Patients In Internal Medicine Wards Research Articles

Prevalence of toxigenic Clostridium difficile in hospitalized patients in the southwestern province of Saudi Arabia: Confirmation using the GeneXpert analysis

ABSTRACT Clostridium difficile (Clostridioides difficile) is a leading cause of nosocomial infections in hospitalized patients worldwide. Stool samples were collected from 112 inpatients admitted to different hospitals and were screened for C. difficile GDH + toxin A + B by immunoassay, and all positive samples by immunoassay were processed for molecular detection of C. difficile using the GeneXpert assay. C. difficile strains were detected in 12 (10.71%) out of 112 stool samples using the GDH + toxin A + B immunoassay method and toxigenic C. difficile was confirmed in 5 stool samples using the GeneXpert molecular assay. C. difficile strains were also detected in 7 (8.97%) out of 78 stool samples from intensive care unit patients, 3 (25%) out of 12 stool samples from internal medicine ward patients, 1 (11.11%) out of 9 stool samples from surgery ward patients, and 1 (10%) out of 10 stool samples from isolation ward patients using the GDH + toxin A + B immunoassay method and the toxigenic C. difficile strain was confirmed in 1, 2, 1, and 1 stool samples, respectively, using the GeneXpert molecular assay. Toxigenic C. difficile was confirmed in patients at 4 (51.14%) out of 7 hospitals. In the present study, we also analyzed the clinical information of patients with C. difficile-positive stool samples who were receiving one or more antibiotics during hospitalization. The binary toxin gene (cdt), the tcdC gene, and the C. difficile strain polymerase chain reaction (PCR) ribotype 027 were not detected using the GeneXpert molecular assay among 12 C. difficile-positive samples by immunoassay. This study should aid in the prevention of unnecessary empiric therapy and increase the understanding of the toxigenic C. difficile burden on the healthcare system in the southwestern province of Saudi Arabia.

Polypharmacy Management in a Gender Perspective: At the Heart of the Problem: Analysis of Major Cardiac Diseases, SARS-CoV-2 Affection and Gender Distribution in a Cohort of Patients in Internal Medicine Ward

COVID-19 patients with any pre-existing major cardio-vascular disease (CVD) are at the highest risk of viral infection and of developing severe disease. The pathophysiological mechanism is characterized by the viral link to angiotensin-converting enzyme 2 (ACE2) and the involvement of the endothelial system with the release of cytokines and the inflicting of direct damage to the myocardium, the induction of microthrombosis, and the initiation of alterations in oxygen diffusion. The aim of the study is to analyze the clinical course and outcomes in patients (gender-stratified) with pre-existing major CVD. Out of the 1833 (973 M/860 F) patients admitted to the Internal Medicine COVID-19 Unit of "Castelli Hospital", Lazio, Italy, from 1 January 2021 to 31 December 2021, 600 patients (320 M/280 F) with a mean age of 77 (78.6 M/75.1 F) previously had CVD. Demographic characteristics, length of the stay (LOS) and oxygen therapy were evaluated. All of the CVD COVID-19 patients underwent non-invasive ventilation (NIV). CVD was linked with increased LOS (21 days F/22 M) compared to no CVD (19 days). In total, 32.7% of total patients had major CVD. Timely identification and evaluation of patients with pre-existing major CVD are fundamental for adequate treatment based on gender, severity, state of illness and for risk reduction.

HUBUNGAN NILAI MINI NUTRITIONAL ASSESSMENT (MNA) DENGAN LAMA RAWAT INAP

Mini Nutritional Assessment (MNA) is an instrument for assessing and screening specific nutritional in the elderly. Elderly are vulnerable to malnutrition because of physiological and functional changes that contribute to increase length of stay. The purpose of this study was to determine the correlation between Mini Nutritional Assessment value with length of stay of elderly patients at RSUD Ulin Banjarmasin. This research is analytic observational with cross-sectional method. A sample of 32 elderly patients was analysis used Spearman correlation test. The median MNA value was 20.00 points and the median length of stay was 8.00 days. The results of the correlation test showed that the value of p = 0.002 and value of r = -0.532 which means there is a significant correlation and a strong correlation with a negative direction. It can be concluded that there is a correlation between the Mini Nutritional Assessment (MNA) value with length of stay of elderly patients in internal medicine ward at RSUD Ulin Banjarmasin.

