Physicians' Knowledge and Perception of Antimicrobial Resistance: A Survey in Khartoum State Hospital Settings.

Aims: To assess physicians' knowledge and perception regarding antimicrobial resistance and current antibiotic practices at the three main hospitals at Khartoum State- Sudan. Study Design: A cross- sectional survey. Place and Duration of Study: Physicians from the three main Khartoum state teaching hospitals (Khartoum, Omdurman and Khartoum North) had been surveyed between October 2011 and March 2012. Methodology: A total of 350 Physicians identified from different departmental specialties were interviewed using a 40 item, self-administered questionnaire. Results: Of physicians surveyed 38.0% considered antibiotic resistance were very important in their hospitals, 41.7% nationally and 44.3% globally. The majority of respondents (47.5%) perceived the problem of antibiotic resistance as sever problem in their hospitals. Factors identified as important in producing resistance include, widespread antibiotic use (54.3%), poor access to local antibiograms (47.4%), inappropriate course duration (46.3%), and inappropriate empiric choice (44.9%).The respondents were less likely to perceive patient's demand and role of pharmaceutical companies' promotion of antibiotics as very important factors (19.1% and 18.3% respectively).The intervention considered very useful by the largest percentage of physicians was "educational programs" (45.7%) followed by "updating about local antibiotic resistance pattern" (37.4%) and "access to current antibiogram" (35.2%). Antibiotic restriction programs were regarded as less helpful. Knowledge of resistance organisms and resistance-prone antibiotics was poor. Conclusion: Although physicians were aware of the antibiotic resistance, their perceptions about its importance, its causes and potential solutions are often contradictory and variable. These contradictory perspectives present challenges that must be overcome if we are to successfully address the mounting problem of antibiotic resistance.

Different modalities of hepatic resection in liver diseases

Blood loss and bile leak remain major issues during liver resection. We aimed to compare the efficacy of two commonly used transaction techniques; the ultrasonic-dissector [UD] and ultrasonic-coagulation-shears [UCS]. 143 consecutive patients were enrolled into a prospective, observational, non-randomized, comparative study, performed from the March 2008 till end of May 2009, in Liver Unit, Queen Elizabeth Hospital, University of Birmingham, UK. Outcomes looked at are blood-loos, speed of transaction and morbidity. Study groups are comparable except that there are more major resections in the UD than in the UCS, [86.9 and 42.4% respectively, p=0.04]. There is no statistically significant difference [SSD] in the mean surface areas of resected liver specimens between the two groups [114 [ +/- 11] versus 94 [ +/- 9] cm[2] [p=0.06]. there is no SSD in the amount of lost blood, amount of blood loss per square centimeters of resection surface area, amount of blood transfused or the percentages of patients, who required blood transfusion, intra- or post-operatively, between the groups. There are no SSD in the mean transaction time, haemostatsis times, mean transaction and haemostasis speeds. The overall "identification of landmarks" score is 4/5 for UD and 3/4 for UCS which is not SSD. The Pringle manoeuvre was resorted to in significantly more patients in the UD than in the UCS [17 [20.2%] and 5 [8.5%] respectively, p=0.03], with mean ischaemic time significantly more in the UD [17 +/- 3] versus 4 [ +/- 4] minutes respectively, p=0.02]. There is no SSD in the magnitude of post-operative liver cell injury reflected by the mean of ALT, AST, bilirubin and INR peak values. There is also no SSD among the two groups regarding postoperative minor [grade 1 and 2] or major [grade 3, 4, and 5] complications, median ICU and hospital stays. This study confirms that both instruments of transaction can be used safely in elective liver resection and it is not possible to recommend any of these two instruments over the other

Evaluation of Hand Hygiene Adherence by Health Care Workers in a Secondary Sudanese Hospital Setting

Most of health care workers [HCWs] are aware of the importance of hand hygiene procedures, but still the adherence and compliance with this simple action remains low. Evaluation of compliance with hand hygiene was carried out in a Sudanese hospital setting. Adherence to hand hygiene was evaluated hospital wide through direct observation, collecting data on hand hygiene carried out whenever indicated opportunity of hand hygiene. The results were analyzed using mixing effects models. A total of 1930 opportunities were observed from different study area of the hospital. Overall compliance was [40.8%]. Adherence was highest in nurses [45%] followed by physicians [37.9%]. High statistical difference [p = 0.0001] was observed in hand hygiene opportunities after [68.1%] than before [31.9%] an activity. The situation in which the compliance was highest were those with intermediate risk of infection [49.7%], where in the high risk situation the hand hygiene carried out in [38.7%] of the occasions. Low adherence observed suggests that more and new interventions should be carried in order to focus in modification of HCWs habits and attitudes, working at several levels: individual and institutional

