Simulation Modeling and Practice of Inpatient Emergency Department in COVID-19 Pandemic

The article presents the experience of using simulation modeling to optimize inpatient emergency department as an admission unit of a hospital — Center for treatment of patients with new coronavirus infection COVID-19. It was noted that the inpatient emergency department effectively performed the functions of the inpatient department of the Center for treatment of patients with new COVID-19 coronavirus infection for a total of more than 7 months. A correct calculation of staffing and a competent use of the department “zones” ensured efficient and rapid reception of patients during both “waves” of the pandemic. The model also proved positive role of such departments with a large number of patients in a multimillion metropolis needed to be hospitalized on a daily basis.

Correlation Analysis between the Characteristics of Helicobacter pylori Resistance and the Antibiotic Use Density in a Hospital from 2012 to 2018

Objective. To explore the correlation between the resistance characteristics of Helicobacter pylori (HP) and antibiotic use density (AUD) in a hospital from 2012 to 2018. Methods. HP strains isolated from Chinese PLA General Hospital from 2012 to 2018 were collected to analyze the drug resistance of clarithromycin, levofloxacin, amoxicillin, and metronidazole, and their correlation with the AUD of the outpatient department and inpatient department was analyzed, respectively. Results. From 2012 to 2018, metronidazole-resistant strains accounted for the largest proportion, followed by clarithromycin and levofloxacin, and amoxicillin-resistant strains accounted for the least. In 2012–2018, the resistance rate of clarithromycin, levofloxacin, amoxicillin, and metronidazole has basically increased year by year; from 2012 to 2018, the highest outpatient AUD in a hospital was amoxicillin, followed by clarithromycin and levofloxacin, metronidazole was the lowest, and the inpatient AUD from high to low was levofloxacin, metronidazole, amoxicillin, and clarithromycin. The drug resistance rate of HP in the hospital from 2012 to 2018 was positively correlated with the AUD of clarithromycin (r = 0.884, P = 0.017 ) and levofloxacin (r = 0.934, P = 0.002 ) in the outpatient department. Conclusions. Helicobacter pylori has the strongest resistance to metronidazole and the worst resistance to amoxicillin in the hospital from 2012 to 2018, being related to the intensity of clarithromycin and levofloxacin in the outpatient department. It may provide certain reference significance for the clinical treatment of Helicobacter pylori.

The structure of the oropharyngeal genus Candida fungi community in HIVinfected patients

At the present time virtually no data are available about the structure of the genus Candida fungus able to target HIV-infected patients and serve as an etiological factor of candidiasis. The aforementioned shaped the aim of the study: to examine structure of the Candida genus community colonizing the oropharynx in HIV-infected patients with clinical manifestations of oropharyngeal candidiasis. There was conducted a microbiological study of the oropharynx in 31 HIV-infected patients (51.6% males and 48.4% females) with clinical manifestations of oropharyngeal candidiasis treated at Moscow Infectious Clinic No. 2 inpatient department in the years 2015–2017. We confirmed the diversity of the oropharyngeal Candida spp. community found in HIV-infected patients. Total 52 isolates of the genus Candida were isolated. C. albicans dominated in 57.7% cases, whereas C. glabrata prevailed (21.1%) among non-albicans species. Minor components were represented by C. tropicalis (11.5%) and C. krusei (9.6%). C. albicans and C. glabrata were sensitive to polyenes, whereas minor community components — to itroconazole and clotrimazole. The vast majority of fungal strains were resistant to fluconazole. The genus Candida community reveals a unique architecture so that any member may exist in the oropharyngeal biotope of HIV-infected patients as a monoculture or in association: homogeneous, consisting of a single species strains, or heterogeneous, formed by several species. Candida fungi in 18 patients (58.1%) were isolated as a monoculture, whereas in 13 (41.9%) subjects — in association consisting of 34 isolates (65.4% of total number), of which 16 (30.8%) and 18 (34.6%) were isolated from homogeneous and heterogeneous associations, respectively. There were identified 9 two-component associations (69.2%), and 4 (30.8%) consisting of three or more components. It turned out that pattern of the examined community was mainly determined by species composition that agrees with previous data. Most common associations were presented by C. krusei (100%) and C. albicans (73.3%). Upon that, most often C. albicans (72.7%) formed a homogeneous type of associations. Sensitivity of Candida fungi to antimycotic drugs also depended on the architecture of related community. C. albicans isolates in heterogeneous associations revealed a wide range of resistance acquired by contact with non-albicans species.

