Pilgaardhandberg6405

Nursing work efforts are important in providing sound healthcare services, especially in the intensive care units (ICU). Complications and adverse events are more liable to occur among patients in the ICU and these patients require more attention and nursing care. Most of the research in this field is mainly focused on the effect of staffing and its correlation to patient safety and satisfaction. Previous studies also showed that reduced nursing staffing was significantly associated with the development of pneumonia in ICU patients who needed more nursing requirements. An increase in nursing workload is also significantly associated with an increased incidence rate of nosocomial infections. The association between nursing workload in ICU patients and increased incidence rates of mortality is also supported by previous studies. The nurse-to-patient ratio has been previously used to evaluate patient safety correlation with the nursing workload as reported by previous reports. However, previous research shows that the nursing workload is a more complex correlation and can not be determined by a simple ratio as the nurse-to-patient one. Evidence shows that many adverse events may occur with patients in the ICU secondary to reduced nursing care such as increased mortality, length of hospital stay, and catching in-hospital infections. In the current study, we aim to review the outcomes from previous investigations to further emphasize the effect of nursing workload on ICU patient outcomes and safety.Patients with end-stage heart failure may require hospitalization for the treatment of respiratory distress. Morphine may be used to relieve symptoms. However, use of morphine is problematic because heart failure is often associated with renal dysfunction. In this case report, intravenous fentanyl infusion reduced dyspnea in a patient with end-stage heart failure who was on dialysis induction to treat renal failure. The patient was able to eat and sleep after administration of an intravenous fentanyl solution and experienced no apparent respiratory depression as a side effect of fentanyl. There have been few reports of dyspnea relief with fentanyl infusion. Because of its adjustable duration of effect, intravenous fentanyl may be a more effective and useful option than rapid or extended-release agents in cases such as this one.The soft tissues are comprised of various structures and supportive tissues in the body, including muscle, connective tissues, endothelium, synovium, fat, lymphatics, and fascia. Soft tissue sarcomas may arise in any part of the body. The most common sites are the trunk and the extremities. Fibrosarcoma is the most common non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) in children, in whom two peaks in incidence are observed. The first is in children younger than five years, and the second is in children and adolescents aged 10-15 years. Infantile fibrosarcoma (IFS) is almost exclusively observed in children younger than two years. Many of these sarcomas are congenital. This tumor is locally aggressive, but rarely metastatic, and occurs in the extremity in 70% of patients. A 29-year-old lady presented to the Oncology unit with the fifth recurrence of fibrosarcoma which was transformed into very vascular and high-grade leiomyosarcoma from the fourth recurrence onwards. Initially, it was diagnosed when she wase series. A multidisciplinary approach is essential in managing infantile fibrosarcoma as it has a high potency of recurrence during teenage or later in life with malignant transformation. This could have been prevented when the clinicians are well aware of this risk of recurrence and primary surgery has to be planned very carefully with multidisciplinary involvement.Background Obesity has been shown to have a positive mortality benefit in patients undergoing percutaneous coronary intervention, dialysis, those with rheumatoid arthritis, chronic obstructive pulmonary disease, and various wasting diseases. Studies for this mortality benefit in ischemic stroke patients are conflicting, and it has not been well studied in mechanical thrombectomy patients. We sought to determine the impact of obesity on outcomes of mechanical thrombectomy patients. Methodology We used a large global health research network to gather clinical data extracted from the electronic medical records of ischemic stroke patients who underwent mechanical thrombectomy, and then stratified these patients into obese and non-obese cohorts. The primary endpoint was mortality. Results After propensity score matching, obese patients who underwent mechanical thrombectomy had decreased mortality (p = 0.0033, odds ratio = 0.81, 95% confidence interval = 0.704,0.932) compared to non-obese patients. No statistically significant difference was shown between these two cohorts for the outcomes of ventilator dependence, hemicraniectomy, or post-procedure intracerebral hemorrhage. Conclusion Despite increasing risk of ischemic stroke, obese patients who undergo mechanical thrombectomy have decreased mortality rates compared to their non-obese counterparts.Crigler-Najjar syndrome is an inborn error of metabolism caused by a point mutation in one of the five exons of UGT1A1 gene, the product of which is responsible for elimination of bilirubin via bile. A number of hyperbilirubinemia disorders similar to Crigler-Najjar syndrome are reported, but they differ in their level of unconjugated bilirubin and responses to the treatment. Here we report a 14-year-old male patient admitted to hospital with the complaint of vomiting and frequent tonsillitis. Further examination revealed that he was jaundiced since birth and had a family history of similar disorder. This report is about an extremely rare case of Crigler-Najjar syndrome type II and also management of the condition to provide the patient with a healthy lifestyle.Background and Importance Intracranial artery fenestrations are very rare, however, when found, there is a high association with cerebral aneurysms. Clinical Presentation This report describes a patient with multiple anterior and posterior circulation intracranial artery fenestrations and an anterior communicating artery aneurysm presenting with a thunderclap headache found to have a subarachnoid hemorrhage (SAH). The patient was treated with open surgery via clipping after a diagnostic angiography and did very well. Conclusion There is an association between cerebral fenestrations and aneurysms, but it has not been studied in a prospective manner. This case is unusual in that the patient had both anterior and posterior circulation fenestrations, which is uncommon. Clinicians should have a high index of suspicion in patients being evaluated for SAH who have a cerebral artery fenestration with no aneurysm found.Rhabdomyolysis is a condition where there is damage of skeletal muscle, causing myoglobin leak into the circulation. We report a case of a 69-year-old female with a history of hypertension, hyperlipidemia, diabetes mellitus, morbid obesity, paroxysmal atrial fibrillation, and chronic kidney disease stage who underwent cardiopulmonary resuscitation following ventricular fibrillation to restore effective cardiac rhythm. After the third attempt of defibrillation she converted to sinus rhythm. Her echocardiography was suggestive of myocardial infarction (MI). On the second day of her hospitalization, she started becoming oliguric and her creatinine started rising up causing acute kidney injury (AKI). The patient's creatinine kinase (CK) level peaked at 6380 u/L (normal range 26-192 u/L), myoglobin was >20,000 ng/mL (normal range 9-83 ng/mL), and myocardial bound (MB) isoenzyme of CK was 4.5 ng/mL (normal range 0-3.6 ng/mL). Plasma creatinine increased to 5.71 mg/dL and ultimately developed renal failure. She was started on hemodialysis. Her cardiac catheterization was suggestive of MI. Our case highlights that MI, cardiopulmonary resuscitation, and cardioversion can be a cause for myoglobinuric renal failure, which has been rarely reported in the literature before.Concomitant ipsilateral fractures of femoral neck and shaft are rare injuries and pose challenging management. Infected non-unions of such fractures can further complicate the management options and have not been discussed in the literature. We present a case of an eight-month-old atrophic non-union of ipsilateral femoral shaft and femoral neck with evidence of intramedullary infection that was managed using a cost-effective, low strain rail fixator assembly and an intramedullary antibiotic cement spacer. Both fracture non-unions were salvaged without the need for any additional procedure. The patient returned to his regular activities within a year follow-up period. There was no clinical evidence of infection during the last follow-up at 16 months, and inflammatory markers were within normal limits. The current case study suggests that while aggressive debridement and intramedullary antibiotic cement spacer can control the intramedullary infection, and simultaneous union of even atrophic nonunion of femoral shaft and femoral neck, both, can be obtained using a tensioned Schanz pin-based external fixator without the need for any secondary procedure. Such a fixator and cement spacer assembly can thus address the dual purpose of fracture stabilization during infection control as well as the union of the non-union sites.