Implementation of strategies to control antimicrobial resistance in Hospitals

Antimicrobial resistance has emerged as a major health issue in recent years. A steady increase in resistance continues despite the introduction of new antibiotics, and resistance bacteria have been associated with increase patient morbidity and mortality as well as with increased cost. Addressing the problem of antimicrobials requires both infection control and regulation of antibiotic use; addressing either alone is insufficient

Optimizing antimicrobial drug use in surgery: an intervention strategy in a Sudanese Hospital to Combat The Emergence of Bacterial Resistant

Antimicrobial control programs are widely used to decrease antibiotic utilization, but effects on antimicrobial resistance and outcomes for patients remain controversial. The purpose of this study was to determine the impact of rotation of antibiotic classes used as empirical surgical prophylaxis on the emergence of bacterial resistance organisms and antibiotics drug use when compared with non-rotation period. Method: Three core, broad spectrum agents [cephalosporins, beta-lactam-inhibitors, and fluoroquinolones] were selected for inclusion in the quaternary rotation for 21 months, based on prior 8 months baseline data from GIT and urology surgical wards in Ibn Sina hospital. Intensive surveillance done for patients admitted to the selected settings. 1681 surveillance samples obtained from 2359 eligible inpatients admitted to hospital from Jan 2008 to May 2010. A significant reduction in the percentage of positive growth had been observed with antibiotic rotation for both wards from 65% and 49% in baseline to 59% and 33% in rotation [1] and 25% and 33% in rotation [2] in GIT and urology ward respectively [p 0.0001]. As general there was a divergent effect of the antimicrobial rotation on the prevalence of resistance among G+ve and G-ve bacteria. We concluded that antimicrobial drug use in surgical departments could be optimized after implementation of antimicrobial cycling policy, and associated in reduction in the incidence of infectious mortality and morbidity but stabilize antibiotic resistance, without significant reduction

Histological changes of some organs in the offspring of mice due to mother malnutrition

This work aimed to evaluate the effect of low carbohydrate diet during pregnancy and lactation on the histological pictures of some organs in the offsprings. The animals were classified into two groups: The first one was kept as a control group; the second group was fed with a 30% low carbohydrate diet from the mating with male to 21 day after delivery. The specimens were examined histologically. The skin of fetuses fed maternally with low carbohydrate diet showed on aggregration of granules in stratum granulosum that became discontinuous, and a decrease in the epidermal thickness. Kidneys of fetuses fed maternally with low carbohydrate diet showed patchy areas of vacuolar degeneration in the tubular epithelium that became accompanied with hemorrhage later on. Pancreatic tissue from fetuses fed maternally with low carbohydrate diet showed lack of basal basophilia of acinar cells and increase in size of islets of Langerhans. It is concluded that getting a balanced diet by pregnant and lactating mother is very important as our work revealed a great effect of the decrease of carbohydrates on the development of some important organs, which may have a relation to some diseases in the adulthood

Awareness of hand hygiene among health care workers in intensive care units Khartoum state tertiary hospitals

Noscomial infections result in significant morbidity and mortality and represent a heavy economic burden for many hospitals and countries. Sub-optimal complicance with hand hygiene guidelines is one of the major risks for nosocomial infections. The aim of this work is to determine the level of awareness of intensive care unit [ICU[healthcare workers towards hand hygiene. Descriptive cross-sectional hospital-based survey methods are used. Awareness to hand hygiene among healthcare workers of the ICUs of Khartoum North Teaching Hospital, Omdurman Teaching Hospital and Khartoum Teaching Hospital was 65.88%, 63.4% and 59.7% respectively. Compliance with hand hygiene materials and badly located sinks are contributory factors to poor compliance. In the most cases, healthcare workers do not comply with hand hygiene. As shown by our results, increasing awareness about hand hygiene and providing accesses to resources for hand hygiene can improve compliance