The Experiences of Chinese Children 5- to 7-year-old during cancer Treatment Reflected Through Interviews and Drawings

Background: For children with cancer, the experience during treatment can be challenging. There is a limited number of studies on self-reported treatment experiences of younger Chinese children with cancer using qualitative methods. Objectives: This study aimed at exploring the experience of Chinese children aged 5 to 7 years during cancer treatment reflected through interviews and drawings. Methods: This study used a descriptive qualitative design with the technique of “draw-and-tell.” Participants were enrolled from the pediatric oncology inpatient department of one national children's medical center in China. They were asked to draw a picture of “your feelings in the hospital.” An inductive content analysis approach was used. Results: Twelve participants were enrolled (8 male, mean age 5.7 years). Four themes were established: (1) suffering from adverse treatment effects; (2) perceiving changed relationships; (3) being thankful for others; and (4) trying out coping strategies. Conclusion: Chinese children aged 5 to 7 years expressed multiple cancer treatment impacts. They appreciated others’ support and had their own way to cope with treatment demands. The authors also extended the dynamic nature of using the “draw-and-tell” methodology. Study findings highlight the importance of inviting and hearing the voice of young children during their cancer treatment, with particular consideration of the influence of disease, treatment, child development, family dynamics, and culture.

Antibiotics Using Pattern in Surgery Department of a Maternity and Children Hospital

Aim: This study aimed to identify antibiotics using pattern in surgery department of a maternity and children hospital in Alkharj. Methodology: This is a retrospective review of the drugs that were prescribed in maternity and children hospital in Alkharj from January 2018 to August 2020. Results: The most prescribed antibiotics by emergency department for surgery patients were metronidazole (45.59%) and ceftriaxone (42.65%). Metronidazole IV was the most commonly prescribed antibiotic (38.73%) by inpatient department for surgery patients followed by ceftriaxone (38.73%). Vancomycin vial (43.75%) was the most commonly prescribed antibiotic by critical care unit for surgery patients. The most commonly prescribed antibiotic outpatient department and day case unit for surgery patients by was fusidic acid ointment (35.00%). Conclusion: The study showed that the most commonly prescribed antibiotics for surgery patients were metronidazole and ceftriaxone. Continuous monitoring for antibiotics prescribing is vital to increase the judicious use of these medications and more educational programs and awareness workshops for surgeons are needed.

Impact of lockdown due to COVID-19 pandemic on psychiatric patients

Background: There was sudden reorganization of services during lockdown due to COVID-19. Care of psychiatric patients was in threat due to closure of inpatient department and conversion of hospitals into COVID treatment centres.Methods: List of follow-up patients not attending our outpatient department during lockdown was obtained. They were contacted through telephone. Evaluation was done with Brief psychiatry rating scales (BPRS) and WHODAS2 scales. Statistical analysis of obtained data was done.Results: Comparison of BPRS total score, WHODAS domain scores and total score between outpatients and inpatients was done using independent samples ‘t’ test. It was found to be statistically significant (p<0.05). Anxiety and distractibility are the more prominent symptoms in majority of psychiatry patients.Conclusions: Psychiatric patients needs safe place, with people to talk and to take care of daily activities. It is highly recommended urgent need of creating awareness program on COVID-19 pandemic which targets this vulnerable population. It is essential to provide continued psychiatric intervention using tele-psychiatric platform and ensure their social support using community mental health services during the pandemic. A standard protocol on the management of patients with serious mental illness during an infectious disaster should be developed.

