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Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18-97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071-5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.
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Objectives: Aim of this study was to evaluate hepcidin levels and its correlation with inflammatory markers, vitamin D levels as well as its effects on intensive care unit (ICU) mortality in critically ill coronavirus disease-2019 (COVID-19) patients. Materials and Methods: Adult patients those were admitted to pandemic ICU between March 1st, 2021 and May 17th 2021 were prospectively included to the study. Hepcidin levels and inflammatory markers on day 1, 2, 3 and 7, admission vitamin D levels, length of ICU stay and ICU mortality were recorded and analysed. Results: Median age of patients was 60.5 (52.50-71.25) and 20 (66.7%) of them was male. It was observed that hepcidin levels and lymphocyte counts were increased significantly from day 1 to day 7 (p=0.01 and p<0.01, respectively). In contrast, C-reactive protein (CRP) and procalsitonin levels were decreased from day 1 to day 7 (p=0.01 and p<0.01, respectively). In the analysis admission hepcidin levels and inflammatory markers [IL-6 (p=0.61), CRP (p=0.82) and ferritin (p=0.27)], vitamin D (p=0.13) and iron level (p=0.90) was not correlated. There was no correlation between hepcidin levels and ICU mortality (p=0.95). Conclusion: In this study, hepcidin levels were above normal limits in critically ill COVID-19 patients. However, our findings do not support the use of hepcidin, IL6, serum ferritin, and vitamin D levels in predicting COVID-19 mortality.
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On 16 May 2022, the UK Government announced changes to the commitments made in the UK 5-year national action plan to tackle antimicrobial resistance (AMR). The national action plan is in its third year of delivery and these changes were required to meet the commitments. In total, 93 commitments have been reworded, 17 new commitments have been added, and eight commitments have been removed. As well as reflecting lessons learned during the COVID-19 pandemic, the proposed changes aim to: (1) improve the surveillance of AMR and antimicrobial use;(2) improve the availability of data to better understand the prevalence of AMR across human health and animals;(3) reflect priorities identified by the UK AMR Research Programme to explore and evaluate antimicrobial use, prescribing, new therapeutics, diagnostics, stewardship and resistance across both human health and animals;(4) reflect the particular role the UK is playing internationally in non-traditional and informal political groupings, including supporting the UK Special Envoy on AMR and taking a lead role in AMR interest groups;and (5) introduce 4 new commitments to reduce urinary tract infections (UTIs), in support of the national action plan ambition to halve healthcare associated Gram-negative bloodstream infections (GNBSIs) by 2024.
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The World Health Organization (WHO) has published the first global report on infection prevention and control (IPC), providing a global situation analysis of how IPC programmes are being implemented in countries around the world, including regional and country-specific focuses. The report discusses how healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) endanger patients and healthcare workers. It also discusses the impact and cost-effectiveness of IPC programs and the strategies and resources that countries can use to improve them. The COVID-19 pandemic and other recent large disease outbreaks have highlighted the extent to which health care settings can contribute to the spread of infections, harming patients, health workers, and visitors, if insufficient attention is paid to IPC. The report shows that where good hand hygiene and other cost-effective practices are followed, 70% of those infections can be prevented. Currently, out of every 100 patients in acute-care hospitals, seven patients in high-income countries and 15 patients in low- and middle-income countries will acquire at least one HAI during their hospital stay. On average, one in every ten affected patients will die from their HAI. The report reveals that high-income countries are more likely to be progressing with their IPC work and are eight times more likely to have a more advanced IPC implementation status than low-income countries. Even though more attention was paid to IPC in general because of the COVID-19 pandemic, there wasn't much change in how IPC national programs were run in low-income countries between 2018 and 2021.
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On 21 September 2021, the Healthcare Associated Infection (HAI) annual report 2020 was published by Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland. The report reflects the work undertaken on healthcare associated infection (HCAI) prevention and reducing antimicrobial resistance (AMR) during 2020. Data are provided for common HCAIs, which are an important cause of severe illness, death, and higher treatment costs. This year the report also includes analysis of hospital onset COVID-19 and its impact on other Scottish national surveillance systems. In 2020, the global pandemic brought new problems, and NHS National Services Scotland's ARHAI Scotland was a key part of the national COVID-19 response to the pandemic. This report shows how far ARHAI Scotland has come in helping to reduce HCAIs in NHS Scotland. It also gives data to help local and national efforts to prevent HCAIs.
