Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study.

Hospital-acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross-sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. The SPSS software package (version 16.0, SPSS Inc., Chicago, IL, USA) was used to analyse the data. Quantitative and qualitative variables were presented using mean (standard deviation) and number (percentage). The Shapiro-Wilk test was used to evaluate the normality of the data in this study. The data did not have a normal distribution. Hence, χ2 and Fisher's exact tests were used to evaluate the relationship between variables. Surgical wound infection occurred in 4.7% (24 cases) of patients with a mean age of 59.34 (SD = 14.61) years. Preoperative (>3 days) and postoperative (>7 days) hospitalisation, history of immunodeficiency (P < 0.001), and interns responsible for changing dressings (P = 0.021) were associated with surgical wound infection incidence. About 9.5% and 4.4% of surgical wound infection cases were significantly associated with pre- and postoperative antibiotic use. Gram-positive cocci were the most prevalent strains isolated from 24 surgical wound infection cases (15/24, 62.5%). Among these, Staphylococcus aureus was the predominant species, followed by coagulase-negative staphylococci. In addition, the most common Gram-negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection-associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.

Diabetic foot care: knowledge and practice.

BACKGROUND: Diabetic foot ulcers (DFUs) are common problems in diabetes. One of the most important factors affecting the quality of diabetes care is knowledge and practice. The current study aimed at determining the knowledge and practice of patients with diabetes regarding the prevention and care of DFUs. METHODS: The current analytical, cross sectional study was conducted in Guilan Province (north of Iran) on 375 patients registered in the medical records as type 2 diabetes mellitus. Demographic characteristics, knowledge, and practice of participants were recorded in a questionnaire during face-to-face interviews conducted by the researcher. Descriptive and inferential statistics were performed using SPSS version18. RESULTS: The mean score of knowledge was 8.63 ± 2.5 out of 15, indicating that the majority of participants had a poor knowledge (84.8%). The mean practice score was 7.6 ± 2.5 out of 15, indicating that a half of them had poor performance (49.6%). There was a significant and direct correlation between knowledge and practice. Knowledge level, place of residence, marital status, and history of admission due to diabetic foot were predictors of practice score. CONCLUSIONS: According to the low level of knowledge and practice in patients with diabetes regarding the prevention and care of DFUs, and considering the significant relationship of some demographics of patients with knowledge and practice scores, a targeted educational program is needed to promote knowledge of patients with diabetes.

Perceived Stress and Level of Uncertainty Among Hospitalized COVID-19 Patients.

Introduction: Disease uncertainty refers to the inability to assign meaning to events related to the illness. Uncertainty of the disease can affect various aspects of human life such as psychological aspects. Objectives: This study aims to examine the relationship between disease uncertainty and perceived stress in COVID-19 patients. Methods: An analytical cross-sectional study was conducted on 212 hospitalized COVID-19 patients who were initially admitted to the intensive care units (ICUs) and later transferred to general wards within the same hospitals. Three instruments were utilized to collect data for this study. The Demographic Information Questionnaire, Mishel Uncertainty in Illness Scale (MUIS) for disease uncertainty, and Perceived Stress Questionnaire. For data analysis, both descriptive and inferential statistics were employed using IBM SPSS Statistics version 25. Results: The Pearson correlation coefficient matrix results showed a positive and significant relationship between uncertainty about the illness (P < .001, r = 0.829), ambiguity (P < .001, r = 0.795), complexity (P < .001, r = 0.835), inconsistency or instability (P < .001, r = 0.787), and unpredictability (P < .001, r = 0.776) with perceived stress in COVID-19 patients transferred from the intensive care units. Conclusion: Based on the findings of the current study, both uncertainty and perceived stress are elevated among COVID-19 patients, and a significant and direct relationship exists between these two variables. Healthcare providers, particularly nurses, should address the uncertainties surrounding emerging diseases, both at the hospital and community levels.

Investigation of Anxiety and Depression Predictors in Burn Patients Hospitalized at Velayat Hospital, a Newly Established Burn Center.

