Association analysis of serotonin transporter gene polymorphism among the South-Indian migraineurs.

Background: Migraine is a multifactorial neurological disorder characterized by frequent moderate to severe intensity headaches. The genetic variations in synaptic and post-receptor signalling proteins have direct effect on the process of serotonergic neurotransmission. Methods: We aimed to investigate the genetic association of serotonin transporter (SERT) 5-hydroxytryptamine transporter-linked promoter region (5-HTTLPR) polymorphism and migraine risk in South-Indian population. A total of 304 subjects with migraine including with aura (MA) and without aura (MO) and 308 controls were included in the present study. The single nucleotide polymorphism (SNP) was detected using polymerase chain reaction (PCR) and confirmed by deoxyribonucleic acid (DNA) sequencing. Results: The genotyping analysis revealed insignificant relationship with migraine subjects when compared with controls (P > 0.05). The minor 'S' allele showed no association with odds ratio (OR) = 1.23 [95% confidence interval (CI): 0.90-1.66], heterozygote with OR = 1.18 (95% CI: 0.82-1.69), and homozygote with OR = 1.51 (95% CI: 0.52-4.35). Conclusion: Further clinical studies are required to validate the results of SERT 5-HTTLPR promoter polymorphism in diverse ethnic descents especially in Asian populations.

Staffing critical care with nurses amid the COVID-19 crisis: Strategies and plans.

AIM: To describe a nursing staffing surge model in critical care units that can be used during a pandemic or crisis. This model may give useful guidance for hospitals or centers that must immediately react in response to the devastating challenges introduced by disease outbreaks. BACKGROUND: During the COVID-19 pandemic, many hospitals were challenged to maintain the quality of care and safe practice in critical care units while accommodating the daily rapidly increasing number of infected cases that needed critical care. The nursing staffing shortage in critical care units and its consequences were among the top issues to deal with. METHOD: This is a descriptive study about our experience in preparing for nursing staffing in critical care as a part of the COVID-19 surge plan. We have used evidence-based strategies to design our team-based model for staffing during the COVID-19 pandemic. RESULTS: The team-based model for staffing during the COVID-19 pandemic had shown success in dealing with the acute shortage of nursing staff in critical care units. We had implemented other additional supportive strategies to help enhance this staffing. CONCLUSION: With the support of available evidence-based resources and on-the-fly preparation and training, we were able to augment the tremendous increase in patient influx during the pandemic using the team-based model. IMPLICATIONS FOR NURSING MANAGEMENT: The team-based approach and other strategies included in this article can help support critical care units with staff during crises. However, we strongly recommend developing a nursing deployment policy that makes staff redeployment and re-allocation smoother, whenever needed.

Genetic predisposition of TNFα gene polymorphism in South-Indian Migraineurs and meta-analysis.

Migraine (Mg) is a multifaceted neurovascular disorder caused by genetic and several environmental etiologies. We have implemented a case-control study of TNFα gene polymorphism in 212 Mg patients and 218 healthy controls utilizing the ARMS-PCR technique, followed by Sanger sequencing. Besides, we have conducted a meta-analysis of different genetic models (five genetic models) to combine and summarize the available data from 11 studies (including this present research). The strength of genetic associations in the meta-analysis used to assess by the pooled odds ratio (OR) and 95% confidence intervals (CI). The results of this case-control study discovered a significant relationship with Mg in recessive and homozygous genotype with OR = 2.35 (95% CI [0.96-5.74]), p-value = 0.045. Also, the outcomes of meta-analysis suggested an irrelevant relationship between TNFα gene (rs1800629) polymorphism and Mg susceptibility in the five genetic models. However, subgrouping based on ethnic background showed a significant association in the allelic genetic model with OR = 1.53 (95% CI [1.02-2.31]), p = 0.040 respectively. The meta-analysis results of TNFα gene polymorphism may represent a risk factor for Mg among Asians. In the future, large scale, multicentric case-control study by classification of patients with Mg with or without aura can be performed worldwide to identify the potential genetic risk factors leading to Mg pathogenesis.

Intraventricular Tigecycline as a Last Resort Therapy in a Patient with Difficult-to-Treat Healthcare-Associated Acinetobacter baumannii Ventriculitis: a Case Report.

