Tertiary Level Hospital Research Articles

Variation among venous thromboembolism risk assessment tools for postcesarean patients: a retrospective cohort study.

Venous thromboembolism (VTE) risk in pregnant women is four to five-fold higher than in nonpregnant women, and the risk of VTE is an additional four-fold higher after Cesarean section compared to normal vaginal delivery. Recommendations regarding anticoagulant prophylaxis are inconsistent across international guidelines, and VTE remains one of the leading causes of maternal morbidity and mortality. This study aimed to compare the need for postcesarean anticoagulation for VTE prophylaxis based on three major guidelines and our own institutional protocol. It was a retrospective cohort study that reviewed the medical records of patients who underwent a cesarean section at a tertiary-level care hospital in the United Arab Emirates (UAE). The need for anticoagulation was assessed using clinical tools from the American College of Obstetricians and Gynecologists (ACOG), Royal College Obstetricians and Gynecologists (RCOG), American College of Chest Physicians (ACCP), and the study site hospital protocol. A total of 1134 postcesarean women, aged 18-55 years, were included in the study. Most patients (87%) were at moderate risk for VTE. According to the study site hospital tool, 90.7% qualified for anticoagulant prophylaxis, while the ACOG, RCOG, and ACCP tools indicated that 0.5, 90.9, and 36.7% qualified, respectively. Enoxaparin was the primary anticoagulant used in 95% of cases. Only one patient developed VTE during the follow-up period. Anticoagulation needs assessment tools vary extensively in their estimations, highlighting the need for a uniform tool across multiple societies to establish a consistent standard of care and guide the development of evidence-based, site-specific protocols.

Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk

Sciatica is commonly caused by herniated lumbar disc and contributes to severe pain and prolonged disability. Although acupuncture is widely used by patients with chronic sciatica, the evidence of its efficacy is scarce. To investigate the efficacy and safety of acupuncture compared with sham acupuncture in patients with chronic sciatica from herniated disk. This was a multicenter 2-arm randomized clinical trial conducted in 6 tertiary-level hospitals in China of patients with chronic sciatica from herniated disk. Participants were recruited from March 25, 2021, to September 23, 2021, with a final follow-up through September 22, 2022. Data analyses were performed from December 2022 to March 2023. Participants were randomly assigned to receive 10 sessions of acupuncture (n = 110) or sham acupuncture (n = 110) over 4 weeks. Participants, outcome assessors, and statisticians were blinded. The 2 coprimary outcomes were changes in visual analog scale (VAS) for leg pain and Oswestry Disability Index (ODI) from baseline to week 4. Secondary outcomes were adverse events. A total of 216 patients (mean [SD] age, 51.3 [15.2] years; 147 females [68.1%] and 69 males [31.9%]) were included in the analyses. The VAS for leg pain decreased 30.8 mm in the acupuncture group and 14.9 mm in the sham acupuncture group at week 4 (mean difference, -16.0; 95% CI, -21.3 to -10.6; P < .001). The ODI decreased 13.0 points in the acupuncture group and 4.9 points in the sham acupuncture group at week 4 (mean difference, -8.1; 95% CI, -11.1 to -5.1; P < .001). For both VAS and ODI, the between-group difference became apparent starting in week 2 (mean difference, -7.8; 95% CI, -13.0 to -2.5; P = .004 and -5.3; 95% CI, -8.4 to -2.3; P = .001, respectively) and persisted through week 52 (mean difference, -10.8; [95% CI, -16.3 to -5.2; P < .001; and -4.8; 95% CI, -7.8 to -1.7; P = .003, respectively). No serious adverse events occurred. This randomized clinical trial found that in patients with chronic sciatica from herniated disk, acupuncture resulted in less pain and better function compared with sham acupuncture at week 4, and these benefits persisted through week 52. Acupuncture should be considered as a potential treatment option for patients with chronic sciatica from a herniated disk. Chictr.org Identifier: ChiCTR2100044585.

