An evaluation of medication errors among staff nurses working in medicine intensive care unit of tertiary care hospital

Background: Medication errors are common problem in the hospitals leading to adverse drug event which is usually under reported by the health-care professionals; hence, the study on medication error would help to create consciousness in medical care providers and give quality care to patients and society. Aim and Objective: The aims of the study were as follows (i) To assess the types of medication error that occurs during medication use in the medicine intensive care unit (ICU) and (ii) to evaluate the adverse drug events by medication errors. Materials and Methods: The data were collected in medicine ICU Patients. Clinical data include age, gender, IP number, and diagnosis of the patient were collected. Data were analyzed on transcribed and administered medication errors. Out of 386 patients, 122 were females and 264 were males. Results: Most common age group was 41–60 year. Near seven drugs were prescribed per patient. Most common errors occurred during the drug transcribing stage (51.4%) than the administration stage (44.29%). Adverse events were more common in allergic reaction (46.15%) and musculoskeletal system (19.23%), and nervous system (11.53%). Conclusion: Medication errors are most routine problem faced in hospitals, which can significantly harm the patient. It should be recognized and their causes should be studied to minimize the recurrence and to prevent further adverse drug events.

A study on prescription pattern and safety profile of antimicrobial agents in medicine department of tertiary care hospital

Background: Antimicrobial agents (AMAs) are an integral part of management of diseases in the department of general medicine, and a wide range of antimicrobials are used for prevention, prophylaxis, or treatment of various infectious diseases. Systematic studies regarding the pattern of AMAs use may help in improving the quality of patient care by evidence-based practices and also in formulating effective antimicrobial usage guidelines. Aim and Objectives: The objectives of this study were as follows: (i) To analyze the prescribing trends of Antimicrobials in Medicine wards of a Tertiary Care Hospital; (ii) to assess safety profile of AMAs; and (iii) to analyze extraneous factors influencing AMAs prescription. Materials and Methods: The prospective analysis of Antimicrobial prescriptions of Medicine wards for the period of July 2018–August 2019. The class of AMAs, formulation, dose, route of administration, frequency, and duration of administration and their safety was assessed using the WHO indicators. Results: The most frequently used AMAs were third generation cephalosporin (Ceftriaxone) and it was frequently combined with metronidazole. The choice of initial AMAs was empirical, which was later changed depending on the clinical response. The AMAs were effective in preventing or controlling infections and well tolerated without any serious adverse reactions or drug interactions. Conclusions: The rational use of AMAs is necessary to control worldwide emergence of antibacterial resistance, side effects, and to reduce the cost of treatment.

The Association of Alcohol Use Disorder with Perioperative Complications following Primary Total Hip Arthroplasty / 대한고관절학회지

Purpose@#Alcohol use disorder is a leading mental health disorder in the United States. Few studies evaluating the association of alcohol use disorder following primary total hip arthroplasty (THA) have been reported.Therefore, the purpose of this study was to determine whether patients with alcohol use disorder undergoing primary THA have higher rates of: 1) in-hospital lengths of stay (LOS); 2) complications (medical/implant-related);and 3) costs. @*Materials and Methods@#Using a nationwide claims database from January 1st, 2005 to March 31st, 2014, patients with alcohol use disorder undergoing primary THA were identified and matched to a comparison group according to age, sex, and various comorbidities, resulting in 230,467 patients who were included in the study (n=38,416) and a matched-cohort (n=192,051). Outcomes of interest included comparison of LOS, 90-day medical and 2-year implant-related complications, and costs. A P-value less than 0.002 was considered statistically significant. @*Results@#Patients with alcohol use disorder had longer in-hospital LOS (4 days vs 3 days; P<0.0001) as well as higher frequency and odds ratio (OR) of 90-day medical (45.94% vs 12.25%; OR, 2.89; P<0.0001) and 2-year implant-related complications (17.71% vs 8.46%; OR, 1.97; P<0.0001). Patients in the study group incurred higher 90-day costs of care ($17,492.63 vs $14,921.88; P<0.0001). @*Conclusion@#With the growing prevalence of alcohol use disorder in the United States, the current investigation can be utilized to evaluate the need for interventions prior to THA which can potentially minimize the rates of morbidity and mortality within this population.

