Objective:Results: One hundred ninety four patients were enrolled. There were 58 deaths (42.65%) at ICU discharge. APACHE II and SAPS II predicted hospital mortality 35.32 ± 21.81and 37.11 ± 27.34 respectively. Both models showed excellent discrimination. The overall discriminatory capability, as measured by the aROC, was generally good for two models and ranged from 0.78 to 0.89. APACHE II is slightly better compared to SAPS II score but not significantly better than SAPS II. Both systems exhibited good calibration ( = 8.304, p = 0.40 for APACHE II, = 9.040, p = 0.34 for SAPS II). Hosmer-Lemeshow goodness-of-fit test revealed a good performance for APACHE II scores.Conclusion: APACHE II provided better performance than SAPS II in predicting mortality in our ICU patients but SAPS II also performed well. Our observed mortality was similar with the predicted mortality from APACHE II and SAPS II scores, which suggests that the result of this study reveals good intensive care quality.

No abstract

Aim To evaluate healthcare professionals’ perceived organizational support and its effect on their compassion, resilience, and turnover intention in the United Arab Emirates. Background The COVID‐19 pandemic exerted unprecedented pressure on healthcare systems, professionals, and management systems. Healthcare organizations begin to explore their roles and function in relation to risks and resilience, in addition to ascertain what level of organization support they are providing to their workers. Methods A cross‐sectional study was conducted with a questionnaire administered to 538 healthcare workers, to examine their personal resources and organizational support during the pandemic. Results 37.7% of nurses were found to have a moderate level of resilience, and logistic regression showed that being married is a protective factor against resigning from the profession (OR = 0.462, P = 0.012, 95% CI: 0.254–0.842), and healthcare workers who perceived higher organizational support were approximately 50% less likely to have a turnover intention (OR = 0.506, P = 0.009, 95% CI: 0.303–0.845). Multiple linear regression model indicated significantly higher resilience among physicians (β = 0.12, P < 0.05) and allied healthcare practitioners (β = 0.12, P = 0.022). Organizational support had a significant positive relationship with resilience scores (β =0.20, P <.001); adequate training was significantly related to higher compassion levels (β = 0.11, P < 0.05); and high organizational support scores were associated with increased compassion scores (β = 0.27, P <.001). Conclusions Front‐line healthcare workers reported moderate organizational support during the pandemic, commensurately reflected in moderate levels of personal resilience and self‐compassion. Continued and better support is vital for employee sustainability and the increased health system performance, including quality of care and patient outcomes. Implications for nursing management Nurse managers should help healthcare workers improve self‐care strategies by strengthening personal resources, including by shortened duty hours, offering adequate break time, providing a safe work climate, and purveying adequate personal protective equipment and supplies to combat infections. They should build an empathetic work environment through understanding the needs of staff, helping tackle their work stress and sustaining cultures of compassion through promoting rewarding and flexibility strategies. Moreover, policymakers and nurse mangers should create a rewarding culture for nurses and other healthcare workers to increase their commitment to their jobs.

Tuberculosis is an infectious disease caused by acid fast bacilli, Mycobacterium tuberculosis that usually affects the lung although it may affect any organ. Tuberculous osteitis of the cranial bone is known as calvarial tuberculosis. The disease is considered secondary to an active or latent tuberculous lesion elsewhere in the body, but direct spread from orbit, paranasal sinuses and face has also been implicated. Though tuberculosis is endemic in Bangladesh, calvarial tuberculosis is very very rare. We report a case of a female, diabetic, hypertensive, chronic kidney disease(CKD), bronchial asthma patient presented with osteolytic lesion in skull with adjacent subcutaneous swelling. She was eventually diagnosed as calvarial tuberculosis on the basis of positive MTB- PCR from the pus aspirated from the swelling.Bangladesh Crit Care J March 2016; 4 (1): 41-43

No abstract

Background : Ventilator-associated pneumonia (VAP) is the most common type of nosocomial infection in critical care practice with high morbidity and mortality. Microorganisms responsible for VAP vary from place to place. So, identification of causative organism and knowledge of their resistance pattern is very important for empirical choice of antibiotic in managing VAP. The aim of this survey was to evaluate the quantitative cultures of endotracheal aspirates to determine the microorganisms responsible for VAP and to study their antibiotic resistance pattern.Materials and Methods: This cross sectional study was performed over a period of six month starting from November, 2015 to April, 2016 in the Intensive Care Unit (ICU) of BIRDEM General Hospital. Patients with a clinical and radiological diagnosis of VAP were included in this study.Result: A total of 51 patients with a clinical diagnosis of VAP were included in this study. Growth was obtained in100% of the samples yielding 88 organisms. Gram-negative organisms were the mostly isolated organism (76.13%), followed by fungi (17.04%) and gram-positive cocci (6.81%). The most common pathogen was Acinetobacter sp. followed by Klebsiella sp., Candida sp. and Pseudomonas sp. respectively. Among the gram negative organisms, Acinetobacter sp., Klebsiella sp. and Pseudomonas sp. were highly resistant (>80%) to third generation cephalosporins and fluoroquinolones. Resistance to aminoglycosides (>68%) and imipenem (>60%) was also high. Resistance of Pseudomonas sp. to piperacillin-tazobactum was lower (18.2%) in comparison to Acinetobacter sp. and Klebsiella sp. All the Gram-negative organisms were 100% sensitive to colistin except proteus. Regarding gram-positive cocci,Staphylococcus aureus is 100% sensitive to netilmycin and vancomycin with variable resistance pattern to other antibiotics.Conclusion: Emergence of drug resistance against the microorganism causing VAP is a serious concern in most of the ICUs. A knowledge of antibiotic susceptibility pattern will avoid its irrational use in order to control the spread of infection and for proper management of VAP.Bangladesh Crit Care J September 2016; 4 (2): 69-73