Short-term Clinical Outcomes of COVID-19 Patients Hospitalized with Chronic Obstructive Pulmonary Disease and Asthma in Three Tertiary Level Hospitals in Bangladesh

Background: Several comorbidities including chronic obstructive pulmonary disease (COPD) or bronchial asthma have been found associated with COVID-19 cases. But it remains unclear which of the comorbidities are associated with worse outcomes of the patients. Objectives: This study was carried out to determine the clinical outcomes of hospitalized COVID-19 patients with COPD or asthma. Methodology: This prospective study was carried out at Respiratory Medicine unit of Monno Medical College and Hospital, Manikganj, from April 2020 to December 2022. Admitted COVID-19 patients, suffering from COPD or bronchial asthma, were enrolled purposively upon fulfilling the inclusion and exclusion criteria. The patients were divided into two groups with associated comorbidities: Group A suffering from COPD and Group B suffering from Asthma. Data were collected from the patients on variables of interest using a semi-structured questionnaire. Results: Among the 144 enrolled patients, 96(66.67%) in group A were suffering from COPD and the other 48 (33.33%) in group B had bronchial asthma. In this study, 41(42.7%) patients in Group A exhibited &gt;25% lung field involvement in the high-resolution computed tomography (CT) chest imaging, compared to only 10(20.8%) in COVID-19 patients in Group B, and this difference in distribution was statistically significant (p=0.026). The COVID-19 patients in Group A were more severe to critically ill (45, 46.9%), compared to patients in Group B (12, 25.0%) with a p value of 0.011. Group A study subjects required intensive care unit (ICU) admission (49, 51.0%) more than the group B participants (16, 33.3%), which was also found statistically significant (p&lt;0.05). Nearly one-fifth (17, 17.7%) of the patients died among the Group A, compared to only 2(4.2%) mortality observed in Group B (p=0.024). The COVID-19 patients with COPD were found significantly associated with the risk of &gt;25% lung field involvement, severe to critical illness, ICU admission, invasive mechanical ventilation, and death (all p values &lt;0.05). Conclusion: The comorbidity of COPD was found to increase the risk of disease severity and adverse outcomes in COVID-19patients significantly. It also heightened the risk of lung field involvement, exceeding 25% more severe disease and increased mortality rates compared to individuals with bronchial asthma. Journal of Monno Medical College December, 2023; 9 (2):47-52

Knowledge on Risk Factors of Coronary Heart Diseases Among Diabetic Patient Attending at a Tertiary Level Hospital in Bangladesh

Knowledge on Risk Factors of Coronary Heart Diseases Among Diabetic Patient Attending at a Tertiary Level Hospital in Bangladesh

Elevated Cardiac Troponin Levels as a Predictor of Increased Mortality Risk in Non-Cardiac Critically Ill Patients Admitted to a Medical Intensive Care Unit.

Background: Cardiac troponin I (TnI) is a specific marker of myocardial damage used in the diagnosis of acute coronary syndrome (ACS). TnI levels can also be elevated in patients without ACS, which is linked to a worse prognosis and mortality. We evaluated the clinical implications and prognostic significance of serum TnI levels in critically ill non-cardiac patients admitted to the intensive care unit (ICU) at a tertiary-level hospital. Materials and Methods: A three-year retrospective study including the years 2017-2020 was conducted to evaluate in-hospital mortality during ICU stay and mortality rates at 28 and 90 days, as well as one and two years after admission, in 557 patients admitted to the medical ICU for non-cardiac causes. Results: TnI levels were elevated in 206 (36.9%) patients. Patients with elevated TnI levels were significantly older and had higher rates of comorbidities, including chronic heart failure, coronary heart disease, and chronic kidney disease (p < 0.05 for all). Patients with elevated TnI levels required more invasive mechanical ventilation, vasopressor infusion, and dialysis in the ICU and experienced more shock within the first 72 h (p = 0.001 for all). High TnI levels were associated with higher Acute Physiological and Chronic Health Evaluation (APACHE) II (27.6 vs. 20.3, p = 0.001) and Sequential Organ Failure assessment (8.8 vs. 5.26, p = 0.001) scores. Elevated TnI levels were associated with higher mortality rates at 28 days (58.3% vs. 19.4%), 90 days (69.9% vs. 35.0%), one year (78.6% vs. 46.2%), and two years (82.5% vs. 55.6%) (p < 0.001 for all). Univariate logistic regression analysis revealed that high TnI levels were a strong independent predictor of mortality at all time points: 28 days (OR = 1.2, 95% CI: 1.108-1.3, p < 0.001), 90 days (OR = 1.207, 95% CI: 1.095-1.33, p = 0.001), one year (OR = 1.164, 95% CI: 1.059-1.28, p = 0.002), and two year (OR = 1.119, 95% CI: 1.026-1.22, p = 0.011). Multivariate analysis revealed that age, albumin level, APACHE II score, and requirements for dialysis and vasopressor use in the ICU were important predictors of mortality across all timeframes, but elevated TnI levels were not. Conclusions: Elevated TnI levels in critically ill non-cardiac patients are markers of disease severity. While elevated TnI levels were significant predictors of mortality in the univariate analysis, they lost significance in the multivariate model when adjusted for other factors. Patients with elevated TnI levels had higher mortality rates across all timeframes, from 28 days to two years.