Baseline moderate-range albuminuria is associated with protection against severe COVID-19 pneumonia.

Diabetes mellitus is considered a leading contributor to severe coronavirus disease 2019 (COVID-19). To characterize differences between hospitalized diabetic patients with vs without COVID-19, and parameters associated with COVID-19 severity for prediction. This case-control study included 209 patients with type 2 diabetic mellitus hospitalized at the Galilee Medical Center (Nahariya, Israel) and recruited between September 2020 and May 2021, 65 patients with COVID-19 infection in dedicated wards and 144 COVID-19-negative patients in internal medicine wards hospitalized due to other reasons. Clinical parameters - including age, type of antiglycemic medications, presence of retinopathy, smoking history, body mass index (BMI), glycosylated hemoglobin, maximum neutrophil:lymphocyte ratio (NLRmax), C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), and albumin (blood and urine) - were compared between the two primary patient groups, and then between COVID-19-negative patients hospitalized due to infectious vs non-infectious disease. Finally, we explored which parameters were associated with severe COVID-19 pneumonia. COVID-19-negative patients were older (63.9 ± 9.9 vs 59.8 ± 9.2, P = 0.005), and had longer duration of diabetes (P = 0.031), lower eGFR (P = 0.033), higher albumin (P = 0.026), lower CRP (P < 0.001), greater smoking prevalence (P < 0.001), and more baseline albuminuria (54.9% vs 30.8%, P = 0.005) at admission; 70% of COVID-19 patients with albuminuria had moderate-range albuminuria (albumin:creatinine 30-300 mg/g). Most of the patients with albuminuria had chronic kidney disease stage II (CKD II). Oral antiglycemic therapies were not significantly different between the two groups. Multivariable logistic regression showed that higher BMI was significantly associated with severe COVID-19 (OR 1.24, 95%CI: 1.01-1.53, P = 0.04), as was higher NLRmax (OR 1.2, 95%CI: 1.06-1.37, P = 0.005). Surprisingly, pre-hospitalization albuminuria, mostly moderate-range, was associated with reduced risk (OR 0.09, 95%CI: 0.01-0.62, P = 0.015). Moderate-range albuminuria was not associated with bacterial infections. Moderate-range albuminuria in COVID-19-positive diabetic patients with CKD II is associated with less severe COVID-19. Further studies should explore this potential biomarker for risk of COVID-19-related deterioration and early interventions.

2032. Sources of Primary Bloodstream Infections in Internal Medicine Patients – a Cohort Study

Abstract Background The sources of bloodstream infections (BSIs) in internal-medicine patients, on admission and during hospitalization, are not well-defined. We wish to evaluate these infections and determine the proportion of BSIs in which no secondary cause could be defined (i.e. primary-BSI). Methods We analyzed all BSIs at the internal-medicine wards of the two campuses of the Hadassah Hebrew-University Medical Center, during 2017-2018. We defined the BSI source of each event (secondary, Central-line associated BSI (CLABSI) or primary non-CLABSI) and compared BSIs present on admission (POA) to hospital acquired (HA). Flow chart of the classification of bloodstream infection (BSI) events in the internal medicine wards 2017-2018. Results There were 595 patient-unique BSI events, 316 (53.1%) POA-BSI and 279 (46.9%) HA-BSI. Overall, 309 (51.9%) were secondary, 194 (32.6%) primary non-CLABSI and 92 (15.5%) CLABSI. Primary non-CLABSI in the POA-BSI group was 20.6% vs. 46.2% in the HA-BSI group (p=0.001). The length of hospital stay (LOS) from culture to discharge of the HA-BSI group was longer than in the POA-BSI group (mean LOS, 19 days vs. 13.6 days, p=0.01) and the mortality rate was higher (48.7% vs. 19%, p=0.001). Staphylococcus aureus was more common in primary non-CLABSI than in CLABSI and secondary BSI (29.5%, 12.8% and 16.2%, respectively). Conclusion The proportion of primary non-CLABSI among HA-BSI events is very high (46.2%). The absence of any plausible source for these BSIs, and the fact that most patients in Internal-medicine wards have peripheral lines, suggests that the peripheral catheter is a probable source for primary non-CLABSIs. Measures to prevent peripheral line associated BSI (PLABSI), similar to those implemented successfully for the prevention of CLABSI, should be considered. Disclosures All Authors: No reported disclosures.

