Evaluation of parenteral nutritional support in the surgical and medical wards of a referral teaching hospital

BACKGROUND AND PURPOSE: Malnutrition is a common problem in patients who are hospitalized in surgical and medical wards. Surgical patients, geriatric populations and individuals with severe illness are more vulnerable to malnutrition during their hospitalization course. The purpose of this study was evaluation of parenteral nutrition services in a referral teaching hospital, Tehran, Iran. METHOD: Medical records of 72 patients who received parenteral nutrition during one year period in different surgical and medical wards of Imam Khomeini hospital were reviewed retrospectively by clinical pharmacists. Criteria for initiation of parenteral nutrition, selection of appropriate formulation and monitoring parameters were assessed based on the American Society of Parenteral and Enteral Nutrition recommendations. RESULTS: Based on the patients' anthropometric parameters and serum albumin levels, 4.2%, 75% and 20.8% of the patients were well-nourished, moderately malnourished and severely malnourished respectively at the hospital admission and before nutritional support. Adequate calorie, protein, carbohydrate and lipid supports were achieved in 21.1%, 32.4%, 23.7% and 10.5% of the patients respectively. About 91% of the patients experienced at least one complication of the nutritional support. CONCLUSION: In this evaluation, several errors in assessment, establishing goals, and monitoring of parenteral nutrition regimens have been detected. Approximately all of the patients did not receive to the trace elements supports goals

Antibiotics Induced Acute Kidney Injury: Incidence, Risk Factors, Onset Time and Outcome

Drug induced acute kidney injury (AKI) has been implicated in 8% to 60% of all cases of in-hospital AKI and as such is a recognized source of significant morbidity and mortality. Evaluation of incidence, risk factors, onset time, and outcome of  antibiotics' associated acute kidney injury. During one-year period, all patients who developed acute kidney injury during their hospital stay in the infectious diseases ward of Imam Khomeini hospital were included in the study prospectively. Patients' demographic data, baseline diseases, cause of current hospital admission, history of past and current medications and hemodynamic parameters were collected and monitored closely. Drug induced acute kidney injury was defined based on acute kidney injury network criteria. From 424 admitted patients, 76 (17.9%) developed acute kidney injury. Aminoglycosides (gentamicin and amikacin), amphotericin B, vancomycin, beta-lactam antibiotics (cefazolin and ceftriaxone) in monotherapy and combination therapy were the causes of acute kidney injury in most of the patients. From the co-morbid diseases in patients with acute kidney injury, diabetes mellitus (26.3%) and hypertension (5.5%), were the most frequent ones. Presence of diabetes mellitus as comorbidity (OR=2.6; CI=1.3-5.7, P=0.01), dehydration of patients upon admission (OR=3.4; CI=1.9-6.4, P<0.001), and administration of nephrotoxic combinations (OR=2.1; CI=1.2-4.1, P=0.04) were independent risk factors for antibiotic induced nephrotoxicity in our study. About 18% of the patients developed acute kidney injury during their hospitalization period in the infectious diseases ward. Aminoglycosides, amphotericin B, vancomycin and beta-lactam antibiotics were responsible agents for acute kidney injury in this study

Relationship between Self-care Behaviors and Quality of Life among Hypertensive Patients Visiting Comprehensive Health Centers in Hamadan, Iran

Background and Objectives: Non-adherence to self-care behaviors can deteriorate quality of life among hypertension patients. Thus, we sought to examine the association between self-care behaviors and quality of life among patients with hypertension visiting Comprehensive Health Centers in Hamadan, Iran. Materials and Methods: This descriptive, cross-sectional study was carried out in 200 hypertensive patients presenting to Comprehensive Health Centers in Hamadan, Iran, 2017. The participants were recruited using multistage sampling method. A demographic form, Self-Care Behaviors Scale, and the Quality of Life (SF-36) questionnaire were used to collect the data. Pearson correlation coefficient, t-test, and One-way analysis of variance were run to analyze the data in SPSS, version 16. Results: The self-care behavior and quality of life overall scores were respectively 63.5% and 56.6%, indicating that they were at admissible and inadmissible levels, respectively. There was a significant relationship between quality of life and gender, marital status, and body mass index (BMI; P<0.05). Also, there was a positive significant correlation between self-care behavior and three dimensions of quality of life, including physical status, emotional well-being, and bodily pain (P<0.05). Further, there was a positive significant correlation between self-care behavior and total score of quality of life (P=0.005; r=0.196). Conclusion: Considering the relationship of quality of life with well-being and self-care behaviors, we recommend designing and implementing educational programs for hypertensive patients to increase adherence to self-care behaviors