Rapid Administration Research Articles

Protocolo anestésico em cão submetido à enucleação para correção de prolapso do globo ocular – relato de caso

Orbital injuries are common in dogs, resulting from mechanical trauma or orbital diseases that may or may not be considered emergencies, characterized as an ocular protrusion that in extreme cases will require a surgical procedure for the extraction of the eyeball through enucleation, for this procedure, it is necessary to adopt specific and individual anesthetic protocols for each patient, since each situation may have different characteristics and the adoption of anesthetic drugs may lead to cardiovascular and respiratory changes when the appropriate procedures and medications are not adopted, in this case. In this context, the study aimed to evaluate the anesthetic protocol in a dog submitted to a surgical procedure of enucleation to correct an eyeball prolapse, using pre-anesthetic medication. Dosages of propofol 3 mg/kg IV, midazolam 0.4 mg/kg IV and morphine 0.5 mg/kg IV did not cause adverse effects such as changes in heart and respiratory rates and/or vomiting. The surgical and anesthetic procedure adopted for that patient had a positive effect, it is inferred that this factor is associated with rapid intervention, therapeutic choice and administration dosages, contributed to the final result of the case.

Time to treatment and mortality for clinical sepsis subtypes

BackgroundSepsis is common, deadly, and heterogenous. Prior analyses of patients with sepsis and septic shock in New York State showed a risk-adjusted association between more rapid antibiotic administration and bundled care completion, but not an intravenous fluid bolus, with reduced in-hospital mortality. However, it is unknown if clinically identifiable sepsis subtypes modify these associations.MethodsSecondary analysis of patients with sepsis and septic shock enrolled in the New York State Department of Health cohort from January 1, 2015 to December 31, 2016. Patients were classified as clinical sepsis subtypes (α, β, γ, δ-types) using the Sepsis ENdotyping in Emergency CAre (SENECA) approach. Exposure variables included time to 3-h sepsis bundle completion, antibiotic administration, and intravenous fluid bolus completion. Then logistic regression models evaluated the interaction between exposures, clinical sepsis subtypes, and in-hospital mortality.Results55,169 hospitalizations from 155 hospitals were included (34% α, 30% β, 19% γ, 17% δ). The α-subtype had the lowest (N = 1,905, 10%) and δ-subtype had the highest (N = 3,776, 41%) in-hospital mortality. Each hour to completion of the 3-h bundle (aOR, 1.04 [95%CI, 1.02–1.05]) and antibiotic initiation (aOR, 1.03 [95%CI, 1.02–1.04]) was associated with increased risk-adjusted in-hospital mortality. The association differed across subtypes (p-interactions < 0.05). For example, the outcome association for the time to completion of the 3-h bundle was greater in the δ-subtype (aOR, 1.07 [95%CI, 1.05–1.10]) compared to α-subtype (aOR, 1.02 [95%CI, 0.99–1.04]). Time to intravenous fluid bolus completion was not associated with risk-adjusted in-hospital mortality (aOR, 0.99 [95%CI, 0.97–1.01]) and did not differ among subtypes (p-interaction = 0.41).ConclusionTimely completion of a 3-h sepsis bundle and antibiotic initiation was associated with reduced risk-adjusted in-hospital mortality, an association modified by clinically identifiable sepsis subtype.

A multimodal pain protocol for treatment of vaso-occlusive crisis in patients with sickle cell disease: Implementation and evaluation.

Pain management during a vaso-occlusive crisis (VOC) for patients with sickle cell disease (SCD) remains a major challenge and strongly depends on opioids. We developed a multimodality pain protocol for rapid, opioid-sparing pain treatment of VOC and evaluated its feasibility. Patients were included for evaluation if they were ≥18 years, diagnosed with SCD and visited the emergency department (ED) because of VOC between July 2018 and December 2020. Primary evaluation outcome was the feasibility of multimodal pain analgesia (i.e., the use of at least two analgesics with different underlying mechanisms of action). A total of 131 SCD patients visited the ED because of VOC with a total of 550 ED presentations, of which 377 were eventually hospitalised. A total of 508 (92.4%) ED presentations and 374 (99.2%) hospital admissions received multimodal pain treatment. Time to first administration of an opioid was median [IQR] 34.0 [21.0-62.0] minutes. The implementation of a pain protocol using multimodal analgesia for VOC in patients with SCD appeared to be feasible and facilitated rapid administration of opioids. Controlled trials are needed to investigate the effectiveness of multimodal analgesia on pain and should focus on patient reported outcome measures.