Healthcare-associated ventriculitis and meningitis is a common complication in patients who suffer from head trauma or have undergone a neurosurgery. Healthcare-associated ventriculitis and meningitis is associated with significant morbidity and mortality. Complications of healthcare-associated ventriculitis and meningitis include persistent vegetative state, moderate and severe disability, and death. Acinetobacter baumannii is the causative pathogen in 3.6-11.2% of cases of healthcare-associated ventriculitis and meningitis. Cases of difficult-to-treat healthcare-associated A. baumannii ventriculitis and meningitis are being reported more frequently. However, in most of these cases, a combination of intravenous (IV) and intraventricular (IVT)/intrathecal colistin achieves good therapeutic outcome. This report describes a clinical case of difficult-to-treat healthcare-associated A. baumannii ventriculitis. The A. baumannii strain was sensitive to colistin and trimethoprim-sulfamethoxazole, intermediate to tigecycline, and resistant to other antibiotics. While colistin was the drug of choice in our case, the patient developed anaphylactoid reaction during the IV administration of the loading dose of colistin, which mandated us to discontinue colistin and complicated the treatment of our patient. The patient did not respond to a combination of IV antibiotics that included meropenem, trimethoprim-sulfamethoxazole, and tigecycline. However, when IVT tigecycline was added as a last-resort therapeutic option, the patient's ventriculitis dramatically improved, and the patient was discharged from the hospital. Physicians who treat patients with healthcare-associated A. baumannii ventriculitis might resort to IVT tigecycline when they run out of therapeutic options.

Association between PPARγrs1801282 polymorphism with diabetic nephropathy and type-2 diabetes mellitus susceptibility in south India and a meta-analysis.

BACKGROUND: Diabetic Nephropathy (DN) is a major complication of Type 2 Diabetes Mellitus (T2DM) with high morbidity rates worldwide. OBJECTIVE: To determine the association of PPARγ rs1801282 polymorphism in T2DM and DN in south Indian population. METHODS: We have conducted a case-control study to test the association of rs1801282 polymorphism with T2DM and DN in 424 subjects (DN=128; T2DM=148 and controls=148) belonging to the south Indian population using ARMS-PCR and Sanger sequencing method. Further, a meta-analysis was performed for rs1801282 polymorphism from the published literature retrieved from various electronic databases to determine the susceptibility among T2DM and DN across various ethnic populations under five genetic models. RESULTS: The genotyping of rs1801282 polymorphism showed significant (p-value<0.05) association with DN and T2DM compared to controls. In the meta-analysis, no significant association (p-value>0.05) was noticed for rs1801282 with DN vs. controls in homozygote, heterozygote, allelic, recessive and dominant genetic models. However, a significant association was observed between rs1801282 SNP and T2DM under heterozygote (Jj vs JJ) genetic model with OR=0.56, (95%CI [0.43-0.74]), p≤0.0001 of Asian and Caucasian populations. CONCLUSION: Overall analysis suggests that the rs1801282 polymorphism might be associated with DN and T2DM. More case-control studies on the PPARγ gene with a larger sample size including all the confounding factors are required to corroborate the findings from this meta-analysis.

Impact of an Educational Program on the Knowledge and Attitude About Pain Assessment and Management Among Critical Care Nurses.

BACKGROUND: Pain assessment and management are imperative parts of nursing care and considered as one of the most fundamental patient rights. The role of pain management education is well established in improving knowledge and attitude among nurses. OBJECTIVES: This study aims to evaluate the impact of pain management educational program on the knowledge and attitudes of intensive care unit (ICU) staff nurses toward pain assessment and management. The baseline score of pain assessment and management knowledge and attitude of ICU nurses has been identified in a previous research, and the result showed immense lack of knowledge and poor attitudes among ICU nurses toward pain assessment and management when dealing with ICU patients. METHODS: This is a pretest-posttest experimental study, utilizing a self-reporting questionnaire tool to obtain information about nurses' knowledge and attitudes toward pain assessment and management after implementation of new pain management educational program for critical care nurses. Data were collected using the Knowledge and Attitudes Survey Regarding Pain tool that measures knowledge with 22 question items and measures attitude with 17 question items. Paper-based questionnaire was distributed to nurses for data collection. RESULTS AND CONCLUSION: The results showed significant improvement in knowledge and attitudes about pain assessment and management among ICU nurses; it was evident after delivering pain management education program. At baseline, 204 ICU nurses gave consent and completed the questionnaire and thus included in baseline measurement before implementing the intervention. In the postintervention measurement, the questionnaire was distributed to the same participants included in the baseline phase from which 181 participants completed the questionnaire for the second time, with a response rate of 89%; the deficits and preconception in pain assessment and management can be improved through implementing pain management educational programs.

Delirium Incidence and Risk Factors in Adult Critically Ill Patients in Saudi Arabia.