Association of Family-Centered Care With Psychological Distress Among Caregivers of Children With Cancer at a Tertiary-Level Hospital in Ethiopia: Cross-Sectional Study.

Psychological distress (PD) is a common mental health problem faced by caregivers of children with cancer. The involvement of families in childcare was found to be associated with lower levels of distress. The study aims to determine the associations between family-centered care (FCC) and PD among caregivers of children with cancer receiving treatment at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. An institution-based, cross-sectional study was conducted from June to December 2022. Caregivers of children with cancer aged 0-14 years receiving cancer treatment at the pediatric oncology unit completed a face-to-face, interviewer-administered, structured questionnaire during a routine inpatient or outpatient visit. The questionnaire included questions on the characteristics of the child and caregiver, PD (measured by the Kessler Psychological Distress Scale [K10]), FCC (measured by the Measure of Processes of Care [MPOC-20]), and social support (measured by the Oslo-3 Social Support Scale [OSS-3]). Data were collected using the Kobo toolbox and exported to SPSS (version 26; IBM Corp) for cleaning and analysis. A multivariable logistic regression model was used. An odds ratio with a 95% CI was calculated, and a P value less than .05 was considered statistically significant. A total of 384 caregivers of children with cancer participated in the study. The total PD score ranged from 10 to 50, with a mean score of 17.30 (SD 8.96; 95% CI 16.84-18.60). The proportion of caregivers found to have mild, moderate, and severe levels of PD was 43 (11.2%), 35 (9.1%), and 51 (13.3%), respectively. The overall prevalence of mild to severe PD symptoms was 33.6% (95% CI 28.9%-38.3%). A statistically significant negative association was found between FCC and PD (adjusted odds ratio [AOR] 0.68, 95% CI 0.53-0.86). In addition, having no formal education (AOR 2.87, 95% CI 1.28-6.45), having a history of relapse (AOR 3.24, 95% CI 1.17-9.02), beginning cancer treatment at TASH (AOR 2.82, 95% CI 1.4-4.85), beginning treatment within the last 3 months (AOR 3.99, 95% CI 1.73-9.23), and beginning treatment within the last 4 to 18 months (AOR 2.68, 95% CI 1.25-5.76) were significantly associated with higher level of PD. A total of 1 in 3 caregivers have reported PD. FCC was found to be protective of PD. The finding of this study suggests the need for FCC intervention to improve the mental health condition of caregivers. In addition, the intervention needs to consider the educational status of the caregivers, the time since the cancer diagnosis, and the history of relapse.

Factors influencing medication errors among nurses at a tertiary level hospital in Bangladesh

Medication errors represent a significant global issue, leading to numerous fatalities each year and adding complexity to healthcare systems. In Bangladesh, the prevalence of medication errors stands at 38%. This study aimed to identify the factors that influence medication errors among nurses at a tertiary-level hospital in the country. A descriptive cross-sectional study was conducted involving 114 registered nurses at Dhaka Medical College Hospital, utilizing a convenience sampling method. Data were gathered through face-to-face interviews using a structured questionnaire and analyzed using both descriptive and inferential statistics. The findings indicated that nurses in Bangladesh exhibited moderate to high susceptibility to medication errors in a tertiary-level setting. Key factors identified as contributing to these errors included inadequate staffing levels (4.41 ± 0.81), patients being off the ward for other care (4.39 ± 0.74), communication issues between nurses and physicians (4.36 ± 0.95), nurses being pulled between teams and other units (4.32 ± 0.77), and insufficient in-service training on new medications (4.23 ± 0.87). Moreover, nurses working ward (F=11.51, P=.001) and working experience (t=4.13, P=.041) had a significant relationship with factors influencing medication errors. The research found several variables that cause medication mistakes, including nurses' service experience and working ward. This study's results might help hospital administrators establish effective intervention methods and mitigate medication error risk variables to improve patient safety and care. Asian J. Med. Biol. Res. 2024, 10(4), 131-140

Evaluation of Postoperative Electrolyte Imbalance of Oral Squamous Cell Carcinoma Patients: A Study in a Tertiary Level Hospital