Identification of factors to predict low risk febrile neutropenia admissions in patients with acute myeloid leukemia (AML) following intensive chemotherapy.

7031 Background: Febrile neutropenia (FN) is the most common reason for hospital readmission following chemotherapy for AML. Standard practice for FN in AML is hospitalization for rapid administration of IV antibiotics, thus FN is a major driver of healthcare resource utilization and cost. Whether this approach is justified in all situations is unknown. While FN risk models have been developed focusing on solid tumors, factors predicting uncomplicated courses of FN in AML, which may allow identification of patients suitable for outpatient management, have not been studied. We therefore examined whether baseline clinical characteristics could predict which AML patients with FN have a lower risk of progression to severe illness. Methods: We retrospectively reviewed medical records from 7/29/2014-12/24/2022 to identify adults with FN (fever &gt;38.3C and white blood count &lt;1000/µL). Included were patients with high-grade myeloid neoplasm (&gt;10% blasts in blood/marrow) who received intensive chemotherapy (cytarabine dose &gt;=100 2 /day) within 8 weeks. We collected baseline clinical and disease variables. Outcomes were: infections identified, hospital length of stay (LOS), intensive care unit (ICU) admission, and survival. A “low-risk [LR]” outcome was defined as a LOS &lt;72hrs without ICU admission or inpatient death. Univariate and multivariable (MV) logistic regression models were used to assess covariate associations with outcomes. Results: We identified 350 FN admissions in 198 patients with a median age 62 (range: 21-87) yrs. 63% were newly diagnosed and 37% relapsed/refractory. 12% had prior transplant. Median duration of neutropenia prior to fever was 12 (1-287) days. 46% had transfusion &lt;24 hours prior to fever. The median LOS was 5 (1-56) days. 9% of patients went to ICU and 6% died inpatient.Overall, 15% of admissions were classified as LR. 57% had an infection identified. The table shows factors in MV analysis that predicted an infection identified or high-risk (HR) admission. Conclusions: Only 15% of AML admissions for FN were LR. Factors that predict HR outcomes in standard FN models such the MASCC score—e.g. age, prior fungal infection —were not predictive of HR outcomes in AML. As a next step, we will compare our model to other published models used to predict poor outcomes after FN, which have not been developed or validated in AML. [Table: see text]

Antineoplastic and immunomodulating agent effects on immunization outcomes.