Exploring the rates of malnutrition risk and related factors among inpatients

Aim: The purpose of the study was to reveal the rates of malnutrition risk among inpatients, to determine those who were not malnourished but became iatrogenically-malnourished, and to identify whether malnutrition was prevented or alleviated among how many patients following enteral/parenteral nutrition.&#x0D; Materials and Method: We carried out the study with 349 patients hospitalized in internal and surgical medicine wards between March 01-31, 2017 (1 month) at the Medical Faculty Hospital of Kırıkkale University. The data of this descriptive research was gathered using the NRS-2002 test administered at initial admission and in the first and second weeks (for malnutrition screening) and a demographic information form inquiring about patients’ demographic characteristics, chronic illnesses, medication, and malignancy status.&#x0D; Findings: The findings revealed the mean age of the patients was 60.1±15.5 years and that 54.4% were males. While 75.1% were hospitalized in internal medicine wards, 24.9% received inpatient treatment in surgical medicine wards. About one-fourth of the patients (24.4%) had malnutrition at first admission: 28.6% in internal medicine wards and 11.5% in surgical medicine wards (p = 0.001). Besides, %34.9 of the geriatric group and %16.7 of the non-geriatric group had malnutrition risk, and the difference between the groups was significant (p&lt;0.001). Moreover, there was a significant difference between the male and female patients by malnutrition risk (32.1% vs. 15.1%; p&lt;0.001). The patients in internal medicine and pulmonology wards had significantly increased rates of malnutrition risk in the first week (p = 0.001 and p&lt;0.001, respectively). Yet, the second-week evaluations among the patients in these wards and the first-week and second-week evaluations among those in other wards yielded no significant increase in their malnutrition risk.&#x0D; Conclusion: Overall, the NRS-2002 test revealed considerably high rates of malnutrition risk among the participating inpatients. The risk was found to be significantly higher in the males, geriatric patients, patients with malignancy, and patients in internal medicine wards when compared to the females, non-geriatric patients, patients without malignancy, and patients in pulmonology wards, respectively. Besides, the rates of malnutrition risk significantly increased among the patients in internal medicine and pulmonology wards at the end of the first week. Considering the excess rates of malnutrition risk in the present findings, prioritizing malnutrition risk assessment among all patients admitted may be a simple but effective solution to prevent malnutrition from hindering relevant therapies.

Is there a 'weekend effect' on mortality among hospitalised patients in an internal medicine ward? A retrospective study.

Previous studies demonstrated a 'weekend effect' and a 'night effect' of increased mortality among patients admitted during weekends or night shifts, presumably due to understaffing. To examine whether death during hospitalisation follows a similar effect regardless of admission time. A retrospective cohort study among deceased patients hospitalised in the internal medicine wing of a tertiary medical centre in Israel, between 2019 and 2020. Demographic and medical data were retrieved from electronic medical charts. Causes of death were specifically categorised. We applied statistical models to test for differences in mortality using incidence rate ratio (IRR) according to the day, time and cause of death. One thousand, two hundred and seventy-eight deceased patients were included. All-cause mortality was similar between weekends and weekdays. When sepsis was the cause of death, higher IRR were demonstrated on Fridays in comparison with weekdays (IRR 1.4; 95% confidence interval (CI) 1.1-1.9; P < 0.05). Other causes of death were not consistent with a 'weekend effect'. Mortality during night shifts was higher in comparison with the afternoon (IRR 1.5; 95% CI 1.3-4.7) and similar to the morning (IRR 1; 95% CI 0.9-1.2). Our study did not find a pattern of 'weekend effect' or 'night effect' on all-cause mortality among hospitalised patients in internal medicine wards. Our findings suggest that perhaps specifically death from sepsis, and not all-cause mortality, can be used as a surrogate for the measurement of understaffing or quality of care in the internal ward.

