Examining pulmonary TB patient management and healthcare workers exposures in two public tertiary care hospitals, Bangladesh

Implementation of tuberculosis (TB) infection prevention and control (IPC) guidelines in public tertiary care general hospitals remain challenging due to limited evidence of pulmonary TB (PTB) patients’ duration of hospital stay and management. To fill this evidence gap, this study examined adult PTB patient management, healthcare workers’ (HCWs) exposures and IPC practices in two public tertiary care hospitals in Bangladesh.Between December 2017 and September 2019, a multidisciplinary team conducted structured observations, a hospital record review, and in-depth interviews with hospital staff from four adult medicine wards.Over 20 months, we identified 1,200 presumptive TB patients through the hospital record review, of whom 263 were confirmed PTB patients who stayed in the hospital, a median of 4.7 days without TB treatment and possibly contaminated the inpatients wards. Over 141 observation hours, we found a median of 3.35 occupants present per 10 m2 of floor space and recorded a total of 17,085 coughs and 316 sneezes: a median of 3.9 coughs or sneezes per 10 m2 per hour per ward. Only 8.4% of coughs and 21% of sneezes were covered by cloths, paper, tissues, or by hand. The HCWs reportedly could not isolate the TB patients due to limited resources and space and could not provide them with a mask. Further, patients and HCWs did not wear any respirators.The study identified that most TB patients stayed in the hospitals untreated for some duration of time. These PTB patients frequently coughed and sneezed without any facial protection that potentially contaminated the ward environment and put everyone, including the HCWs, at risk of TB infection. Interventions that target TB patients screening on admission, isolation of presumptive TB patients, respiratory hygiene, and HCWs’ use of personal protective equipment need to be enhanced and evaluated for acceptability, practicality and scale-up.

Distribution of Aspergillus species and prevalence of azole resistance in respiratory samples from Swiss Tertiary Care Hospitals

Among 400 Aspergillus spp. from respiratory samples in Switzerland, A. fumigatus was the most frequent species. Non-fumigatus Aspergillus spp. were more prevalent among solid-organ transplant recipients and after azole exposure. Azole-resistance was detected in four A. fumigatus isolates, three of them with the “environmental” mutation TR34/L98H in the cyp51A gene.

Educational Intervention to Improve the Knowledge, Attitude, Practices of Health Care Professionals and Students Regarding the Pharmacovigilance in Tertiary Care Hospitals

Introduction: An adverse drug reaction (ADR) is any noxious, unintended, and undesired effect of a drug, which occurs at the doses which are used in humans for prophylaxis, diagnosis, or therapy, which is reported by ‘‘the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem” known as PV. ADRs are significantly underreported worldwide. A KAP survey usually conducted to collect information on the knowledge, attitudes, and practices about general and/or specific topics of a particular population. Aim and Objectives: To evaluate the KAP studies on the educational intervention to improve the knowledge, attitude, practice of health care professionals and students regarding the pharmacovigilance in tertiary care hospitals. To evaluate, assess and evaluate the measures the knowledge, attitude and practice of PV among students and Health Care Professionals in tertiary care hospital of India. Methods: Pharmacists and HCPs were asked to complete a paper-based 21 item questionnaire. Results: A total of 250 pharmacists received the questionnaire and 214 agreed to participate, giving a response rate of 85.6%. In knowledge, component of ADR were known by 71.2% and the term PV and ADR were answered correctly (97.3%). In practice 55.9% attended the PV workshop and 88.8% were willing to implement ADR reporting in practice. Conclusion: Most of the participants had relatively better knowledge and practice towards PV and ADR reporting. Majority of the health care professional felt ADR reporting to be important. The study also shows, after counseling to them we got better response and results than before. The finding of our study suggests that there is scope for improving the ongoing Pharmacovigilance activities in India. There is a need for continuing educational initiatives for pharmacist and other health care professionals.