1539 Background: Oncologists face a challenge in advising patients on the infection risk associated with antineoplastic and immunomodulating medications, as the extent of risk posed by each medication is not well understood. The rapid administration of COVID-19 immunizations across the population provides an opportunity to assess the influence of immunosuppressing medications on infection outcomes post-vaccination. This study evaluated the effect of antineoplastic and immunomodulating medications as classified by the World Health Organization Anatomical Therapeutic Chemical Classification System (WHO ATC) on post-vaccination risk of COVID-19 infection and antibody response to multiple SARS-CoV-2 epitopes using serial serologic assessments. Methods: At a large, tertiary healthcare system in San Diego, we conducted an observational cohort study from December 11, 2020, to September 22, 2022, comparing vaccinated adult patients taking WHO ATC-classified immunosuppressing medications (“immunosuppressed” group) with matched control patients not prescribed these medications (“immunocompetent” group) for the outcome of PCR+ COVID-19 infection. A subset of immunosuppressed and immunocompetent individuals was consented to provide serial assessments of antibody response to multiple SARS-CoV-2 epitopes using the Genalyte serologic platform. Results: 12,709 vaccinated immunosuppressed patients and 197,151 immunocompetent controls were identified for matched analysis. Receiving an immunosuppressing medication conferred increased risk of COVID-19 infection post-immunization (HR: 1.5, 95% CI: 1.38 – 1.63, p &lt; 0.0001). Among immunosuppressing medications, PD1/PD-L1 inhibiting monoclonal antibodies and calcineurin inhibitors were associated with increased risk of COVID-19 infection (HR: 2.33, 95% CI: 1.35 – 4.04, p = 0.0038; HR 2.72, 95% CI: 1.78 – 4.16, respectively). Receiving three and four COVID-19 immunizations reduced this risk, except in patients taking calcineurin inhibitors. Among 87 consented participants, 218 samples from multiple timepoints revealed a decreased antibody response to both spike S1 and S2 subunits following third and fourth immunization. Despite decreased seroconversion, this study found medications like CD20 inhibiting monoclonal antibodies and folic acid analogs did not increase the post-immunization risk of COVID-19. Conclusions: These results help elucidate the relationship between antineoplastic and immunomodulating medications and COVID-19 immunization outcomes. In our patients, seroconversion efficacy did not always correspond to post-immunization infection, consistent with COVID-19 disease risk being multifactorial. The findings of this study inform oncologists’ shared decision-making process in advising patients of the risk of infection associated with immunomodulating medications and the potential impact on their vaccination response.

Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology.

Episodes of worsening symptoms and signs characterize the clinical course of patients with chronic heart failure (HF). These events are associated with poorer quality of life, increased risks of hospitalization and death and are a major burden on healthcare resources. They usually require diuretic therapy, either administered intravenously or by escalation of oral doses or with combinations of different diuretic classes. Additional treatments may also have a major role, including initiation of guideline-recommended medical therapy (GRMT). Hospital admission is often necessary but treatment in the emergency service or in outpatient clinics or by primary care physicians has become increasingly used. Prevention of first and recurring episodes of worsening HF is an essential component of HF treatment and this may be achieved through early and rapid administration of GRMT. The aim of the present clinical consensus statement by the Heart Failure Association of the European Society of Cardiology is to provide an update on the definition, clinical characteristics, management and prevention of worsening HF in clinical practice.

A prospective interventional study to observe the effectiveness of parenteral iron infusion of iron isomaltoside 1000 (Fur – IV) in obstetrics and gynecology patients suffering from moderate to severe iron deficiency anaemia

Anaemia during pregnancy is allied with maternal and foetal complications like increased risk of intrauterine growth retardation, prematurity, low birth weight, and maternal and infant mortality. The agent iron isomaltose 1000 (Fur-IV) combines iron and isomaltose 1000 for slow, controlled release to reduce the risk of free iron toxicity and provide flexibility and convenience for high dose administration. Iron isomaltoside has been shown to be effective in the treatment of IDA in many treatment groups compared to intravenous iron sucrose and FCM. : It is a prospective interventional study which is conducted to observe an increase in hemoglobin levels in obstetric and gynecological department patients suffering from IDA in whom oral iron preparation was ineffective or in case of clinical need to supply iron rapidly via single infusion of iron isomaltoside 1000. Each patient in the study received 500 mg single intravenous infusion. After this, patient was followed up and haemogram was repeated after 15 and 30 days of infusion while investigation for serum ferritin and serum iron was repeated after 30 days. Average Hb concentration in increased by 30.86% to 9.88 g/dL after 30 days of infusion. There is statistically significant difference between baseline values and post infusion 30 days values for serum ferritin and serum iron (p-value &amp;#60;0.0001 for both).IV iron isomaltoside administration was well tolerated in patients with gynecological IDA who were intolerant or unresponsive to oral iron therapy or who required rapid iron administration.

State of the Union: Timeliness to Antibiotics in Open Fractures.