Burns are a leading cause of global mortality and disability. Burns have the mental, psychological and physical impact on the sufferers. Burn patients need special care, both physical and mental, and majority of them are suffering from symptom of difficulty, such as depression, anxiety, post-traumatic stress disorder, and isolation. Finding the predictors of post-burn anxiety and depression can accelerate the treatment and recovery process and maintain the mental health of the patients. The present study investigated the depression and anxiety predictors in burn patients admitted to a medical facility in northern Iran. The present study is a descriptive-analytical study with a cross-sectional methodology on all the burn patients (n = 611) admitted to the Velayat Subspecialty Burn and Reconstructive Surgery Center, Rasht, Iran during 2013-2019. The study tools included the demographic and clinical questionnaire and the Symptom Checklist-90-Revised (SCL-90-R) for anxiety and depression. Data were collected using interviews. Data analysis was performed using the SPSS version 19 and the statistical tests of Chi-square and logistic regression test. The present study included 611 patients, with 61% males and 39% females. The mean age of the participants was 38.86 ± 18.39, while most participants were in the age group of 20-40 years. The most common cause of admission was burning by flames (36.7%), and most patients had third-degree burns (67%). Five hundred forty three patients showed mental symptoms, of which 343 (52.6%) had anxiety disorder symptoms, and 309 (47.4%) had symptoms suggestive of depression. The independent predictors of depression were found to be the gender (OR = 0.253), age group (OR = 0.706), and the degree of burn (OR = 0.406), while the independent predictors of anxiety disorder included the gender (OR = 1.669), age group (OR = 1.58), the classified burn area (OR = 0.653), marital status (OR = 0.532), and education level (OR = 0.773). It is important to identify predictors of depression and anxiety after burn. The predictors can serve as indicators that these patients may benefit from mental health evaluations and treatment.

Predictors of short-term outcomes of burn in a newly established burn centre in Iran.

AIM: This study aimed to determine the predictors of hospital stay and mortality in patients with burns. DESIGN: This is a cross-sectional, retrospective study. METHODS: This study was performed on 626 medical records in Velayat Subspecialty Burn and Plastic Surgery Center in Rasht, Iran, during 2008-2013. RESULTS: Men comprised 78.4% of the study population. Overall, 50.2% of the participants lived in rural areas, and 72.5% were married. The majority of burns occurred at home (49.5%), and thermal factor (87.4%) was the major cause of burn injuries. Also, 6.9% of the patients died after burns. The mean length of hospital stay was 12.62 ± 13 days. Age (OR = 1.07), total body surface area (TBSA%) (OR = 1.12) and length of ICU stay (OR = 1.06) were the strongest predictors of mortality. Gender (IRR = 0.85), TBSA% (IRR = 1.01), location of burn (IRR = 1.1), skin graft (IRR = 2.12), length of ICU stay (IRR = 1.04), re-hospitalization (IRR = 1.77) and burn degree (IRR = 1.09) were the predictors of the length of hospital stay. CONCLUSION: BSA is still an important predictor of mortality and length of hospital stay, as the most important short-term outcomes of burns.

Risk of type III secretion systems in burn patients with Pseudomonas aeruginosa wound infection: A systematic review and meta-analysis.

PURPOSE: The pathogenesis of Pseudomonas aeruginosa is multifactorial and attributed to the production of several cell-associated and extracellular virulence factors including those implicated in adherence, iron uptake, exoenzymes (Exo) and exotoxins. The present study aimed to determine the prevalence of type III secretion systems (T3SS) effectors in Iranian burn patients with P. aeruginosa wound infection. METHODS: A systematic search was conducted to identify papers published by Iranian authors in the Web of Science, PubMed, Scopus, Embase, and Google Scholar electronic databases during the period of January, 2000 to December, 2018. Publications which met our inclusion criteria were selected for data extraction and analysis by Comprehensive Meta-Analysis Software. The inclusion criteria were articles that include burn patients with a wound infection caused by P. aeruginosa, and reported the prevalence of aimed exoenzymes. RESULTS: Ten publications were selected out of 15 full-text reviewed articles with the inclusion criteria. Of ten studies, the pooled prevalence of ExoS producing isolates was estimated at 57.1% (95% CI: 40.3-72.5%). Five studies reported the prevalence of ExoU and ExoT, from which, the pooled prevalence of ExoU and ExoT producing isolates was estimated at 51.4% (95% CI: 31.4-70.9%) and 86.4% (95% CI: 48.1-97.8%), respectively. Four studies reported the prevalence of ExoY, from which, the pooled prevalence of ExoY producing isolates was estimated at 79.0% (95% CI: 48.6-93.8%). CONCLUSION: Our results showed a remarkable prevalence of T3SS-positive genotype in patients with burn injuries. These findings provided attractive targets for new therapeutic strategies for burn patients who were infected with cytotoxin-producing P. aeruginosa.