BACTERIAL PATTERN AMONG SEPSIS PATIENTS IN INTERNAL MEDICINE INPATIENT WARD DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA IN 2017-2019

Highlights:1. Bacteria remain a major cause of bacterial sepsis.2. The most common causal agent in bacterial septicaemia was the gram-positive bacterium. Abstract: Background: Bacteria remain the primary cause of bacterial sepsis. Gram-negative bacteria are the most commonly isolated from sepsis patients. However, gram-positive bacterial infections have also increased recently. Objective: To identify the pattern of bacterial infection in sepsis patients in Internal Medicine inpatient ward Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Material and Method: This retrospective study reviewed the medical records of all sepsis patients in Internal Medicine Ward Dr. Soetomo General Academic Hospital, Surabaya, Indonesia from January 1 – December 31, 2016. All patients were divided according to bacterial species into two groups: patients with gram-positive and gram-negative infection. The collected data were statistically analyzed using SPSS ver. 16.0 to find out the frequency. Result: From 179 eligible data reviewed, there were 103 (57.5%) patients with gram-positive bacterial infection and 76 (43.5%) patients with a gram-negative bacterial infection. The major isolates of gram-positive bacteria were Staphylococcus hominins (30 isolates) and gram-negative bacteria was Escherichia coli (30 isolates), 43 isolates showed multi-drug resistant organisms; Escherichia coli ESBL 23 isolates, Klebsiella pneumoniae ESBL 3 isolates, Klebsiella oxytoca ESBL 2 isolates and Methilcillin Resistance Staphylococcus aureus 5 isolates. Conclusion: The most common causative agent in bacterial sepsis was gram-positive bacteria. The major isolated gram-positive bacteria are Staphylococcus hominis and gram-negative bacteria were Escherichia coli. The species of multi-drug resistant organisms found are Methilcillin-Resistant Staphylococcus aureus (MRSA), Escherichia coli ESBL, Klebsiella pneumonia ESBL and Klebsiella oxytoca ESBL. Among the patients with multi-drug resistant organism infection, Escherichia coli ESBL were the most prevalent one.

GDS score as screening tool to assess the risk of impact of chronic conditions and depression on quality of life in hospitalized elderly patients in internal medicine wards.

Aging of population is characterized by multiple chronic conditions in the same individual. Health-related quality of life (HR-QOL) reflects the multidimensional impact of chronic disease on population and it is increasingly analysed as outcomes.The aim of this study was the evaluation of the predictors of quality of life among elderly patients hospitalized in internal medicine ward, investigating the effect of comorbidities on health-related quality of life.Data collected in this cross-sectional study were analysed. Socio-demographic, clinical characteristics, disease distribution and quality of life by the 12-Item Short Form Health Survey (SF-12) were evaluated.Of 240 inpatients, subjects with Barthel Index (BI)≤40 were 23.7%, 55% had a Geriatric Depression Scale (GDS)≥2. After categorizing mental component score (MCS) and physical component score (PCS) in five classes, we found that diabetics and patients with cancer were more frequent in the first class of MCS while patients with NYHA III-IV are significantly more frequent in the first class of PCS. When we classified patients according to GDS≥2 or < 2, subjects with GDS≥2 had BI and MCS significantly lower. In the multivariate analysis GDS score ≥2 was independently associated with first MCS class [16.32 (3.77–70.68)] while NYHA III-IV class and claudicatio intermittents were strong predictors of the worst PCS class [9.54 (1.97–47.40), 2.53 (1.16–5.49), respectively]. Liver disease was independently associated with GDS≥2 [5.26 (1.13–24.39)].Our study highlighted the impact of chronic diseases on health-related quality of life in elderly subjects hospitalized in an internal medicine ward pointing out the importance of taking into account patient's needs and perception and the setting up of a personalised health-care. Patients with diabetes and liver disease along with persons affected by cancer need psychological support to improve their quality of life. A GDS score ≥ 2 is a strong predictor of poor quality of life and should trigger an in-depth assessment of mental health in this kind of patients.