In open fractures, early administration of systemic antibiotics has recently been recognized as a universal recommendation, with the current American College of Surgeons Trauma Center Verification recommendation for administration within 1 hour of facility arrival. We sought to quantify the baseline rate of timely antibiotic administration and the various factors associated with delay. Data from the National Trauma Data Bank were obtained for all patients treated for open fractures in 2019. 65,552 patients were included. Univariate and multivariate analyses were performed, first for patient, prehospital, and hospital factors compared with rate of antibiotic administration within 1 hour of hospital arrival, then with a multivariate analysis of factors affecting these times. The overall rate of antibiotic administration within 1 hour of arrival was 47.6%. Patient factors associated with lower rates of timely antibiotics include increased age, Medicare status, and a higher number of comorbidities. Associated prehospital factors included non-work-related injuries, fixed-wing air or police transport, and walk-in arrival method. Patients with lower extremity open fractures were more likely to receive antibiotics within 1 hour of arrival than those with upper extremity open fractures. Traumatic amputations had a higher rate of timely administration (67.3%). ACS trauma Level II (52.5%) centers performed better than Level III (48.3%), Level I (45.5%), and Level IV (34.5%) centers. Multivariate analysis confirmed the findings of the univariate analysis. Despite current clinical standards, rates of adherence to rapid antibiotic administration are low. Certain patient, facility, and environmental factors are associated with delays in antibiotic administration and can be a focus for quality improvement processes. We plan to use these data to evaluate how focus on antibiotic administration as this quality standard changes practice over time. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A systematic review on de-escalation of antibiotics uses in surgical patients in clinical sepsis

Antimicrobial resistance is a feature of the current topography of clinical sepsis, and in the future, fewer and fewer new antibiotics, especially those from novel classes1, will be developed to address these problems. Effective antimicrobial treatment is necessary to ensuring good patient outcomes. Increased duration of stay, multidrug-resistant infections, and death can result from improper or inefficient use of antibiotics. Patients in intensive care who are critically sick are at risk for antibiotic failure and secondary infections brought on by improper antibiotic usage, especially those with severe sepsis and septic shock. Providers can speed up the treatment of common intensive care unit (ICU) infections by starting active empiric antibiotic therapy based on local susceptibilities, daily review of infection signs and symptoms, and, where practical, restricting antibiotic therapy. Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat. Early detection of septic patients enables the use of evidence-based therapies, including goal-directed resuscitation, rapid antibiotic administration, and activated protein C. It may be simpler to provide appropriate care for sepsis if this clinical entity is divided into several phases and new delivery structures that span traditional boundaries are implemented. More specialized treatments will be possible with a better understanding of the molecular underpinnings of the illness process.

Analysis and validation of diagnostic biomarkers and immune cell infiltration characteristics in pediatric sepsis by integrating bioinformatics and machine learning.

Pediatric sepsis is a complicated condition characterized by life-threatening organ failure resulting from a dysregulated host response to infection in children. It is associated with high rates of morbidity and mortality, and rapid detection and administration of antimicrobials have been emphasized. The objective of this study was to evaluate the diagnostic biomarkers of pediatric sepsis and the function of immune cell infiltration in the development of this illness. Three gene expression datasets were available from the Gene Expression Omnibus collection. First, the differentially expressed genes (DEGs) were found with the use of the R program, and then gene set enrichment analysis was carried out. Subsequently, the DEGs were combined with the major module genes chosen using the weighted gene co-expression network. The hub genes were identified by the use of three machine-learning algorithms: random forest, support vector machine-recursive feature elimination, and least absolute shrinkage and selection operator. The receiver operating characteristic curve and nomogram model were used to verify the discrimination and efficacy of the hub genes. In addition, the inflammatory and immune status of pediatric sepsis was assessed using cell-type identification by estimating relative subsets of RNA transcripts (CIBERSORT). The relationship between the diagnostic markers and infiltrating immune cells was further studied. Overall, after overlapping key module genes and DEGs, we detected 402 overlapping genes. As pediatric sepsis diagnostic indicators, CYSTM1 (AUC = 0.988), MMP8 (AUC = 0.973), and CD177 (AUC = 0.986) were investigated and demonstrated statistically significant differences (P < 0.05) and diagnostic efficacy in the validation set. As indicated by the immune cell infiltration analysis, multiple immune cells may be involved in the development of pediatric sepsis. Additionally, all diagnostic characteristics may correlate with immune cells to varying degrees. The candidate hub genes (CD177, CYSTM1, and MMP8) were identified, and the nomogram was constructed for pediatric sepsis diagnosis. Our study could provide potential peripheral blood diagnostic candidate genes for pediatric sepsis patients.