This cross-sectional observational study was performed to evaluate the post-operative electrolyte imbalance in oral squamous cell Carcinoma patients, and it was conducted at the Department of Oral &amp; Maxillofacial Surgery in Dhaka Dental College &amp; Hospital, Dhaka, Bangladesh during June 2022 to June 2023. A total of 100 patients who were clinically and histo-pathologically diagnosed as OSCC patients were enrolled in this study. The collected data were edited, coded processed for computer data entry. The data were analyzed using Statistical Package for Social Sciences (SPSS) software, version-23.0. Descriptive analysis was performed and the results were presented as tables and graphs. Unpaired t tests, Chi-square, Spearman’s rho correlation tests were performed to compare the mean and ratio correlation of the study variables where P&lt;0.05 with 95%CI. The ethical clearance of this study was obtained from the Ethics Committee of Department of Oral &amp; Maxillofacial Surgery in Dhaka Dental College &amp; Hospital, Dhaka, Bangladesh. A total of 100 oral squamous cell carcinoma (OSCS) patients were enrolled in this study. The mean age of the patients was 56.63 ± 9.54 years. The mean BMI of the patients was 18.20 ± 0.60 kg/m2. The majority of the patients were male and it was 54% while female was 46%. 64% patients belonged to lower socio-economic class. 52% patients had the habit of betel nut which was the highest while 39 % had the habit of betel nut with tobacco. The majority, 32% of patients had Stage-I. The mean surgery duration was 5.45± 0:91 hours and 7.2±: 0:15 minutes. The mean blood required for the surgery 1.44±0.68 units. According to the distribution of the post-operative variations of electrolyte imbalances, Sodium (Na+) was observed, hypo 25(25%) and hyper0(0%) on day-1 and hypo 31(31%), and hyper 4(4%) was observed on day 3 and followed by Potassium (K+) hypo 5(5%) and hyper 2(2%) on day- 1 and hypo 7(7%) and, hyper2(25) on day- 3. In comparison of ratio between hypo and hyper of day1 and day-3, showed statistically significant relationship observed (p&lt;0.05). According to postoperative electrolyte distribution, on day-1, mean Sodium (Na+) was observed 136.68±2.69 mmol/L whereas on day-3, mean Sodium (Na+) was observed 133.81±4.21 mmol/Land followed by on day-1 mean Potassium (K+),3.86±0.46mmol/L, day-3, mean Potassium (K+),3.74 ±0.45 mmol/L on day-1. Among the postoperative electrolyte, except, Potassium (K+), all were observed statistically significant (P&lt;0.05). In conclusion, hypocalcaemia, hyponatremia, and hypomagnesaemia are the relatively common after maxillofacial surgeries. Beside this BMI could affect electrolyte abnormalities after maxillofacial surgery.

Doctor interaction behavior, patient participation in value co-creation and patient satisfaction: cross-sectional survey in a tertiary-level hospital from Guangzhou, China

Value co-creation can be defined as the joint benefit that is created by patients and medical service providers through the integration of their respective resources. Participation and interaction between doctors and patients can generate an outcome that benefits both sides. Relevant studies of value co-creation in the healthcare field are limited. This study established hypotheses to explore the association between doctor interaction behavior, patient participation in value co-creation, and patient satisfaction. A cross-sectional survey was conducted with 637 patients (outpatients and inpatients) at a tertiary-level hospital in Guangzhou, China. The analysis result indicated that doctor interaction behavior could stimulate patient participation in value co-creation then increase patient satisfaction. The standardized total effect, direct effect, and indirect effect were 0.641 (95%CI: 0.055 ~ 0.067), 0.546 (95%CI: 0.044 ~ 0.059), and 0.095 (95%CI: 0.032 ~ 0.166), respectively. Patient participation in value co-creation mediated the relationship between doctor interaction behavior and patient satisfaction. Among the different dimensions of doctor interaction behavior, access, risk assessment and transparency dimensions were associated with positive patient participation in value co-creation. During the treatment process, doctor interaction and patient participation can get satisfying results.

A-039 Parathyroid Hormone and Vitamin D Follow an Inversely Correlated Serum Level