The Antibacterial, Antioxidant and Phytochemical Composition of Combretum tanaense (J. Clark) Root Extracts

Aims: To evaluate the antibacterial, antioxidant and phytochemical composition of Combretum tanaense extracts. Study Design: Laboratory-experimental design was used in this study. Place and Duration of Study: Fresh roots of Combretum tanaense were obtained from Mount Kenya University botanical garden in Thika (Kiambu County-Kenya). The study was carried out between November 2017 and February 2018 at Mount Kenya University Biochemistry and Pharmacognosy laboratories. Methodology: Duplicate voucher specimens were prepared and deposited at the East Africa herbarium housed at the National Museums of Kenya and Mount Kenya University herbarium. Extraction of total extracts of C. tanaense roots was conducted according to standard procedures. Agar well diffusion and 2-2-diphenyl picryl hydrazyl (DPPH) assay methods were used to evaluate antibacterial and free radical scavenging activities of the extracts. All assays were performed in triplicate. Antibacterial data was presented as a mean zone of inhibition ± SEM while free radical scavenging activities were expressed regarding IC50. Phytochemical screening was carried out using standard procedures to ascertain the presence or absence of various phytochemical groups in the test plant. Results: The current study indicated that Combretum tanaense root extracts had antibacterial activities against the selected gram-positive and gram-negative bacterial strains. The highest activity was recorded against gram-negative bacteria (Haemophilus influenza) by exhibiting inhibition zones of 13.32±0.15 mm and 12.82±0.36 mm for methanol and water extracts respectively. Antioxidant activities for both methanol and water extracts were ten times higher compared to that of standard (L-ascorbic acid). The extracts were found to have saponins, phenols including tannins and glycosides. Conclusion: Extracts of Combretum tanaense have compounds that exhibit antibacterial and antioxidant activities. From the results obtained, the ability of the extracts to inhibit bacterial growth and scavenge for free radicals was due to the presence of phenolic compounds and will be attributed to the healing properties of this plant. This study recommends further studies including toxicity and isolation of active compounds for the development of products with pharmaceutical value.

Liver transplantation in Asia: past, present and future

With the technical advances and improvements in perioperative management and immunosuppressants, liver transplantation is the standard treatment for patients with end-stage liver diseases. In Asia, a shortage of deceased donor liver grafts is the universal problem to be faced with in all transplant centres. Many surgical innovations are then driven to counteract this problem. This review focuses on 3 issues that denote the development of liver transplantation in Asian countries. These include living donor liver transplantation (LDLT), split liver transplantation (SLT) and liver transplantation for hepatocellular carcinoma (HCC). Minimal graft weight, types of liver graft to donate and the inclusion of the middle hepatic vein with the graft are the main issues to be established in LDLT. The rapid growth and wide dissemination of LDLT has certainly alleviated the supply-and-demand problem of liver grafts in Asia. SLT is another attractive approach. Technical expertise, donor selection and graft allocation are the main determinants for its success. Liver transplantation plays a key role in the management of HCC in Asia. LDLT would be the main strategy in this aspect. The issue of extending the selection criteria for HCC patients for LDLT is still controversial. On the whole, future developments to increase the donor pool for the expanding recipient need in Asia would involve transplantation from non-heart beating donor and ABO incompatible transplantation.