Best Practices for Implementation of an Employee Health COVID-19 Vaccine Clinic-A Model for Future Pandemic Preparedness.

The aims of the study are to determine best practices from two large-scale, academic medical centers' employee coronavirus 2019 (COVID-19) vaccination clinics and to apply them to create scalable modules for rapid administration of 10,000 vaccinations. The weekly number of COVID-19 vaccine doses administered was captured. Processes were compared to determine best practices, which informed the scalable financial model. Within the first 3 months, more than 60,000 COVID-19 vaccine doses were administered, and 70% of employees were fully vaccinated in 4 months with more than 95% by the vaccine mandate deadline. The estimated cost of delivering one dose was $29.95 ($299,505/10,000) compared with $35-$39 per dose when delivered by an on-site retail pharmacy. Successful, safe, and rapid delivery of more than 60,000 COVID-19 vaccine doses in 3 months is practical and scalable. Learnings go beyond COVID-19 and can be applied to future outbreaks/pandemics.

Neurotherapeutic Potential of Water-Soluble pH-Responsive Prodrugs of EIDD-036 in Traumatic Brain Injury.

The C-20 oxime of progesterone, EIDD-036 (2), demonstrates neuroprotection and improved outcomes in animal models of traumatic brain injury (TBI). However, 2 suffers from poor solubility, which renders it unsuitable for rapid administration. Previous prodrugs of 2 aimed at improving solubility by incorporating enzymatically labile amino acid and phosphate ester promoieties. These approaches were effective but led to limitations with in vivo administration. Herein, we disclose a pH-responsive water-soluble prodrug strategy to improve exposure to 2 through enzyme-independent activation. Compound 13l was identified as a lead that exhibits water-solubility, stability in acidic solutions, and rapid conversion to 2 at physiological pH. Administration of 13l to rats resulted in a twofold increase in exposure to 2 compared to the previous generation phosphate prodrug, EIDD-1723 (6). In a rat model of TBI, treatment with 13l resulted in a significant decrease in cerebral edema when administered postinjury.

A novel time-saving multiplex PCR assay for detecting and discriminating the most common canine Babesia species in Europe

In Europe, most cases of canine babesiosis are caused by Babesia canis, Babesia vogeli (large piroplasms) and Babesia vulpes (small piroplasm). Molecular diagnosis is recommended due to its high sensitivity. Species identification after sequencing allows applying a rapid and efficient treatment, leading to a better prognosis; however, it is expensive and time-consuming. Thus, the objective of the present study was to develop a time-saving multiplex polymerase chain reaction (PCR) for simultaneously detecting and discriminating between large and small forms without sequence analysis. A new multiplex PCR was designed and tested using blood samples from 79 dogs showing clinical signs compatible with babesiosis which were previously analysed using blood smears and molecular methods. Multiplex PCR successfully discriminated between both Babesia groups showing bands of 700 and 890 bp for B. canis/B. vogeli and B. vulpes, respectively. No significant differences in the results of both PCR were detected and a substantial agreement between protocols (κ = 0.64) was found. Our multiplex PCR represents a reliable tool for detecting infections by the major Babesia spp. in dogs from Europe. Since no sequence analysis is required for identifying the species involved, this PCR allows the rapid administration of an appropriate treatment, thus improving the survival rate of the infected animals. In addition, it will represent a helpful tool for unravelling the real prevalence and distribution of B. vulpes and its implication in clinical cases.

