Ventilator-Associated Pneumonia and Its Responsible Germs; an Epidemiological Study

Introduction: Ventilator-associated pneumonia (VAP) is one of the most common hospital infections and a side effect of lengthy stay in intensive care unit (ICU). Considering the ever-changing pattern of common pathogens in infectious diseases and the raise in prevalence of hospital infections, the present study was designed aiming to determine the prevalence of VAP and its bacterial causes. Methods: In this cross-sectional study, the medical profiles of all the patients under mechanical ventilation, who had no symptoms of pneumonia at the time of intubation and developed new infiltration in chest radiography after 48 hours under mechanical ventilation along with at least 2 of the symptoms including fever, hypothermia, leukocytosis, leukopenia, or purulent discharge from the lungs, were evaluated. Demographic data, clinical and laboratory findings, and final outcome of the patients were extracted from the patient’s clinical profile and reported using SPSS version 20 and descriptive statistics.Results: 518 patients with the mean age of 62.3 ± 20.8 years were evaluated (50.9% female). Mean time interval between intubation and showing symptoms was 10.89 ± 12.27 days. Purulent discharges (100%), leukocytosis (71.9%), fever (49.1%), hypothermia (12.3%), and leukopenia (8.8%) were the most common clinical and laboratory symptoms and acinetobacter baumannii (31.58%) and klebsiella pneumoniae (29.82%) were the most common germs growing in sputum cultures. 19 (33.3%) cases of pan drug resistance (PDR) and 10 (17.5%) cases of extensive drug resistance (XDR) were seen. Mortality due to VAP was 78.9% and there was no significant correlation between age (p = 0.841), sex (p = 0.473), ICU admission (p = 0.777), duration of hospitalization (p = 0.254), leukocytosis (p = 0.790), leukopenia (p = 0.952), fever (p = 0.171), hypothermia (p = 0.639), type of culture (p = 0.282), and type of antibiotic resistance (p = 0.066) with mortality. Conclusion: Prevalence of VAP and its associated mortality were 11% and 78.9%, respectively. The most common symptoms and signs were purulent discharge, leukocytosis, and fever. Acinetobacter baumannii and klebsiella pneumoniae were the most common germs in sputum cultures with 50% resistance to commonly used antibiotics

Evaluation of Association between duration of Hospitalization in-Patient with Deep Venous Thrombosis and the type of Treatment Considering the Effect of Comorbid Diseases

Introduction: Deep vein thrombosis (DVT) is a common disease with serious risks such as pulmonary embolism and there are different anticoagulant therapies for treatment of this condition. In this study, we investigated the association between the duration of hospitalization with different treatment methods and comorbidities. Materials and methods: In this retrospective cross-sectional study, the hospital records of 213 patients with a diagnosis of acute DVT in Shohada-e-Tajrish Hospital in 2019 and 2020 were reviewed. Patients were divided into five main groups and five subgroups based on the type of treatment. Then, the association between the duration of hospitalization and different treatment methods was studied. Results: Treatment with novel oral anticoagulants (NOACs) with an average length of 2.5 days of hospitalization significantly reduces the duration of hospitalization. Combination therapy with low molecular weight heparin (LMWH) and warfarin or LMWH alone, with an average of 8.38 and 8.20 days, is preferable to treatment with unfractionated heparin (UFH) and warfarin, with an average of 9.2 days. Warfarin treatment with an average duration of hospitalization of 8.43 days is in the third place. The use of other methods has increased the duration of hospitalization. History of comorbidities including history of hospitalization, hypertension, smoking, cancer and trauma are the five comorbidities that have the greatest effect on the length of hospitalization of patients, respectively. Conclusion: According to the present study, treatment with NOACs reduces the duration of hospitalization of patients more than the other treatment methods. The second best choice is LMWH injection therapy and continuation with warfarin or starting and continuing treatment with LMWH preferable to injecting treatment with UFH and continuing with warfarin. The type of underlying disease and comorbidities had a significant effect on the duration of hospitalization

Effect of Nocturnal Oxygen Therapy on Electrocardiographic Changes Among Patients with Congestive Heart Failure

Introduction: Nocturnal hypoxia is an important factor in increasing the risk of mortality in patients with chronic heart failure and is associated with atrial and ventricular arrhythmias. In addition, QT dispersion (QTd) is used as a prognostic sign in determining future malignant arrhythmias and sudden cardiac death. In the current study, we investigated the effect of nocturnal oxygen therapy (NOT) on electrocardiographic changes among patients with chronic heart failure.Methods: In this study, a consecutive of 154 patients (87 males and 67 females) known with chronic heart failure (EF ≤ 40%) were enrolled. The patients were administered NOT (oxygen flow of 2 L/min for 8 hours during sleeping). Electrocardiography was takenbefore and after the NOT, and RR interval, PR interval and QTd were measured each time.Results: The mean age of the participants was 61.3 ± 11.4 years. Our results revealed significant reduction in QTd (55.8 ± 7.5 vs. 61.4± 9.1 msec, P = 0.001) and heart rate (79.6 ± 4.7 vs. 76.8 ± 4.3, P = 0.001) in a patient’s electrocardiogram after NOT.Conclusions: In this study, NOT decreased heart rate and QTd in patients with chronic heart failure, but not PR interval, which could consequently decrease the risk of malignant arrhythmias and sudden cardiac death

