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   2021| October-December  | Volume 11 | Issue 4  
    Online since December 18, 2021

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The burden and characteristics of nosocomial infections in an intensive care unit: A cross-sectional study of clinical and nonclinical samples at a tertiary hospital of Nepal
Manisha Karn, Dipak Bhargava, Binod Dhungel, Megha Raj Banjara, Komal Raj Rijal, Prakash Ghimire
October-December 2021, 11(4):236-245
Background: Patients at intensive care units (ICUs) are vulnerable to acquiring nosocomial infections. The main objective of this study was to explore and characterize the burden of nosocomial infections from an ICU of National Medical College and Teaching Hospital (NMCTH), Birgunj, Nepal. Methods: A prospective hospital-based study was conducted between April and December 2018 at NMCTH, Birgunj, Province 2, of Nepal. A total of 374 specimens including clinical specimens (n = 190) from patients admitted in an ICU and animate and inanimate environmental samples (n = 184) from the ICU were collected. Collected specimens were cultured in specific microbiological media, and microbial isolates were identified and subjected to antibiotic susceptibility test. Results: Altogether, 374 specimens (190 clinical specimens and 184 nonclinical) of an ICU were analyzed. Out of 190 clinical specimens, 51% (97/190) showed bacterial growth. Isolated bacteria were Staphylococcus aureus (33%; 32/97), Escherichia coli (20.6%; 20/97), Klebsiella spp. (15.5%; 15/97), Pseudomonas spp. (11.3%; 11/97), and Acinetobacter spp. (11.3%; 11/97). Out of 184 nonclinical specimens, 51.6% (95/184) of the samples showed microbial growth. Among the isolates, Klebsiella spp. predominated (30.6%; 26/85) the growth, followed by S. aureus (22.4%; 19/85), Acinetobacter spp. (21.2%; 18/85), and Pseudomonas spp. (17.6%; 15/85). Among all clinical and nonclinical isolates, 61.9% (60/97) of the clinical specimens and 65.9% (56/85) of the nonclinical specimens showed multidrug resistance (MDR). Conclusion: Two-thirds of the specimens from both clinical and nonclinical specimens showed MDR. Urgent actions are required to address the augmented rate of nosocomial infections and MDR bacteria among ICUs in Nepal.
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Epidemiology and factors associated with all-terrain vehicle accidents in children: A retrospective cross-sectional study of a trauma registry in Saudi Arabia
Mohammed Al Mutari, Bushra Alasmari, Lama Aldosari, Rahaf Alluhaidan, Reham Aljohani, Shahd Omar Hijazi, Fatmah Othman
October-December 2021, 11(4):191-197
Background: All-terrain vehicle (ATV) accidents have a substantial impact on the pediatric population in Saudi Arabia; however, few local studies are available. An in-depth study of this issue and adequate implementation of regulations are required to prevent additional casualties. The aim of this study was to describe the epidemiology of ATV injuries in the pediatric population and the outcomes associated with the injuries. Methods: We conducted a retrospective chart review at a Level 1 trauma center in Riyadh. All patients, aged ≤14 years and admitted due to an ATV accident, from 2004 to 2018 were included in this study. Demographic information, hospital course, and injury outcomes were extracted from the King Abdulaziz Medical City trauma registry. Each medical record was reviewed for short-term complications and the mechanism of injury. The primary outcome measure was the type of injury associated with ATV accidents; the secondary outcomes were injury site and mechanism of injury, and the association between the impact of injury and the clinical and demographic variable. Results: In total, 165 patients were involved in ATV accidents and met our inclusion criteria. The mean age was 8 ± 4 years, and 79% (131/165) were boys. Over 50% (84/165) of the sample had lower limb injuries. The majority of patients had fracture injuries (37%, 61/165), followed by amputations (30%, 50/165). Of the amputation group, the majority (86%, 43/50) was from 1 to 5 years compared to the no amputation group (P < 0.001). For the amputation group, 67% (33/50) had a limb trapped in the chain of the vehicle as to the mechanism of injury. Conclusion: The majority of patients had lower-extremity injuries, specifically fractured (37%) or amputated (30%) with children from age 1–5 years having a significantly higher proportion of hospital admission compared to the rest of the study population. Despite the existing legislation for ATV use in children, they are not enforced. The finding of this study recommends urgent implementation of these regulations for both ATV retailers and users and promotes public awareness about the severity of such injuries.
