Community acquired versus hospital acquired acute kidney injury; causes and outcome

Objective: To evaluate causes of community-acquired and hospital-acquired acute kidney injury and the factors associated with increased inpatient mortality. Method: The observational prospective study was conducted at the Aga Khan University Hospital, Karachi, from September 2018 to March 2019, and comprised patients having acute kidney injury either at the time of admission in group A or developed it after 48 hours of hospital stay in group B. The patients were followed up for 12 weeks and outcomes were categorised as recovered, developed chronic kidney disease, died or remained dialysis-dependent. Data was analysed using SPSS 19. Results: Of the 400 patients, 347(86.8%) were in group A; 190(54.8%) males and 157(45.2%) females with an overall mean age of 57.2±17.0 years. The remaining 53(13.3%) were in group B; 31(58.5%) males and 22(41.5%) females with an overall mean age of 58.5±16.3 years. Urinary tract infection 105(30.3%) was the most frequent cause in group A, followed by volume depletion 73(21%). The causes in group B were multiple, with nephrotoxic antibiotics vancomycin 21(39.6%) and polymyxin 20(37.7%) being the most common. At 12 weeks, 224(56%) patients recovered, 55(13.8%) died, 82(20.5%) and 38(9.5%) developed new onset and progressive chronic kidney disease, respectively, and 1(0.25%) patient remained dialysis-dependent.  Chronic liver disease, renin angiotensin system inhibitors, infection, shock, invasive ventilation and increasing length of stay were associated with increased inpatient mortality (p<0.05). Conclusion: Acute kidney injury was largely community-acquired, and infection was the leading cause with better outcome in contrast to hospital-acquired acute kidney injury which was mostly multifactorial

An Empirical Investigation of the Challenges of Cloud-Based ERP Adoption in Pakistani SMEs

Cloud-based ERP solutions offer many benefits to small and medium enterprises (SMEs) and help them to integrate their activities, such as improve communications and reduce operational and maintenance costs. Primarily, it was only adopted by large organizations, but now SMEs are also keen on adoption. However, the motivation regarding the adoption of these systems in SMEs is relatively low in developing countries. This fact urges us to investigate the challenges faced by Pakistani SMEs. A qualitative research approach along with unstructured interviews was conducted by means of face to face. Interview methods are used to extract understanding, opinions, and challenges faced by SMEs on their way to adopt the cloud-based ERP system. The data were collected from eight well-reputed organizations, directly involved in the adoption. The study found ten (10) themes that are reluctant to adopt cloud ERP among Pakistani SMEs. The main benefit of these themes is to provide results that can be easily accessible to enterprises who want to adopt a cloud-based ERP. This can also contribute to the lack of the literature of cloud ERP and delivers insight for future study by practitioners and researchers

COVID-19 and <i>Clostridioides difficile</i> Coinfection Outcomes among Hospitalized Patients in the United States: An Insight from National Inpatient Database

The incidence of Clostridioides difficile infection (CDI) has been increasing compared to pre-COVID-19 pandemic levels. The COVID-19 infection and CDI relationship can be affected by gut dysbiosis and poor antibiotic stewardship. As the COVID-19 pandemic transitions into an endemic stage, it has become increasingly important to further characterize how concurrent infection with both conditions can impact patient outcomes. We performed a retrospective cohort study utilizing the 2020 NIS Healthcare Cost Utilization Project (HCUP) database with a total of 1,659,040 patients, with 10,710 (0.6%) of those patients with concurrent CDI. We found that patients with concurrent COVID-19 and CDI had worse outcomes compared to patients without CDI including higher in-hospital mortality (23% vs. 13.4%, aOR: 1.3, 95% CI: 1.12–1.5, p = 0.01), rates of in-hospital complications such as ileus (2.7% vs. 0.8%, p p p p < 0.001). Patients with concurrent COVID-19 and CDI had increased morbidity and mortality, and added significant preventable burden on the healthcare system. Optimizing hand hygiene and antibiotic stewardship during in-hospital admissions can help to reduce worse outcomes in this population, and more efforts should be directly made to reduce CDI in hospitalized patients with COVID-19 infection