Abstract Background Parathyroid hormone (PTH) is a polypeptide responsible for regulating the physiological level of serum calcium through a complex homeostatic process closely associated with bone metabolism. In response to a decreased serum concentration of calcium, PTH level is increased leading to the elevation of calcium via bone resorption. Furthermore, Vitamin D (Vit-D) is a critical component of the endocrine system that also contributes to calcium homeostasis. Vit-D increases the level of serum calcium by stimulating intestinal absorption and renal reabsorption. Vit-D impacts the serum level of PTH by two distinct mechanisms. First indirectly, an increase in serum concentration of calcium, caused by Vit-D-mediated intestinal absorption and renal reabsorption disengages the process of PTH release through interaction with calcium-sensing receptors on parathyroid cells. Secondly, Vit-D directly interacts with parathyroid cells resulting in a reduced expression of PTH. Taken together, Vit-D is assumed to negatively impact the serum level of PTH. This study examined the homeostatic correlation between the circulating concentrations of Vit-D and PTH. Methods Retrospective serum concentrations of PTH and Vit-D were retrieved from the biochemical profiles of hospitalized and ambulatory patients who presented to or admitted at the tertiary care level hospital of University of Texas Southwestern Medical Center during the period between July-to-September of 2021. Correlation analysis between Vit-D and PTH was performed using GraphPad-PRISM-version-8. Results A total of 163 corresponding serum Vit-D and PTH values were obtained. Vit-D and PTH values displayed an inverse correlation (Figure 1). Pearson r values for linear and logarithmic trendlines (-0.6745 and -0.785, respectively) demonstrated a negative correlation between Vit-D and PTH. Conclusions Measuring Vit-D and PTH levels are critically important for assessing the homeostatic status of calcium. PTH level maintains an inverse relationship with Vit-D. Therefore, therapeutic targeting of Vit-D or PTH would mutually affect their concentration eventually reflected in calcium homeostasis.

The pressure injury prevalence and practice improvements (PIPPI) study: A multiple methods evaluation of pressure injury prevention practices in an acute-care hospital.

Pressure injuries are a significant problem for immobile patients in acute care and can have a profound impact on patients' health and well-being, putting pressure on healthcare systems and strain on the healthcare economy. Nurses play a pivotal role in preventing pressure injuries. A study using multiple methods was conducted to explore pressure injury prevention practices in four inpatient units within a tertiary-level Australian Hospital. Quantitative and qualitative methods were used to gather data across a 9-month period. Observations, audits, surveys and interviews were used to collect data across five time points. Statistical analysis of the quantitative data was undertaken, and thematic analysis was used to analyse qualitative data. Data were integrated using a realist evaluation framework. Ethical approval for the study was granted. The quantitative results demonstrated significant reductions in pressure injury prevalence from 11.5% at commencement to 4.8% at completion of the study. Hospital-acquired pressure injuries also reduced from 4.6% to 1.9%. These results were achieved even though nursing knowledge and attitudes did not increase during the study period. Three qualitative themes were identified: Making Nursing Care Visible, Understanding the 'Why' and Engagement is Key. This study demonstrates that pressure injuries can be prevented with improvements in nursing care processes. Nurses' knowledge and attitudes towards pressure injury prevention did not change throughout this study and further research is required on how nurses' knowledge and attitudes contribute towards pressure injury prevention practices.

Antimicrobial resistance profiles of and associated risk factors for Pseudomonas aeruginosa nosocomial infection among patients at two tertiary healthcare facilities in Lusaka and Copperbelt Provinces, Zambia.

Antimicrobial resistance (AMR) of pathogens such as Pseudomonas aeruginosa is among the top 10 threats to global health. However, clinical and molecular data are scarce in Zambia. We, therefore, evaluated the AMR profiles of P. aeruginosa nosocomial infections (NIs). A year-long hospital-based cross-sectional study was conducted at two large tertiary-level hospitals in Zambia. Patients with current or previous hospital contact were screened for NIs. The current study focused on patients diagnosed with P. aeruginosa NIs. Clinical specimens were collected for bacteriological culture, and PCR amplification of 16S rRNA gene fragments was performed on pure isolates. Hospital or NIs were defined as infections that arise during hospitalization, occurring at least 48 h after admission. The Kirby-Bauer's disk diffusion method was used to evaluate antibiotic resistance patterns. The association between AMR and risk factors was analysed using the χ2 test. Eight hundred and forty-one patients were screened, and clinical specimens were collected and analysed. Of them, 116 (13.7%) were diagnosed with P. aeruginosa NIs. The participants' ages ranged from 15 to 98 years, with a mean of 51 (SD ± 18). Catheter-associated urinary tract infections (57%) were the most common, followed by pressure sores (38.7%). P. aeruginosa isolates were primarily susceptible to amikacin, which had the highest resistance to FEP. We observed a high prevalence of multidrug resistance (73.6%). The AMR was associated with carbapenem-hydrolysing β-lactamase gene blaOXA-51 and surgical care. This study has demonstrated that multidrug-resistant P. aeruginosa is prevalent in hospitals in Zambia's Lusaka and Ndola districts and possibly countrywide.