Background: Septicaemia in critically ill patients is a life threatening condition and requires rapid antimicrobial treatment. Infections caused by drug-resistant organisms are more likely to increase risk of death in these patients. The present study was aimed to study the profile of organisms causing septicaemia and their antibiotic resistance pattern in an intensive care unit (ICU) of a teaching hospital in Bangladesh.Materials and Methods: This cross-sectional study was done in a 21-beded adult ICU of Dhaka city from November 2015 to April 2016.Results: A total of 362 patients were diagnosed clinically as septicaemia during the study period of six month. 696 blood samples were analyzed and 92 blood samples yielded growth of 94 organisms, which included 89 bacteria and 5 fungal isolates. Mean age of the patients whose blood samples showed growth of organisms was 65.1 ± 9.1 years, with female preponderance (56.7%). High prevalence of diabetes, hypertension and chronic kidney disease was found in these patients. The major organisms isolated were Acinetobacter (29.7%), Pseudomonas (26.5%), Klebsiella (18.08%), Eschericia coli (11.7%) and Candida (5.3%). All the isolates were resistant (>50%) to 3rd generation cephalosporins. Acinetobacter was highly resistant (>75%) to most of the antibiotics except colistin. Isolated Pseudomonas was also resistant to aminoglycosides (>90%) and imipenem (>65%). Klebsiella was resistant to aminoglycosides and imipenem, but Eschericia coli was sensitive to these antibiotics. Among the Enterobacteriaceae, 81.8% Eschericia coli and 11.7% Klebsiella had extended spectrum ?-lactamase activity. Frequency of gram positive organisms (6.38%) was significantly low in this study (p<0.05).Conclusion: This study provides information on antibiotic resistance of blood isolates found in ICU patients with septicaemia. It will guide the intensivists to formulate the initial empiric antibiotic therapy for the critically ill patients of ICU.Bangladesh Crit Care J September 2016; 4 (2): 100-104

Antimicrobial resistance plays a vital role in determining the outcome of the critically ill patients with infections in intensive care unit (ICU).Aim: The objective of this study was to evaluate the frequencies of isolated pathogens and their resistance pattern in an ICU of Bangladesh. The study also aimed to analyze and compare the trends of bacterial population and their resistance pattern in the same ICU between 2004 and 2011 in four different studies.Materials and Method: A cross sectional study was carried out in a 10 bed adult ICU of a tertiary care hospital of Bangladesh over a period of 10-month, from January 2011 to October 2011. Blood, respiratory secretions and urine from patients with clinically suspected infections were included in the study. Findings were compared with previous three studies done in 2004, 20006-07, and 2008-09 in same ICU.Results: In 2011, a total of 1408 samples were analyzed. Six hundred eighty-four micro-organisms were isolated from 597 samples. Maximum growth was obtained from respiratory secretions (71.7%). Organisms isolated were Acinetobacter sp. (46.4%), Pseudomonas sp. (21.4%), Candida sp. (11.5%), Klebsiella sp. (9.9%), Eschericia coli (4.1%) and Staphylococcus aureus (2.9%). Major gram negative organisms were highly resistant to 3rd generation cephalosporins (>70%). All Acinetobacter sp. were extremely resistant (>85%) to all antibiotics except colistin. Resistance of isolated Pseudomonas sp. was >65% to ciprofloxacin, >70% to aminoglycosides, and >85% to imipenem. About 72% of the isolated Staphylococcus aureus was methicillin resistant with variable resistant to other antibiotics. Comparing the findings of this study with previous three studies done in same ICU, it has been found that rate of isolation of Acinetobacter sp., was increased significantly (p<0.05) in this ICU population with decrease in rate of Pseudomonas sp., Eschericia coli, Staphylococcus aureus, Enterococci sp., and Candida sp. Resistances pattern of two commonest gram negative organisms, eg Acinetobacter sp. and Pseudomonas sp., to the available antibiotics showed gradual increase in resistance from 2004 to 2011.Conclusion: It is recommended that strict infection control policies and antibiotic stewardship program must be implemented to solve this emerging drug resistance problem which might cause high morbidity and mortality in ICU patients.Bangladesh Crit Care J September 2016; 4 (2): 79-85