Inflammatory cytokines and childhood obstructive sleep apnoea

<p><b>OBJECTIVE</b>To evaluate serum cytokine concentrations in children with and without obstructive sleep apnoea (OSA) and to investigate the effects of OSA treatment on cytokines.</p><p><b>MATERIALS AND METHODS</b>Consecutive children with habitual snoring and symptoms suggestive of OSA were recruited. They completed a sleep apnoea symptom questionnaire, underwent physical examination and overnight polysomnography (PSG). OSA was diagnosed if obstructive apnoea index (OAI) >1. A blood sample was collected for analysis of IL-6, IL-8, and TNF-alpha after PSG.</p><p><b>RESULTS</b>One hundred forty-two children (97 males) with a median (IQR) age of 11.1 years (9.0-12.8) were recruited. The commonest presenting symptoms were nocturnal mouth breathing, prone sleeping position and poor attention at school. Forty-seven children were found to have OSA and they had higher serum IL-6 [0.1 (0.1-0.4) vs 0.1 (0.1-0.1) pg/mL, P = 0.001] and IL-8 [1.7 (1.0-2.3) vs 1.3 (0.9-1.7) pg/mL, P = 0.029] concentrations compared to their non-OSA counterparts. Multiple regression analysis indicated that OAI was significantly associated with both IL-6 (r = 0.351, P <0.001) and IL-8 (r = 0.266, P = 0.002). Sixteen children underwent treatment and there was significant reduction in mean (SD) serum IL-8 after intervention [pre vs post levels of 1.9 (1.0) vs 1.1 (0.6) pg/mL, P = 0.001] independent of weight loss.</p><p><b>CONCLUSION</b>Children with OSA had elevated levels of pro-inflammatory cytokines that normalised following treatment suggesting that the inflammatory response is potentially reversible. Early detection and intervention may be beneficial.</p>

Cardiovascular changes in children with snoring and obstructive sleep apnoea

<p><b>INTRODUCTION</b>Adults with obstructive sleep apnoea (OSA) are well documented to be at high risk for cardiovascular abnormalities. Growing evidence suggests that OSA is also associated with cardiovascular consequences in children. The purpose of this review is to examine the available data on this association in children.</p><p><b>METHODS</b>Primary studies were extracted from a MEDLINE search limited to those published between 1970 and 2008. The keywords used included child, sleep disordered breathing, sleep apnoea, snoring, blood pressure and hearts. The relevant articles were selected by consensus between 2 authors.</p><p><b>RESULTS</b>The results suggested that OSA was consistently associated with hypertension. Meta-analysis of risk of hypertension in those with high apnoea-hypopnoea index was undertaken. A combined odds ratio equal to 3.15 was found (95% confidence interval, 2.01 to 4.93). There was evidence for increased sympathetic activation, decreased arterial distensibility and ventricular hypertrophy in children with OSA.</p><p><b>CONCLUSION</b>Childhood OSA is associated with blood pressure dysregulation. The association of OSA with other cardiovascular morbidities requires further study in view of the limited data available currently.</p>

Current treatment strategy for hepatocellular carcinoma

With the current practice of surveillance programs in high-risk patients, early stage hepatocellular carcinoma [HCC] is commonly diagnosed. This poses great challenge to clinicians, in terms of prognostic estimation, patient stratification to various treatment modalities and patient management during long-term follow-up. This review focuses on the current trends in the management of HCC, with special attention to tumor staging, treatment algorithm, and outcome of various treatment modalities. According to the American Association for the Study of Liver Diseases [AASLD] practice guideline, Barcelona Clinic Liver Cancer [BCLC] staging system has fulfilled the criteria that HCC patients can be stratified into different prognostic subgroups, to which optimal treatments can be offered. Under this management scheme, curative treatments [hepatic resection, liver transplantation, and percutaneous ablation] would be reserved to the subgroup of patients with relatively good prognosis. For patients with advanced malignancy localized to the liver, local ablation or transarterial chemoembolization [TACE] may offer effective symptomatic palliation, and prolongation of patients' survival. For patients with distant metastases, no effective therapy can be offered, and symptomatic palliative care is the best option. Until now, favorable survival outcomes have been reported following hepatic resection, liver transplantation, and local ablation for HCC. Although the therapeutic effect of TACE is less pronounced than curative treatments, randomized controlled studies have proven its survival benefit for HCC patients. A comprehensive treatment algorithm involving these treatment modalities is mandatory to ensure optimal care of patients with HCC