Unplanned readmission after hospital discharge in burn patients in Iran.

INTRODUCTION: Burns are considered as one of the most serious health problems throughout the world. They may lead to adverse consequences and outcomes. One of these outcomes is unplanned readmission. Unplanned readmission has been commonly used as a quality indicator by hospitals and governments. This study aimed to determine the predictors of unplanned readmission in patients with burns hospitalized in a burn center in the North of Iran (Guilan province, Rasht). METHODS: This retrospective analytic study has been done on the medical records of hospitalized patients with burns in Velayat Sub-Specialty Burn and Plastic Surgery Center, Rasht, Iran during 2008-2013. In general, 703 medical records have been reviewed but statistical analysis was performed on 626 medical records. All data were entered in SPSS (version 16) and analyzed by descriptive and inferential statistics. RESULTS: Among 626 patients with burns, the overall readmission rate was 5.1%. Predictors of readmission included total body surface area (OR 1.030, CI 1.011-1.049), hypertension (OR 2.923, CI 1.089-7.845) and skin graft (OR 7.045, CI 2.718-18.258). CONCLUSION: Considering the outcome, predictors following burn have a crucial role in the allocation of treatment cost for patients with burns and they can be used as one of the quality indicators for health care providers and governments.

Changes in serum phosphorus level in patients with severe burns: A prospective study.

BACKGROUND: The second most abundant mineral in the body, phosphorus (P), is absorbed in the small intestine after ingestion enhanced by 1,25-dihydroxy vitamin D, and its excretion is exclusively regulated by the kidney. It is clinically significant, aside from its disturbance in burn ICU patient's P mechanism. The increasing rate of morbidity and mortality among the patients can be associated with severe hypophosphatemia. The current study aimed at investigating the changes in serum P levels in the early period after burns, the relationship between serum P level and TBSA (total body surface area) of burn, and the impact of hypophosphatemia on patients' clinical outcomes. MATERIAL AND METHODS: The current prospective, observational study was conducted on 137 patients hospitalized in the burn intensive unit (BICU) of Velayat Sub-specialty Burn and Plastic Surgery Center from December 2015 to May 2017. According to the TBSA percentage, the patients were divided into three groups. The level of serum P was determined in the 1st, 3rd, 5th, 7th, and 9th days of hospital stay and before discharge. To evaluate the trend of P changes in the sixtime-points, the average changes along with 95% confidence intervals (CI) were used for multivariate analysis of variance with repeated measures (repeated measures ANOVA). A P-value of 0.05 or less was considered statistically significant. The analyses were performed using SPSS software, version 19 (SPSS Inc.). RESULTS: Totally, 137 patients (70% male, mean age 32 ± 21years, and TBSA 32.6 ± 14%) were included in the study. The overall incidence of hypophosphatemia was 75.1%. Hypophosphatemia developed as early as 1.66 ± 0.136 (95%CI: 1.4-1.9) days after injury. The highest decrease in the serum P level was observed on the 3rd and 5th days after burn as 2.78 mg/dL and 2.85 mg/dL, respectively (P-value = 0.001). A correlation was observed between TBSA and serum P level. The mean serum P level decreased with increasing the percentage of burns. There was a correlation between serum P level and mortality; therefore, a decrease in serum P level increased the patient's mortality rate (P < 0.05). CONCLUSION: The current study highlighted that hypophosphatemia is often observed in patients with burn injuries during their hospitalization. It is potentially beneficial to identify patients at risk of hypophosphatemia. Therefore, it is suggested that P level be assessed regularly in patients with burn injuries for the timely initiation of P replacement therapy.

Simultaneous multiple organs immature teratomas: a case report and literature review.

Primary simultaneous multiple organs teratomas are extremely rare. They usually arise in the gonads, and only 1-3 % of them arise in the mediastinum. We present a case of simultaneous multiple organs immature teratomas who was admitted to Razi hospital because of cough, dyspnea, and left-side supraclavicular mass. Computed tomography (CT) showed a big mass with multiple high densities, nodular, semi-solid, heterogenic structures on the left side of the neck, left-side anterior mediastinum, right-side middle mediastinum and right-side suprarenal region. CT-guided needle biopsy was performed and histopathological study showed immature teratoma. After performing neoadjuvant therapy, the tumors were removed. The patient underwent chemo radiation therapy on the mediastinum and abdomen. On 6-months follow-up, he was asymptomatic. This case is being reported because of the rarity of multiple organs immature teratomas and informing other clinicians about managing these cases.