prospective observational study assessing the outcome of Sepsis in intensive care unit of a tertiary care hospital, Peshawar

Objective: The current study aims to explore the factors associated with outcome among patients with severe sepsis and septic shock admitted to the intensive care unit, Northwest General Hospital and Research Centre, Peshawar, Pakistan

Methods: A prospective observational study was carried out at intensive care unit of our hospital from February 2014 to October 2015. Data was collected using a structured format and statistical analysis was done using SPSS version 20®. Regression model was applied to identify the factors contributing to the outcome of severe sepsis and septic shock. P-value less than 0.05 was considered statistically significant

Results: Majority of the patients meeting the criteria of this study were male 147 [54.9%] with a mean age of 54.8. The most common source of sepsis was lung infections [42.2%] followed by urinary tract infections [18.7%], soft tissue infections [6.3%] abdominal infections [6%] and in 6.3% patients the source remained unknown. Further analysis has revealed that increase in number of days of hospitalization was observed to be slightly associated with the outcome of the treatment [1.086 [1.002 - 1.178], 0.046]. Moreover, the risk of mortality was the higher among the patients with septic shock 22.161[10.055 - 48.840], and having respiratory, kidney and central nervous system complications. Overall it is seen that septic shock alone was found responsible to cause death among 32.0% of the patients [Model 1: R2 0.32, p=0.000], and upon involvement of the organ complications the risk of mortality was observed to 42.0%

Conclusion: Chances of recovery were poor among the patients with septic shock. Moreover, those patients having respiratory and urinary tract infection are least likely to survive

Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia

Involvement of pharmacists in improving medication adherence among diabetic patients is recognized globally. In Malaysian healthcare system, pharmacists are also operating health services i.e. Diabetes Medication Therapy Adherence Clinic [DMTAC]. This study aimed to assess the clinical outcomes of patients managed by pharmacists [DMTAC], in a Malaysian hospital setting. This was an open labelled randomised study. Type 2 diabetes patients with HbA1c >/=8% were recruited and arbitrarily divided into the intervention group [usual care plus DMTAC] and the non-intervention group [usual care only]. Those enrolled in the intervention group were scheduled for follow-up for eight consecutive visits. Improvements in lab results were compared longitudinally [pre and post analysis] between the groups. Data analysis was done using PASW 18[registered] version. A total of 76 patients were enrolled, with 39 patients in the intervention group and 37 patients in the non-intervention group. Mean HbA1c [-0.90% vs. -0.08%, p=0.011] and fasting blood glucose levels [-3.45mmol.l vs. +0.79mmol/l, p=0.002] reduced significantly between the intervention group vs. non-intervention group. Total cholesterol and low-density lipoprotein cholesterol [LDL-C] were also significantly reduced in the intervention group [TC -0.34mmol/l, p=0.018] [LDL -0.45mmol/l, p=0.001]. In conclusion, pharmacists managed DMTAC significantly improved glycaemic control and lipid profile of diabetic patients

Antimicrobial activity of Nigella sativa L. seed oil against multi-drug resistant Staphylococcus aureus isolated from diabetic wounds

Microbial resistance to existing antibiotics has led to an increase in the use of medicinal plants that show beneficial effects for various infectious diseases. The study evaluates the susceptibility of multidrug resistant Staphylococcus aureus to Nigella sativa oil. Staphylococcus aureus was isolated from 34 diabetic patient's wounds attending the Renaissance hospital, Nsukka, Southeast Nigeria. The isolates were characterized and identified using standard microbiological techniques. Isolates were cultured and a comparative In vitro antibiotic susceptibility test was carried out using the disk diffusion method. Of the 34 samples collected, 19[56%] showed multidrug resistance to the commonly used antibiotics. Nigella sativa oil was then studied for antibacterial activity against these multidrug resistant isolates of Staphylococcus aureus in varying concentration by well diffusion method. The oil showed pronounced dose dependent antibacterial activity against the isolates. Out of 19 isolates, 8[42%] were sensitive to undiluted oil sample; 4[21%] of these showed sensitivity at 200 mg/ml, 400 mg/ml and 800 mg/ml respectively. Eleven [58%] of the isolates were completely resistant to all the oil concentrations. The present study, reports the isolation of multi-drug resistant S. aureus from diabetic wounds and that more than half of isolates were susceptible to different concentrations N. sativa oil

Prevalence of potential drug-drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia

<p><b>OBJECTIVE</b>To determine the prevalence, clinical significance and the associated risk factors of potential drug-drug interactions (DDIs) at internal medicine ward of University of Gondar (UOG) hospital.</p><p><b>METHOD</b>A prospective cross-sectional study was conducted on patients treated in internal medicine ward of UOG hospital from April 29, 2013 to June 2, 2013. Data was collected from medical records and by interviewing the patients face to face. Descriptive analysis was conducted for back ground characteristics and logistic regression was used to determine the associated risk factors.</p><p><b>RESULT</b>In our study, we have identified a total number of 413 potential DDIs and 184 types of interacting combinations with 4.13 potential DDIs per patient. Among 413 potential DDIs most were of moderate interactions 61.2% (n=253) followed by 26% (n=107) of minor interactions and 12.8% (n=53) of major interactions. There was significant association of occurrence of potential DDIs only with taking three or more medications.</p><p><b>CONCLUSION</b>We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.</p>

Tuberculous lymphadenitis at Penang general hospital, Malaysia

To evaluate the incidence, treatment and clinical outcomes of tuberculous [TB] lymphadenitis at Penang General Hospital, Malaysia. Penang General Hospital is the referral center for all tuberculosis patients in the state of Penang. Patient records were reviewed to identify patients with confirmed diagnosis of TB lymphadenitis between January 2006 and December 2008. Data were analyzed using SPSS version 15. Of 1,548 tuberculosis cases, 109 [7.0%] patients had TB lymphadenitis. The mean age was 36.4 +/- 12.87 years and of the 109 patients with TB lymphadenitis, 35 [33.0%], 37 [34.0%] and 36 [33.0%] were observed for 2006, 2007 and 2008, respectively. Ethnically, 45 [41.3%] were Malay followed by 37 Chinese [33.9%]. Among risk factors for TB lymphadenitis, HIV and diabetes mellitus were seen in 17 [15.6%] and 11 [10.0%] patients, respectively. Cough and fever were the most frequently reported symptoms. In a majority of cases [n = 90, 82.5%] positive results were obtained for fine-needle aspiration [FNA]. Directly observed therapy was given to all patients. Sixty-two [56.9%] patients were successfully treated, and 5 [4.6%] patients died during the treatment. There was no increase in the incidence of TB lymphadenitis over the 3-year study period. The incidence was slightly higher in male than female gender and in Malay [ethnic group]. Diabetes mellitus and HIV were the most commonly reported risk factors. FNA is the most reliable diagnostic test