Prescribing Pattern of Antihypertensive Drugs in Hypertensive Patients with Non-Insulin Dependent Diabetes Mellitus at Tertiary Care Hospitals in Karachi Pakistan

Introduction: Hypertension (HTN) is one of the most serious public health issues in the world, affecting around 1.4 billion people worldwide. HTN is becoming highly prevalent in Pakistan, about more than 33% of people over the age of 40 years suffering from the HTN. The illness burden is continuously growing due to the incorrect medicine prescriptions, a lack of education, and a lack of patient compliance. The existence of comorbidities such as Diabetes Mellitus (DM) should be properly considered while choosing an Antihypertensive medication. Similarly, the prescriptions of Oral Hypoglycemic agent’s appropriate consideration are essential. Oral hypoglycemic medications are divided into several categories. Physicians face a challenge in rationally selecting a regimen from a variety of classes, and the situation becomes more complicated when the patients have additional non-communicable illnesses, such as HTN. The combination therapy of ailments not only effects the patient`s economic status but also effects the quality of life. Objective: To study the prescribing pattern of Antihypertensive drugs in Hypertensive patients with Type 2 Diabetes Mellitus at Tertiary care hospitals in Karachi, Pakistan. Methods: A cross sectional study was undertaken for six months in medicine outpatient department at tertiary care hospitals of Karachi. The study population was observed for the prescribed pattern of Antihypertensive medicines by assessing the 300 prescriptions of Hypertensive patients with Type 2 Diabetes Mellitus. Statistical analysis was performed using SPSS version 20. Data was presented as frequencies and percentages. Results: The result revealed that the most commonly prescribed single antihypertensive drug was Enalapril 66 (22%) followed by Amlodipine 63(21%), Ramipril 57(19%), Diltiazem 33(11%), Lisinopril 21(7%) losartan k 6(2%), Nebivolol 6(2%), Bisoprolol 3(1%). Dual therapy included Ramipril and Nebivolol 1(0.33%) and Amlodipine+Valsartan 35 (11.67%), Amlodipine+Valsartan+HCTZ 9 (3%) were the antihypertensive drugs prescribed as fixed dose combinations. Conclusion: The present study shows Enalapril belonging to Angiotensin Converting Enzyme Inhibitor (ACEI) class was frequently used as single Antihypertensive agent and Amlodipine+Valsartan belonging Calcium Channel Blockers (CCBs) and Angiotensin Receptor Blockers (ARBs) was the most frequently prescribed fixed dose combination while managing Hypertension of Hypertensive patients with Type 2 Diabetes Mellitus.

Inducible Clindamycin Resistance and Biofilm Production among Staphylococci Isolated from Tertiary Care Hospitals in Nepal

Resistance to antibiotics, biofilm formation and the presence of virulence factors play important roles in increased mortality associated with infection by staphylococci. The macrolide lincosamide streptogramin B (MLSB) family of antibiotics is commonly used to treat infections by methicillin-resistant isolates. Clinical failure of clindamycin therapy has been reported due to multiple mechanisms that confer resistance to MLSB. This study aims to find the incidence of different phenotypes of MLSB resistance and biofilm production among staphylococci. A total of 375 staphylococci were isolated from different clinical samples, received from two tertiary care hospitals in Nepal. Methicillin resistance was detected by cefoxitin disc diffusion method and inducible clindamycin resistance by D test, according to CLSI guidelines. Biofilm formation was detected by the tissue culture plate method and PCR was used to detect ica genes. Of the total staphylococci isolates, 161 (42.9%) were Staphylococcus aureus, with 131 (81.4%) methicillin-resistant strains, and 214 (57.1%) isolates were coagulase-negative staphylococci, with 143 (66.8%) methicillin-resistant strains. The overall prevalence of constitutive MLSB (cMLSB) and inducible MLSB (iMLSB) phenotypes was 77 (20.5%) and 87 (23.2%), respectively. Both iMLSB and cMLSB phenotypes predominated in methicillin-resistant isolates. The tissue culture plate method detected biofilm formation in 174 (46.4%) isolates and ica genes in 86 (22.9%) isolates. Among biofilm producing isolates, cMLSB and iMLSB phenotypes were 35 (20.1%) and 27 (15.5%), respectively. The cMLSB and iMLSB were 11 (12.8%) and 19 (22.1%), respectively, in isolates possessing ica genes. Clindamycin resistance in the form of cMLSB and iMLSB, especially among MRSA, emphasizes the need for routine D tests to be performed in the lab.