Validity of "Sepsis-3" criteria in identifying patients with community-onset sepsis in Internal Medicine wards; a prospective, multicenter study

BackgroundFew data are available on the validity of “Sepsis-3” criteria in identifying patients with sepsis in internal medicine wards (IMWs). Real-life data about this topic and on the prevalence of sepsis in IMWs could be useful for improving hospital organization. ObjectivesTo assess the validity of "Sepsis-3" criteria in identifying patients with community-onset sepsis in IMWs. Secondary objectives: to evaluate the prevalence of these patients in IMWs and to compare "Sepsis-3" and "Sepsis-1" criteria. MethodsMulticenter, prospective, observational, cohort study, carried out in 22 IMWs of Tuscany (Italy). All patients admitted to each of the study centers over a period of 21-31 days were evaluated within 48 hours; those with clinical signs of infection were enrolled. The main outcome was in-hospital mortality. Results2,839 patients were evaluated and 938 (33%) met the inclusion criteria. Patients with sepsis diagnosed according to “Sepsis-3” were 522, representing 55.6% of patients with infection and 18.4% of all patients hospitalized; they were older than those without sepsis (79.4±12.5 vs 74.6±15.2 years, p<0.001). In-hospital mortality was significantly higher in patients with sepsis compared to others (13.8% vs 4.6%; p<0.001). “Sepsis-3” criteria showed greater predictive validity for in-hospital mortality than “Sepsis-1” criteria (AUROC=0.71; 95%CI, 0.66-0.77 vs 0.60; 95%CI 0.54-0.66; p=0.0038). Conclusions"Sepsis-3" criteria are able to identify patients with community-onset sepsis in IMWs, whose prevalence and in-hospital mortality are remarkably high. Medical departments should adapt their organization to the needs for care of these complex patients.

Pneumocystis pneumonia in HIV-negative immunocompromised patients in Internal Medicine ward