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COVID-19 is a disease caused by the SARS-CoV-2 virus, multi-organ, with a wide spectrum of symptoms, the most common being pneumonia with fever, dry cough and shortness of breath. There are more and more reports of persistent long-term effects, especially after acute disease. Regardless of the way the virus enters the brain, it attacks neurons, contributing to neurological complications. The main symptoms of the central and peripheral nervous system are dizziness and headaches, impaired consciousness, sometimes acute ischemic stroke and intracranial hemorrhages, loss of taste and smell, visual disturbances, neuralgia and skeletal muscle damage. After recovery, patients experience symptoms such as persistent fatigue, diffuse muscle aches, symptoms of depression, non-renewable sleep, tinnitus, and erectile dysfunction. Early intervention and supportive care at the end of the acute phase of COVID-19 could alleviate the symptoms of the disease as well as prevent their long-term consequences. Taking into account plant raw materials, the standardized extract of Ginkgo leaves (Ginkgo biloba) may be useful at various stages of the disease: it prevents the penetration of the virus into the host cells, has anti-inflammatory, antioxidant and antithrombotic properties, and above all, it is the only plant material with proven neuroprotective and neuroregulatory properties, widely used in the treatment of Alzheimer's, Parkinson's and other diseases and disorders related to the nervous system.
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Background: The pattern of bacterial infection in coronavirus disease 2019 (COVID-19) patients differ worldwide. Objectives: This study aimed to determine the patterns of bacterial infections and the antibiotic resistance profile by VITEK 2 (bioMerieux, France) in the culture of blood samples from hospitalized patients with COVID-19.
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The transmission routes of SARS-CoV-2 include droplet, air and contact transmission, but regardless of the transmission route, the virus must eventually be exposed through the oral, nasal and ocular mucous membranes to invade the human body. Guaranteeing the respiratory protection of front-line medical staff in the prevention and control of COVID-19 is one of the primary tasks of nosocomial infection management. According to "Technical Guidelines for Prevention and Control of COVID-19 in Healthcare Settings (3rd Edition)", oral/nasal cavity can be disinfected with hydrogen peroxide, iodophor, in the event of occupational respiratory exposure. But, at the moment, In the field of nosocomial management, compared with hand hygiene, "mucosal hygiene" is rarely mentioned, especially the treatment of respiratory mucosa after exposure to acute infectious respiratory pathogens, which is still blank in the domestic research. After a rapid literature review, it is found that some antiseptics have been widely used in clinical practices, such as gargling with bactericidal solution before the diagnosis and treatment procedure for dental patients under COVID-19 epidemic, nasal decolonization for patients undergoing elective surgery to prevent surgical site infection, and use of eye drops of antiseptics to prevent neonatal conjunctivitis. In view of the current lack of effective antiviral drugs for treatment of SARS-CoV-2, and the constantly emerging mutant strains can break through the immune barrier of human body, this paper recommends that medical personnel use antiseptics for emergency mucosal disinfection as an supporting measure for respiratory tract protection after accidental exposure to SARS-CoV-2 of oral, nasal and ocular mucosa.
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INTRODUCTION: Acinetobacter baumannii is an important causative agent of ventilation-associated pneumonia capable of long-term survival in the hospital setting. Increasing resistance to antibiotics effective against this pathogen is of concern. In this study, the antibiotic resistance profiles of A. baumannii strains grown in endotracheal aspirate (ETA) cultures in intensive care units and the effect of the COVID-19 pandemic on the resistance profiles in our province where the highest number of cases were observed in our country for a long time were investigated. METHODS: Our study included 74 A. baumannii isolates isolated from ETA samples that was sent to our laboratory from the intensive care units of Bafra State Hospital between January 2019 and December 2020. Bacteria were identified using conventional methods and a semi automatic bacterial identification system Vitek-2 (bioMerieux, France). The antibiotic susceptibility tests of the isolated strains were studied in accordance with the European Committee for Antimicrobial Susceptibility Testing (EUCAST) standards. Antibiotic susceptibility of A. baumannii strains was tested with Vitek-2 system. RESULTS: The mean age and standard deviations of 18 patients before the COVID-19 pandemic and 56 patients after the pandemic were found to be 83.0 +or- 8.3 and 70.5 +or- 14.9 (p < 0.001), respectively. A statistically significant difference was found between the distributions of gender by years (p=0.025). While 55.6% of the patients were female in 2019, 73.2% of the patients in 2020 were male. There was no difference between the two periods in terms of death rates (p=0.628) and respiratory support needs (p=0.191). It was determined that the pandemic increased the number of isolated A. baumannii by 311%. For the two periods, resistance was greatest for piperacillin/tazobactam, ceftazidime, ciprofloxacin and against imipenem. Examinig