Septicemia caused by Micrococcus luteus. Example of a clinical case

Micrococcus luteus is a representative of normal microflora of the human skin, which is commonly localized on open surfaces of the body. Dissemination of the agent with disease development is possible if intactness of the skin is impaired. Aim of the paper – to present a clinical case of septicemia caused by Micrococcus luteus.Results. A clinical case of septicemia, caused by Micrococcus luteus, in a 39-year-old patient treated in an inpatient department of Infectious Diseases Communal Clinical Hospital in Lviv. Conclusion. A presented clinical case demonstrates a severe course of septicemia caused by Micrococcus luteus with involvement of internal organs in the process, in particular, accompaniment of community-acquired left-sided pneumonia, exudative pleurisy, pericarditis, and meningitis. Although antibacterial therapy was prescribed to this patient on admission to an inpatient department, the result in treatment could be achieved only after thorough additional examination of the patient, conduction of proper bacteriological tests and determination of sensitivity of the agent to antibacterial medicines.

Drug Utilisation Pattern in Ear, Nose and Throat Inpatient Department using WHO Prescribing Indicators

Introduction: Assessment of drug utilisation pattern (DUP) based on World Health Organisation (WHO) drug prescribing indicators would enhance the standards of patient care at all levels of the healthcare. It helps to improve the quality of life in developing countries like Nepal. Objective: To assess DUP in patients admitted in ear, nose and throat inpatient department at a tertiary hospital in Eastern Nepal using the WHO prescribing indicators. Methods: A hospital based cross-sectional descriptive study was carried out in 96 patients in ENT department of a tertiary care teaching hospital from February-April 2019. Pre-designed proforma was used to collect the relevant data from the medical case sheets and drug charts. Descriptive statistics were calculated using Microsoft Excel 2010. Results: Out of 96 patients, 52 (54.17%) were female. Most of the patients (46, 47.18%) were pre­scribed four drugs. Combination of Ibuprofen and Paracetamol (77, 19.74%) was the commonest prescribed drug. Ceftriaxone (62, 63.92%) was the most frequently prescribed systemic antibiotic. The average number of drugs per prescription was 4.06. None of the drugs were prescribed by generic name. Out of 360 drugs, only 118 (30.26%) were prescribed from National List of Essential Medicines (NLEM) and 117 (30.00%) drugs were fixed drug combinations. Ninety two (95.83%) patients had been prescribed at least one antibiotic. Conclusions: The prescribing practices of essential medicines, generic drugs, antibiotics and inject­able drugs showed deviation from the standard recommended by the WHO. The prescribers should be motivated to enhance prescription of drugs by generic names and from NLEM.

Predisposing Factors for Severe Complications after Cataract Surgery: A Nationwide Population-Based Study

We conducted a retrospective group study to evaluate the potential systemic risk factors for major postoperative complications of cataract surgery. Individuals diagnosed with (n = 2046) and without (n = 8184) serious complications after cataract surgery were matched 1:4 for age, sex, and index date obtained using Taiwan’s National Health Insurance Research Database. The outcome was defined as at least one new inpatient or outpatient diagnosis of systemic disease one year before the index date. The effect of demographic data on postoperative complications was also analyzed in the multivariable model. Data were analyzed using univariate and multivariate conditional logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals of the risk of developing serious complications. After the entire study interval, the major postoperative complications of cataract surgery were associated with the following systemic diseases: hypertension (adjusted OR (aOR) = 2.329, p < 0.001), diabetes mellitus (aOR = 2.818, p < 0.001), hyperlipidemia (aOR = 1.702, p < 0.001), congestive heart failure (aOR = 2.891, p < 0.001), rheumatic disease (aOR = 1.965, p < 0.001), and kidney disease needing hemodialysis (aOR = 2.942, p < 0.001). Additionally, demographic data including old age, higher urbanization level, higher level of care, and more frequent inpatient department visits were associated with a higher rate of postoperative complications. In conclusion, metabolic syndrome, chronic heart failure, end-stage renal disease, rheumatic disease, older age, and frequent inpatient department visits are correlated with the development of severe postoperative complications of cataract surgery. Therefore, cataract surgery patients should be informed about a higher possibility of postoperative complications.