Enteric fever or typhoid fever is a major public health issue affecting greater than 27 million individuals globally and is responsible for greater than 200,000 deaths per year. Due to the extensive overuse of antimicrobials, the world is moving toward a pre-antibiotic era. The emergence and transmission of antibiotic-resistant

species are a global threat and a serious concern in developing countries such as Pakistan. This study aimed to determine the trends in antimicrobial resistance (AMR) of typhoidal strains of

in a tertiary care hospital in Pakistan.

It was a descriptive, cross-sectional study conducted in the pathology department of Sharif City Hospital, Lahore, after approval by the ethical committee of the institution. A total of 50 blood culture specimens positive for

and

from January 2019 to March 2020 were included by the non-probability consecutive sampling technique. The samples were processed by conventional bacteriological methods for isolation and identification. see more The antimicrobhe increasing frequency of MDR and XDR

species in Pakistan is a major concern. A significant percentage of the typhoidal strains of

is resistant to the first-line (16%) and second-line (54%) antibiotics. Carbapenems and azithromycin are the last resort of therapy in such cases.

The increasing frequency of MDR and XDR Salmonella species in Pakistan is a major concern. A significant percentage of the typhoidal strains of Salmonella is resistant to the first-line (16%) and second-line (54%) antibiotics. Carbapenems and azithromycin are the last resort of therapy in such cases.Background The first case of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was diagnosed in Wuhan, China, in 2019. By the first half of 2020, coronavirus disease 2019 (COVID-19) turned into a global pandemic. Objectives The aim of this study is to describe the clinical and demographic characteristics including comorbidities and their outcomes among patients hospitalized with COVID-19 in four tertiary care hospitals across Lahore. This retrospective study was conducted at Fatima Memorial Hospital, Sir Ganga Ram Hospital, Lahore General Hospital, and Jinnah Hospital, all in Lahore, Pakistan, from May 1, 2020, to June 30, 2020. The sample size was 445, which was derived using the convenient sampling method. Clinical outcomes during hospitalization included the requirement of invasive positive pressure ventilation, need for renal replacement therapy (RRT), and death. Data regarding demographics, baseline comorbidities, important vital signs on reporting, and initial workup with results were also collected.