BACKGROUND: Delirium in intensive care units (ICUs) is associated with long ICU stay, long hospital stay and increased costs of treatment. Unfortunately, delirium in ICU is significantly underestimated and overlooked by healthcare providers. AIMS: The aim of this tudy is to determine the incidence and associated risk factors of delirium among critically ill patients in Saudi Arabia. METHODS: This is a prospective study. Patients were assessed for delirium using the confusion assessment method for the ICU. Delirium was the independent variable in this study. RESULTS: Fifty-nine patients (17.3%) showed positive delirium at least once compared to 283 patients (82.7%) who did not show positive delirium. Certain factors for delirium found to be significantly correlated with delirium (P < 0.005); including receiving sedation, mode of sedation, receiving mechanical ventilation, resistance to mechanical ventilator, and baseline Glasgow Coma Scale. CONCLUSION: Delirium occurred in >17% of our ICU patients. More efforts should be directed to consider ICU delirium and to minimize its triggering factors.

Effect of short-term carbapenem restriction on the incidence of non-pseudomonal multi-drug resistant Gram-negative bacilli in an intensive care unit.

We conducted a two-phase retrospective study to investigate the impact of a short-term carbapenem restriction on the incidence of non-pseudomonal multidrug-resistant (MDR) Gram-negative bacilli in our intensive care unit (ICU). The first phase of the study (before carbapenem restriction) was conducted between May and July 2016, and the second phase (implementation of carbapenem restriction) between September and November 2016. The incidence of all non-pseudomonal MDR Gram-negative bacilli (extended-spectrum ß-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae and MDR Acinetobacter baumannii) decreased significantly after carbapenem restriction. Patients positive for non-pseudomonal MDR Gram-negative bacilli before and after carbapenem restriction were comparable in terms of age, weight, Acute Physiology and Chronic Health Evaluation IV score, central venous catheter placement, and vasopressor use. This report suggests that short-term carbapenem restriction for 3 months may be an effective strategy for reducing the incidence of non-pseudomonal MDR Gram-negative bacilli.

Ramsay Sedation Scale and Richmond Agitation Sedation Scale: A Cross-sectional Study.

BACKGROUND: Many sedation scales and tools have been developed and compared for validity in critically ill patients. However, selection and use of sedation scales vary among intensive care units. OBJECTIVE: The aim of this study is to compare the reliability of 2 sedation scales-Ramsay Sedation Scale and Richmond Agitation-Sedation Scale (RASS)-in the adult intensive care unit. METHOD: Four hundred twenty-five patients were recruited in the study. Informed consent had been obtained from each patient guardian/relative. However, only 290 patients (68.24%) completed the study and were independently assessed for sedation effect by investigator and bedside nurses simultaneously using Ramsay scale and RASS. RESULTS: Agreement between the nurse and investigator scores on Ramsay scale (weighted κ = 0.449, P < .001) indicated weak level of agreement. Agreement between the nurse and investigator on RASS (weighted κ = 0.879, P < .001) indicated a strong level of agreement. Cronbach α analysis showed that 10 items of RASS had an excellent level of internal consistency (α = .989) compared with good level of internal consistency of Ramsay scale (α = .828). DISCUSSION: Richmond Agitation-Sedation Scale showed excellent interrater agreement compared with weak interrater agreement of Ramsay scale. The results also support that RASS has consistent agreement with clinical observation and practice among different observers. The results suggest that use of RASS is linked to a more reliable assessment of sedation levels in the intensive care unit.

Impact of carbapenem restriction on the antimicrobial susceptibility pattern of Pseudomonas aeruginosa isolates in the ICU.

BACKGROUND: Rates of carbapenem-resistant Pseudomonas aeruginosa are increasing. Aggressive prevention strategies, including instituting antimicrobial stewardship programmes, are essential for combating antimicrobial resistance. OBJECTIVES: We conducted this study to compare the antimicrobial susceptibility pattern of P. aeruginosa before and after carbapenem restriction. METHODS: We conducted a two-phase retrospective study in an adult ICU. The first phase was from May until July 2016 (before carbapenem restriction), whereas the second phase was from September until November 2016 (while implementing carbapenem restriction). The antimicrobial susceptibility pattern of P. aeruginosa was reviewed in August and December 2016. The measure of carbapenem-resistant P. aeruginosa was the proportion of resistant isolates (percentage resistant). The measure of antibacterial consumption in the study phases was DDDs/1000 patient days. RESULTS: The overall carbapenem consumption decreased significantly in the second phase, from 28.44 to 11.67 DDDs/1000 patient days (P = 0.012). The resistance of P. aeruginosa to imipenem and meropenem decreased significantly from 76.0% to 38.5% (P = 0.019) and from 74.1% to 30.0% (P = 0.012), respectively. Susceptibility of P. aeruginosa to other antibacterials was not affected by carbapenem restriction. CONCLUSIONS: These data suggest that restricting carbapenems, even for a short duration, may be an effective strategy for managing the problem of carbapenem resistance in P. aeruginosa.