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection typically observed in AIDS patients, for whom it represents a leading cause of death. However, its incidence among HIV-negative immunocompromised patients is progressively increasing, with a significantly higher mortality compared to that of AIDS-patients. We performed a retrospective observational study on HIV-negative patients with PJP. We aimed to determine their epidemiological features and their biohumoral and therapeutic variables, searching for a correlation between them and our patients’ outcome. We included all patients admitted to our Internal Medicine ward from January 2010 to June 2015, who were immunocompromised at the time of admission and had microbiologically confirmed PJP (association between compatible clinical-radiological findings and qualitative polymerase chain reaction positivity on bronchoalveolar lavage). Their immune impairment was assessed considering both their medical history and their complete white blood cells (WBC), differential WBC and their CD4 cell count. Transfer to Intensive Care Unit (ICU) or death was considered as an unfavorable clinical outcome, while hospital discharge or transfer to a non-ICU ward was considered as a favorable outcome. We included a total of 18 patients in our statistical analysis. We used Student’s t-test and Fischer’s χ-square test to compare, respectively, normally distributed continuous variables and non-continuous variables. Our patients’ mean age was 65±13.9 years. All of them had cancer, mostly hematological malignancies (13/18), notably non-Hodgkin lymphoma (NHL; 8/13). They were all being or had been recently treated with chemotherapy (10/18) and/or high-dose glucocorticoids, with full dose or during tapering (13/18). Statistical analysis of blood tests results showed a significant difference between mean serum lactate dehydrogenase (LDH) concentration in the group of patients with favorable vs unfavorable outcome. Also, mean serum immunoglobulins G (IgG) concentration and certain arterial blood gas findings (mean arterial paO2/FiO2, mean blood Ph and mean paCO2) at the time of admission were significantly different in the two groups of patients. 12/18 patient’s outcome turned out unfavorable. Trimethoprim + sulfamethoxazole (TMP+SMX) treatment was given to all our patients, with a mean duration of 13.39±9.36 days. Patients with a favorable outcome had received TMP+SMX treatment significantly earlier than those with an unfavorable outcome. Hematological malignancies, according to literature, confer the strongest predisposition to PJP. Both chemotherapy and high-dose Glucocorticoid treatment are well known predisposing factors. A remarkable elevation of serum LDH represents both a typical clinical feature and a well-known negative prognostic factor in PJP. Low IgG levels have never been reported as a negative prognostic factor, but their role in enhancing macrophage killing of pneumocystis may account for the worst observed prognosis in the group of patients with lower mean levels. Therefore, in order to reduce the heavy mortality rate associated with PJP, an early beginning of specific treatment is of utmost importance, and even if this is certainly true for many infectious diseases, the time gap is particularly limited in the setting of this type of pneumonia. Hence, PJP should be ruled out as soon as possible and, in case of a strong clinical- radiological suspicion, therapy should be started immediately, even while waiting for microbiological confirmation (especially in critically-ill patients).

Mechanically ventilated patients in internal medicine wards: Survival and outcome one-year post-discharge

Mechanically ventilated patients in internal medicine wards: Survival and outcome one-year post-discharge

Management of bleeding in palliative care patients in the general internal medicine ward: a systematic review

BackgroundPalliative care patients, those suffering from at least one chronic lifelong medical condition and hospice care patients, those with a life expectancy less than 6 months, are regularly hospitalised in general internal medicine wards. By means of a clinical case, this review aims to equip the internist with an approach to bleeding in this population. Firstly, practical advice on platelet transfusions will be provided. Secondly, the management of bleeding in site-specific situations will be addressed (from the ENT/pulmonary sphere, gastrointestinal - urogenital tract and cutaneous ulcers). Finally, an algorithm pertaining to the management of catastrophic bleeding is proposed.MethodsElectronic databases, including EMBASE, Pubmed, Google Scholar and the Cochrane Library were studied as primary resources, in association with local guidelines, to identify papers exploring platelet transfusions and alternative management of site-specific bleeding in palliative care patients.ResultsHaemorrhagic complications are frequent in palliative care patients in the internal medicine ward. Current guidelines propose a therapeutic-only platelet transfusion policy. Nonetheless, prophylactic and/or therapeutic transfusion remains a physician-dependent decision. Site-specific therapeutic options are based on expert opinion and case reports. While invasive measures may be pertinent in certain situations, their application must be compatible with patient goals. Catastrophic bleeding requires caregivers' comforting presence; pharmacological management is secondary.ConclusionLiterature is lacking regarding management of bleeding in the palliative care population hospitalised in an acute medical setting. Recommendations are of limited quality, the majority based on case reports or expert opinion. Further studies, exploring for example the impact on patient quality of life, are desirable to improve the management of this frequently encountered complication.

Cancer patients' perspectives on dignity in care.