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Recurrent gastrointestinal bleeding in a patient with Heyde syndrome with elevated factor VIII levels: A case report
Omar Al-Radaideh, Iyad Farouji, Hossam Abed, Hamid Shaaban
October-December 2021, 11(4):253-256
Heyde syndrome is the association between gastrointestinal (GI) bleeding from intestinal angiodysplasia (IA) and aortic stenosis (AS). Although the course of disease progression that links AS and GI bleeding has not been determined, overlaps among AS, intestinal dysplasia, and acquired von Willebrand's syndrome is thought to result in GI bleeding. Proper repair of the aortic valve can result in significant improvement of GI bleeding and its recurrence. Herein, we are reporting this rare case, in which a patient with moderate AS on echocardiogram presents with recurrent GI bleeding from multiple IA in the setting of elevated factor VIII levels, to propose a theory that angiodysplasia could potentially develop due to intermittent, recurrent low-grade obstruction of submucosal veins at the level of the muscularis propria secondary to venous thrombosis related to elevated factor VIII levels.
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Epidemiology and patterns of road traffic fatalities in India pre- and post-motor vehicle (Amendment) act 2019: An autopsy-based study
Manas Ranjan Sahu, Manoj Kumar Mohanty, Prakash Kumar Sasmal, Rakesh Vadakkethil Radhakrishnan, Chitta Ranjan Mohanty, Ijas Muhammed Shaji, Alagarasan Naveen, Madhusmita Parida
October-December 2021, 11(4):198-203
Background: Road traffic accidents (RTAs) are a preventable cause of death. The government of India enacted the motor vehicle amendment (MVA) act on September 01, 2019, to curtail the alarming trend of RTAs and their associated fatality. The study objective was to compare the epidemiology and pattern of fatal RTAs before and after the MVA Act 2019 of India. Methods: An autopsy-based cross-sectional study was conducted at the Department of Forensic Medicine and Toxicology (FMT) of a tertiary-care hospital from March 2019 to February 2020. The sample comprised 75 fatal RTA victims who underwent postmortem at FMT. Patients were studied in two groups: One pre-MVA group (n = 47) and one Post-MVA group (n = 28). The data were obtained from medical records and inquest reports with autopsy correlation. Data pertaining to sociodemographic profile, mechanism, injury profile including injury-severity-score (ISS) and survival-time was recorded. Results: There was a 40.4% decline in mortality among RTA victims (P = 0.057) in the post-MVA group. The case fatality rate also declined during post-MVA implementation months compared to pre-MVA months (1.61 vs. 1.96). A significant correlation was noted between the ISS and survival-time of victims (P < 0.001, r = −0.522). The mean age of patients was 39.87 ± 17.44 years. Heavy motor vehicles along with motorized two-wheeler were the most common offending-vehicle. The median ISS of all victims was 41 (33–57). Head injury was the most common cause of death (60%). Conclusion: Study results signal-toward early triumph of the new MVA act, probably due to enhanced adherence to safety gears and constructive behavioral change.
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Stress and burnout among health-care workers in the coronavirus disease 2019 intensive care unit
Shibu Sasidharan, Harpreet Singh Dhillon
October-December 2021, 11(4):257-261
Since late December 2019, the city of Wuhan in China has reported a novel pneumonia caused by coronavirus disease 2019 (COVID-19), which has now spread domestically and internationally. The COVID-19 pandemic has caused unthinkable consequences and has challenged and, in numerous cases, beaten the capacity of hospitals and intensive care units (ICUs) worldwide to handle it. Apart from the obvious burden of patient care, extended work timings, and fear of personal safety, health-care workers (HCWs) also suffer from occupational stress as a result of lack of skills, organizational factors, and low social support at work leading to distress, burnout, and psychosomatic problems. This leads to stress, direct deterioration in quality of life as well as the quality of service provided. In this article, the authors navigate on the root cause of stress that is peculiar to the HCWs deployed in the ICU and suggest recommendations to alleviate it. To aid in the research, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, CINAHL, NIOSHTIC-2, and Web of Science up to May 2021.