Association between Anatomic Configuration of Thrombosis with Clinical Symptoms and Risk factors in Admitted Patients with Deep Vein Thrombosis

Introduction: Deep vein thrombosis (DVT) is prevalent and challenging for physicians. Previously, the clinical symptoms of DVT are different based on the location of the thrombosis. In this study, the anatomic location of thrombosis and its relation with clinical symptoms and DVT risk factors were investigated. Methods: In this retrospective study, the hospital documents of 204 patients with acute lower extremity DVTs in Shohada-e-Tajrish hospital were reviewed from April 2020 to February 2021. The diagnosis was confirmed using Doppler ultrasound. Based on the location of the thrombosis, the patients were divided into four groups: unilateral proximal group (UPG), bilateral proximal group (BPG), unilateral distal group (UDG), and ipsilateral proximal and distal group (IPDG). Finally, the frequency of risk factors and symptoms were compared between the groups. Results: In this retrospective study, 204 patients with the diagnosis of acute lower extremity DVTs at the time of hospitalization or during hospitalization were studied. The mean±SD age of the patients was 57.1±19.2 years (range: 12-98 years). Of these, 114 (55.9%) were men and 90 (44.1%) were women. There were 174 patients in UPG, 16 in BPG, 5 in UDG and 9 in IPDG. In total, 97.5% of the patients had proximal thrombosis while only 6.9% of them had distal thrombosis. The incidence of different limb circumferences was significantly higher in UPG and IPDG compared to BPG and UDG (P<0.05). There was no statistically significant difference between groups in terms of other symptoms and risk factors. Conclusion: Most of the DVTs were found in the proximal veins of the lower extremities. It seems that these DVTs are more likely to create edema compared to others and in unilateral cases may result in different circumferences of the lower limbs. But there was no significant association between other clinical signs of DVT including limb pain, edema, erythema, palpitations, and shortness of breath with thrombosis location. Also not significant association between DVT risk factors and the location of thrombosis were found

Cutaneous vasculitis following COVID-19 vaccination: a case-based review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging virus that causes a disease mainly known by its pulmonary and thrombotic complications. Although cutaneous complications, including vasculitis, have been reported in infected patients, the development of vasculitis after receiving vaccine is a rare clinical finding. Here, we report a case of vasculitis in a female patient who received a COVID-19 vaccine and was later infected with SARS-CoV-2, and was also diagnosed with hepatitis B during hospitalization. Our patient did not have a previous history of similar cutaneous manifestations of vasculitis, and the development of the symptoms approximately one month from the vaccination suggests immune complex hypersensitivity reaction

Prevalence of Non-Thromboembolic Incidental Findings on Computed Tomography-Pulmonary Angiography for Pulmonary

Introduction: Computed Tomography-Pulmonary Angiography (CTPA) is a noninvasive imaging modality for direct diagnosis of pulmonary thromboembolism. The potential advantage of CTPA is possible alternative and incidental findings in cases that PTE is ruled out. This study was performed to determine the prevalence of incidental findings in CTPA in patients suspected to have PTE.Methods: This cross-sectional retrospective study was performed in patients with suspected PTE admitted to Shohada-e-Tajrish Hospital in 2014 and 2015 and underwent CTPA for final diagnosis. Incidental findings in CTPA and associated clinical symptoms were assessed.Results: According to CTPA performed in 188 patients, PTE was diagnosed in 61 cases (32.4%). Prevalence of incidental abnormal findings in the two groups with and without PTE were 93.7% and 90.9%, respectively. The most common incidental finding was pleural effusion (42%). There was no significant association between clinical symptoms and incidental findings in CTPA in patients with suspected pulmonary embolism (P > 0.05). The only significant finding was association between lung mass and tachypnea (P=0.007).Conclusion: In patients with primary clinical symptoms of suspected pulmonary embolism, in most cases there was a wide range of incidental findings and simultaneous pathologies in CTPA mimicking the primary symptoms of pulmonary embolism. However, in this study there was no significant association between clinical symptoms and incidental findings. Determination of definite indications of CTPA in patients with suspected pulmonary embolism is necessary

Findings of the Peripheral Blood Smear in Patient Suspected with Sepsis Admitted in Emergency Department