Since "dignity" is one of the fundamental rights of every patient, consideration for patients' dignity is essential. Unfortunately, in many cases, especially in cancer patients, dignity is not fully respected. Dignity is an abstract concept, and there are only a few comprehensive studies on the dignity of cancer patients in Iran. This study aimed to evaluate the perception of Iranian cancer patients on human dignity. A qualitative research approach was used as the study design. The data were collected through individual semi-structured interviews and analyzed using the qualitative content analysis method. This study was conducted on cancer patients in internal medicine wards in Iran. The data were gathered through semi-structured interviews from May 2017 to February 2018. The study protocol was approved by the Research Ethics Committee of medical universities located in Southwest of Iran. The ethical principles were carefully followed throughout the study. Based on the results of the interviews, 3 main themes and 11 categories were determined. The main themes were identified as the "personal space and privacy," "respect for human values," and "moral support." The results of the present study showed the necessity of care for cancer patients in a respectful manner. The key elements in such care were the preservation of their personal space and privacy, respect for their values, and the provision of adequate moral support. These measures will have a positive effect on the perception of such patients on human dignity. Considering the special care required by cancer patients, the Iranian healthcare and hygiene managers should design and implement a care plan that includes the ethical principles related to human dignity.

Mortality Facts in Internal Medicine Wards: A Descriptive Study From A University Hospital

Objective: We aimed to determine the mortality rates and the causes of death in hospitalized patients in Internal Medicine Wards in a University Hospital.&#x0D; Material and Methods: Medical records of patients who were hospitalized between 01 June 2014 and 31 May 2015 in Internal Medicine Wards of a University Hospital were reviewed and patients who died were examined retrospectively. Patient characteristics and causes of death were sorted out. &#x0D; Results: In the defined time frame, 5314 hospitalization episodes of 4500 patients were recorded and 416 (9.2%) patients died during hospital stay. The mean age of the patients who died was 62 (19-95) years and 54% of them were male. The median duration of hospitalization was 16 (0-142) days. The mean Charlson score was 6.3 ± 2.7. The rates of hospitalization and death did not differ between seasons. Malignancy was present in 71% of the cases and, 46% had metastatic solid cancer. The most common accompanying diseases were diabetes mellitus (25.7%), hypertension (35%) and congestive heart failure (18.8%). The most common reasons of admission were respiratory distress (23.8%), pneumonia (11.1%), and general deterioration (10.6%) among the patients who died. Sepsis (69%) and respiratory failure (15.9%) were the leading causes of deaths.&#x0D; Conclusion: Patients who died in internal medicine wards have high chronic illness burden. Sepsis was the most common cause of death. &#x0D; Keywords: Internal medicine, mortality, sepsis.

A Study on Clinical Assessment of Antibiotic Used in Chronic Kidney Disease Patients

A 6-week longitudinal prospective study was conducted to assess the effectiveness and the safety antibiotic used in chronic kidney disease (CKD) patients in internal medicine ward. We compared white blood count and glomerular fi ltration rate before and after antibiotic used. The CKD patients who admitted in the internal medicine ward and age ≥18 years old were included this study. Patients with incomplete laboratory data and renal replacement therapy were excluded in this study. The 25 patients who enrolled in this study were recruited. The majority gender of CKD was male (64%), the mean of age was 61.52±14.17 years old with length of stay (LOS) was 6.92±4.05 days. The highest number of patients was in CKD stage 3 (n=10, 40%) and was followed by CKD stage 2 (n=6, 24%). Most of them were diagnosed community acquired pneumonia. Tablet azithromycin (n=16, 64%) then Cefotaxime intra venous injection (IV) (n= 6, 24%), and Ceftazidime IV (n=5, 20%), Cloxacillin IV (n=4, 16%) were the most antibiotics prescribed. Generally patients had been prescribed appropriate dose of antibiotic and 88% of them showed improved white blood count. In contrast, the glomerular fi ltration rate of 44% CKD patients was getting worse. In conclusion, this study clearly indicate the CKD patients require close monitoring to maintenance of renal function even the antibiotic had been prescribed appropriately.

Potential drug-drug interactions among hospitalized patients in a developing country.