the two periods, amikacin resistance was seen to a lesser extent in 2020. A statistically significant difference was found between tigecycline resistance rates according to years (p < 0.001). While the tigecycline susceptibility of strains was 88.9% in 2019, it was found to be 26.8% in 2020.11.1% of the strains in 2019 and 64.3% in 2020 were found to be moderately susceptible. In this study, colistin resistance was observed in one (1.4%) of all isolates, while tigecycline resistance was detected in five isolates (6.8%). One isolate (1.4%) was susceptible to all antibiotics except ceftazidime. When the multi-antibiotic resistance of 73 A. baumannii isolates was examined, multidrug resistant (MDR) was 22.9% (n: 17), extensive drug resistance (XDR) was 74.3% (n: 55), pandrug resistance (PDR) was 1.4% (n: 1). Although there was a statistical difference in amikacin, meropenem and tigecycline resistances before and after the pandemic, no difference was found between the resistance patterns (p=0.281). DISCUSSION AND CONCLUSION: It has been observed that the most effective antibiotics against A. baumannii are colistin and tigecycline. It was determined that the COVID-19 pandemic did not change the resistance pattern rates. It is thought that success in fighting this infection will increase when each hospital determines its own resistance patterns, updates empirical treatment protocols based on their results, and clinicians use appropriate antibiotics early.
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Efforts to prevent the spread of the COVID-19 virus and overcome the impact of the pandemic require the participation of community elements. The incidence of Covid-19 in RW 09, Tanjung Rejo Village, Sukun District, amounted to 15 cases with a death toll of 1 resident in December 2020. The lack of community knowledge about COVID-19 and its prevention efforts can be seen from the many residents who do not comply with health protocols, make the importance of community-based health interventions in the RW area. The intervention was carried out with 3 main programs, namely: the movement for the formation of the COVID-19 Task Force (Satgas);healthy living communities (GERMAS);and the movement for people to use masks, antiseptics, and disinfectants (GEMAD). The results of the intervention showed the formation of a COVID-19 task force tasked with disseminating the right information and increasing social support in efforts to prevent COVID-19, and increasing knowledge of the COVID-19 task force and health cadres after counseling activities were carried out. After the intervention, it is hoped that all RWs in Sukun District can empower the community to form a COVID-19 task force in an effort to prevent the spread of COVID-19.
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This proceedings contains the s submitted by the participants of the meeting, which summarize clinical research data diagnosis, prevention and treatment of pediatric infectious diseases;controversies in antibacterial therapy;multidrug resistance;progress towards better antimicrobial stewardship and policy;and COVID-19.
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. Medicine shortages have become increasingly common in a number of countries in recent years and the COVID-19 pandemic has exacerbated the situation. The aim of this paper was to develop further insights into the extent and nature of medicine shortages in OECD countries (pre COVID-19). However, absent both a common nomenclature and harmonised notification systems for reporting shortages, intercountry comparisons, and an overarching global perspective remain challenging. Notwithstanding these challenges, the number of shortage notifications increased by 60% over the period 2017 to 2019 in a sample of 14 OECD countries. . In OECD's analysis, more than half of all notifications were concentrated in three main therapeutic areas: medicines targeting the nervous system, cardiovascular system and antiinfectives. In nearly two-thirds of cases, a shortage of a given active substance was reported in more than one country. Shortages affected predominantly older, off-patent molecules. However, the impact on patient health is largely unknown, given that a notification does not necessarily impact patients adversely if appropriate alternatives remain available and accessible. . The multifactorial nature of this issue and complexity of this industrial sector confound root cause analysis, with different stakeholder perceptions, poor data quality, and general misconceptions further complicating understanding of the issue. Pharmaceutical supply chains are highly complex, involving multiple stakeholders, often with different procedural steps occurring in multiple countries and/or locations. Nevertheless, in general, shortages may be considered as arising from exogenous factors that increase demand (such as in the case of COVID-19), or exogenous or endogenous factors that limit or reduce supply. . Several analyses have noted that shortages, as reported by marketing authorisation holders, are predominantly due to (exogenous) manufacturing and quality issues (in about 60% of cases). Manufacturing and quality problems include, for example, production quality issues or defects in any component of a product;shortages of inputs;inventory and storage practices;temporary and permanent suspension of production due to e.g. technical issues with production or non-compliance with Good Manufacturing Practice, or manufacturing site closure or relocation. Linked to this, policy debates also point to the issues of concentration of manufacturing, or limited availability of manufacturing facilities to produce