The Role Of Peer Assessment Model With A Web Platform In Participation And Learning Achievement Of Students

Technological innovations have led to the widespread use of web-based peer evaluation as an alternative formative assessment strategy. This assessment method has significant potential benefits for the education of the student population (Chien, Hwang, &amp; Jong, 2020). A web-based peer evaluation system and a method for team improvement were developed in order to allow the rapid administration of the assessment, stimulate the provision of quality feedback, and construct effective team operations (Friedrich, 2019). However, very few teachers really put into practice peer evaluations that are completely anonymous. When implementing web-based peer assessment systems, both students and instructors will have obligations. The teachers often have a considerable impact on the outcomes of the usual classroom assessments (Liu, Li, &amp; Zhang, 2017). The finding of this study suggests that there is a wider gap between the evaluations that males and females have of themselves based on their own self-assessments and the evaluations that the lecturer has of them based on their own evaluations. One of the many possible explanations for this phenomenon is that individuals often have a more favourable perception of their own intellect than females. The aim of this article is to provide evidence on the role of the Peer Assessment Model with A Web Platform in participation and learning. A total of fifty reputable publications were searched out; however, only five were proved to have a high level of authenticity and relevancy with the topic.

THE EMPIRIC ANTIMICROBIAL THERAPY: THE COMPARISON OF INITIAL CHOICE WITH THE RESULTS OF MICROBIOLOGICAL INVESTIGATIONS. AN OBSERVATIONAL STUDY

Introduction: Hospital infections are serious medical problem, causing deterioration in patients’ outcome, prolonged hospital stay and increase costs of hospitalization. Rapid administration of wide spectrum antimicrobial agents is a well known way to increase patient survival rate. Aim: To analyze the efficacy of initial empiric antimicrobial treatment in a large academic hospital. Methods: In this retrospective cohort study, the initial choice of empiric therapy was compared with the results of the microbiological investigation and the susceptibility/resistance of isolated pathogens. Results: Between February 1, 2018 and February 1, 2020, a total number of 267 samples were analyzed. Amongst all 267 samples 163 (61%) were positive and 104 (39%) were negative. In those 163 samples 247 pathogens were isolated. In empirical therapy the most frequently administered antibiotic was meropenem (55/267, 20.6%), vancomycin (16/267, 6%), meropenem with vancomycin (14/267, 5.2%), ceftazidime (11/267, 4.1%), and imipenem/cilastatin (5/267, 1.9%). The total number of samples where the empiric therapy corresponded with the results of microbiological tests was 166. There were forty-seven (28.3%) Gram positive bacteria, including 11 MRSA and 1 VRE, and 119 (71.7%) Gram negative pathogens, including 35 K. pneumoniae ESBL+, 12 A. baumannii, and 2 E. coli ESBL+. In 81 cases, the isolated pathogens were resistant to empirically administered drugs. The empiric antimicrobial therapy complied with the results of microbiological analyses in 67.2% (166/247) of cases. Conclusion: In our center, meropenem and vancomycin seem to be a good choice in empiric therapy.

Critically ill severe hypothyroidism: a retrospective multicenter cohort study

BackgroundSevere hypothyroidism (SH) is a rare but life-threatening endocrine emergency. Only a few data are available on its management and outcomes of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management, and in-ICU and 6-month survival rates of these patients.MethodsWe conducted a retrospective, multicenter study over 18 years in 32 French ICUs. The local medical records of patients from each participating ICU were screened using the International Classification of Disease 10th revision. Inclusion criteria were the presence of biological hypothyroidism associated with at least one cardinal sign among alteration of consciousness, hypothermia and circulatory failure, and at least one SH-related organ failure.ResultsEighty-two patients were included in the study. Thyroiditis and thyroidectomy represented the main SH etiologies (29% and 19%, respectively), while hypothyroidism was unknown in 44 patients (54%) before ICU admission. The most frequent SH triggers were levothyroxine discontinuation (28%), sepsis (15%), and amiodarone-related hypothyroidism (11%). Clinical presentations included hypothermia (66%), hemodynamic failure (57%), and coma (52%). In-ICU and 6-month mortality rates were 26% and 39%, respectively. Multivariable analyses retained age > 70 years [odds ratio OR 6.01 (1.75–24.1)] Sequential Organ-Failure Assessment score cardiovascular component ≥ 2 [OR 11.1 (2.47–84.2)] and ventilation component ≥ 2 [OR 4.52 (1.27–18.6)] as being independently associated with in-ICU mortality.ConclusionsSH is a rare life-threatening emergency with various clinical presentations. Hemodynamic and respiratory failures are strongly associated with worse outcomes. The very high mortality prompts early diagnosis and rapid levothyroxine administration with close cardiac and hemodynamic monitoring.