Association between Serum Vitamin D Level and Parkinson’s Disease: Case Control Study in a Tertiary Level Hospital, Bangladesh

Background: Parkinson's disease is a neurodegenerative disorder that is frequently observed in individuals who are 50 years of age or older. The etiology of this disease is still unknown, but research has shown the influence of factors like vitamin D acting as a hormone in Parkinson's disease. The current study aimed to explore the association between serum vitamin D levels and Parkinson's disease. Methods: In 2019 to 2020, the current researchers conducted this case control study on 50 patients with Parkinson’s disease and 50 healthy subjects as the control group in the department of Neurology of Sir Salimullah Medical College &amp; Mitford Hospital, Dhaka, Bangladesh. Demographic information (age, gender, and education), serum levels of vitamin D in the two groups, disease duration, disease severity, and cardinal features of the disease in the patient group were investigated. Data were analyzed using the SPSS 23 software with the t-test, Kruskal Wallis, Mann-Whitney, and adjusted logistic regression. Results: The mean age of cases was 72.30 ±454 and the control group had a mean age of 60.08±8.305. Regarding the symptoms of the cases tremor 30 (60%), rigidity 5 (10%), bradykinesia 12 (24%) and postural instability 3 (6%) and regarding disease duration (y) &lt;5 years-26 (52%), 5 to 10 years-17 (34%), &gt;10years 7 (14%) and disease severity 1 to 2.5 – 26 (52%) , 2.5-to-3 -18 (36%) and &gt;3 – 6 (12%) Serum vitamin D levels of males were 17.70±6.06 ng/mL in patients and 30.31±5.59ng/mL in control groups, respectively which is clinically significant. Serum vitamin D levels of females were 20.03±5.75ng/mL in patients and 28.53±6.31ng/mL in control groups, respectively, which is clinically significant (P = 0.001). For the participants under 60 years of age, the mean serum vitamin D levels were 27.70±0.00 ng/mL and 30.78±5.44 ng/mL in patient and control groups, respectively. In participants aged 60 and older, the mean serum vitamin D levels were 18.40±5.91 ng/mL and 28.13±6.26 ng/mL in patient and control groups, respectively. These differences were statistically significant (P=0.001).Logistic regression analysis with adjusted demographic variables showed that the observed lower levels of serum vitamin D in cases compared with the control group was statistically significant(OR=4.17;95% CI:1.37,12.71;P=0.012). Conclusion: There was a significant relationship between low serum vitamin D and Parkinson’s disease. Bangladesh J Medicine 2024; 35: 180-186

Association of corticosteroid therapy with reduced acute kidney injury and lower NET markers in severe COVID-19: an observational study

BackgroundAcute kidney injury (AKI) is common in critical cases of coronavirus disease 2019 (COVID-19) and associated with worse outcome. Dysregulated neutrophil extracellular trap (NET) formation is one of several suggested pathophysiological mechanisms involved in the development of COVID-19 associated AKI. The corticosteroid dexamethasone was implemented as a standard treatment for severe COVID-19 as of June 2020. A sub-analysis of a prospective observational single center study was performed to evaluate the effect of corticosteroid treatment on AKI development and NET markers in critical cases of COVID-19.ResultsTwo hundred and ten adult patients admitted to intensive care at a tertiary level hospital due to respiratory failure or shock secondary to SARS-CoV-2-infection between March 13th 2020 and January 14th 2021 were included in the study. Ninety-seven of those did not receive corticosteroids. One hundred and thirteen patients were treated with corticosteroids [dexamethasone (n = 98) or equivalent treatment (n = 15)], but the incidence of AKI was assessed only in patients that received corticosteroids before any registered renal dysfunction (n = 63). Corticosteroids were associated with a lower incidence of AKI (19% vs 55.8%, p < 0.001). Fewer patients demonstrated detectable concentrations of extracellular histones in plasma when treated with corticosteroids (8.7% vs 43.1%; p < 0.001). Extracellular histones and in particular non-proteolyzed histones were observed more frequently with increasing AKI severity (p < 0.001). MPO-DNA was found in lower concentrations in patients that received corticosteroids before established renal dysfunction (p = 0.03) and was found in higher concentrations in patients with AKI stage 3 (p = 0.03). Corticosteroids did not ameliorate established AKI during the first week of treatment.ConclusionCorticosteroid treatment in severe COVID-19 is associated with a lower incidence of AKI and reduced concentrations of NET markers in plasma.

The Model for End-Stage Liver Disease (MELD) Score Predicting Mortality Due to SARS-CoV-2 in Mexican Patients.