certain categories or components of medicines, as additional sources of supply vulnerability. While the contributions of these factors are challenging to assess based on available information, in general, ensuring that the manufacturing of particular components is not highly concentrated at one or few manufacturing sites or in small geographic areas, could reduce the overall vulnerability of medicines' supply to these types of risks. . Beyond manufacturing and quality issues, (endogenous) commercial factors, and the policy settings that influence them, may play important underlying roles in propagating shortages, particularly for off-patent products, although further analysis is needed. Regulation and reimbursement policies, such as those that favour unsustainably low prices, may influence commercial decisions, putting supply at risk. In the United States, for example, an empirical analysis identified three root causes, key among them a lack of incentive for the continued production of less profitable drugs in a setting of highly competitive tendering and contracting practices. The analysis also cited a lack of incentives to upgrade production facilities or maintain quality management systems as another root cause. There have also been suggestions that similar issues are implicated in Europe, but the links between production problems and market attractiveness warrant further exploration. . Many OECD countries are pursuing policies aimed at improving the monitoring, mitigating the impact, and/or preventing the future occurrence of shortages. For
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Hand sanitizer is one of the mandatory to be used in this covid-19 pandemic. It is purposed to protect from covid-19 viruses transmitted. There are many benefits of using hand sanitizer example simple in using all around. Although the benefits, it has many negative effects in using this product. The methods of this study use re-review from many references inside the internet website. The results of this study inform that many negative effects of this study like dry skin, diarrhea, disrupting child immunity, and infertility. As a recommendation, the user of hand sanitizer must be aware of using this product. Hands washing with water flowing more qualify to be used to clean the hand.
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Health care-associated infections can be painful, potentially blinding, and even life threatening. Infection prevention and control is therefore a vital part of caring for the patients. The multidisciplinary nature of the infection control committee is an important reminder that everyone has a responsibility to reduce health care-associated infections and prevent harm to patients. This is particularly important with the emergence of antimicrobial resistance, as health care-associated infections are more likely to be multi-drug resistant and therefore difficult to treat. Hopefully, one of the lessons that will come out of the COVID-19 pandemic will be to pay more heed to routine infection prevention and control hygiene measures.
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This special issue consists of 25 articles which include a review the first pandemic in recorded history beginning in the crowded walled city of Athens. Topics covered include: the impact of the COVID-19 pandemic on the course and management of chronic inflammatory immune-mediated skin diseases with particular focus on psoriasis, atopic dermatitis, and hidradenitis suppurativa;the problems of susceptibility, severity, and therapeutic options in patients with connective tissue diseases during the coronavirus infection era, focusing on lupus erythematosus, dermatomyositis, systemic scleroderma, and vasculitides;how the current pandemic has affected the diagnostic approach, staging, and management of primary cutaneous lymphoma;antimicrobials and anti-androgen drugs prescribed to patients with various types of alopecia in addition to immunomodulatory therapies, such as hydroxychloroquine, oral corticosteroids, and immunosuppressants. A systematic review of the current literature related to the cutaneous manifestations of COVID-19 in the pediatric population, focusing on pediatric chilblains and its association with the novel coronavirus infection is also provided. The multivariate pattern of occupational skin diseases observed during the COVID-19 pandemic is overviewed and classified by Razvigor Darlenski and his co-authors into four subgroups: Mechanical skin injury, moisture-associated skin damage, contact reactions, and exacerbation of pre-existing dermatoses;numerous clinical photographs complete the discussion. Grisha Mateev and his colleagues advocate the hypothesis that the BCG vaccine, as a nonspecific stimulation of the immunity, will increase the chances for resistance to the novel coronavirus, thus decreasing the related morbidity and mortality and providing basic or even partial protection against SARS-CoV-2. The COVID-19 pandemic has bypassed the clinical trials industry, as D..d..e F. Murrell and her team emphasize delineating the number of challenges clinical research is currently facing, for example, site closures, mandatory self-isolation, travel restrictions, and interruptions to delivery of investigational products or staff or trial subjects becoming infected with SARS-COV-2;the authors provide practical considerations and recommendations for dermatology clinical trial operations. Finally, W. Clark Lambert and his co-authors provide a global overview of the profound effect of COVID-19 not only on our lives and careers, but also on all lessons that we can, and should, learn from this pandemic.