Minimum Inhibitory Concentration of Tigecycline on Acinetobacter in Burn Patients.

BACKGROUND: Burn infection is a major cause of morbidity and mortality in spite of significant improvements in burn care and treatment. Pseudomonas aeruginosa, Acinetobacter spp., Staphylococcus aureus etc. are the commonest isolates in which rapid development of resistance to multiple drugs limits the therapeutic options for infections by Acinetobacter species. Hence, this study was done to find the occurrence of Acinetobacter and to determine the minimum inhibitory concentration of tigecycline against Acinetobacter isolates. METHODS:   This cross-sectional study was conducted in Phect-Nepal Hospital, Kirtipur, Nepal from September to December 2018. Total 205 samples were included for the isolation and identification of Acinetobacter and further minimum inhibitory concentration of isolates were done following the standard laboratory protocol. Collected data were analyzed by SPSS version 23.0. RESULTS: Among 155 culture positive samples, 27 isolates were Acinetobacter spp.  Antimicrobial Susceptibility Test revealed that 24 isolates were resistant to ceftriaxone and ceftazidime, but all isolates were susceptible to polymyxin B. For tigecycline, 19 isolates were resistant through dis diffusion test while 20 isolates cross the Minimum Inhibitory Concentration value from E test. The reliability of the E-test and disc diffusion was 0.920, which represent strong agreement between E- test and dis diffusion test. CONCLUSIONS: Tigecycline resistance is presenting as serious problem to the management of infection caused by Acinetobacter species. Therefore, minimum inhibitory concentration for the detection of resistance should be included in routine laboratory diagnosis.

Older people's perspectives on an elderly-friendly hospital environment: an exploratory study.

BACKGROUND: Many older people are vulnerable with multiple health problems and need of extensive care and support for quality of life. The main objective of this study was to explore the older people's perspectives on an "elderly-friendly" hospital. METHODS: Hospital was stratified by four domains including government, semi-government, community, and private. We interviewed 33 hospitalized older patients and four hospital managers between June and December 2014 in Kathmandu, Nepal, using purposive sampling technique. We executed a qualitative content analysis step with extensive review of the interviews. Final name of the theme was given after the agreement between the research team and experts to improve trustworthiness. Elderly-friendly services, expectation from government and hospital, and health policy related to senior citizen were developed as main themes. RESULTS: Most of the participants were satisfied with the behavior of health personnel. However, none of the health personnel were trained with geriatric health care. Elderly-friendly hospital guidelines and policy were not developed by any hospitals. Older people health card, advocacy for older people's health and benefit, and hospital environment were the common expectations of older patients. Government policy and budget constraint were the main obstacles to promote elderly-friendly health care services. CONCLUSION: Elderly-related health policies, physical environments of hospital, elderly-friendly health manpower, advocacy, and other facilities and benefits should be improved and developed. There are urgent needs to develop elderly-friendly hospital policies and guidelines that focus on older people's health benefits and friendly services.

Role of metformin for weight management in patients without type 2 diabetes.

OBJECTIVE: To evaluate the efficacy and safety of metformin for weight management in overweight and obese patients without type 2 diabetes. DATA SOURCES: Literature was obtained through MEDLINE Ovid (1950-February week 3, 2008), EMBASE (all years), and a bibliographic review of relevant articles. Key words included metformin, obesity, overweight, and weight loss. STUDY SELECTION/DATA EXTRACTION: All studies published in the English language that evaluated the effects of metformin on weight in obese or overweight individuals were critically analyzed. Relevant articles were selected for inclusion in this review. DATA SYNTHESIS: Metformin is first-line pharmacotherapy in the treatment of overweight or obese patients with type 2 diabetes, with beneficial effects on weight in this population. Multiple trials have evaluated the effect of metformin on weight and other metabolic parameters in adults and adolescents without diabetes. Five of 12 trials in adults evaluated weight loss as a primary endpoint. Significant weight reduction was found in 4 of these studies; however, the trials were small and of weak design. Weight reduction was significant in 5 of the 6 adolescent trials; similarly, these studies were limited by weak study design and small patient population. Metabolic parameters (blood pressure, waist circumference, cholesterol parameters, insulin/glucose levels) often showed varying results. Metformin was well tolerated; gastrointestinal effects were the most frequently reported adverse effects. CONCLUSIONS: The weight loss effects of metformin in overweight or obese adults and adolescents without diabetes appear promising; however, trials have been limited by small patient populations and weak design. Metformin may also have a positive effect on metabolic parameters such as waist circumference, fasting insulin and glucose levels, and triglycerides. Further research involving large-scale trials that evaluate weight loss as a primary outcome is necessary to firmly establish the role of metformin in this population.