مقدمه: شناخت بهترین شیوه های تشخیص پاراکلینیک نقش مهمی در تشخیص افتراقی مبتلایان به سپسیس و بهبود پیش آگهی نهایی بیماران ایفا می نماید. لذا این مطالعه به منظور بررسی یافته های لام خون محیطی در بیماران مشکوک به سپسیس و ارتباط آن با تشخیص نهایی انجام شد. روش کار: در این مطالعه مشاهده ای که به صورت مقطعی انجام گردید، تعداد 348 بیمار مشکوک به سپسیس بستری در اورژانس بیمارستان شهدای تجریش در سال 1396 مورد ارزیابی قرار گرفتند و یافته های لام خون محیطی در آنها تعیین شده و ارتباط آن با تشخیص نهایی در بیماران بستری ارزیابی گردید. یافته ها: میانگین سنی بیماران مورد بررسی 3/62 سال با انحراف معیار 7/17 سال بود. همچنین 2/53 درصد از بیماران مورد بررسی مذکر و 8/46 درصد مونث بودند. شایعترین تشخیص های نهایی شامل پنومونی (29 درصد) و عفونت ادراری (1/18 درصد) بودند. در مورد یافته های لام خون محیطی ارتباط آماری معناداری با تشخیص نهایی بیماران در مورد یافته های ترومبوسیتوپنی (000/0 = p)، ترومبوسیتوز (032/0 = p)، مورفولوژی غیرطبیعی (049/0 = p) وجود داشت. نتیجه گیری: در مجموع چنین استنباط می شود که تعداد پلاکتها و مورفولوژی غیرطبیعی می توانند کارآیی تشخیصی خوبی در مورد بیماران مشکوک به سپسیس داشته باشند.Introduction: Determination of good diagnostic tools is an issue of importance specially to differentiate between sepsis etiologies and improvement of prognosis. Hence our purpose was to determine the finding of the peripheral blood smear (PBS) in patients with suspected of sepsis and its association with the final diagnosis in the year 1396. Methods: In this cross-sectional comparative survey, 348 consecutive patients with suspected of sepsis admitted in emergency department of Shohaday-e-Tajrish Hospital were enrolled and the association of finding of the peripheral blood smear in patients with the final diagnosis in the year 1396 were determined. Results: The results in this study demonstrated that pneumonia and urinary tract infection were seen in 29% and 18.1%. Thrombocytopenia (p=0.000), thrombocytosis (p=0.032), and abnormal morphology (p=0.049) were related to final diagnosis. Conclusion: Totally, according to the obtained results it may be concluded that platelet count and PBS morphology are important related factors for sepsis

Evaluation of the acute effects of smoking on cardiac electrical function and hemodynamic indices in smokers

Background: Smoking is one of the most important risk factors for cardiovascular diseases. Although numerous studies have evaluated the long-term consequences of smoking, few studies have assessed the short-term effects of smoking, especially on the electrical activity of the heart. The aim of this study was the evaluation of the acute effect of smoking on cardiac electrical function and hemodynamic indices in smokers. Materials: In this single-arm pretest-posttest study, 130 healthy smokers participated if they had smoked at least 100 cigarettes in their lifetime and were smoking daily. After considering the exclusion criteria, participants were monitored before and 10 minutes after smoking by electrocardiography (ECG) to measure QT dispersion (QTD) and P-wave dispersion (PWD), systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and respiration rate (RR). Finally, the data obtained before and after smoking were compared. Results: The mean age of the participants was 40.3 ± 10.6 years (range 19 to 71 years). 55 (42.3%) participants smoked between 10-15 years and 67 (51.5%) smoked 10 to 20 pack-years. After smoking, SBP (127.3 ± 10.4 vs. 138.4 ± 12.8 mmHg), QTD (33.5 ± 9.6 vs. 43.9 ± 10.7 ms) and PWD (28.9 ± 6.6 vs. 34.5 ± 7.4 ms), HR (80.1±9.8 vs 87.6±9.9) increased significantly (P value <0.001). In other parameters, no significant differences were observed. Conclusions: Smoking is associated with an acute increase in QTD and PWD, and thus an increased risk of ventricular arrhythmias (e.g. Torsade’s de pointes), atrial fibrillation, sudden death, and other heart problems

Pulmonary thromboemboli in smokers and nonsmokers; Risk factors and anatomic disturbution of emboli in CT angiographies

Introduction: Recognition of risk factors in different high-risk groups such as smokers in comparison with non-high risk groups would help to develop good preventive strategies for pulmonary thromboemboli (PTE). The purpose of this study was to investigate and compare clinical findings and risk factors in smoker and nonsmoker patients with pulmonary thromboembolism and assessing anatomical variant in pulmonary computerized tomography angiographies.Methods: In this descriptive study 260 consecutive patients suspected to have PTE underwent pulmonary computerized tomography angiographies in a training hospital since 2015 to 2018. Patient with documented PTE were enrolled. Clinical finding and risk factors were determined and compared between them.Results: From 260 patients 172 subjects (66.15%) had PTE and enrolled in the study. Fifty-six (32%) were smoker and 116 (68%) non-smoker. The smoker group was younger and male gender was more predominant. Oxygen saturation and inspired oxygen partial pressure differed between smokers and non-smokers (P &lt; 0.05). The predisposing factors of thromboembolism and anatomic distribution of emboli were the same in smokers and non-smokers.Conclusion: Regarding different factors responsible for PTE in smokers and non-smokers, clinical presentation and anatomic distribution of PTE are comparable