Drug-drug interactions (DDIs) may often lead to preventable adverse drug events and health damage. Particularly in hospitals, this might be an important factor as multiple drug therapies are common. The objective of this study was to identify the frequency and levels of potential DDIs in internal medicine wards in an Iranian university hospital. A cross-sectional study was conducted by reviewing charts of 448 hospitalized patients in internal medicine wards of a teaching hospital, from November 2014 to May 2015. "Lexicomp drug interaction software" and Micromedex Drug-Reax system were used for screening the potential DDIs. The identified DDIs were categorized by level of severity. Logistic regression was applied to determine the odds ratio for specific risk factors of potential DDIs e.g., age, gender, hospital stay and number of medications. The mean age of patients was 61 years, the length of hospital stay for patients was 9 days and the number of drugs per patient was 9. Potential interactions were detected in 386 patients. The most common types of interactions were type C (78.6%), moderate (60.9%) and delayed onset (56.5%). There was a significant association of the occurrence of potential DDIs with seven or more numbers of prescribed medications (OR: 0.048, 95% CI:0.02-0.12, p<0.0001). The present study has recorded a high prevalence of potential DDIs in internal medicine wards. Patients with polypharmacy were at high risk for DDIs. Education, computerized prescribing systems, drug information, and pharmaceutical care are important measures that were recommended to minimize harm associated with DDIs.

Hospital Readmission ,Malnutrition and Associated Factors among Elderly Hospitalized Patients in Internal Medicine Wards, Menoufia University Hospitals

Hospital Readmission ,Malnutrition and Associated Factors among Elderly Hospitalized Patients in Internal Medicine Wards, Menoufia University Hospitals

Epidemiology, microbiology, clinical characteristics, and outcomes of candidemia in internal medicine wards—a retrospective study

The clinical characteristics of internal medicine ward (IMW) patients with candidemia are unclear. The aim of this study was to define the clinical characteristics of candidemic IMW patients and to study the incidence, species distribution, and outcomes of these patients compared to surgical and intensive care unit (ICU) candidemic patients. A retrospective cohort of candidemic patients in IMWs, general surgery wards, and an ICU at Beilinson Hospital during the period 2007-2014 was analyzed. A total of 118 patients with candidemia were identified in six IMWs, two general surgery wards, and one ICU in the hospital. Candida albicans was the leading causative agent (41.1%). Higher proportions of Candida parapsilosis and Candida tropicalis isolates were observed in the IMW patients. IMW patients were significantly older, with poorer functional capacity, and had more frequently been exposed to antibiotic therapy within 90 days, in particular β-lactam-β-lactamase inhibitor combinations and cephalosporins. At onset of candidemia, a significantly lower number of IMW patients were mechanically ventilated (p<0.01); these patients did not have central line catheters comparable to ICU and surgical patients (p<0.001). They were less likely to receive adequate antifungal therapy within 48h, and this was the only significant predictor of survival in these patients (p=0.028): hazard ratio 3.7 (95% confidence interval 1.14-12.5) for therapy delayed to >48h. IMW candidemic patients account for a substantial proportion of candidemia cases and have unique characteristics and high mortality rates.

MEDical wards Invasive Candidiasis ALgorithms (MEDICAL):Consensus proposal for management

IntroductionA majority of invasive Candida infections occur in medical wards; however, evidence for management in this setting is scarce and based primarily on the intensive care or surgical setting. On behalf of the Italian Society for Anti-Infective Therapy (SITA) and the Italian Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), the MEDICAL group produced practical management algorithms for patients in internal medicine wards. MethodsThe MEDICAL group panel, composed of 30 members from internal medicine, infectious disease, clinical pharmacology, clinical microbiology and clinical epidemiology, provided expert opinion through the RAND/UCLA method. ResultsSeven clinical scenarios were constructed based on clinical severity and probability of invasive candidiasis. For each scenario, the appropriateness of 63 different diagnostic, imaging, management, or therapeutic procedures was determined in two Delphi rounds. The necessity for performing each appropriate procedure, was then determined in a third Delphi round. Results were summarized in algorithms. DiscussionThe proposed algorithms provide internal medicine physicians and managers with an easy to interpret tool that is exhaustive, clear and suitable for adaption to individual local settings. Attention was paid to individual patient management and resource allocation.