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An assessment of measures to reduce injuries and mortality among motorcyclists: A cross-sectional survey-based study
Hadi Fadaei, Elaheh Ainy, Roghayeh Paydar
October-December 2021, 11(4):204-208
Background: Motorcyclists are one of the most vulnerable groups in road accidents. This study aimed to investigate the effective measures to reduce injuries and deaths in the most vulnerable road users' motorcyclists in 2020. Methods: The study was a cross-sectional study. In this study, 147 motorcycles were randomly selected from the list of all motor courier units in Tehran, which was prepared through an internet search. The required information was collected through questionnaires and interviews. The inclusion criteria had a minimum high school education and an age range of 18–65 years. The trained questioners referred to the selected courier offices and after obtaining consent to participate in the study, project questionnaire were completed. Results: The mean age of subjects was 31.4 ± 8.0 years. All subjects were male. The purpose of the trip was going to work (84.4%). The highest percentage of leaving home time (94.6%) was observed in the morning. More than half of the subjects had a history of accidents (54.5%), and also more than half of the subjects (54.0%) had a history of an accident in their 2nd degree relatives' families. Forth-fifths of the studied motorcyclist (89.5%) wore helmets. Nearly half of the subjects (48.3%) always fastened their helmets strap. The highest action (72.0%) was suggested to separate the motorcycle lanes. Conclusion: In the viewpoint of the motorcyclist, separating the motorcycle lines could be one of the most effective measurements to injury reduction. Hence, officials and planners need to pay more attention to the logical demands of motorcyclists.
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What's new in critical illness and injury science? Driving characteristics and rates of road traffic accidents and associated serious injuries and fatalities during the COVID-19 pandemic
Andrew C Miller
October-December 2021, 11(4):189-190
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Intimate partner violence constrains timely utilisation of antenatal care services among Armenian women: Results from a nationally representative sample
Russell Kabir, Rhyddhi Chakraborty, Divya Vinnakota, Nazeeba Siddika
October-December 2021, 11(4):209-214
Background: Well-timed utilisation of antenatal care (ANC) services during pregnancy emphatically impact pregnancy outcomes. Intimate Partner Violence (IPV) predominance during pregnancy is exceptionally noticeable in Armenia, yet we have restricted information on the association between IPV and ANC attendance. The aim of this study was to determine the association between IPV and utilisation of adequate ANC services among Armenian women. Methods: A nationally representative sample survey from 2015 to 2016 Armenia Demographic and Health Survey was considered for this study. A total of 6116 women were interviewed. To estimate the association between outcome and explanatory variable, Pearson's Chi-square test followed by bivariate logistic regression analysis were performed. Results: About 58% of participants, more than 35 years old has encountered IPV. Women with advanced education (54.7%) attended ANC services between 0 and 3 months. It was found that only the richer women are two times more likely to visit ANC services above four times than other groups and its association with IPV claimed that richer women are more likely to face IPV. Moreover, women who are residing with alcoholic husbands/partners are two times more likely to suffer from partner abuse (P < 0.001). Conclusion: The impact of IPV on accessibility and timely utilisation of ANC services in Armenia cannot be overlooked as IPV is causing risk in healthy delivery and the country's overall productivity in a broader perception.
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Evaluation and analysis of new design traditional handloom performance in reducing work musculoskeletal disorders among Sarong Samarinda female weavers: A quasi-experimental study
Iwan Muhamad Ramdan, Krishna Purnawan Candra
October-December 2021, 11(4):215-222
Background: Work musculoskeletal disorder (WMSDs) are occupational health problems whose prevalence is still high in various countries. Ergonomic interventions are the most successful approach to reducing WMSDs. This study evaluated the effect of redesign traditional handloom on the work posture and musculoskeletal disorders of Samarinda Sarong traditional weavers. Methods: The quasi-experiment has been carried out on 40 traditional weavers from February to September 2019 in Samarinda, Indonesia. The weaver using the new design handloom then evaluated its impact on work posture and WMSDs in the first 3 months and the second 3 months. Work posture was assessed using Rapid Upper Limb Assessment (RULA). WMSDs were assessed using a Nordic Body Map questionnaire. Data were analyzed using Friedman and Dunn's test. Results: The RULA score decreased from 7 to 3 and 2, while the WMSD risk at “very high” level decreased from 12.5% to 7.5% and 2.5% and the WMSD at “high” risk level decreased from 87.5% to 10.0% and 5.0% following the introducing of the new design traditional handloom at 3 and 6 months, respectively. Conclusions: The new design of the traditional handloom on Sarong Samarinda female weavers has succeeded in improving work posture and reducing WMSDs.