Implementation of Intravenous Catheter Treatment to Prevent Phlebitis: A Cross-Sectional Study

Peripheral vein cannulation is commonly performed for rapid and accurate administration of medications. Phlebitis is the most common complication of intravenous catheter insertion. This study aims to investigate the implementation of intravenous catheter care to prevent phlebitis that was implied on a patient's cannulation conditions. This study was a cross sectional observational study conducted on patients at a hospital in Bali. Study conducted on 35 patients who were admitted to inpatient ward of the hospital in April 2022. The factors studied were age, gender, site of insertion, precision of dressing, dressing integrity, date on dressing, administration set integrity, date on administration set, and VIP score documentation. The results show that the mean age of the patient was 45.31 years old and 60% of the patients were men. 48,6% cannula was inserted in the movement area (wrist and ankle) while only 51,4% dressing was used properly so cannulation sites can be observed. All dressing were intact, dry and clean, but only 48.6% cannulation date documented on the dressing. Majority the administration sets were in good performance (94.3%) but there were only 31,4% with the installation date. The monitoring of peripheral vein cannulation using VIP score has not been widely applied (11,4%). Further intervention is needed to improve adherence to peripheral vein cannulation care so that phlebitis can be prevented optimally.

Performance of a System for Rapid Phenotypic Antimicrobial Susceptibility Testing of Gram-Negative Bacteria Directly from Positive Blood Culture Bottles.

The rapid administration of optimal antimicrobial treatment is paramount for the treatment of bloodstream infections (BSIs), and rapid antimicrobial susceptibility testing (AST) results are essential. Q-linea has developed the ASTar system, a rapid phenotypic AST device. Here, we report the performance of the ASTar BC G- (Gram-negative) kit when assessed according to the ISO 20776-2:2007 standard for performance evaluation of in vitro diagnostic AST devices. The evaluated ASTar BC G- kit uses a broad panel of 23 antimicrobials for the treatment of BSIs caused by Gram-negative fastidious and nonfastidious bacteria across a range of 6 to 14 2-fold dilutions, including cefoxitin as a screening agent for AmpC-producing Enterobacterales. The ASTar system processes blood culture samples to generate data on MICs and susceptible, intermediate, or resistant (SIR) category. The automated protocol includes concentration determination and concentration adjustment to enable a controlled inoculum, followed by broth microdilution (BMD) and microscopy performed continuously to generate MIC values within approximately 6 h once the test is run on the ASTar system. The performance of the ASTar system was assessed against the ISO 20776-2:2007 standard BMD reference method. Testing was performed across three sites, with results from 412 contrived blood cultures and 74 fresh clinical blood cultures. The ASTar system was also tested for reproducibility, with triplicate testing of 11 strains. The accuracy study comprised 8,650 data points of bacterium-antimicrobial tests. The ASTar system demonstrated an overall essential agreement (EA) of 95.8% (8,283/8,650) and a categorical agreement (CA) of 97.6% (8,433/8,639) compared to the reference BMD method. The overall rate of major discrepancies (MDs) was 0.9% (62/6,845), and that of very major discrepancies (VMDs) was 2.4% (30/1,239). This study shows that the ASTar system delivers reproducible results with overall EA and CA of >95%.