Awareness of hand hygiene among health care workers in intensive care units of Khartoum state tertiary hospitals

Noscomial infections result in significant morbidity and mortality and represent a heavy economic burden for many hospitals and countries. Sub-optimal compliance with hand hygiene guidelines is one of the major risks for nosocomial infections. The objectives of this work are to determine the level of awareness of intensive care unit [ICU] healthcare workers towards hand hygiene. The method used is descriptive cross-sectional hospital-based survey. The results show that the awareness to hand hygiene among healthcare workers of the ICUs of Khartoum North Teaching Hospital, Omdurman Teaching Hospital and Khartoum Teaching Hospital was 65.8%, 63.4% and 59.7% respectively. Compliance with hand hygiene was suboptimal. A combination of individual and related factors such as unavailability of hand hygiene materials and badly located sinks are contributory factors to poor compliance. It was concluded that, in the most cases, healthcare workers do not comply with hand hygiene. As shown by our results, increasing awareness about hand hygiene and providing accesses to resources for hand hygiene can improve compliance

Intramuscular ketamine for prevention of postanesthesia shivering in children

To compare the effects of intramuscular ketamine with pethidine and placebo on post operative shivering in children undergoing tonsillectomy. A prospective randomized double-blind study was conducted at King Abdulaziz Naval Base Hospital, Jubail, Kingdom of Saudi Arabia, from November 2006 to October 2007. One hundred and twenty children [American Society of Anesthesiologists Grade 1, aged 5-12 years] were enrolled. Children were randomly allocated to receive ketamine 1 mg/kg [group K, n=40], or pethidine 0.5 mg/kg [group P, n=40], or normal saline [group S, n=40] intramuscularly just after induction of general anesthesia. Hemodynamic parameters, oxygen saturation and tympanic temperature were measured and recorded before induction of anesthesia and at regular intervals thereafter. An investigator blinded to the treatment group, graded postoperative shivering using a 5 point scale. The number of patients shivering on arrival to the recovery room and at 10 and 20 minutes after operation were significantly less in groups K [1,1,1] than in group S [19,12,17]. No patient that received pethidine shivered. The time to first analgesic requirement in group S was shorter than groups K and P [p=0.001]. The study indicates that the use of a prophylactic low dose ketamine was found to be effective in preventing post anesthesia shivering in children undergoing tonsillectomy. Ketamine may have at least theoretical advantages over pethidine as regard respiratory depression, nausea, and vomiting

Evaluation of combined hyperfractionated radiotherapy and chemotherapy in locally advanced irresectable carcinoma of the pancreas

Thirty-two patients with locally advanced irresectable adenocarcinoma of the pancreas were treated with hyperfractionated radiotherapy and simultaneous application of 5-fluorouracil. Chemotherapy was administered as short infusion before each fraction of radiotherapy for four days in the first week to be repeated on the fourth week according to toxicity. Radiotherapy consisted of two fractions per day for five days per week during four consecutive weeks up to a total dose of 48 Gy, each fraction 1.2 Gy with interfraction period not less than six hours. The median survival time for all patients was 12.7 months compared with three and seven months after palliative radiotherapy alone [historical control]. Toxicity and therapy induced morbidity were recorded according to WHO criteria and were acceptable. This combined modality treatment consisting of hyperfractionated radiotherapy and chemotherapy seems to be feasible for patients with locally advanced and irresectable pancreatic cancer

Complete abdominal wound dehiscence incidence

This study was carried out on 690 patients with abdominal surgery excluding hernia operations, appendicectomy and minor procedures. This was carried out in Assiut University Hospital, Department of General Surgery in the period from April 1994 to April 1996. Twenty-two risk factors were checked for each patient [personal, general and local] to look for the significant factors and the relation between wound disruption and the total number of factors. It was found that with six factors or more disruptions is inevitable and when the number of factors reached eleven death is expected. These risk factors were arranged in the order of their significance in relation to disruption and death

six months evaluation of the trauma admissions in Assiut University Hospital

This study was done in Assiut University Hospital from January 1994 till the July 1st, 1994 and included all patients admitted in the trauma unit. The study aims at evaluation of the magnitude of this problem and proceeding to further evaluation of the needs of that center. This study included 1178 cases with 777 [66%] males and 401 [34%] females. The type of trauma varied, but it can be collectively classified into five categories. The major cause is falling from a height: 696 cases [59%], the second is road traffic accidents: 351 cases [29%], the third is fire injuries: 31 cases [2.6%], the fourth is stab wound injuries: 27 cases [2.3] and lastly other causes which account for 6.3% of the causes. Age and sex incidence varied in each type of trauma