P-O08 Effect of socioeconomic deprivation on clinical characteristics and outcomes of patients undergoing an emergency appendectomy

Background Appendicectomy is one of the commonest emergency general surgical operations performed. Previous studies have shown that socioeconomic status (SES) impact outcomes in a number of diseases. Currently, there is no study analysing the impact of SES on the outcome of appendectomy. Our aim was to compare the clinical characteristics and outcomes of adults having an emergency appendectomy between deprived and less deprived SES groups. Methods A multicentre retrospective observational study of all adult patients who had an emergency appendectomy across four hospitals (two district general and two tertiary care hospitals) between August 2018 and November 2020 was performed. Patients were identified through pathology records. Data was extracted from electronic records for demographics, pre-operative (peak) blood results, pre and post-operative imaging, operative details and the clinical outcomes. Patient’s residential address was used to calculate Scottish Index of Multiple Deprivation (SIMD). The patients were grouped by SIMD into a more deprived SES group (SIMD 1-5) and a less deprived SES group (SIMD 6-10) and results compared. Results A total of 1,105 patients (57.5% male) were included. Median age was lower in the more deprived group (35 vs 40 years, p < 0.001). The less deprived group were more likely to be fitter: ASA-1 grade 51.6% vs 43.5%, p = 0.008. There were fewer appendectomies in most deprived decile compared to the least deprived decile (5.2 vs 11.3 per 10,000 population per year, p < 0.001). There was no difference in inflammatory markers, pre-operative imaging, surgical approach, severity of appendicitis and the median length of stay (3 days). However, there were more surgical site infection in the more deprived group (3.4% vs 0.9%, p = 0.006). Conclusions This study demonstrates that SES does impact on the age of presentation and incidence of appendectomy. Surgical site infection were seen more frequently in the more deprived patients undergoing emergency appendectomy. This may be a reflection of the underlying comorbidities.

Prevalence of First Birth Order with Myopia Among KPK Population

Objective: To find out the prevalence of myopia and hyperopia among the population of KPK. Study Designed: Cross-sectional analytical study. Place and duration of Study: OPD of tertiary care hospitals of KPK, Khyber Teaching Hospital and Hayatabad Medical Complex from 1st July 2020 to 30th June 2021. Methodology: Four hundred patients visiting to OPD of tertiary care hospitals of KPK, Khyber Teaching Hospital and Hayatabad Medical Complex, Peshawar were enrolled. Both male and female were included from 17 to 24 years visiting to the hospital were included. All patients on any medication for any systemic illness like asthma, TB, cardiac issues, liver problems etc. patients suffering from eye disorders like glaucoma, cataract, diabetic retinopathy, uveitis etc. and patients who refused to give consent and uncooperative patients were excluded from the study. Results: Two hundred and seventy seven got normal eye structure, function and vision while 123 got abnormal eye vision, with the frequency of myopia 26.5% (106) while hyperopia was 4.3% (17). Among gender the refractive errors of an eye was found to be 25% in male while 35.5% in female pvalue-0.024. The frequency of refractive error was not significant in age 17, 18, 23 and 24years the refractive error was found to be less as compare to age 19-22 years the refractive errors were seen to be greater. The patients visiting to hospital for eye examination with abnormal refractive errors were 41.1% while the result was significant p value was 0.0001. Genetically 1st order birth got 40% refractive errors while other got 23.5% the results were significant (P=0.004). Conclusion: The prevalence of eye defects related to refractive errors was present among adult population of KPK. Age is not related to refractive errors and refractive errors can be genetically determine. Key words: Myopia, Hyperopia, Refractive errors, Birth order