Comparative study on intravenous iron sucrose versus intravenous ferric carboxymaltose in the management of iron deficiency anaemia in pregnancy in a tertiary care hospital, Bengaluru

Background: Iron deficiency is the most common nutritional deficiency worldwide; it affects 1.6 billion people Iron deficiency (ID) and iron deficiency anemia (IDA) are often encountered in the general population, particularly among children and women with abnormal uterine bleeding (AUB) and during pregnancy as well as postpartum period Intravenous (IV) iron replacement can deliver the total amount of required iron over a short period. Currently, the most commonly used IV iron formulations are iron sucrose (IS) and ferric carboxymaltose (FCM) [4-6]. Iron sucrose does not require test dose and is safe. Ferric carboxymaltose (FCM) is the latest I.V. iron formulation which can be used at high doses and allows rapid administration (up to 1000 mg in a single dose infused in 15 minutes) The present study was a comparative study of parenteral iron therapy (intravenous iron sucrose versus intravenous ferric carboxymaltose in the management of iron deficiency anaemia in pregnancy.Methods: In the present study, 50 pregnant women with IDA were randomly distributed into two groups of 25 each. Group - A: 25 receiving intravenous iron sucrose therapy; Group - B: 25 receiving intravenous ferric carboxymaltose therapy.Results: Majority of the study participants in Group A had gestational age between 20–25 weeks (48%). The mean age of the study participants in Group A was found to be 22.86+4.42 weeks. Majority of the study participants in Group B had gestational age between 20-25 weeks (36%). The mean age of the study participants was found to be 23.01+3.01 weeks. Majority of the study participants in Group A had nil parity (40%). 36% of the study participants in Group B had nil parity. 60% of the study participants in group A had Mild degree of anaemia with 52% in group B having mild degree of anaemia. 40% and 44% of the study participants in group A and group B had Moderate degree of anaemia respectively. The association was found to be statistically significant between the mean Hb and Ferritin values pre-treatment, 3rd and 6th week follow-up post treatment and the 2 groups of study participants. The adverse effects were comparatively lower among Group B (IV ferric carboxymaltose) than Group A (IV iron sucrose) of the study participants.Conclusions: IV ferric carboxymaltose administration increases the hemoglobin level more rapidly as compared to iron sucrose in women with iron deficiency anemia in the pregnancy. It also stores iron more rapidly. No serious adverse effects were recorded. Ferric carboxymaltose is well tolerated, safe and effective alternative to iron sucrose in iron deficiency anemia of pregnancy. FCM has the advantage of a large dose administration per sitting and early rise in hemoglobin level.

Evaluation of Efficacy and Safety of Topical Nanoliposomal Amphotericin B 0.4% Gel as a Potential Treatment for Onychomycosis: An Interventional Pilot Clinical Study

Onychomycosis is a frequent fungal nail disease that is hard to treat and, in most cases, needs long‐term therapy with oral agents. Traditionally, oral agents are favored over topical agents, but it should not be overlooked that they come with broad adverse effects and concomitant drug interactions, which can be unsuitable for many individuals. Therefore, alternative approaches need to be addressed by the medical team for numerous cases. On the other hand, local administration of antimicrobials can come as advantageous because of having a more selective site of activity, avoiding off‐target systemic adverse effects, and rapid administration at the site of infection. In this study, we are evaluating a new topical delivery method of amphotericin B. To investigate the efficacy and safety of topical nanoliposomal amphotericin B 0.4% as a possible therapeutic option, this pilot, single‐group, before‐after clinical study was conducted on 15 onychomycosis patients. The evaluation was processed during 36 weeks of follow‐up and on three endpoints of week 12, week 24, and week 36, for both clinical and mycological responses. Three patients were excluded; of the remaining 12, 50% showed a complete cure, 16.66% had an effective clinical response, 16.66% had a partial clinical response, and 16.66% showed no response at week 12. Mycological cure was calculated as 50% at week 12. At week 24, our measurements were calculated as 91.66% for complete cure, 8.33% for no response, and 91.66% for mycological cure. One patient reported nail plate detachment at week 2 but continued the topical application; follow‐up between weeks 2 and 24 showed a complete cure and regrowth of healthy nails. No other adverse effects were detected. Overall, our study suggests that topical nanoliposomal amphotericin B 0.4% is an effective treatment, which is accessible, affordable, and user‐friendly, has minimum adverse effects, and could be regarded as an alternative treatment for those ineligible for systemic therapy. This trial is registered with IRCT20150101020514N18.