Management of splenic trauma

This work included 90 patients with splenic trauma, 76 [84.4%] males and 14 females [15.6%]. Ages varied between 5 and 50 years with a median of 19.4 years. The highest peak lies between 11 and 20 years. On analysis of the cases of trauma, the patients were divided into 5 groups. Falling from a height accounts for the highest number of cases which was 32 [35.5%] followed by road traffic accidents [24 cases] [26.6%], stab-injuries due to civilian violence accounted for 12 cases [13.3%], fire-arm injuries were seen in 8 cases [8.8%]. Other causes including blunt violence [6 cases] and iatrogenic injuries [8 cases] had good participation. Diagnosis based on rapid history and clinical evaluation with ultrasound examination of all patients. Laboratory tests played a minor role for diagnosis. 28 patients underwent splenectomy. 16 patients were subjected to splenerrhaphy, partial splenectomy was done in 20 cases and splenic autotransplants [after splenectomy] was done in 26 cases. Early postoperative complications were minor and none of the patients died in the early postoperative period. All patients were followed every 3 months for detection of remanents of splenic tissue and for detection of post-splenectomy infection. Only one case of over-whelming post- splenectomy infection [OPSI] was picked-up [following splenic autotransplantation]. It was clear that splenic preservation techniques can be safely done. The impetus is the recognized risk of [OPSI] especially in the pediatric group

Darn repair in inguinal hernia

This study included 260 cases with inguinal hernia, the majority were males [255 cases], and the ages varied from 15 to 60 years. Right sided hernias were 170 cases [65.4%] and left sided hernias were 90 [34.6%]. Bilateral hernias were 21 but, only one side was considered for operation at a time. Indirect hernias were 230 [88.5%] and direct hernias were 30 [11.5%]. Out of the total number, 20 patients had huge hernias and 11 cases proved to be of the sliding variety, 28 patients had strangulated hernias and 30 cases were darned for recurrent hernias. All patients were subjected to general and local examination. Cases of chronic straining were of prime importance to be corrected before surgery. Anesthesia was general endotracheal inhalation type. Antibiotic prophylaxis was given as cefradin 1 g I.V. 1 hour preoperatively and 1 and 8 hours postoperatively. Antibiotics were further given only for cases with signs of wound sepsis. Follow up monthly for recurrence, hydrocele, paresthesia and testicular atrophy was performed. 12 [4.6%] cases showed wound sepsis. 14 [5.4%] cases had postoperative hydrocele and only 3 cases persisted and required further scrotal operation. Inguinal pain of moderate severity was noticed in 9 cases [3.5%]. Only 7 [2.7%] cases showed recurrence and 2 cases out of these had huge sliding hernias

Delorme's procedure for complete rectal prolapse

26 cases of complete rectal prolapse were operated upon by Delorme's procedure between January 1991 and December 1992 with a follow up for recurrence till December 1993. Age ranged between 23 and 82 years. There were 22 males and 4 females. Two cases of recurrence were seen [ages 58 and 76]; one of them was successfully reoperated and the other resorted to an abdominal procedure. Only one case developed mucosal prolapse which was treated by ligation excision. Four patients with associated incontinence to solid stools and gas were corrected for both by Delorme's procedure. This procedure proved to be easy and safe especially in debilitated patients

Evaluation of microbiology quality assessment scheme in Kuwait

A comparative statistical analysis was performed to detect various types of specimens and organisms used in the microbiology Quality Assessment Programme in Kuwait for 16 participant laboratories. A total of 139 samples were used during a period of 6 years. Organisms had more effect than specimens on the performance of the various laboratories. Samples prepared with one organism [fluids] obtained the highest mean scores, followed by mixtures prepared as wound swabs, stool, and material obtained from the respiratory and genital tracts. Organisms were sorted into five groups and the analysis gave high mean score performances in the following order: Entero-bacteriaceae, Micrococcaceae, other gram-positive organisms, other gram-negative bacteria and non-fermenters. The results of our experience will prove useful in improving the performance of various laboratories of Kuwait