antibiotic and started another, and 14% preferred intramuscular injections and self-medication. Conclusion. A significant number of patients (48%) take antibacterial drugs without a doctor's prescription and 52% search for information on the Internet. 76% of patients use the same drug for a recurrent disease. Amoxicillin is the most often preferred (42%), a smaller number of patients came to the pharmacy for ciprofloxacin (28%), 22% of respondents preferred azithromycin. This study underscores the necessity for public health interventions to tackle antibiotic misuse and misconceptions in the Poltava region. Promoting responsible usage, emphasizing the importance of completing treatment courses, and discouraging self-medication are crucial steps in combating the growing threat of antibiotic resistance.

Resilience and Value: Pediatric Trauma Care in Safety Net Hospitals.

Background: In the setting of limited funding and high expectations for quality care, safety net hospitals play a crucial role in treating pediatric trauma patients. This study aimed to compare outcomes and hospitalization costs of pediatric trauma patients in safety net hospitals across the United States. Methods: The Nationwide Readmissions Database for 2016-2020 was queried for all patients under the age of 18years hospitalized for traumatic injury. Patients admitted to safety net hospitals were propensity matched 1:1 to all other patients. The primary outcome was mortality. The secondary outcomes were readmission within 1-year, mean length of stay (LOS), total charges, and total hospitalization costs including readmissions. Results: There were 176,325 patients meeting inclusion criteria, and 30,869 were admitted to safety net hospitals. All safety net patients were successfully matched across predictors, and 61,738 patients were included. The overall mortality rate was 1.4% (n = 834), and the mortality risk was similar in safety net hospitals (OR 1.11 [.96-1.27] P = .15). The overall readmission rate, mean LOS, and mean total cost were similar for safety net hospitals when compared to all hospitals. However, the overall mean total charge was $78,724 (±$224,884) and was lower in safety net hospitals ($76,575 [±$198,342], P = .02). Discussion: Safety net hospitals deliver comparable outcomes as other health care facilities when caring for pediatric trauma patients. Notably, these hospitals appear to undercharge for their services, despite incurring similar costs in the process. These results shed light on the resilience of safety net hospitals in delivering quality and cost-effective care.

Does on-site computed tomography matter? A cross-sectional study of stroke patients' door-to-scan-time in rural hospitals.

Many rural Australian hospitals lack on-site computed tomography (CT). These hospitals often refer patients to local off-site private radiology clinics or to central hospitals, challenging the achievement of time-sensitive scans. For stroke patients, timely access to CT affects treatment options. This study questions whether on-site CT matters in rural hospitals by investigating stroke patients' door-to-scan-time (DTST) and CT scan sequence referrals. A retrospective chart audit was completed across four rural hospitals; two with on-site CT and two without. Adult emergency stroke presentations were randomly sampled. Comparisons between on-site and off-site CT hospitals were made for DTST and CT sequence referrals using Mann-Whitney U-tests and Fisher's exact tests. A total of 120 charts were audited (on-site CT, n = 60; off-site CT, n = 60). DTST was longer for off-site vs. on-site CT hospitals (median = 4.30 h vs. median = 0.70 h; U = 338, p < 0.001) regardless of whether presentations occurred in business hours or out of hours (p < 0.001). Off-site CT hospitals ordered less CT angiography or perfusion scanning (32% vs. 85%, p < 0.001). Off-site CT hospital patients had longer DTST and received less angiography or perfusion scanning. These findings suggest that on-site CT matters to rural stroke patients by improving equitable access to CT and appropriate scan referrals.