Use of tigecycline [tygacil] against drug resistant organisms in eastern region

This study was designed to look for sensitivity and resistant pattern of tigecycline in different gram positive and gram negative infections which were resistant to different antibiotics and also look for various methods to prevent drug resistance against tigecycline [tygacil] group of antibiotic. Three hundred seventy five [375] isolates which includes MRSA [Methicillin Resistant Staphylococcus Aureus], VRE [Vancomycin Resistant Enterocooci], ESBL [Extended Spectrum Beta Lactamase], Stenotrophomonas maltophilia and MDR [Multi Drugs Resistant] Acinetobacter species were identified with the help of colonial characteristics, gram staining, biochemical reactions including API strips system, and special techniques used for each organism. Sensitivity was done with help of disc diffusion [Kirby Bauer] method for tigecycline [tygacil] 15 ug disc provided by company. This is a retrospective study which has showed that MRSA were 100% sensitive to tigecycline and VRE were also 100% sensitive to this antibiotic. The ESBL were 90% sensitive and Stenotrophomonas maltophilia 87% to tigecycline. The MDR Acinetbacter species were only 41% resistant which was high in 2008 as compared to overall sensitivity pattern. Male and female were almost equal in this study. Highest number of cases was reported from 70-80 years age group. The different isolates were from different locations from human body and different wards including ICU [Intensive Care Unit]. Tigecycline exhibit high in vitro activity against most of the commonly encountered gram positive and gram negative resistant organisms which were pathgens in this region. We should take care not to get antibiotic resistance to be developed against tigecycline by appropriate uses and preventive measures [hand hygiene etc.]

Quality improvement program in an emergency department

To describe the quality assurance/improvement program in our emergency department ED. This program involved monthly data collection and analysis, data-driven process change, staff education in the core concepts of quality, and data reanalysis from the years 2003 to 2006 at the King Abdul-Aziz Hospital, Al-Ahsa, Kingdom of Saudi Arabia. Data captured during the program included census data, chart review, and focused clinical audits. Continuous quality improvement measures collected at the beginning of the program and quarterly included: 1 quality indicators length of stay [LOS] and rates of left against medical advice [AMA] or left without being seen [LWBS], 2 percentage of patients that stay ?3 hours in ED, unscheduled returns within 48 hours, inter-hospital transfer data, sentinel events tracking rates, and 3 nature of patient complaints. During the study period, the program demonstrated improvement in all measured areas. Despite an increase in patient volume of 47% to 51,698 visits/year, the mean monthly LOS remained static, the unscheduled returned visits dropped by 50% 2% to 1%, and patients leaving AMA decreased from 1.5% to 1.2%, and LWBS decreased from 1.6% to 0.8%. The rate of complaints dropped by 5 fold 1.3 per 1000 patients to 0.25. Our program demonstrated improvement in all the measured parameters

Trends in emergency department utilization in a hospital in the Eastern region of Saudi Arabia

To examine the changes in emergency department [ED] utilization over a 3-year period and identify the factors that affect utilization. We performed an analysis of administrative ED records at King Abdul-Aziz Hospital from the years 2003 to 2005 for all patients to assess the demographic characteristics, periodicity of ED use, and acuity level. During the study period, the number of ED visits increased approximately 30%. Patients demographic characteristics, periodicity, and acuity were comparable for ED visits across each study year. Fall [between September and November] was the busiest season [30%], and the greatest volume was between 3 and 11 pm [57.5% of all visits]. We found that 52% had 1 visit, 18% had 2 visits, 12% had 3 visits, and 8% had 4 or more visits. The Canadian Triage and Acuity Scale [CTAS] IV and V visits comprised 59.5% of the ED visits. The patients' admission has increased from 7.2-9%, while the ED length of stay increased from 72 minutes to 78 minutes during the study period. Emergency department utilization increased during the study period, with almost no change in the proportions for triage category. The numbers of patients requiring hospital admission increased, as the length of their stay. Nearly 60% of emergency visits are for CTAS IV and V care. There were significant patients with multiple visits to ED. We recommend the strengthening of the primary health care in our institution and a designated "Fast Track" in ED for the expeditious management of low acuity patients

Initial experience with an intensive care hyperglycemia protocol in a Saudi Arabian intensive care unit

