Prospective study of the prescribing pattern of antibiotics and their outcome in patients admitted to intensive care unit at tertiary center

Background: Antibiotics are currently the most commonly prescribed drugs in hospitals, worldwide. overuse of antibiotics has important economic implications. Periodic evaluation of drug utilization in the intensive care unit (ICU) is necessary for optimization of health care system, proper use of resources and making prescription policy because ICU is considered as the epi-center of antimicrobial resistance. The aim of this study is to evaluate antibiotic prescription and consumption patterns at admission into intensive care unit and to know the average costs of antibiotics.Methods: The prescription data on 250 consecutive patients at admission into the ICU was audited from January to March 2019. Total antibiotics, dose, route and cost of antibiotics were noted and the defined daily dose/100 bed days of most common antibiotics were calculated. Statistical analysis is done using SPSS software.Results: A total of 689 antibiotics were prescribed in the 250 patients studied that is, an average of 2.28 antibiotics/prescription. Empirical antibiotics were prescribed to all the patients admitted to ICU. Average cost of the antibiotics was rupees 163.89 per patients. The most commonly prescribed antibiotic at ICU admission was ceftriaxone (62%) of all prescription. Second most common is metronidazole (32%). In this study, 76 patients recovered while 174 patients expired.Conclusions: Our study reveals that antibiotics are widely prescribed in critically ill patients and form significant drug consumed in the ICU. At admission elderly patients are prescribed >2 antibiotics and prescribing antibiotics where the cost of antibiotic is high

On the energy and spectral properties of the he matrix of hexagonal systems

summary:The He matrix, put forward by He and He in 1989, is designed as a means for uniquely representing the structure of a hexagonal system (= benzenoid graph). Observing that the He matrix is just the adjacency matrix of a pertinently weighted inner dual of the respective hexagonal system, we establish a number of its spectral properties. Afterwards, we discuss the number of eigenvalues equal to zero of the He matrix of a hexagonal system. Moreover, we obtain a relation between the number of triangles and the eigenvalues of the He matrix of a hexagonal system. Finally, we present an upper bound on the He energy of hexagonal systems

The utility of early warning score in adults presenting with sepsis in the emergency department of a low resource setting

Background: Sepsis is a condition with high mortality and morbidity. Delay in early recognition and prompt management results in higher mortality. There are many clinical scores to identify early sepsis; however, Early Warning Score (EWS) has clinical/physiological parameters that are easy to apply in the ED for timely diagnosis and management. In the present study, we collected information regarding the utilization of EWS in timely identifying the sick patients at triage of a tertiary care center.Methods: This study was a descriptive cross-sectional investigation conducted in the ED of Aga Khan University Hospital in Karachi, the largest metropolitan city in Pakistan. A total of 240 participants were selected by non-probability convenient sampling after fulfilling the inclusion criteria. Data collected included EWS criteria, demography, length of hospital stay, patient disposition (ward, intensive care or high dependency area), and differentials like sepsis, severe sepsis or septic shock.Results: A total of 240 patients were enrolled, out of which 139 (57.9%) patients were male, and 101 (42.1%) were female with a mean age of 52.7 ± 15.3 years (range: 18 to 80 years). In this study, the length of stay (LOS) was 2.2 ± 1.1 (range: one to six days), and there was an EWS of 8.2 ± 2.6 (4-15). There were 143 patients in the elderly age group \u3e 50 years (59.6%); however, most elderly presented with sepsis among both age groups. The least affected age group was aged 16 to 30 years, with 23 (9.6%) cases. An EWS \u3e7 is best to detect cases with sepsis or severe sepsis with a sensitivity of 98.5% (95% CI: 92.13 to 99.92) and specificity of 89.57% (95% CI: 82.64 to 93.93). Similarly, the EWS for severe sepsis or septic shock was \u3e9 with a sensitivity of 86.76% (95% CI: 76.72 to 92.88) and specificity of 88.24% (95% CI: 78.47 to 93.92).Conclusions: This study revealed that the sensitivity and specificity of EWS for the detection of sepsis, severe sepsis and septic shock was found to be high; hence, it could be a valuable and readily useable system for early diagnosis and proper management of sepsis, severe sepsis, and septic shock

Interval Load Forecasting for Individual Households in the Presence of Electric Vehicle Charging

The transition to Electric Vehicles (EV) in place of traditional internal combustion engines is increasing societal demand for electricity. The ability to integrate the additional demand from EV charging into forecasting electricity demand is critical for maintaining the reliability of electricity generation and distribution. Load forecasting studies typically exclude households with home EV charging, focusing on offices, schools, and public charging stations. Moreover, they provide point forecasts which do not offer information about prediction uncertainty. Consequently, this paper proposes the Long Short-Term Memory Bayesian Neural Networks (LSTM-BNNs) for household load forecasting in presence of EV charging. The approach takes advantage of the LSTM model to capture the time dependencies and uses the dropout layer with Bayesian inference to generate prediction intervals. Results show that the proposed LSTM-BNNs achieve accuracy similar to point forecasts with the advantage of prediction intervals. Moreover, the impact of lockdowns related to the COVID-19 pandemic on the load forecasting model is examined, and the analysis shows that there is no major change in the model performance as, for the considered households, the randomness of the EV charging outweighs the change due to pandemic

Genomes of Helicobacter pylori from native Peruvians suggest admixture of ancestral and modern lineages and reveal a western type cag-pathogenicity island

BACKGROUND: Helicobacter pylori is presumed to be co-evolved with its human host and is a highly diverse gastric pathogen at genetic levels. Ancient origins of H. pylori in the New World are still debatable. It is not clear how different waves of human migrations in South America contributed to the evolution of strain diversity of H. pylori. The objective of our 'phylogeographic' study was to gain fresh insights into these issues through mapping genetic origins of H. pylori of native Peruvians (of Amerindian ancestry) and their genomic comparison with isolates from Spain, and Japan. RESULTS: For this purpose, we attempted to dissect genetic identity of strains by fluorescent amplified fragment length polymorphism (FAFLP) analysis, multilocus sequence typing (MLST) of the 7 housekeeping genes (atpA, efp, ureI, ppa, mutY, trpC, yphC) and the sequence analyses of the babB adhesin and oipA genes. The whole cag pathogenicity-island (cagPAI) from these strains was analyzed using PCR and the geographic type of cagA phosphorylation motif EPIYA was determined by gene sequencing. We observed that while European genotype (hp-Europe) predominates in native Peruvian strains, approximately 20% of these strains represent a sub-population with an Amerindian ancestry (hsp-Amerind). All of these strains however, irrespective of their ancestral affiliation harbored a complete, 'western' type cagPAI and the motifs surrounding it. This indicates a possible acquisition of cagPAI by the hsp-Amerind strains from the European strains, during decades of co-colonization. CONCLUSION: Our observations suggest presence of ancestral H. pylori (hsp-Amerind) in Peruvian Amerindians which possibly managed to survive and compete against the Spanish strains that arrived to the New World about 500 years ago. We suggest that this might have happened after native Peruvian H. pylori strains acquired cagPAI sequences, either by new acquisition in cag-negative strains or by recombination in cag positive Amerindian strains