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Statin therapy associated with decreased neuronal injury measured by serum S100β levels in patients with acute ischemic stroke
Hayder M Al-Kuraishy, Ali I Al-Gareeb, Marwa Thaier Naji
October-December 2021, 11(4):246-252
Background: Acute ischemic strokes (AIS) are a common cause of morbidity, mortality, and disability. The serum biomarker S100β correlates with poor neurological outcomes in the setting of AIS. This study describes the impact of statin treatment on S100β levels following AIS. Methods: This was a prospective case–control study of AIS patients compared to healthy controls. Patients were stratified into three groups: (1) AIS patients on statin therapy, (2) AIS patients not on statin therapy, and (3) healthy controls. Demographics, clinical parameters, stroke risk scores (SRS), and S100β levels were recorded for all patients. Results: Blood pressure, lipids, and SRS scores were higher in stroke versus control patients (all P < 0.05), and lower in Group I versus II (all P < 0.05). S100β levels were higher in stroke versus nonstroke patients (P = 0.001), and lower in Group I versus II (P = 0.001). Furthermore, patients on atorvastatin showed greater S100β reductions than those on rosuvastatin therapy (P = 0.01). Conclusion: In acute stroke patients, statins therapy correlated with reductions in the neuronal injury biomarker S100β, with greater reductions observed for atorvastatin than rosuvastatin therapy.
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Surgeons' re-operative valve replacement practices in patients with endocarditis due to drug use
Julie M Aultman, Oliwier Dziadkowiec, Dianne McCallister, Michael S Firstenberg
October-December 2021, 11(4):229-235
Background: This study discerns surgeons' attitudes and practices in the determination of heart valve replacement for patients with infectious endocarditis (IE) due to intravenous drug use (IVDU). We aimed to identify the factors contributing to surgeons' decision-making process for initial and recurrent surgical heart valves and the availability of institutional guidance. Methods: An IRB-approved, anonymous mixed-methods, open survey instrument was designed and validated with 24 questions. A convenience sample of cardiothoracic surgeons in the United States and globally resulted in a total of 220 study participants with 176 completing every question on the survey. Results: A cluster analysis revealed that although surgeons can be divided into subgroups based on their previous experience with valve replacements, these groups are not perfectly homogenous, and the number of identified clusters is dependent on technique used. Analysis of variance revealed the variables that most clearly divided the surgeons into subgroups were, in order of importance, years of practice, number of valve replacements, and geography. Conclusions: Our analysis showed heterogeneity among cardiothoracic surgeons regarding how they make clinical decisions regarding re-operative valve replacement related to IE-IVDU. Therefore, an opportunity exists for interprofessional teams to develop comprehensive guidelines to decrease variability in surgical decision-making regarding valve replacement associated with IE-IVDU.
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Perioperative colloid choice and bleeding in patients undergoing musculoskeletal surgery: An observational administrative database study
Vijay Krishnamoorthy, Calvin O Motika, Tetsu Ohnuma, Duncan McLean, Alan R Ellis, Karthik Raghunathan
October-December 2021, 11(4):223-228
Background: The synthetic colloid hydroxyethyl starch (HES) received a black box warning, issued by the US Food and Drug Administration (FDA) in June 2013, in patients with sepsis, due to increased risk of bleeding, renal injury, and death. Risks of HES in populations undergoing noncardiac surgery are unclear. Here, we examine the association of colloid choice – human-derived albumin versus HES – with bleeding in musculoskeletal surgery. Methods: Inpatient musculoskeletal surgical patients who received colloids on the day of surgery were included during a time period before the FDA warning on HES using the Premier Healthcare database. The exposure was type of colloids administered on the day of surgery: HES versus albumin. The primary outcome was major perioperative bleeding, measured on the 1st postoperative day through hospital discharge. The secondary outcomes included acute renal failure and postoperative length of stay >75th percentile. Results: We identified 41,211 patients who received albumin (n = 12,803) and HES (n = 28,408) on the day of surgery. The propensity-weighted multivariable analysis demonstrated a reduced risk of major perioperative bleeding on the day after surgery following treatment with albumin versus HES (relative risk: 0.89 [95% confidence interval, 0.84–0.93]). No significant differences were observed in the secondary outcomes. Conclusion: When compared with albumin, treatment with HES on the day of musculoskeletal surgery was associated with an increased risk of major perioperative bleeding on subsequent days. Given that HES continues to be used as a colloid in multiple patient populations worldwide, further studies examining the safety of HES versus albumin solutions are needed.
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