Background/Objectives: Coronavirus Disease 2019 (COVID-19) can cause liver injury and a deterioration of hepatic function. The Model for End-Stage Liver Disease (MELD) score is a good predictor for poor prognosis of hospitalized COVID-19 patients in the United States, Egypt and Turkey. Nevertheless, the best cut-off value for the MELD score to predict mortality in the Mexican population has yet to be established. Methods: A total of 234 patients with COVID-19 were studied in a tertiary-level hospital. Patients were stratified into survivors (n = 139) and non-survivors (n = 95). Receiver operating characteristic curves, Cox proportional hazard models, Kaplan-Meier method, and Bonferroni corrections were performed to identify the predictors of COVID-19 mortality. Results: MELD score had an area under the curve of 0.62 (95% CI: 0.56-0.68; p = 0.0009), sensitivity = 53.68%, and specificity = 73.38%. Univariate Cox proportional hazard regression analysis suggested that the leukocytes > 10.6, neutrophils > 8.42, neutrophil-to-lymphocyte ratio (NLR) > 8.69, systemic immune-inflammation index (SII) > 1809.21, MELD score > 9, and leukocyte glucose index (LGI) > 2.41 were predictors for mortality. However, the multivariate Cox proportional hazard model revealed that only the MELD score >9 (Hazard Ratio [HR] = 1.83; 95% confidence interval [CI]: 1.2-2.8; Pcorrected = 0.03) was an independent predictor for mortality of COVID-19. Conclusions: Although the MELD score is used for liver transplantation, we suggest that a MELD score >9 could be an accurate predictor for COVID-19 mortality at admission to ICU requiring mechanical ventilation.

A Comparative Analysis of International Classification Systems to Predict the Risk of Collapse in Single-Level Osteoporotic Vertebral Fractures.

Various classifications for osteoporotic vertebral fractures (OVFs) have been introduced to enhance patient care and facilitate clinical communication. However, there is limited evidence of their effectiveness in predicting vertebral collapse, and very few studies have compared this association across different classification systems. This study aims to investigate the association between OVF categories, according to the most widely used classification systems, and vertebral collapse. A retrospective single-center study was conducted involving patients diagnosed with acute OVFs at the emergency department of a tertiary-level academic hospital with a minimum follow-up of 6 months. Vertebral fractures were independently classified by two radiologists according to several classification systems, including those proposed by Genant, Sugita, the German Society for Orthopedics and Trauma (DGOU), and the AO Spine. Associations between vertebral collapse and OVF classification systems were analyzed using bivariate and logistic regression analyses. This study included 208 patients (82.7% females; mean age of 72.6 ± 9.2 years). The median follow-up time was 15 months, with L1 being the most common fracture site (47.6%). The most frequent OVF types observed, according to Genant's morphological, Genant's quantitative, Sugita 's, DGOU's, and AO Spine's classifications, were biconcave (50%), grade 0.5 (47.6%), bow-shaped (61.5%), OF2 (74%), and A1 (61.5%), respectively. All classifications, except for Genant's quantitative system, were significantly associated with vertebral collapse in bivariate analyses. Logistic regression analyses showed a significant association (p = 0.002) between the AO Spine classification and vertebral collapse, with 85.7% of A4 fractures developing collapse on follow-up. The AO Spine classification showed the highest predictive capacity for vertebral collapse. Specifically, A4 fracture types showed a very high risk of vertebral collapse, confirming the need for non-conservative management of these fractures. Further multicentric and prospective studies are warranted to confirm these findings.

The mediating and moderating role of nursing information competence between nurses’ creative self-efficacy and innovation behavior in a specialized oncology hospital

ObjectiveThis study aims to examine the impact of nurses’ nursing information competence on their creative self-efficacy and innovation behavior, and to investigate its role as a mediating factor between these two elements.MethodsA survey was conducted from July to September 2023 involving 1,200 nurses from two tertiary-level oncology specialty hospitals in Beijing, selected through convenience sampling. Instruments used included the Creative Self-Efficacy Scale, Nursing Information Competence Assessment Scale, and Nurses’ Innovative Behavior Scale. Data analysis was conducted using SPSS 25.0 and R 4.1.2; AMOS26 was used to construct structural equation models and Bootstrap method was used to test the mediating hypotheses.ResultsOut of the distributed questionnaires, 1,166 were valid, yielding an effective response rate of 97.16%. Pearson correlation analysis revealed significant correlations between innovation self-efficacy, nursing information competence, and nurses’ innovative behaviors (P < 0.001). The Bootstrap method indicated that nursing information competence serves as a mediating factor in the relationship between creative self-efficacy and innovative behaviors, contributing to 24.5% of the observed effect. Additionally, regression analysis suggested that nursing information competence moderates the relationship between creative self-efficacy and innovation behavior.ConclusionThe findings suggest that nursing information competence not only mediates but also moderates the relationship between creative self-efficacy and innovative behavior. Enhancing nurses’ information competence could therefore foster creative self-efficacy, leading to an increase in innovative behavior and, subsequently, improvements in the quality of oncology nursing care.