To study the efficacy of nurse-driven intensive glucose management protocol in an intensive care setting. This cohort study took place at King Abdul-Aziz National Guard Hospital, Al-Hasa, Saudi Arabia from April 2005 through June 2005. We modified a validated nurse-driven glycemic protocol when glucose level was >11.1 mmol/L. Protocol was applied to 103 consecutive patients. Three months after implementing the protocol, we analyzed the glucose control and relevant patient variables. To check the efficacy, glucose values were compared with patients admitted consecutively 2 months prior to the implementation of the protocol. Duration and mean insulin infusion rates were also recorded. A brief nursing survey was also conducted. The median blood glucose upon ICU admission was 8.7 mmol/L [interquartile range 6.9 -12.05]. Our cohort included 45 patients with history of diabetes while the remaining 58 were non-diabetics. Mean blood glucose decreased from 10 +/- 4.4 mmol/L on admission to 8.2 +/- 1.8 mmol/L for the duration of ICU stay. Protocol was effective in both diabetics and non-diabetics. Insulin infusion was employed in 33 patients. Median insulin; infusion rate required throughout the ICU length of stay was 4.3 units/hour. Duration and rate of insulin infusion were not statistically significant between diabetics and non-diabetics. The glucose control was significantly better when compared with the prior practices of glucose control. Our study demonstrates that nurse-driven hyperglycemia protocol were manageable to be used in critically ill patients. Moreover, the protocol is equally effective in both diabetic and non-diabetic patients

Characteristics and outcome of chest pain in young adults

To estimate the frequency of acute coronary syndrome [ACS] at 30 days in patients less than 40 years of age reporting with acute chest pain in Emergency Department [ED]. Prospective cohort study. Emergency Department [ED] of Aga Khan University Hospital, Karachi between July to December 2002. Patients and One hundred young patients with chest pain in whom an electrocardiogram [ECG] was performed. A standardized data collection form was completed. Physical examination included initial vital signs and presence or absence of jugular venous pressure [JVP], rales, or fourth heart sound. Outcome variables were seen in the patients admitted or discharged within 30 days of reporting to the ED. Out of one hundred young patients in the study, 24 had an ACS. Of those, 22 [91.66%] were males and their mean age was 35 years. Most of these patients had cardiac risk factors on physical findings. The final diagnosis of patients consisted of 47 patients with atypical chest pain, 20 with acute myocardial infarction [AMI], 16 with musculoskeletal chest pain, 7 with psychogenic chest pain, 4 with angina, 4 with others and 2 with gastritis. Young patients, presenting to ED with chest pain, had a greater likelihood of suffering from ACS if they were male and between 30 to 40 years of age. People of any age group, presenting to ED with chest pain should not be disregarded in the presence of cardiac risk factors and positive physical findings

Disaster Drill at a University Hospital

The course of a disaster drill held on 23 October 2001 at Aga Khan University, Karachi is reported. The Hospital Emergency Plan was put to trial on that day. Volunteers were invited to become simulated casualties in the drill. Briefing seminars had been conducted with the key players of the hospital. The scenario was a man-made type disaster. A 747 jumbo jet with 200 passengers had crashed at the end of the runway at Quaid-e-Azam International Airport while taking off in a thunderstorm. Fifty casualties were sent to Emergency Room by ambulance. The Plan was activated and relevant units were mobilized according to the Plan. It took 2 hours to complete the disaster drill. Major difficulties were identified in the operations, communications, staff deployment, and emergency control center. Debriefing sessions reviewed difficulties encountered throughout the drill and the possible remedies

Accuracy of urine dipstick to predict urinary tract infections in an emergency department

Background: Urine dipstick is a useful and commonly used test in the Emergency Department because of its rapidity and low cost; however its diagnostic accuracy is debatable. Our objective was to compare the urine dipstick and urinalysis for Urinary Tract Infection in a developing country, where there are significant cost considerations

Methods: This was an observational study of adults' patients presenting to Section of Emergency section [SEM] of the Aga Khan University Hospital, from March to May 1998. The patient's urine sample was tested immediately, using the Multistix 10SG. The sample was sent within one hour to the hospital laboratory for analysis, while the urinary specimen was sent for culture, where appropriate. The dipstick results were compared with the results of automated urinalysis in the laboratory, leukocyte counts on microscopy and urine culture. Sensitivity, Specificity, and predictive values were also calculated

Results: We evaluated 984 samples of urine during the study period. The sensitivity of nitrite test was 81% and that of leukocyte esterase 77% for positive cultures. However, the sensitivity for combined nitrite and leukocyte esterase test was 94%. Nitrite test was more specific [87%] than leukocyte esterase test [54%] or both tests taken together [50%]. The predictive value of nitrite and leukocyte esterase together for a negative urine culture was 95%. Leukocyte esterase test sensitivity increased as the number of white blood cells on microscopy increased. Similarly the predictive value of leukocytes on microscopy for a positive culture increased as the number of leukocytes increased

Conclusion: Dipstick alone cannot accurately predict urinary tract infection in emergency department