Background: Gram-negative pathogens, notably Klebsiella pneumoniae, pose a global challenge due to their propensity for multidrug resistance, particularly in nosocomial infections like urinary tract infections (UTIs). Antimicrobial stewardship programs (ASPs) have been instituted to address the rampant misuse of antibiotics, aiming to foster judicious prescribing practices. This study evaluates the impact of an ASP on antibiotic sensitivity patterns of K. pneumoniae in a tertiary care hospital in Central India.
Methods: Urine samples positive for K. pneumoniae collected during 2023 and 2024 were subjected to antimicrobial susceptibility testing.
Results: Results demonstrate significant improvements in sensitivity patterns, notably in carbapenems and chloramphenicol. These findings underscore the effectiveness of ASPs in guiding antibiotic prescribing practices, attributed to enhanced acceptance among healthcare professionals.
Conclusion: Sustained initiatives to encourage responsible antibiotic utilization and garner support from healthcare professionals remain crucial in effectively tackling antibiotic resistance. Additionally, further research is needed to assess the long-term viability and scalability of such interventions.
Background: Tube thoracostomy is a surgical method frequently used by thoracic surgeons and emergency physicians to drain air, fluid, pus, blood and bile from the pleural cavity. In our study, we aimed to evaluate the demographic and clinical characteristics, complications, morbidity/mortality of patients who underwent tube thoracostomy in the emergency department of our hospital.
Methods: We retrospectively analysed 111 patients who presented to the emergency department and underwent tube thoracostomy. Pearson chi-square test, Fisher's Exact test and Mann Whitney U test were used to analyse the data in our study.
Results: In our study, 22.5% (25) of the patients died and 54.1% (60) were discharged. The mean duration of hospitalisation was 8.9±6.3 days. Among the patients who underwent tube thoracostomy, 79.3% (88) had traumatic and 20.7% (23) had spontaneous pneumothorax. The incidence of pneumothorax was significantly higher in patients under 40 years of age than in patients over 40 years of age (p=0.003). Complications developed in 17.1% (19) of the patients. The most common complication was malposition.
Conclusion: Tube thoracostomy is frequently performed in our emergency department. Although it is a life-saving procedure, complications are common and may result in death. Morbidity and mortality can be reduced with experience and compliance with surgical sterility.
Background: Accurate measurement of hematologic analytes is essential for physicians to establish correct diagnoses, plan of patient’s treatment, evaluate treatment response and monitor the progression of disease over time. For the most accurate hematological results, blood specimens should be analyzed as soon as possible after collection. This study aimed to determine the effect of storage durations of blood samples stored at room temperature on the measurement of red blood cell (RBC) count, hemoglobin (Hb) concentration, packed cell volume (PCV), red cell indices (MCV, MCH, MCHC) and red cell distribution width-Coefficient of variation (RDW-CV).
Methods: A cross sectional study was conducted between 2019 to 2020. Fifty healthy students (male and female) were randomly selected according to predefined inclusion and exclusion criteria. Blood samples were collected into EDTA tubes. RBCs parameters were measured immediately after collection to obtain baseline values, then stored at room temperature (24°C) and further measurements were obtained at 6, 12 and 24 hours after collection. Analysis was performed using fully automated hematology analyzer (sysmex XP-300).
Results: Data were analyzed using Statistical Package for Social Sciences (SPSS) computer program (version 20). P-value >0.05 was considered statistically significant. The study proved that RBC's count, Hb and MCH were least affected by storage at 24°C, showed stability after 24 hours (P= 0.943, 0.999, 0.75 respectively). In contrast, MCV showed a significant increase after 6 hours (P= 0.002), and PCV increased significantly after 12 hours (P> 0.001). A highly significant decrease was observed in MCHC after 12 hours (P> 0.001). While RDW-CV, revealed a highly significant increase after 12 hours (P < 0.001).
Conclusion: The study concluded that some RBCs parameters are changed with storage at room temperature. Therefore, it is recommended that RBCs parameters should be measured immediately after blood sample collection.
Background: Hemoglobin A1c (HbA1c) acts as the primary biomarker for evaluating long-term glucose regulation. Nevertheless, high concentrations of fetal hemoglobin (HbF) can affect the accuracy of HbA1c assays in a manner dependent on the method used, possibly leading to falsely low HbA1c readings even when there is considerable hyperglycemia.
Case Presentation: The outpatients showed significant hyperglycemia (random blood glucose: 433 mg/dL) and highly positive urine ketones (+++), aligning with a diagnosis of diabetic ketoacidosis. Ironically, HbA1c obtained through standard immunoassay was 6.5%, which is categorized within the non-diabetic range. Follow-up hemoglobin fractionation showed an increased fetal hemoglobin (HbF) concentration of 4.1%, causing worry about assay interference and leading to a reassessment of the HbA1c outcome.
Conclusion: Elevated fetal hemoglobin (>4%) can falsely lower HbA1c, especially with immunoassay or boronate-affinity methods. Ion-exchange HPLC or electrophoresis is recommended, and clinicians should integrate alternative glycemic markers or continuous glucose monitoring to guide management accurately.
Dear Editor,
In this study, demographic data of neurosurgery patients brought to the emergency room were examined and their results were evaluated. Patients who were brought to the Emergency Department of the Faculty of Medicine Hospital and hospitalized for neurosurgery over a three-year period were retrospectively analyzed from computer records. Of the 82250 patients who came to the emergency department within three years, 354 (0.43%) were followed up in the neurosurgery clinic. The mean age of the patients was 39.42 ± 22.50 (0-90), of which 213 (60.4%) were male and 141 (39.6%) were female. The most frequent applications were in October, December and January. The patients were brought to the emergency department with the most common complaints of headache, low back pain, traffic accident, falling from a height and dizziness. Glasgow coma scale was below 8 in 70 of the patients, and it was between 9-12,160 in 124 and 13-15 in 124 patients.
The most common diagnoses were lumbar pathologies (disc hernia, vertebral fracture), brain mass (diagnosed control patients), subarachnoid hemorrhage, hydrocephalus, epidural and subdural hemorrhage. Medical treatment was applied to 187 patients and surgical treatment was applied to 167 patients. While the number of patients hospitalized in the intensive care unit was 136, the mean day was 1.75 ± 5.91 (0-82) days, while the mean length of stay in the service was 8.06 ± 5.62 (1-37) days. Of the patients followed, 66 died and the most common diagnosis was intracranial hemorrhage. 288 patients were discharged with good recovery and were followed up in the outpatient clinic.
As a result, when neurosurgery patients are evaluated in emergency service admissions, it is seen that the number is low.
However, patients who are really urgent should be evaluated by making a differential diagnosis with a good physical examination and necessary tests (Şenol et al., 2014; Cook et al., 2020; Yang et al., 2021; Madhok et al., 2022).