Frequency of Carbapenem Resistance in UTI Patients in a Tertiary Level Hospital

Background: Urinary tract infections (UTIs) remain the common infections diagnosed in outpatients as well as hospitalized patients. Current knowledge on antimicrobial susceptibility pattern is essential for appropriate therapy. Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria may not be detected by routine disk diffusion susceptibility test, leading to inappropriate use of antibiotics and treatment failure. The aim of this study was to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from patients with community acquired urinary tract infections (UTIs) at Comilla Medical College Hospital, Comilla as well as identification of ESBL producers in the population of different uropathogens. Objectives: To obseve the frequency of carbapenem resistance in UTI patients in a tertiary level hospital. Methods: This cross sectional observational study was done on inpatients and outpatients department of Comilla Medical College Hospital, Comilla in 6 months’ period. Formal ethical approval was taken before commencement of the study. Adult patients presenting with features of UTI were approached and finally selected in accordance to selection criteria. Convenience sampling technique was applied to enroll the total 100 study population. Following describing the purpose, methods and benefits of study written consent was taken from each patient. All patients were subjected to detail history, clinical examination and relevant investigation. Value of clinical investigations were noted on questionnaire. Following data collection, all were verified and prepared for data entry. Final analysis was done by using SPSS version 19. Results: Out of 100 patients attending in Comilla Medical College Hospital with symptoms suggestive of UTI, 31% had culture positive. Our study showed a high prevalence of UTI in females (61%) than in males (39%). Most common symptom was urgency (88%) followed by abdominal pain (77%), dysuria (67%) and ........

Seroprevalence of Transfusion Transmitted Infection among Blood Donor at a Tertiary Level Hospital of Bangladesh: One Year Retrospective Study

Background: A transfusion transmitted infection (TTI) is an infection that is transmitted from person to person through parental administration of blood and blood products. The magnitude of transfusion transmitted infection (TTI) varies from country to country depending on TTI’s load in that particular population. Measuring their severity their severity WHO (World Health Organization) has recommended pre transfusion blood test for Human Immunodeficiency virus (HIV), Hepatitis B Virus (HBV), Hepatitis C virus (HCV) and Syphilis as mandatory. The aim of the study was to assess the trend and prevalence of TTI among blood donors in BRB Hospitals Limited. Method: A retrospective cross-sectional study was conducted by reviewing the record from 2022 to 2023 at BRB hospitals limited Transfusion Medicine department. All blood donors who presented to the blood bank and screened for TTI during study period were included. Data was collected, entered and analyzed using Microsoft Excel 2007. The descriptive statistics were determined in means of percentage. Chi- square was used for trend analysis and p-value was used to declare the statistical significance between variable. Result: The study included a total of 5074 donors-4,920 (97%) male and 154 (3%) female. Of them 3,840 (76.3%) were directed donor while 1,204 (23.7%) were replacement donor. An overall TTI prevalence rate of 0.95%. The prevalence of HBV, HCV, HIV and Syphilis was 0.5%, 0.1%, 0.07% and 0.2%. Conclusion: Methods to ensure a safety blood supply should be encountered. For that screening with a better selection of donor and used of screening tests including nucleic acid testing technology should be implemented.

Needs for discharge planning and facilitators-barriers to implementing discharge plans for patients with SLE: A qualitative study

Objective To investigate the needs of patients with SLE in terms of discharge planning, to outline the practical perspectives of clinical healthcare professionals regarding the enablers and impediments to SLE patients’ discharge planning, and to establish a basis for the creation of SLE discharge plans for subsequently diagnosed patients. Methods Descriptive qualitative research methodology was used in this study, with the researcher herself as the research instrument. Healthcare professionals formally employed in the rheumatology and immunology department, as well as SLE patients admitted to a tertiary-level hospital in Anhui Province between August and December 2023, were chosen for the study using a purposeful sample technique. In-person, semi-structured in-depth interviews were carried out, and used thematic analysis to analyze the interview data and distil themes. Result A total of 17 patients and 13 healthcare professionals were interviewed. Five themes and sixteen sub-themes in all were extracted: ①the needs of SLE patients for discharge planning; ②the present state of discharge planning implementation; ③factors conducive to the implementation of discharge planning; ④factors hindering the implementation of discharge planning; ⑤recommendations for implementing of discharge planning. Conclusion Planning for the discharge of SLE patients is essential, and in order to support patients’ successful discharge, management should strengthen training, thoroughly evaluate the needs of SLE patients, and create customized discharge plans.